Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section A where you will indicate the type and date of change. You can add yourself to the Business Arrangement (BA), change your start date, designate a default skill, or end your relationship with the BA. Make sure to choose the appropriate option and fill in the effective date.
3. Provide the BA Contract Holder Name and your Practitioner Name along with your Practitioner ID. If applicable, indicate the skill that will be used on most claims in the designated field.
4. Move to Section B for Authorization. Read the statement carefully. By signing, you assign your benefits from the Alberta Health Care Insurance Plan related to this Business Agreement. Ensure that you include your signature and phone number.
5. Have the BA contract holder or an authorized representative sign the form. Include their phone number, name, and position/title as required.
6. Review all completed sections for accuracy. Once satisfied, you can save changes, download, print, or share the form as needed. Make sure to return the completed form to the Professional and Facility Management Unit using the contact details provided.

Complete your Business Arrangement And Relationships Application online today for a smooth processing experience.