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Membership Application Form 2021

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Membership Application Form 2021 MEMBERSHIP APPLICATION FORM 2021 CONTACT DETAILS Name: Date of birth: Tel: Cell: Email: Address: City: Region: ZIP Code: Short description of practice: AFFILIATIONS BHF no.: HPCSA no.: AHPCSA no.: Are you a member of SA Medical Association? QUALIFICATIONS Qualifications and Training: Institution: Year: PRACTICE MODALITIES – PLEASE INDICATE WITH X Acupuncture Herbalism Nutritional therapy Anthroposophic medicine Homotoxicology Orthomolecular medicine Anti-aging medicine Homeopathy Ozone therapy Ayurvedic medicine Hypnotherapy Prolotherapy Biopuncture Intravenous therapy PNI BEMER therapy Kinesiology Rife Resonator therapy Bio-energetic tools Laser therapy TCM Breathwork Lifestyle modification Trauma releasing exercise Chelation Live blood analysis VoiceBio Energy healing Mindfulness-based medicine Western medicine Functional medicine Naturopathy Other, please specify: MEMBERSHIP CATEGORIES 1. Medical members Medical doctors and biological dentists registered with HPCSA R990 p.a. 2. Allied members Allied Doctors registered with the AHPCSA R880 p.a. All other practitioners registered with a medical statutory council – dieticians, psychologists, nurses, pharmacists and vets, etc. – include registration number Clinical nutritionists – attach qualifications – must have 3 year 3. Associates BSc degree or diploma R880p.a. Ethnomedicine practitioners registered with EPASA. Other practitioners who have FM and IM qualifications – please include your qualifications for the EXCO to evaluate your application. This is a new category to accommodate everyone who does NOT fit into the above categories, but who does practise some aspect of IM. They will not participate in the SASIM Professional Discussion Group 4. Affiliates R770 p.a. (previously called the Medical chats) and will not be listed on the SASIM website. They may join regional Whatsapp groups, attend meetings as “members” and benefit from group discounts. Students may join regional Whatsapp groups, attend meetings as 5. Students “members” and benefit from group discounts. They will not be listed R440 p.a. on the SASIM website. A once-off registration fee of R330 applies to categories 1, 2 and 3, for new registrations. Please state the membership category relevant to you: BANKING DETAILS Payment can be made into the account below: SASIM Nedbank, Stellenbosch Branch code: 135705 Account number: 1357 003986 NOTES Please complete this application form on your computer - type in your signature or use your digital one - and send to our administrator, Elma Pollard, together with your proof of deposit. Please include a good photograph of your face for the website listing. Tel: 021-8550518 Email: [email protected] This information will not be given out to any other party, nor will it appear on any website other than our own. Membership is subject to the approval of the Committee. Please read our Code of Conduct on the following page, and type YES if you are prepared to abide by it: SIGNATURES Do you wish to have your details, as given above, advertised on the SASIM website? Signed: Date: Please name 2 colleagues who are willing to vouch for you: 1. Contact no.: 2. Contact no.: CODE OF CONDUCT Medical and Allied SASIM members belong to professional regulatory bodies like HPCSA and AHPCSA. We expect our members to follow these councils’ code of ethics/conduct: 1. HPCSA Professional Conduct & Ethics (Booklet 1-15) 2. AHPCSA Code of Ethics 3. The scope of practice in Integrative Medicine varies from practitioner to practitioner depending on the field of expertise of that practitioner. The modalities of treatment will therefore vary among practitioners. SASIM encourages their members to: Respect and work with other practitioners in the pursuit of best healthcare possible for all patients. Support colleagues who uphold the core values in these guidelines. Refer to other professionals in order to provide the best treatment for your patient. Refrain from speaking badly about a professional to any other colleague. Refrain from making a patient doubt a colleague’s skill, knowledge or choice of treatment. 4. If a member is found guilty of unprofessional conduct, he will be liable to provide an explanation to the SASIM executive committee. Following this inquiry, a member may be suspended for a period or their membership may be terminated with immediate effect. 5. Whatsapp Group: The aim of the group is to provide a platform for communication between all practitioners in South Africa, so that knowledge can be shared. It is also a place where a practitioner can get advice and support, which is in the patient's best interest. It is a group where referrals can be made. Ideally, we would prefer to limit the chat group texts between Monday and Friday. Jokes and personal messages should be avoided. The SASIM code of conduct applies to the Whatsapp group as well. A practitioner shall not speak ill of another colleague or patient. We encourage all practitioners to partake in the discussions that take place on the group. We aim to foster a sense of belonging among all integrative practitioners in South Africa. .
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