Form 11 Nolo Contendere (no contest) plea

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

Nolo Contendere (no contest) plea

Nolo Contendere (no contest) plea

OMB: 0915-0126

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Non-visible Questions
Label

PDF Name
(step)

Location

Response
Input Item

Visibility Trigger

Other

Date of Death

Nolo
Below "Is this
Contendere person
(no contest) deceased?"
plea (1)

Text Entry The field is displayed
if the user selects the
"Yes" radio
button for "Is this
person deceased?"

Organization
Description

Nolo
Below
Contendere Organization
(no contest) Type
plea (1)

Text Entry

The field is displayed
if the user selects an
organization type
that requires a
description.

Name of
Occupation

Nolo
Contendere
(no contest)
plea (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

Nolo
Contendere
(no contest)
plea (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)

Nolo
Contendere
(no contest)
plea (1)

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)

Nolo
Below FEIN text
Contendere entry
(no contest)
plea (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
Nolo
Food and Drug Contendere
Administration) (no contest)
plea (1)

Below checkbox Text Entry
"Does the
subject have a
FDA or CLIA
identification
number?"

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.

Nolo
Contendere
(no contest)
plea (1)

Below checkbox Text Entry
"Does the
subject have an
FEIN, or UPIN
identification
number?"

Type of
Affiliation

Nolo
Contendere
(no contest)
plea (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.

Nolo
Below Type of
Contendere Affiliation
(no contest)
plea (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.

Nolo
Contendere
(no contest)
plea (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

Nolo
Below Country
Contendere
(no contest)
plea (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

Nolo
Below Address
Contendere
(no contest)
plea (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

Nolo
Below Address
Contendere Line 2
(no contest)
plea (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

Nolo
Below City
Contendere
(no contest)
plea (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

Nolo
Below State
Contendere
(no contest)
plea (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

Nolo
Below “Act or
Contendere Omission”
(no contest)
plea (2)

Text Entry

Date of Appeal

Nolo
Below "Is the
Contendere action on
(no contest) appeal"
plea (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

Nolo
Beside Sentence Drop List
Contendere of Judgment
(no contest) drop list
plea (2)

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

Nolo
Beside Years
Contendere
(no contest)
plea (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

Nolo
Beside Months
Contendere
(no contest)
plea (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

Nolo
Beside Months
Contendere
(no contest)
plea (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

Nolo Contendere
(no contest) plea

Modal

When the user selects the Public Burden Statement
link the modal is displayed.

Select a
Profession or
Field of
Licensure

Nolo Contendere
(no contest) plea

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

Nolo Contendere
(no contest) plea

Text Entry

Text entry is disabled if the user does not select a
profession or field of licensure requiring a
description.

License
Number

Nolo Contendere
(no contest) plea

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 Nolo Contendere
Omission
(no contest) plea


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File Modified2017-11-09
File Created2017-09-25

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