Information request form

Step 1 of 7

Background on approved uses

ACP provides searchable pharmacy and registrant information on its website to meet its legislative obligation to assist the public in identifying licensed pharmacies and registered pharmacists and pharmacy technicians in Alberta. See the website for further details.

The form below may be used to request a compiled list of pharmacy or registrant information. ACP only provides information for approved purposes as follows:

Registrant data: contains personal information and will only be disclosed in accordance with ACP’s Privacy Policy. The use must fall within the approved purposes and the registrants must have consented to the disclosure of their information for this purpose. The approved purposes are
- Continuing education: opportunities for education related to pharmacy practice;
- Member recruitment: opportunities for information from relevant member associations;
- Practice-based research: opportunities to participate in pharmacy/health related research;
- Health promotion: information related to the promotion of health as it relates to pharmacy practice; and
- Programs/benefits: opportunities for programs or benefits relevant to regulated members.
Research: if a request for pharmacy or registrant information is for research purposes, the research objective and source of funding must be disclosed in the application, and the ethics board approval attached.
Commercial use: ACP only provides pharmacy information for specific approved commercial uses that, in ACP’s view, facilitate pharmacy operations in the public interest, not for private business development purposes. At its discretion, ACP may provide information to assist in the verification of pharmacy information for the purposes of narcotic authority validation, drug distribution, and claims adjudication.

For all approved purposes, the type and amount of information requested must be narrowly defined to be that which meets the specific purpose the information is requested for, and no more.

If you are a physician or representing a medical clinic looking to populate an Electronic Medical Record (EMR), visit Alberta Health’s Delivery Site Registry (DSR) to obtain current pharmacy data that ACP provides directly to Alberta Health for your access via Alberta Netcare.

If you would like to request a compiled list of pharmacy and/or registrant information for an approved purpose, please complete and submit the information request form for ACP’s consideration.

1. Identification

Identify the organization and, if applicable, departmental unit requesting the information. Any information that ACP provides is to be restricted to the organizational persons and groups necessary to undertake the purpose identified further below.

Organization(Required)

Department unit (if applicable)

Street address(Required)

City/town(Required)

Postal code(Required)

2. Purpose

List the specific purpose for which the information will be used. Information provided by ACP may only be used for the purpose identified in this form. If the listed purpose is not an approved purpose, and clearly described with a clear link to the information requested, it will not be considered.

Purpose(Required)

If the request is for research purposes, provide the research objective.

If the request is for research purposes, provide the source of funding.

If the request is for research purposes, attach a copy of the ethics approval.

Max. file size: 32 MB.

3. Requested data

Data elements

Identify the data being requested. The data must be that which is sufficient to achieve the approved purpose listed above, and no more; check only those that are necessary. ACP will contact you for further information if the rationale for requested data elements is not clear.

Which type of data are you looking for? Make your selection from the list below

Pharmacy directory – standard report consists of

Pharmacy name
Licence type
Pharmacy address
Pharmacy phone and fax
Listing of staff registrants (employee name, registration type, licensee, signing authority)

One-time pharmacy list request

Allows you to select the type, location, and pharmacy information you would like included in the report.

One-time registrant list request

This is a one-time registrant list request. Check only those data elements required. Information will only be provided for registrants who have provided consent in accordance with ACP’s Privacy Policy.

Type of data(Required)

Pharmacy directory – standard report

One-time pharmacy list request

One-time registrant list request

Refer to the description above.

Duration of subscription (payment must be received in full for entire period)(Required)

One year

Two years

Three years

Desired frequency of updates within the year (check all that apply)(Required)

Quarterly (through updated pharmacy directory report)

Weekly (through weekly updates with only changes noted)

As changes made (through change memos issued when changes are processed)

Email addresses to be added to pharmacy directory distribution list(Required)

This list must be restricted as narrowly as possible to include only the individuals required to carry out the identified purpose. Please separate email addresses with commas.

Type of pharmacy(Required)

All licensed pharmacies

Community pharmacies

Compounding and repackaging pharmacies

Licensed institution pharmacies

Other type of pharmacy

If you selected "Other type of pharmacy," please specify.

