22.1. Before engaging in the professional activities referred to in section 36.1 of the Nurses Act (chapter I-8), a nurse who holds a specialist’s certificate of specialized nurse practitioner must provide to the secretary of the Order, not later than 1 April of each year and on the prescribed form, a statement that contains
(1) the nurse’s class of specialization;
(2) the name and membership number of the partner physicians with whom the nurse has signed a partnership agreement under the Regulation respecting specialized nurse practitioners (chapter M-9, r. 23.1);
(3) the name, address and telephone number of the institution, clinic, dispensary or any other place where the nurse practises under the partnership agreement; and
(4) the area of care where the nurse engages in the professional activities referred to in section 36.1 of the Nurses Act.