( f) Upon discovery of an incomplete application the processing will cease and not be processed until such additional information or clarification is received from the applicant.
( g) Applicants and members are responsible for notifying the Medical Staff Office, in writing, of any change in status or any change in the information provided on the application form. This information is required to be provided with or without request, promptly but no later than ten( 10) days of the change occurring, and includes, but is not limited to:
( 1) any information on the application form;( 2) any threshold eligibility criteria for appointment or clinical privileges;
( 3) complaints, documents or other information known to the practitioner regarding, or changes in, licensure status or DEA registration or state-controlled substance license;
( 4) changes( incident and / or aggregate amounts and or carrier / policy changes) in professional liability insurance coverage;
( 5) the filing, regardless of status, of a professional liability lawsuit against the individual;
( 6) the filing of any lawsuit or administrative complaint or proceeding by any federal or state government agency related to the individual’ s professional practice;
( 7) a criminal investigation involving the individual, arrest, charge, indictment, conviction, or a plea of guilty or no contest in any criminal matter other than a misdemeanor traffic citation;
( 8) exclusion or preclusion from participation on any private health insurance panel of providers or in Medicare, Medicaid, or any other federal or state healthcare program, or any sanctions imposed with respect to the same; or voluntary decision to opt-out of Medicare;
( 9) changes in status( e. g., appointment, clinical privileges, or employment) at any medical group or health care entity; and
( 10) any changes in the practitioner’ s ability to safely and competently exercise clinical privileges or perform the duties and responsibilities of appointment because of health status issues, including, but not limited to, impairment due to addiction( all of which will be referred for review under the policy on practitioner health).
4877-0873-6192, v. 3
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