Application for Scope of Clinical Practice (SoCP) – Application Form SoCP Only (v1.00 06/2014) Completed Form Examples and Samples
View a detailed example of a completed Application for Scope of Clinical Practice (SoCP) – Application Form SoCP Only (v1.00 06/2014). Our sample SoCP form provides a clear guide on how to correctly fill out your application, including personal details, requested scope, and supporting evidence. Use this free resource to ensure your submission is accurate and complete.
Application for Scope of Clinical Practice (SoCP) Example – GP Adding Minor Surgical Procedures
How this form was filled:
This is a sample of a completed Application for Scope of Clinical Practice (SoCP) form. It illustrates how a General Practitioner, Dr. Emily Carter, applies to expand her clinical scope to include specific minor surgical procedures, such as skin lesion excisions and toenail resections. The example highlights the correct completion of personal details, professional qualifications, a detailed description of the requested scope, and the necessary supporting information like supervision plans and recent training.
Information used to fill out the document:
- Applicant Name: Dr. Emily Carter
- Date of Birth: 15/08/1994
- Medical Registration Number (AHPRA): MED0001234567
- Primary Medical Qualification: MBBS, University of Melbourne
- Year of Primary Qualification: 2019
- Postgraduate Qualifications: FRACGP (Fellowship of the Royal Australian College of General Practitioners)
- Current Appointment: General Practitioner, Newtown Medical Centre
- Contact Phone: 0412 345 678
- Contact Email: [email protected]
- Requested Scope of Practice: Minor Surgical Procedures including: 1. Excision of skin lesions (elliptical, punch, shave). 2. Ingrown toenail wedge resection. 3. Implanon NXT insertion and removal. 4. Suturing of minor lacerations.
- Evidence of Competency: Certificate of Completion - 'Minor Surgical Skills Workshop', HealthCert Australia (2025)
- Proposed Supervisor: Dr. David Chen (FRACGP, FACRRM)
- Supervision Details: Direct supervision for first 5 procedures of each type, followed by indirect supervision and case review for 6 months.
- Application Date: 18/07/2026
What this filled form sample shows:
- Accurately completed applicant identification and registration details.
- A clear and specific list of the new procedures or activities being requested.
- Inclusion of relevant supporting evidence, such as recent training and certification.
- A well-defined supervision plan with a named supervisor.
- Correctly signed and dated applicant declaration section.
Form specifications and details:
| Form Name: | Application for Scope of Clinical Practice (SoCP) – Application Form SoCP Only |
| Form Version: | v1.00 06/2014 |
| Use Case: | General Practitioner expanding scope to include specific minor surgical procedures. |
| Jurisdiction Example: | Australian Healthcare System (based on AHPRA registration) |
Created: February 03, 2026 05:32 AM
