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 revocation of certification and/or eligibility for certification. Do not include any actions that were resolved before your entry into your PA educational program or previously reviewed by NCCPA.
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, fines, stipulations, limitations, restrictions, conditions, censure or reprimand, or denial of licensure.
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 reviewed by 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? Must be reported: any adverse regulatory or credentialing action within 30 days of revocation, suspension, surrender, lapse, loss or denial of or any restrictions imposed on a license, authorization, or credential to practice as a health care provider (including authorization to practice as an employee of the federal government or in a jurisdiction not requiring licensure), whether such adverse action is by decision, consent order, stipulation, or agreement.
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)? Include all misdemeanors and felonies, even if the court withheld adjudication so that you would not have a record of conviction. Must be reported: Any adverse legal action within 30 days of conviction of (including a guilty plea or no contest plea) (i) any felony; (ii) any misdemeanor related to health care practice, violence, drug offenses, sex offenses, or fraud; or (iii) any other misdemeanor with a minimum penalty of more than 30 days in jail, except for traffic infractions, first-time DUI offenses, disorderly conduct, obscenity, tax violations, or trespassing.
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?