in New York State Board [or Professional Medical Conduct Li 433 River Street. Suite 3f}3 Troy, New l'ork 402-0663 ttirtrurrt PZ Dainer. M. I). Kendrick .4. Sean, .m.m1so..>>m crum- DupurtmururrJHeutitr Carmelo .trmru>> WL ('lvne, Jr. Wee Choir Iiwcutive Deputy (2nn.mLrsioner Katherine A. Hawkins, JJ1 Keith JH Siervis. Director Ererutive Secretmjv twice (`onduct July 30. 2010 CERTIFIED RECEIPT REQUESTED Ali Sherzoy. M.D. Re: License No. 186480 Dear Dr. Sherzoy: Enclosed is a copy of Order BPMC #10-136 ofthe New York State Board for Professional Medical Conduct. This order and any penalty provided therein goes into effect August 6, 2010. lf the penalty imposed by this Order is a surrender, revocation or suspension, you are required to deliver your license and registration within five (5) days of receipt of this Order to: Office of Professional Medical Conduct, cfo Physician Monitoring Unit, New York State Department of Health, 433 River Street, Suite 303, Troy, NY 12180-2299. lf the clocumcnt(s) are lost, misplaced or destroyed, you are required to submit to this oitice an afidavit to that effect. Enclosed for your convenience is an affidavit. Please complete and sign affidavit before a notary public and retum it to the Otlice of Professional Medical Conduct. lf the penalty imposed by the Order is a fine. please write the check payable to the New York State Department of Health. Noting the BPMC Order number on your remittance will assist in proper crediting. Payments should be directed to the following address: Bureau of Accounts Management New York State Department of Health Corning Tower. Room 1717 Empire State Plaza Albany, New York 12237 Sincerely, Katherine A. Hawkins, MD., .D. Executive Secretary Board for Professional Medical Conduct linclosure cc: Andrew L. Esq. Garhmkel Wild, P.C. 11 Great Neck Road Great Neck, NY 11021 NEW YORK STATE DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER CONSENT OF ORDER ALI SHERZOY, M.D. BPMC Upon the application of ALI SHERZOY, (Respondent), in the attached Consent Agreement, that is made a part of this Consent Order, it is ORDERED, that the Consent Agreement, and its temws, are adopted and it is further ORDERED, that this Consent Order shall be effective upon issuance by the Board, either by mailing of a copy Consent Order, either by class mail lo Respondent at the address in the attached Consent Agreement or by certified mail to Respondents attomey, or upon facsimile or email transmission to Respondent or Respondents attorney, whichever is tirst. SO ORDERED. REI) _i KENDRICKA SEARS, M.D. Chair State Board lor Professional Medical Conduct I STATE OF NEW YORK. DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER CONSENT OF AGREEMENT ALI SHERZOY, M.D. ALI SHERZOY, M.D (Respondent), representing that all of the following statements are true, deposes and says; That on or about August 1, 1991, I was licensed to practice medicine in the State of New York and issued license number 186480 by the New York State Education Department. My current address is- and I will advise the Director (Director) of the Office of Professional Medical Conduct (OPMC) of any change of my address within thirty (30) days, thereof. I understand that the New York State Board for Professional Medical Conduct (Board) has charged me with three (3) Specifications of professional misconduct. A copy of the Statement of Charges, marked as Exhibit A, is attached to and part of this Consent Agreement. I do not contest the three (3) Specifications, and agree to the following sanction. Eighteen (18) months suspension of my New York State medical license, six (6) months Actual (to commence on August 1, 2010), the remainder stayed, with live (5) years probation, in accordance with Exhibit B, attached, hereto. The term of probation shall be reduced to a term of two (2) years should the evaluation referenced below demonstrate the lack of any impairment on the part of Respondent. Respondent shall be subject to the condition that he comply with attached Exhibit ("Requirements for Closing a Medical Practice Following Medical License Revocation, Surrender or Suspension of a Medical License"). Within ninety (90) days ofthe effective date of the Consent Order, at the direction ofthe Director, OPMC, Respondent shall submit to an evaluation by a board--certitied licensed mental health practitioner or other health care professional or I program designated by the Director (hereafter "Evaluator") Respondent shall provide the Evaluator with a copy of this Order and copies of all previous treatment records OPMC. at its discretion, may provide information or documentation from its investigative 1 