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Jackson, Marjorie Jean (CPSO#: 61142)

Current Status: Active Member as of 12 Jul 1990

CPSO Registration Class: Restricted as of 25 Oct 2016

Indicates a concern or additional information

Summary

Former Name: No Former Name

Gender: Female

Languages Spoken: English

Education:McMaster University, 1989

Practice Information

Primary Location of Practice
Practice Address Not Available
View Professional Corporation Information

Professional Corporation Information

Corporation Name: Dr. Jordan Golubov Medicine Professional Corporation

Certificate of Authorization Status: Issued Date:  Oct 13 2015

Shareholders:
Dr. M. Jackson ( CPSO# 61142 )
Dr. J. Golubov ( CPSO# 55728 )

Business Address:
Suite 203
585 Queen Street South
Kitchener ON  N2G 4S4
Phone Number: (519) 744-9389

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 15 Jun 1989
Expired: Terms and conditions of certificate of registration Expiry: 14 Jun 1990
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 12 Jul 1990
Transfer of class of certificate to: Restricted certificate Effective: 25 Oct 2016
Terms and conditions imposed on certificate by member Effective: 25 Oct 2016

Practice Restrictions

Imposed By Effective Date Expiry Date Status  
member Effective: 25 Oct 2016 Active View Details [+]
            As from October 25, 2016, the following is imposed as a term, condition and
            limitation on the certificate of registration held by Dr. Marjorie Jean
            Jackson, in accordance with an undertaking and consent given by Dr. Jackson to
            the College of Physicians and Surgeons of Ontario:


                        UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT 
                                          ("Undertaking")
                  
                                                of

                                    DR. MARJORIE JEAN JACKSON
                                          ("Dr. Jackson")
                  
                                                to
                  
                        COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
                                          (the "College")
            ________________________________________________________________________

            A.    PREAMBLE

            (1)   I, Dr. Jackson, certificate of registration number 61142, am a member of
                  the College. The College has inquired into my compliance with the
                  requirement to participate in a program of continuing professional
                  development.    

            (2)   I, Dr. Jackson, have ceased to practise medicine due to retirement.

            B.    UNDERTAKING

            (3)   I, Dr.  Jackson, undertake that, effective immediately, I will not
                  practise medicine in any jurisdiction until each and every one of the
                  following conditions have been met:

                  (a)   I provide a minimum of forty-five (45) days' notice to the College
                        of my intent to return to the practice of medicine; 
                  
                  (b)   I provide the College with proof that I am participating in a
                        program of continuing professional development that meets the
                        requirements for continuing professional development of the Royal
                        College of Physicians and Surgeons of Canada, the College of Family
                        Physicians of Canada, or an organization that has been approved by
                        the College for that purpose that meets the requirements for
                        continuing professional development set by the Royal College of
                        Physicians and Surgeons of Canada or the College of Family
                        Physicians of Canada; and
                  
                  (c)   The College approves my return to the practice of medicine.
                  
            (4)   I, Dr. Jackson, undertake that upon signing this Undertaking I shall
                  forward a request to the General Manager of the Ontario Health Insurance
                  Plan ("OHIP") that my billing number be deactivated for services rendered
                  after the date I cease to practise and before the date the College agrees
                  that I may return to practise in accordance with the provisions of this
                  Undertaking. 

            (5)   I, Dr. Jackson, undertake to abide by the College's Policy on Practice
                  Management Considerations for Physicians Who Cease to Practise, Take an
                  Extended Leave of Absence or Close Their Practice Due to Relocation, a
                  copy of which is attached hereto as Appendix "A". 

            C.    ACKNOWLEDGEMENTS

            (6)   I, Dr. Jackson, acknowledge that all appendices attached to or referred
                  to in this Undertaking form part of this Undertaking.

            (7)   I, Dr. Jackson, acknowledge and agree that in considering my request to
                  return to practice, the Registrar may, among other things:

                  (a)   request that I agree to specified terms, limitations or conditions
                        being placed upon my certificate of registration; and
                  
                  (b)   request that I enter into an appropriate assessment and/or
                        monitoring agreement with the College.
                  
            (8)   I, Dr. Jackson, acknowledge and agree that I shall be solely responsible
                  for payment of all fees, costs, charges, expenses, etc. arising from the
                  implementation of any of the provisions of this Undertaking.

            (9)   I, Dr. Jackson, undertake to comply with the provisions of this
                  Undertaking and acknowledge that a breach by me of any provision of this
                  Undertaking may constitute an act of professional misconduct and/or
                  incompetence, and may result in a referral of specified allegations to
                  the Discipline Committee of the College.

            (10)  I, Dr. Jackson, acknowledge and confirm that I have read and understand
                  the provisions of this Undertaking and that I have obtained independent
                  legal counsel in reviewing and executing this Undertaking, or have waived
                  my right to do so.

            (11)  I, Dr. Jackson, acknowledge that this entire Undertaking constitutes
                  terms, conditions, and limitations on my certificate of registration for
                  the purposes of section 23 of the Health Professions Procedural Code,
                  which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O.
                  1991, c. 18, as amended. I understand that this Undertaking shall be
                  information on the College's Register that is available to the public
                  during the time period that the Undertaking remains in effect.

            (12)  I, Dr. Jackson, acknowledge that the following summary will appear on the
                  College's Register that is available to the public during the time period
                  that this Undertaking remains in effect:

                        Dr. Jackson has voluntarily ceased to practise medicine due to
                        retirement and therefore cannot see any patients or provide any
                        medical advice or services.
                  
            D.    CONSENT

            (13)  I, Dr. Jackson, give my irrevocable consent to the College to make
                  appropriate enquiries of OHIP and any person or institution who may have
                  relevant information, in order for the College to monitor my compliance
                  with the provisions of this Undertaking. 

            (14)  I, Dr. Jackson, acknowledge that I have executed the OHIP consent form,
                  attached hereto as Appendix "B" and that the consent forms part of this
                  Undertaking.

Concerns

Source: Member
Active Date: October 25, 2016
Expiry Date:
Summary:
Summary of the Undertaking given by Dr. Marjorie Jean Jackson to the College of Physicians and Surgeons of Ontario, effective October 25, 2016:

Dr. Jackson has voluntarily ceased to practise medicine due to retirement
and therefore cannot see any patients or provide any medical advice or services.