Out-of-State Disciplinary Actions
Read the question referring to any actions taken against you as a result of professional misconduct proceedings by any other state or licensing entity within the past 10 years.
Respond to question by clicking in the 'Yes' or 'No' button. (Click again to de-select).
If you answered 'Yes', list the following data:
State Select from drop down box
Licensing Entity Enter in box
Date of Action Taken Enter date (Example: 03-24-2015)
Action Taken Enter text
Under appeal Click on the box.
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.
To add an additional out-of-state licensee action, click on 'Click here to add additional Out-of-State Licensee Actions' button and proceed as above. (You may add multiple actions.)
When finished, click one of the buttons at the bottom of the screen:
Save & go to previous page
Save & stop for now
Save & go to next page