Health Facility Peer Review Reporting Form (805 Report) Health Facility Peer Review Reporting Form ( 2025

See details

4.2 out of 5

56 votes

The document outlines the Health Facility/Peer Review Reporting Form required by Section 805 of the California Business & Professions Code, which mandates reporting certain actions regarding medical staff privileges and employment for disciplinary reasons to the Medical Board of California. It includes details on the types of actions that must be reported, penalties for failing to report, confidentiality provisions, and instructions for completing the form.

Here's how it works

01. Edit your 805 report online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Health Facility Peer Review Reporting Form (805 Report) with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Health Facility Peer Review Reporting Form (805 Report) in the editor.
Begin by selecting the type of reporting entity from the options provided, such as Health Care Facility or Professional Society. Fill in the name and contact details of your organization.
In the 'Licentiate' section, enter the name and license number of the physician or medical professional involved. Ensure accuracy to avoid any compliance issues.
Detail the actions taken against the licentiate by checking all applicable boxes under 'Type(s) of Action(s)'. Include dates and durations where necessary.
If required, attach additional sheets describing any relevant circumstances surrounding the disciplinary action for clarity.
Finally, ensure that both the Chief Executive Officer/Medical Director and Chief of Medical Staff sign and date the form before submission.

Start using our platform today to streamline your form completion process for free!

See more Health Facility Peer Review Reporting Form (805 Report) Health Facility Peer Review Reporting Form ( versions

We've got more versions of the Health Facility Peer Review Reporting Form (805 Report) Health Facility Peer Review Reporting Form ( form. Select the right Health Facility Peer Review Reporting Form (805 Report) Health Facility Peer Review Reporting Form ( version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2023	4.5 Satisfied (48 Votes)
2020	4.9 Satisfied (48 Votes)
2019	4.2 Satisfied (56 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an 805 report?

California. Form 805. State and local government agencies may use this form to identify consultants that will make or participate in making governmental decisions on behalf of the agency. A consultant must file a Statement of Economic Interests (Form 700) within 30 days of assuming office.

What is reportable to the California Medical Board?

The types of complaints the Board handles include: Substandard care (misdiagnosis, negligent treatment, delay in treatment, etc.) Prescribing issues (violation of drug laws, excessive/under prescribing) Sexual misconduct, impairment (drug, alcohol, mental, physical)

What is Section 805 of the California Business and Professions Code?

Section 805(l) of the California Business and Professions Code states: Except as otherwise provided in subdivision (k), any failure by the administrator of any peer review body, the chief executive officer or administrator of any health care facility, or any person who is designated or otherwise required by law to

Try more PDF tools