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How to use or fill out Health Facility Peer Review Reporting Form (805 Report) with our platform
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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.
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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
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Health Facility/Peer Review Reporting Form (805 Report)
Attach additional sheet(s) describing the facts and circumstances of the medical disciplinary cause or reason and any other relevant information related to the
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934.
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