Alex Dinovich, Nurse Practitioner and Medical Director at Bradford Skin Clinic and Medical Spa, acts as medical director for Registered Nurses and Registered Practical Nurses injecting in Toronto. Authority to inject in Ontario comes from an authorizing mechanism issued by an authorized provider under the Nursing Act, 1991, and it is not restricted by which city either of you works in.
Written and reviewed by Alex Dinovich, NP, Nurse Practitioner and Medical Director at Bradford Skin Clinic & Medical Spa.
College of Nurses of Ontario registration 13564840, verifiable on the
public Find a Nurse register.
Last reviewed .
At a glance
The short version.
InvestmentQuoted per arrangement. Scope, number of nurses and case review volume all move the figure
What the arrangement includes
Included in the arrangement
Directives written around where you actually injectOne document per site, or one that names each, rather than a template that assumes a single clinic.
Mobile and multi site circumstances stated explicitlyBecause a directive has to describe the circumstances it covers, and a client's living room is a different circumstance from a treatment room.
Prescribing for neuromodulatorsWhere that applies to what you do.
Case review by phone or video, with a route that works from the cityThe clients who do not fit the directive are the reason the route has to be real.
An agreed escalation plan for complicationsIncluding which Toronto emergency department you would use, and what you send with the client.
Review when your practice or the College's expectations changeDocuments are reissued rather than left to age.
Not included: training. Directorship gives you authority, not technique.
Who you would be working with
A person, not a signature.
Directorship is a professional relationship rather than a
location. You are choosing the person who authors your mechanism, reviews it as
your practice changes, and picks up when a client does not fit it.
Alex Dinovich is Nurse Practitioner and Medical Director here. She is registered with the College
of Nurses of Ontario as 13564840, verifiable on the
public register.
What a directive gives you
Authority to perform the controlled act it names.
A written mechanism you can show.
A named provider accountable for authoring it.
What it does not cover
Anything the directive does not say.
Competence, which comes from training and practice.
Your own accountability to the College for your own decisions.
A directive covers what it says it covers.
Accountability under an authorizing mechanism is specific and bounded.
You remain accountable to the College of Nurses of Ontario for your own practice.
Alex Dinovich, NP. The authorising provider, not a name on a certificate.
Directorship is not a local service
A medical director arrangement is a set of documents, a prescribing relationship and an agreement about who you call when a client does not fit the plan. None of those three things is geographic.
What creates your authority to inject is an authorizing mechanism issued by an authorized provider under the Nursing Act, 1991. A Nurse Practitioner holds that authority across Ontario, and your own registration with the College of Nurses of Ontario is provincial too. A director one street away and a director an hour north are in exactly the same legal position with respect to your practice.
So the question is never how close somebody is. It is whether the documents fit what you actually do, and whether the person behind them picks up.
What Toronto practice adds to the paperwork
Toronto is the one place in Ontario where a nurse injector’s working week is routinely spread across several addresses. That has real consequences for the drafting, and it is the part most template directives get wrong.
Several sites. A directive states the circumstances in which it applies. If you inject on Mondays in a medi-spa on Queen, Thursdays in a rented room in a hair salon, and occasionally at a third clinic covering for somebody, that is three sets of circumstances, not one. Equipment, drug storage, privacy, record keeping and the route to help are different in each. The document should say so.
Mobile and in-home work. If any of your practice happens in clients’ homes, the drafting has to be stricter rather than looser. What you carry, what you cannot manage away from a clinical setting, which presentations you decline rather than treat, and what you do if something goes wrong in a condominium forty minutes from your car. A director who writes you the same directive for home visits as for a treatment room has not thought about it.
Storage and transport of product. Neuromodulator is a prescription drug with handling requirements. Moving between sites raises cold chain and security questions that a nurse working in one building never has to answer.
Escalation in a city with many hospitals. Your plan should name the route, not gesture at it. Which emergency department, what you send with the client, who you call on the way, and what you document afterwards.
The practical side of working with somebody north of the city
Authorship, review and case discussion are done by phone, video and email, which is how most directorship arrangements run regardless of distance. Documents are drafted, sent, revised and reissued.
If you want the first conversation in person, Bradford is about an hour north of downtown up Highway 400, or a Barrie line train from Union Station to Bradford GO. Some nurses come up once at the start, see the treatment rooms, and never need to again. Others never come at all. Neither is better.
