Contents
Hospital and Health Care Facility Privilege Restrictions
Within the past 10 years at any hospital or health care facility:
Have your privileges been revoked or involuntarily restricted for reasons related to competence or misconduct or impairment;
and/or Have restrictions been placed on your privileges in lieu of or in settlement of a pending disciplinary case related to competence or misconduct or impairment?
If yes, the restrictions should be listed below, or you will need to add them.
Review any pre-printed information for factual accuracy.
If the information is correct, no action required
If you disagree with the information or the information is incorrect, you can dispute the action by following the disputed steps.
Disputed - The Default is NO. If you want to dispute this event, please choose YES
Dispute Reason - Required when choosing YES to an action.
Your dispute will be directed to the New Jersey Board of Medical Examiners for review.
Adding a Hospital and Health Care Facility Privilege Restrictions
Enter the following data:
Date of Action: Enter date (Example: 03-24-2015)
Facility: Enter the Name of the facility.
State: Click on arrow to select from list.
Action Taken: Enter text
If you disagree with the information or the information is incorrect, you can dispute the action by following the disputed steps.
Disputed The default is No. . If you want to dispute this event, please choose YES and follow the disputed steps above.
Your dispute will be directed to the New Jersey Board of Medical Examiners for review.
When finished, click one of the buttons at the bottom of the screen:
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