files conceming Respondent to Respondent's Evaluator. The Evaluator shall report to the Director regarding Respondents condition and htrtess or incapacity to practice medicine. Respondent shall comply with all treatment recommendations based upon the evaluation; failure to comply with such treatment recommendations shall constitute professional misconduct Respondent shall pay a $5,000.00 fine, to be paid within thirty (30) days ofthe effective date of the Consent Order to the NYS Department of I-lealth, Bureau of Accounts Management, Revenue Unit, Empire State Plaza, Corning Tower, Room 1717, Albany, NY 12237-0016. I agree, further, that the Consent Order shall impose the following conditions; That Respondent shall remain in continuous compliance with all requirements of New York Education Law 5502 including, but not limited to, the requirements that a licensee shall register and continue to be registered with the New York State Education I Department (except during periods of actual suspension) and that a licensee shall pay all registration fees. Respondent shall not exercise the option provided in New York Education Law 6502(4) to avoid registration and payment of fees. This condition shall take effect 30 days after the effective date ofthe Consent Order and will continue so long as Respondent remains a licensee in New York State; and That Respondent shall cooperate fully with the OPMC in its administration and enforcement of the Consent Order and in its investigations of matters concerning Respondent, Respondent shall respond in a timely manner to all OPMC requests for written periodic veritication of Respondent's compliance with this Consent Agreement. Respondent shall meet with a person designated by the Director, OPMC, as directed. Respondent shall respond and provide all documents and information within Respondents control, as directed. This condition shall lake effect upon the Boards issuance of the Consent Order and will continue so long as Respondent remains licensed in New York State. I stipulate that my failure to comply with any conditions: ofthe Consent Order shalt constitute misconduct as defined by New York Education Law 6530(29). I agree that, ifi am charged with professional misconduct in future, this Consent Agreement and the Consent Order shalt be admitted into evidence in that proceeding I ask the Board to adopt this Consent Agreement. I understand that if the Board does not adopt this Consent Agreement, none of its terms shall bind me or constitute an admission of any of the acts of alleged misconduct; this Consent Agreement shall not be used against me in any way and shall be kept in strict confidence, and the Board's denial shall be without prejudice to the pending disciplinary proceeding and the Boards final determination pursuant to New York Public Health Law I agree that. it the Board adopts this Consent Agreement, the Chair ofthe Board shall issue a Consent Order in accordance with its terms. I agree that the Consent Order shall take effect upon its issuance by the Board, either by mailing of a copy of the Consent Order by first class mail to me at the address in this Consent Agreement, or to my attorney by certified mail, or upon facsimile or email transmission to me or my attorney, whichever is tirsl. The Consent Order, this Consent Agreement, and all attached Exhibits shall be public documents, with only patient identities. if any, redacted. As public documents, they may be posted on the Department of Health website. I stipulate that the proposed sanction and Consent Order are authorized by New York Public Health Law 230 and 230-a. and that the Board and OPMC have the requisite powers to carry out all included terms. I ask the Board to adopt this Consent Agreement of my own free will and not under duress, compulsion or restraint. In consideration of the value to me ofthe Board's adoption of this Consent Agreement, allowing me to resolve this matter without the various risks and burdens of a hearing on the merits, I knowingly waive my right to contest the Consent Order for which I apply, administratively andlorjudicially, I agree to be bound by the Consent Order, and I ask that the Board adopt this Consent Agreement. I understand and agree that the attorney for the Department, the Director, OPMC, and the Chair ofthe Board each retain complete discretion either to enter into the proposed Consent Agreement and Consent Order, based upon my application, or to decline to do so. I further understand and agree that no prior or separate written or oral communication can limit that discretion. I AFFIRMED: I oixreo- 2; 6 [0 ALI SQERZOY, M.D. Respondent The undersigned agree