College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

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NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM

Appropriate Procedures ListORAL AND MAXILLOFACIAL SURGERY

Surgeon name: CPSID:

Facility applying to:

Please indicate only the procedures you wish to perform at the above-mentioned facility.

FaceBiopsyChin augmentationCleft lip – bilateral completeDebridement – jointDrainage/aspirationExcision – scarExcision – tumour, cyst, soft tissue massFaceliftIrrigation and debridementMalar augmentationMandibular osteotomy – internal fixation – bilateralMaxillary fracture zygomatic – arch – open reduction and wiringMaxillary fracture zygomatic – reductionNasal fracture – wire plate fixation – open reductionOrbital floor open reductionOsteotomies, mandibular maxillofacial – bilateralRepair lacerationsScar revision

DentalAlveolectomy Caries Dental implantsExtractions Minor oral surgery – root resections/dissections Pediatric dental – caries, extractions, excision lesions, restorationsRestorations

OtherTMJ arthroscopy

I hereby certify that the procedures selected in this application are within the scope of my current practice.

Surgeon signature: Date: