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Sample FACIS® Level III Background Check

FACIS® Level 3 is the gold standard of exclusion screening, verification, and monitoring, and includes: All sources in FACIS® 1M and the sanctioning boards from all 56 U.S. jurisdictions across all provider types. This accesses more than 3,000 sources.

Turnaround time: Near-instant. Ideal for: Doctors, Nurses, Trained Medical Staff, Students in clinical placement.

Name match only. Please carefully review list for a license number, address, DOB or SSN identifiers as common name combinations may yield multiple results. Government source website is listed with each result, so that you may ascertain more information.

JOHN R. DOE
ADDRESS
City Rochester State MN
Country US
LICENSE
Number D38954 State MN
Minnesota Board of Dentistry
Publication Name: Minnesota Board of Dentistry; DISCIPLINARY ACTIONS
Publication Date: 12/19/2001 12:00:00 AM
SANCTION
Subject Title D.D.S.
Acquisition Date 12/19/2001 12:00:00 AM
Action Summary Conditional; Date of Order: 12/10/99
ACTIONS – N/A
CHARGES – N/A
FINDINGS
Description
CAUSE R: Debarment by any Federal agency pursuant to Executive Order 12549 and the agency implementing regulations for one or more 153 of the following causes:
(a) conviction or a civil judgment for fraud, violation of antitrust laws, embezzlement, theft, forger, bribery, false statements, false claims, or other offense indicating a lack of business integrity or honesty; (b) violation of the
terms of a public agreement or transaction so serious as to affect the integrity of an agency program; or (c) other causes specified in the agency implementing regulations, or such other cause of a serious and compelling nature affecting
responsibility.
TAXONOMIES
Provider Type DENTISTRY
NOTES
1 Note Text
Listed below are the names of licensees/registrants who are currently subject of disciplinary actions. Following the list of current disciplinary actions, is a listing of licensees/registrants who have either surrendered their license/registration to practice or the Board has revoked the license/registration. For questions regarding any other Disciplinary Actions, please contact the Board of Dentistry at 612.617.2250y
2 Note Text
Minnesota Board of Dentistry, 2829 University Avenue, S.E., Suite 450,
Minneapolis, MN 55414-3249; Phone: (612) 617-2250, Fax: (617) 617-2260; website:
http://www.dentalboard.state.mn.us/main_disciplinary_actions.htmy
3 Note Text
Defining Disciplinary Actions: Conditional License/Registration: The individual may continue to practice, but must meet certain conditions within a specified time period. Conditions could include completing specific coursework,
submitting reports to the Board, conducting infection control or recordkeeping inspections, or all of the above. Once all conditions are met, the licensee/registrant may petition the Board to have the conditions removed from the license/registration, and upon Board approval, be issued an unconditional license/registration. Limited License/Registration: The individual may continue to practice but only within well-defined parameters. The Board may order a licensee or registrant from providing certain kinds of treatment. Some orders allow for the limitation to be lifted once certain conditions are met. Others are intended to remain in place permanently. Suspended: The individual must cease all practice until the suspension is lifted. As with conditional and limited licenses, a suspended license may be reinstated upon Board approval once the individual has complied with the order and demonstrated fitness to practice. Voluntary Surrender & Revocation: The license or registration is removed through an order for voluntary surrender or revocation order. In both cases, the individual must cease practicing for an indefinite period of time and surrender their license/registration. In order to resume practice, the licensee or registrant must meet all of the requirements for reinstatement in the disciplinary order, as well as apply for reinstatement. This action requires
Board approval.

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JOHN R. DOE
ADDRESS
City Robinson
LICENSE
Number LPN13589546
State GA

Pennsylvania Department of Public Welfare
Publication Name: Pennsylvania Dept. of Public Welfare, Office of Medical Assistance
Programs (OMAP), Medicheck List Publication Date: 9/29/2009 12:00:00 AM

SANCTION
Acquisition Date 9/29/2009 12:00:00 AM
Action Summary
Medicheck (Precluded Providers) List; Begin Date: 8/18/1978; End Date: Indefinitely
ACTIONS
Start Date 8/18/1978 12:00:00 AM
CHARGES
FINDINGS
Description Employee Misconduct
TAXONOMIES
Provider Type
MISCELLANEOUS
NOTES
1 Note Text
Please note, this information was downloaded from the following website:
www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/FraudAbuse/003673510.aspxy

2 Note Text
Pennsylvania Department of Public Welfare, Health & Welfare
Building, Room 515, PO Box 2675, Harrisburg, PA 17105-2675; Phone: 717-787-1870,
Website: http://www.dpw.state.pa.us/OMAP/y

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Mr. JOHN R. DOE OT
Gender: M
Specialty: Respiratory, Developmental, Rehabilitative and Res
ADDRESS
State TN Country US
LICENSE Number: Not Applicable

Tennessee Department of Health, Board of Occupational Therapy

Publication Name: Tennessee Department of Health, Board of Occupational Therapy- Minutes Publication Date: 8/10/2010 8:03:29 AM
SANCTION
Subject Title OT Subject Occupation Occupational Therapist
Publication Date
3/11/2010 12:00:00 AM Acquisition Date 8/10/2010 8:03:29 AM
Entry Date
8/10/2010 10:47:59 AM
Action Summary
Consent Orders Occupational Therapy
Minutes March 11, 2010 3 John R. Doe, OT Ms. White presented a Consent Order on John R. Doe, OT for a violation of 63-13-209(a) (1)(6) when he pled guilty to reckless driving and implied consent. Mr. Doe has consented to his occupational therapist license being placed on probation for a period of no less than three (3) years and will undergo an evaluation by the Tennessee Professional Assistance Program (TnPAP). Should the evaluation recommend a contract with TnPAP, the probationary period of Mr. Doe’s license will run concurrent with said TnPAP contract, and will continue until Mr. Doe complies with every term of the contract. Should Mr. Doe contract with TnPAP be extended, the term of probation of his license will be extended to the new term of the TnPAP contract. Ms. Paul made a motion seconded by Mr. Griffin to approve the Consent Order as presented. The motion carried.
ACTIONS
1
Type Consent Order Start Date
3/11/2010 12:00:00 AM
2
Type probation Term 3 Years
Start Date
3/11/2010 12:00:00 AM
CHARGES
FINDINGS
Description Employee Misconduct

TAXONOMIES
Code 225X00000X
Provider Type
Respiratory, Developmental,
Rehabilitative and Restorative Service Providersy
NOTES
1 Note Text
Please note, this information was downloaded from the following website:
www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/FraudAbuse/003673510.aspxy
2 Note Text
Pennsylvania Department of Public Welfare, Health & Welfare
Building, Room 515, PO Box 2675, Harrisburg, PA 17105-2675; Phone: 717-787-1870,
Website: http://www.dpw.state.pa.us/OMAP/y

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