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      Have your privileges been revoked or involuntarily restricted for reasons related to competence or misconduct or impairment; 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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