H. Additional
Requirements.
(1) Each applicant shall submit
a chronological list of all activities beginning with the date of completion of
medical school through the date of application. The activities shall be listed
by month and year, account for all periods of time, and include but not be
limited to the following:
(a) All
postgraduate training programs attended, regardless of whether the program was
completed or not;
(b) Each job
held, regardless of whether the job was:
(i)
Medically related or not; or
(ii)
Compensated or not;
(c)
Any other activity engaged in, including all periods of unemployment;
(d) An action, by a state licensing or
disciplinary board, or a comparable body in the armed services, denying an
application for licensure, reinstatement, or renewal;
(e) An action taken against the physician's
license, by a state licensing or disciplinary board, or a comparable body in
the armed services, including but not limited to limitations of practice,
required education, admonishment, reprimand, suspension, or revocation for an
act that would be grounds for disciplinary action under Health Occupations
Article, §14-404, Annotated
Code of Maryland;
(f) An
investigation or charge brought against the physician by a licensing or
disciplinary body or comparable body in the armed services;
(g) A medical or health professional license
for which the physician has applied if the application was withdrawn for
reasons that would be grounds for disciplinary action under Health Occupations
Article, §14-404, Annotated
Code of Maryland;
(h) An
investigation or charge brought against the physician by a hospital, related
institution, or alternative health care system that would be grounds for action
under Health Occupations Article, §14-404, Annotated
Code of Maryland;
(i) Any
limitation or loss in privileges by a hospital, related health care facility,
or alternative health care system that would be grounds for disciplinary action
under Health Occupations Article, §14-404, Annotated
Code of Maryland;
(j) A plea of
guilty or nolo contendere, a conviction, or receipt of probation before
judgment for a criminal act;
(k) A
plea of guilty or nolo contendere, a conviction, or receipt of probation before
judgment for an alcohol or controlled dangerous substance offense, including
but not limited to driving while under the influence of alcohol or controlled
dangerous substances;
(l) An arrest
which would provide a basis for investigation or charge which would be grounds
for disciplinary action under Health Occupations Article, §14-404, Annotated
Code of Maryland;
(m) A physical or
mental condition that currently impairs the physician's ability to practice
medicine; and
(n) The filing or
settling of a medical malpractice action in which the physician is, or has
been, named as a defendant within the past 5 years.
(2) An applicant shall submit the following
additional information:
(a) Copies of the
complaints, pleadings, and judgments in all malpractice claims if the applicant
has had 3 or more claims in the 5 years before the filing of the application
for licensure;
(b) Copies of all
arrests, disciplinary actions, judgments, and final orders which occurred or
were issued within the 7 years before submitting the application for licensure
for driving while intoxicated, driving while under the influence of a chemical
substance or medication, or any license probation, suspension, or revocation;
and
(c) All medical licensure,
certification, and recertification examination results and the dates when these
examinations were taken.
(3) On forms supplied by the Board, an
applicant shall agree to release to the Board relevant information from
appropriate individuals, other institutions, and government agencies including,
but not limited to, the National Practitioner Data Bank, hospitals, and other
licensing bodies.
(4) On forms
supplied by the Board, an applicant shall allow the Board to release
information which is not statutorily protected.
(5) During the application process, an
applicant for licensure shall have the duty to inform the Board by electronic
or first-class mai of any of the circumstances listed in §H(1) and (2) of
this regulation within 30 days of the occurrence of or notification about these
circumstances.
(6) If reasonable
questions regarding an applicant's physical, mental, or professional competency
have been raised by the information provided on the application, the Board may
request additional information regarding the applicant's competency from the
chief of staff of a hospital where the applicant has practiced.