Self-Queriers Survey: Module 7
Number of questions: 16
Report in the NPDB
Q 7.1. What types of reports does the NPDB contain in which you are a subject? (Please select all that apply.)
Medical Malpractice Payment
State Licensure Action
Clinical Privileges / Panel Membership Action
Health Plan Other Adjudicated Action (e.g., contract termination)
Professional Society Membership Action
Federal Licensure (including DEA)
Government Administrative Action
Federal or State Exclusion or Debarment
Private Accreditation / Peer Review Organization Action
Judgment or Conviction
Other (Please Explain) ____________
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Q 7.2. How would you rate the impact of having a report in the NPDB on your career?
Neutral
Slightly Negative
Somewhat Negative
Moderately Negative
Extremely Negative
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Q 7.3. Have you suffered loss of certification, licensing, credentialing, clinical privileges, or employment due to having a NPDB report?
Yes
No
Other (Please Explain) ____________
If they say “yes” above, then show the next question; otherwise skip the next question.
Q 7.4. Have you been able to return to the same position?
Yes
No
Other (Please Explain) ____________
Not Applicable
Q 7.5. Have you been able or will you be able to obtain a similar position in the health care industry?
Yes
No
Other (Please Explain) ____________
Not Applicable
Q 7.6. Were your career opportunities affected by having a report in the NPDB?
Yes
No
Other (Please Explain) ____________
Not Applicable
Q 7.7. When you were first notified of being a subject of a report in the NPDB, did you work at or have clinical privileges at two or more facilities simultaneously?
Yes
No
Other (Please Explain) ____________
Not Applicable
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Directions: For the next two questions, we are interested in experiences of individuals who might have held several positions simultaneously.
Q 7.8. If you held positions in more than one facility at the same time, how long did it take the second employer to contact you regarding a report in the NPDB that was previously known by the first employer?
Less than 1 week
At least 1 week but less than 1 month
At least 1 month but less than 3 months
At least 3 months but less than 6 months
At least 6 months but less than 1 year
More than 1 year
Never
Unknown
Other (Please Explain) ____________
Not Applicable
Q 7.9. If you held positions in more than one facility at the same time, what type of actions were taken by the second employer as a result of you having a report in the NPDB? (Please select all that apply.)
No Action Taken
Restrictions of Clinical Privileges
Employment or Contract Termination
Placed on Administrative Leave
Initiated an Investigation
Legal Actions
Declined as a Candidate (if you were applying for a new position)
Unknown
Other (Please Explain) ____________
Not Applicable
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Q 7.10. Have you provided a copy of a report containing adverse action information from a self-query that ultimately resulted in an organization denying licensure, certification, credentialing, clinical privileges, or employment?
Yes
No
Other (Please Explain) ____________
Q 7.11. Have you provided a copy of a report containing medical malpractice payment information from a self-query that ultimately resulted in an organization denying licensure, certification, credentialing, clinical privileges, or employment?
Yes
No
Other (Please Explain) ____________
Q 7.12. Have you provided a copy of a report containing medical malpractice payment information from a self-query to an insurance provider?
Yes
No
Other (Please Explain) ____________
If “yes” above show Q 7.13, otherwise skip to Q 7.14.
Q 7.13. What did the insurance provider do?
Nothing
Increased the Premium
Cancelled the Insurance Policy
Asked for Additional Information
Other (Please Explain) ____________
Not Applicable
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Q 7.14. Have you ever added your own statement (also called a subject statement) to the NPDB report?
Yes
No Skip the next question
Q 7.15. What impact has adding your own statement made?
Text box
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Q 7.16. Please share any other thoughts about your experience of being the subject of a report in the NPDB.
Text box
Survey Page Break
Piping Logic:
Survey will be directed to Module 8.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Microsoft User |
| File Modified | 0000-00-00 |
| File Created | 2021-04-12 |