Background Questions

Every two years during the certification maintenance cycles and when a PA applies for an NCCPA exam, they are required to answer three background questions which are listed below.

ALL QUESTIONS MUST BE ANSWERED. Providing incorrect or incomplete information may lead to disciplinary action, including denial or revocation of certification.

The following words and terms should be interpreted as described below.

“License” means any healthcare license and includes but is not limited to registrations, certifications, permits, temporary licenses, limited licenses, institutional licenses, and/or training licenses, permits/certificates.

“Disciplinary Action” means any adverse action and includes but is not limited to revocation, suspension, voluntary surrender, probation, stipulations, limitations, restrictions, conditions, censure or reprimand, or denial of license.

Have you been the subject of any of the following actions that you have not already reported to NCCPA? ( Do not include any actions that were resolved before your entry into your PA educational program or previously reported to NCCPA.)

1. During the period between November 17, 2002 and today's date, have you been denied a license, or has any state board or other governmental agency taken any disciplinary action (as described above) against your license to practice as a Physician Assistant or as any other health-care provider?

2. During the period between November 17, 2002 and today's date, have you been convicted of, or entered a plea of guilty, nolo contendere, or no contest to, a crime in any jurisdiction (including under the Uniform Code of Military Justice and/or any international jurisdiction) other than a minor traffic offense? Include all misdemeanors and felonies, even if the court withheld adjudication so that you would not have a record of conviction. Any convictions for driving under the influence or while impaired should be reported here.

3. During the period between November 17, 2002 and today's date, have you been adjudicated as mentally incompetent by a court or other government entity?