International Institute for Restorative Reproductive Medicine (IIRRM) Clinician Recognition Program | International Institute for Restorative Reproductive Medicine

Application for RRM Clinician Recognition

Before beginning your application, please review the application and renewal requirements here, and gather or prepare any supporting or supplementary information you may need.

PURPOSES

BENEFITS

GENERAL PROCESS

To recognize physicians and other clinicians who are providing restorative reproductive medicine (RRM) care and encourage clinical excellence in RRM
Development and maintenance of a high standard of care for RRM
Support clinicians in their local environment by a recognition of their expertise in providing appropriate care in RRM
Maintain a list of clinicians actively providing high-quality restorative reproductive health care for patient referrals
To create a network of physicians, who can support and work with FABM/NFP teachers.

Distinguished recognition as a Recognized RRM Clinician by the IIRRM, which may be displayed on the clinician’s website, professional listings, LinkedIn profile, email signature, curriculum vitae, and other professional credentials.
Receive a certificate from the International Institute for Restorative Reproductive Medicine, which can be displayed in on the clinician’s practice or online, showcasing your commitment to excellence in providing RRM care.
Support practice growth through IIRRM’s centralized referral program, in which patient inquiries are reviewed and coordinated by a nurse manager who connects individuals with appropriate restorative reproductive medicine clinicians. This opens doors for patients actively seeking reliable RRM care, and educators searching to refer patients, expanding the clinician’s reach within the RRM community.

Review and meet the program requirements below.
Complete an online application for Clinician Recognition through the IIRRM member portal, upload the requested supporting information (CME completed though the IIRRM does not need to have documentation submitted) and pay the application or renewal fee.
A review committee authorized by the IIRRM which may include members of the IIRRM Board will review your application to determine the criteria and qualifications for certification are met. Email communication may be used to clarify any of the items where necessary.
A certificate and recognition decision will be sent by email and updated in the clinician’s online IIRRM account after determination is made.
Complete or review your provider information to ensure it is up to date and accurate
Recognition is valid for 3 years, and is renewed online through a simplified application form.
To view the full requirements and process please download this overview.

1PART I: Clinician Information

2PART II: Baseline training in RRM

3PART III: Documentation of Clinical Outcomes

4PART IV: Practice Information & Consent

Personal Information

The information provided below is for internal use only and will not be shared with patients, members, or the public. Section IV (Practice Information) will be used for patient referrals and may be shared as part of that process.

Name

First

Last

Fax

I would also like to receive a copy of my certificate by fax

Phone

Country you are licensed to practice

State(s) or Province(s) you are licensed to practice

Please select all that apply.

Licensing Body

PART III: Documentation of Clinical Outcomes

** Please remove all patient identifiers before uploading or entering any information below and ensure to abide by any privacy laws in your region related to the collection, sharing, and storage of patient data **

Please select and complete ONE of the FOUR following options:

Describe or submit documentation of how you track clinically relevant outcomes, and how that data is made available to the public. If you do not yet maintain a registry to track patient outcomes, please describe how you plan to implement this in the future
Describe or submit documentation of your participation in Quality Improvement (QI) or clinic audits tracking clinically relevant outcomes
Submit a written case review using a template provided
Present a pre-reviewed case at an IIRRM or IRRMA case discussion

PART IV: Practice Information

IIRRM has a patient referral program which receives daily requests to be connected to care. Please indicate below if you are accepting referrals and your preferred process to receive patient referrals.

Are you currently accepting new patients?

Yes
No
Other / Comments (for example temporary on leave, extended waitlist, not currently accepting fertility patients, etc.)

How do you provide patient care? (Select all that apply)

Telehealth (virtual consultations)
In-person consultations
Both telehealth and in-person

Preferred email to receive patient referrals

Office Phone

Clinic Website (if available)

Acknowledgements

I am a currently licensed clinician
To the best of my knowledge, the information I have provided is true and accurate
I consent to IIRRM using and sharing my practice information as described above for patient referral purposes. I understand that my practice information may be included in publicly accessible directories or referral listings maintained by IIRRM. This information will be used solely to support patient access to care and professional referrals. You may request to update or remove your information at any time by contacting IIRRM.

After submitting this form you will be redirected to a payment page to submit the application fee. A preview of your copy of your application is below and will be emailed to you for your records. If you prefer to pay by bank transfer (for example IBAN or e-transfer) you can request an invoice from [email protected] or check "Bank transfer" at check out.

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Application for RRM Clinician Recognition

Personal Information

PART II: Baseline training in restorative reproductive medicine, including medical applications of FABM(s)/NFP

PART III: Documentation of Clinical Outcomes

PART IV: Practice Information