Kiellerman, Andrew John

             (1 of 2) As from August 9, 2017, the following is imposed as a term, condition
            and limitation on the certificate of registration held by Dr. Andrew John
            Kiellerman, in accordance with an undertaking and consent given by Dr.
            Kiellerman to the College of Physicians and Surgeons of Ontario:

                        UNDERTAKING, ACKNOWLEDGEMENT AND CONSENT
                                          ("Undertaking")
                  
                                                of
                  
                              DR. ANDREW JOHN KIELLERMAN
                                          ("Dr. Kiellerman")
                  
                                                to
                  
                        COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
                                          (the "College")
                  
                  
                  
            A.    PREAMBLE

            (1)   In this Undertaking:

                  "Code" means the Health Professions Procedural Code, which is Schedule 2
                  to the Regulated Health Professions Act, 1991, S.O. 1991, c. 18, as
                  amended; 
                  
                  "Discipline Committee" means Discipline Committee of the College;
                  
                  "OHIP" means the Ontario Health Insurance Plan;
                  
                  "Public Register" means the College's register that is available to the
                  public;
                  
                  "QAC" means the Quality Assurance Committee of the College.
                  
            (2)   I, Dr. Kiellerman, certificate of registration number 97058, am a member
                  of the College.  

            B.    UNDERTAKING

            (3)   I, Dr. Kiellerman, undertake to abide by the provisions of this
                  Undertaking, effective upon the date this Undertaking is approved by the
                  QAC ("Effective Date").

            (4)   Practice Restrictions

                  (a)   I, Dr. Kiellerman, undertake that I will cease to engage in
                        "walk-in" practice.
                  
            (5)   I, Dr. Kiellerman, undertake to inform the College of each and every
                  location that I practise or have privileges, including, but not limited
                  to, hospital(s), clinic(s) and office(s), in any jurisdiction
                  (collectively my "Practice Location(s)"), within five (5) days of
                  executing this Undertaking.  Going forward, I further undertake to inform
                  the College of any and all new Practice Locations within five (5) days of
                  commencing practice at that location.

            (6)   I, Dr. Kiellerman, undertake that I will not engage in "walk-in" practice
                  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 "walk-in" practice and
                  
                  (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
                  
            (7)   I, Dr. Kiellerman, undertake that upon my return to the "walk-in"
                  practice, I shall, at minimum, submit to a reassessment of my "walk-in"
                  practice within three (3) to six (6) months after resuming my "walk-in"
                  practice. 

            (8)   I, Dr. Kiellerman, undertake that I will submit to, and not interfere
                  with, unannounced inspections of my Practice Locations and patient charts
                  by a College representative for the purposes of monitoring my compliance
                  with the provisions of this Undertaking.

            C.    ACKNOWLEDGEMENT

            (9)   I, Dr. Kiellerman, acknowledge and undertake 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. 

            (10)  I, Dr. Kiellerman, acknowledge 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. Kiellerman, acknowledge that the College will provide this
                  Undertaking to any Chief of Staff, or a colleague with similar
                  responsibilities, at any Practice Location ("Chief(s) of Staff").

            (12)  I, Dr. Kiellerman, 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 any one or more of the following:
                  consideration by the QAC, an investigation by the College, or further
                  action by the College, including a referral of specified allegations to
                  the Discipline Committee.

            (13)  I, Dr. Kiellerman, acknowledge that this Undertaking constitutes terms,
                  conditions, and limitations on my certificate of registration for the
                  purposes of section 23 of the Code. 

            (14)  Public Register

                  (a)   I, Dr. Kiellerman, acknowledge that, during the time period that
                        this Undertaking remains in effect, this Undertaking shall be
                        posted on the Public Register.
                  
                  (b)   I, Dr. Kiellerman, acknowledge that, in addition to this
                        Undertaking being posted in accordance with section (14)(a) above,
                        the following summary shall be posted on the Public Register during
                        the time period that this Undertaking remains in effect:
                  
                              Dr. Kiellerman has voluntarily ceased "walk-in" practice.
                  
            D.    CONSENT

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

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

            (17)  I, Dr. Kiellerman, give my irrevocable consent to the College to provide
                  all Chief(s) of Staff with any information arising from the monitoring of
                  my compliance with this Undertaking.

            (18)  I, Dr. Kiellerman, give my irrevocable consent to any Chief of Staff to
                  disclose to the College, and to one another, all information relevant to
                  this Undertaking and/or relevant for the purposes of monitoring my
                  compliance with this Undertaking.


            (2 of 2) The certificate of registration held by Dr. Andrew John Kiellerman
            also carries the following term, condition and limitation imposed by the
            Registration Committee, effective November 25, 2011:

                  Dr. Andrew John Kiellerman may practice medicine independently in
                  General/Family Medicine, only.