Five-star Doctor Professional Portfolio Update Form

Five-Star Doctor Excellence Portfolio

Introduction Text

The Five-Star Doctor framework recognizes physicians who excel as:

⭐ Care Provider

⭐ Decision Maker

⭐ Communicator

⭐ Community Leader

⭐ Manager/Leader

This form allows members to document achievements aligned with global primary care standards.

SECTION 1 — MEMBER DETAILS

Full Name

Practice Name

Parish of Practice

Email Address

Telephone Number

MCJ Registration Number

Years in Practice

SECTION 2 — SERVICE TO ORGANIZED MEDICINE

Describe service to:

AGPJ MAJ CCFP Medical Committees Insurance Negotiations Professional Advocacy

Describe your selected service

⭐ CARE PROVIDER

Describe clinical excellence demonstrated during the past year.

Examples:

Improved patient outcomes Chronic disease programmes Practice innovations

Describe your selected service

⭐ DECISION MAKER

Describe leadership in evidence-based medicine or ethical practice.

Teaching activities completed:

CME Lecturer Medical Student Teaching Residency Training Public Education Media Engagement

Provide details.

⭐ COMMUNICATOR

Describe community health leadership activities.

Teaching activities completed:

CME Lecturer Medical Student Teaching Residency Training Public Education Media Engagement

Provide details.

⭐ MANAGER / LEADER

Describe practice management leadership or healthcare system improvements.

SECTION — IMPACT STATEMENT

“How does your work reflect the Five-Star Doctor model?”

DOCUMENT UPLOAD

Updated CV (optional)

Max 10 MB

Supporting Documents (Optional)

Max 10 MB

DECLARATION

NAME:

Information submitted may be used for professional recognition consideration.

Date

Leave this field empty