Location(Required)

Entire province

Select regions

Select cities

If you selected "Select regions" or "Select cities," please specify.

Pharmacy information(Required)

Pharmacy name

Physical address

Mailing address

Phone number

Fax number

Pharmacy licence number

Name of licensee/manager

Licensee email address

Date pharmacy information is required by(Required)

MM slash DD slash YYYY

Type of registrant(Required)

Clinical pharmacist

Pharmacy technician

Provisional pharmacist

Provisional pharmacy technician

Student pharmacist

Other type of registrant

If you selected "Other type of registrant," please specify.

Locations(Required)

Alberta residents only

Within Canada

All locations

Data elements(Required)

Email address

Pharmacy employment address (Alberta)

Other data elements

If you selected "Other data elements," please specify.

Date registrant information is required by(Required)

MM slash DD slash YYYY

4. Fees and payment

Fee listing

One-time full registrant (subject to ACP Privacy Policy) or pharmacy list request ($250.00)
One-time partial registrant (subject to ACP Privacy Policy) or pharmacy list, fewer than 500 entities ($150.00)
Annual subscription (payment must be received in advance for all years): annual only ($250.00 per year), with quarterly update ($400.00 per year), with weekly and/or updates as changes made ($750.00 per year).

All fees listed include GST.

Fee exemption requests

Fees will only be exempted for an Alberta government department or agency, Canadian educational institution (provided it is acting independently and not as part of a private-public partnership), or non-profit organization, at ACP’s sole discretion. Check below if you are requesting a fee exemption and identify your type of organization. ACP will not waive fees for privately owned and operated entities.

Fee exemption request(Required)

I am not requesting a fee exemption

I am requesting a fee exemption for my organization

Indicate the type of organization for which you are requesting a fee exemption

Governmental

Educational

Non-profit

You will be contacted for payment (if applicable) upon review of your application.

5. Responsible individual and Terms of Use

Responsible individual

Note that the organization must identify one individual who will be responsible for the management and security of the data, in accordance with the purpose described above. This individual must sign and comply with the Terms of Use included below. Should this individual depart or change roles within the organization, ACP requires the identification of a new responsible individual and signing of a new Terms of Use.

ACP will supply the information to the responsible individual only and will not manage user lists on behalf of the organization. Distribution and access to the list, in accordance with the approved purpose and Terms of Use, is the responsibility of the organization through its responsible individual.

Name of the responsible individual(Required)

Position/title(Required)

Street address(Required)

City/town(Required)

Postal code(Required)

Phone number(Required)

Email address(Required)

Terms of Use

As the individual designated as being responsible for the use and security of the information being provided by ACP, I agree to the following:

Any weekly updates received will be used only for the purpose described in this Request for Information.
If a new desired use arises, I will seek approval through a new Request for Information inclusive of the additional use prior to using the information for that purpose.
The information will be stored with appropriate security provisions to prevent unauthorized access (e.g., secure servers, restricted access network folders, not emailed in an unprotected file).
Access will be granted only to those individuals needing to undertake the identified purpose, with appropriate access restrictions to prevent access by others in the organization (e.g., restricted folders and systems with designated access rights).
The information will be destroyed when no longer in use for the approved purpose.
Personal information transmitted as a result of this agreement must be protected under my organization’s privacy policy and procedures, to a standard no less than that of the Alberta College of Pharmacy’s Privacy Policy, which is governed by the Personal Information Protection Act. I will enquire with ACP’s privacy officer (privacy@abpharmacy.ca) as needed to ensure that adequate protections are in place.
The information will not be duplicated, disclosed, shared, or sold without the express written consent of the Alberta College of Pharmacy.

Acknowledged and agreed to by

Name(Required)

Date(Required)

MM slash DD slash YYYY

By typing my name below, I understand and agree that this form of electronic signature has the same force and effect as a manual signature

Typed signature(Required)

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In this Section

Background on approved uses

3. Requested data

4. Fees and payment

5. Responsible individual and Terms of Use

Registrant information

Registrant place of work

Registrant position

Authorizations

Pharmacy information

Pharmacy Address