What you should insist on, from us or from anybody else, is a stated route to reach the authorizing provider and a realistic expectation of response. An arrangement where consultation is technically permitted but practically impossible is the most common failure in this field, and it is the one that shows up when a client in front of you does not fit the directive.
What to check before you sign anything, here or in the city
Ask for the registration number and look it up on the College of Nurses of Ontario register. Ask whether the directives will be written for your practice or issued from a template. Ask who revises them when the guideline changes, and how quickly. Ask what case review actually includes and how you reach the person. Ask what happens to your booked clients if the arrangement ends, and what notice you get. Ask what is excluded.
Our page on how to choose a medical director sets those out in full, including the answers that should worry you. What directorship costs explains what moves the figure, because a quote given before anybody asks what you inject is not a quote.
Who you would be working with
Alex Dinovich, FNP-PHC, is a Nurse Practitioner and the Medical Director at Bradford Skin Clinic and Medical Spa, College of Nurses of Ontario registration 13564840. As a Nurse Practitioner she assesses, diagnoses, prescribes, issues direct orders and authors directives in her own right. She also injects, daily, in her own clinic, which is the difference between a director who has met your failure modes and one who has read about them.
Tell us what you inject, where you inject it, how many sites are involved and what you are competent to manage yourself. We will tell you what the directives need to cover, what the arrangement would look like, and what it costs. If the answer is that you are not ready for this yet, we will say that instead.
Call 647-333-6805. Bradford Skin Clinic and Medical Spa, 444 Holland Street West, Unit 2, Bradford, Ontario.
Asked by nurses
Asked and answered.
Can a medical director in Bradford cover me if I inject in Toronto?
Yes. The authority comes from the authorizing mechanism, not from a postcode. A Nurse Practitioner registered with the College of Nurses of Ontario can author a directive or issue a direct order for a nurse practising anywhere in the province, and your accountability to the College is the same wherever you work. What matters is whether the document fits your practice and whether the person behind it is genuinely reachable.
Does my medical director have to be on site when I inject in Toronto?
The requirements differ depending on which regulator governs the authorizing provider, and we confirm the specifics with you rather than state them from a web page. What is fixed is that a directive sets its own conditions and those conditions bind you. If yours requires the author to be reachable at the time of treatment, that is a requirement of your practice, not a formality, and it has to be workable from where you inject.
I work out of three different rooms across the city. Does that change the directive?
It does, and this is the most common thing Toronto practice adds. A directive names the circumstances in which it applies. Rented rooms in a salon, a shared clinic day and a client's home are three different sets of circumstances, with different equipment, different privacy and different escalation routes. They need to be described, not glossed over with the word clinic.
Do we have to meet in person?
Not usually, and not routinely. Authorship and review are document and conversation work, which is done by phone and video. Bradford is about an hour up Highway 400 from downtown, or a Barrie line train from Union to Bradford GO, if you would rather do the first conversation face to face. Some people do. It is not a requirement.
There are plenty of directors in Toronto. Why look north?
Only for a reason that matters to you. The honest ones are these: a Nurse Practitioner authorizes in her own right rather than lending a signature, the directives are written for your practice instead of issued as a template, and you are told what the arrangement excludes. If a Toronto arrangement offers you the same things, take it. Distance is not an argument on its own.
How quickly can an arrangement start?
It depends on what you inject and how many sites are involved, and on how long it takes to establish competence properly. Anybody who quotes you a turnaround before asking what you inject is selling a template. The first conversation is free and will tell you what the documents need to cover.
Sources
Where this comes from.
Everything on this page is drawn from the regulator, not from a
competitor's marketing. Read the originals rather than taking our word for any of it.
General information about Ontario regulatory requirements. Not
legal or regulatory advice. Nurses remain accountable to the College of Nurses of Ontario
for their own practice decisions.
Talk to us
Ask before you commit to anything.
Leave four details and Alex will come back to you directly. If what
you need is not something we do, we will say so and point you at whoever does.
Written and reviewed by Alex Dinovich, NP, Nurse Practitioner and Medical Director at Bradford Skin Clinic & Medical Spa.
College of Nurses of Ontario registration 13564840, verifiable on the
public Find a Nurse register.
Last reviewed . 
