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pdf Non-visible Questions
Label
PDF Name
(step)
Location
Response
Input Item
Visibility Trigger
Other
Date of Death
Deferred
Below "Is this
Conviction person
or Pre-Trial deceased?"
Diversion
(1)
Text Entry The field is displayed
if the user selects the
"Yes" radio
button for "Is this
person deceased?"
Organization
Description
Deferred
Below
Conviction Organization
or Pre-Trial Type
Diversion
(1)
Text Entry
The field is displayed
if the user selects an
organization type
that requires a
description.
Name of
Occupation
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Beside
Profession or
Field of
Licensure
Text entry
The field is displayed
if the user selects a
profession or field of
licensure that
requires a
description.
“Specialty” is
displayed in place of
“Name of
Occupation” if the
selected profession
or field of
licensure requires
specialty
information.
Specialty
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Beside
Profession or
Field of
Licensure
Drop List
The field is displayed
if the user selects a
profession or field of
licensure that
requires information
for specialty.
“Name of
Occupation” is
displayed in place of
“Specialty” if the
selected profession
or field of licensure
does not require
information for a
specialty.
FEIN (Federal
Employer
Identification
Number)
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Below checkbox
"Does the
subject have an
FEIN, or UPIN
identification
number?"
Text Entry
The field is displayed
in the individual
report form if the
user selects the
checkbox for "Does
the subject have an
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
UPIN (Unique
Physician
Identification
Numbers)
Deferred
Below FEIN text
Conviction entry
or Pre-Trial
Diversion
(1)
Text Entry
The field is displayed
in the individual
report form if the
user selects the
checkbox for "Does
the subject have an
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
FDA (Federal
Deferred
Food and Drug Conviction
Administration) or Pre-Trial
Diversion
(1)
Below checkbox
"Does the
subject have a
FDA or CLIA
identification
number?"
Text Entry
The field is displayed
in the organization
report form if the
user selects the
checkbox for "Does
the subject have a
FDA or CLIA
identification
number?"
Selecting the
checkbox displays
FDA and CLIA, and
text entry fields.
CLIA (Clinical
Laboratory
Improvement
Act)
Below text entry Text Entry
FDA (Federal
Food and Drug
Administration)
The field is displayed
in the organization
report form if the
user selects the
checkbox for "Does
the subject have a
FDA or CLIA
identification
number?"
Selecting the
checkbox displays
FDA and CLIA, and
text entry fields.
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Type of
Affiliation
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Entity Name
Country
Below "Is the
practitioner
affiliated with a
health care
entity?"
checkbox
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Deferred
Below Type of
Conviction Affiliation
or Pre-Trial
Diversion
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Deferred
Conviction
or Pre-Trial
Diversion
(1)
Drop List
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. United
States is the default
selection. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Below "Is the
practitioner
affiliated with a
health care
entity?"
checkbox
Drop List
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Address
Deferred
Below Country
Conviction
or Pre-Trial
Diversion
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Address Line 2
Deferred
Below Address
Conviction
or Pre-Trial
Diversion
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
City
Deferred
Below Address
Conviction Line 2
or Pre-Trial
Diversion
(1)
Text Entry
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
State
Deferred
Below City
Conviction
or Pre-Trial
Diversion
(1)
Drop List
The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
ZIP
Deferred
Below State
Conviction
or Pre-Trial
Diversion
(1)
Text Entry The field is displayed
if the user selects the
"Is the practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State and ZIP
entries. For
organization
reports, the check
box label is “Is the
organization
affiliated with a
health care entity?”
Description
Deferred
Below “Act or
Conviction Omission”
or Pre-Trial
Diversion
(2)
Text Entry
Date of Appeal
Deferred
Below "Is the
Conviction action on
or Pre-Trial appeal"
Diversion
(2)
Text Entry The field is displayed
if the user selects the
"Yes?" radio button
for "Is the action on
appeal?"
The field is displayed
if the user selects an
act or omission that
requires a
description.
Years
Deferred
Beside Sentence
Conviction of Judgment
or Pre-Trial drop list
Diversion
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Months
Deferred
Beside Years
Conviction
or Pre-Trial
Diversion
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Days
Deferred
Beside Months
Conviction
or Pre-Trial
Diversion
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
does not apply, then
Years, Months and
Days drop lists are
displayed.
Hours
Deferred
Beside Months
Conviction
or Pre-Trial
Diversion
(2)
Drop List
This field is displayed
if a time frame is
applicable for the
sentence the user
selects.
If the user selects a
sentence in which
an hours timeframe
applies, then an
Hours drop list is
displayed.
State Changes
Label
PDF Name
Item Type
Trigger
Public Burden
Statement
Deferred
Conviction or PreTrial Diversion
Modal
When the user selects the Public Burden Statement
link the modal is displayed.
Select a
Profession or
Field of
Licensure
Deferred
Conviction or PreTrial Diversion
Modal
When the user sets focus on the Profession or Field of
Licensure text entry, 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 populates the Profession or Field of
Licensure text entry.
Name of
Occupation
Deferred
Conviction or PreTrial Diversion
Text Entry
Text entry is disabled if the user does not select a
profession or field of licensure requiring a
description.
License
Number
Deferred
Conviction or PreTrial Diversion
Text Entry
Text entry is disabled if the user selects the "No/ Not
sure" option for "Does the subject have a license for
the selected profession or field of licensure?" For
organization reports, the label is “Does the
organization have a license?”
Modal
When the user sets focus on the Act or Omission text
entry, the modal to select an act 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 act
or select an act from the list without searching. The
modal is hidden once the user selects an act from the
list. The user's selection populates the Act or
Omission text entry.
Select an Act or Deferred
Omission
Conviction or PreTrial Diversion
| File Type | application/pdf |
| File Modified | 2017-11-09 |
| File Created | 2017-09-25 |