FINAL Licensing Board Attestation

FINALLicensing Board Attestation.pdf

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms

FINAL Licensing Board Attestation

OMB: 0915-0126

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Non-visible Questions
Label

PDF Name
(step)

Location

Response
Input
Item

Visibility Trigger

Why are you
removing this
profession?

Licensing
Below the name Text Entry
Board
of the profession
Attestation
(Verify
Regulated
Professions)

The section for
Removed
Professions is only
displayed if the user
selects No for any of
the professions
listed on the Verify
Professions page

Other Name for
Profession
(Optional)

Licensing
Board
Attestation
(Verify
Regulated
Professions)

If the user adds a
profession from the
modal that requires
a description then
the field is
displayed.

Why are you
Licensing
unable to attest? Board
Attestation
(Attest to
Reporting)

Below “Add a
Text
profession if your Entry
board regulates a
profession that is
not listed.

Below the name Text Entry If the user selects
of the profession
the “No” option for
“Can you attest?”
then the field is
displayed.

Other

Required if the
user adds
profession with a
generic “Other”
name such as
“Other Nurse,
Specify”

State Changes
Label
Select an
Occupation or
Field of
Licensure

PDF Name

Item Type

Licensing Board
Modal
Attestation (Verify
Professions)

Trigger
When the user selects the link “+ Add a profession”
the modal to select a profession is displayed and focus
is set on the Search text entry. The user can enter
text in the Search text box to find a specific profession
or select a profession from the list without
searching. The modal is hidden once the user selects
a profession from the list. The user's selection adds
the selected profession to the list under “Additional
Profession(s)”


File Typeapplication/pdf
File Modified2018-01-05
File Created2018-01-05

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