to Respondents attached Consent Agreement and to its proposed penalty, terms and conditions. REDAC ome: IZ kl .. ANDREW L. ZW LING Attomey for Res ndentf I ol I RIEDACTEIJ ROBERT Qi 7 Associate Counse Bureau of Professional Medical Conduct DATE: JMEITH W. SERVIS Director Oflice of Professional Medical Conduct i STATE OF NEW YORK DEPARTMENT OF HEALTH STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT IN THE MATTER STATEMENT OF OF ALI SHERZOY, M.D. CHARGES ALI SHERZOY, M.D., Respondent, was authorized to practice medicine in New York state on August 1, 1991, by the issuance of license number 186480 by the New York State Education Department. FACTUAL ALLEGATIONS A. On or about June 30, 2008, in the New Jersey Superior Court, Law Division Criminal, Bergen County, New Jersey, Respondent was found guilty, based on a plea of guilty, of Criminal Sexual Conduct inthe Fourth Degree, a crime, and on or about September 5, 2008, was Sentenced, inter alia, to two (2) years probation. thirty (30) hours of community service, and a $100.00 sex crime surcharge. B. On or about January 15, 2010, the State of New Jersey, Department of Law and Public Safety, Division of Consumer Affairs, State Board of Medical Examiners, (hereinafter "New Jersey Board"), by a Consent Order (hereinafter "New Jersey Ordef), inter alia, suspended Respondents license to practice medicine for two (2) years, the first six (6) months to be an active suspension, the remainder stayed and to be served as a period of probation, and imposed a $10,000.00 civil penalty and $1,800.00 costs, based on the guilty plea, set forth in Paragraph A, above. C. The conduct resulting in the New Jersey Board disciplinary action against Respondent would constitute misconduct under the laws of New York state, pursuant to the following sections of New York state law: 1. New York Education Law ?B530(9)(a)(i) (being convicted of committing an act constituting a crime under state law). SPECIFICATIONS FIRST SPECIFICATION Respondent violated New York Education Law by being convicted of committing an act constituting a crime under the law of anotherjurisdiction and which, if committed within this state, would have constituted a crime under New York state law, in that Petitioner charges: 1. The facts in Paragraph A. SECOND SPECIFICATION Respondent violated New York Education Law ?5530(9)(b) by having been found guilty of improper professional practice or professional misconduct by a duly authorized professional disciplinary agency of another state where the conduct upon which the finding was based would, if committed in New York state, constitute professional misconduct under the laws of New York state, in that Petitioner charges: 2. The facts in Paragraphs A, B, and/or C. THIRD SPECIFICATION Respondent violated New York State Education Law by having his license to practice medicine suspended and/or having other disciplinary action taken by a duly authorized professional disciplinary agency of another state, where the conduct resulting in the suspension andfor other disciplinary action would, if committed in New York state, constitute professional misconduct under the laws of New York state, in that Petitioner charges; 3. The facts in Paragraphs A, B, andlor C. 5. 2010 Albany, New York PETER D. VAN BUREN Deputy Counsel Bureau of Professional Medical Conduct EXHIBIT Terms of Probation Respondents conduct shall conform to moral and professional standards of conduct and governing law. Any act of professional misconduct by Respondent as defined by Y, Educ Law 5530 or 6531 shall constitute a violation of probation and may subrect Respondent to an action pursuant to N.Y. Pub. Health Law 230(19) 1 Respondent shall maintain active registration of Respondents license (except during periods of actual suspension) with the New York State Education Department, Division of Professional Licensing Senrices, and shall pay all registration fees. i Respondent shall provide the Director, Office of Professional Medical Conduct (OPMC), Hedley Park Place, 433 River Street Suite 303, Troy, New York 12180-2299 with the following information, in writing, and ensure that this infomation is kept currenti a full description of Respondent's employment and practice; all professional and residential addresses and telephone numbers within and outside New York State; all current and past affiliations and/or privileges, with hospitals, institutions, facilities, medical practices. and managed care organizations, andlor applications for such affiliations, andlor privileges; and all investigations, arrests, charges, convictions andfor disciplinary actions by any local. state or federal agency. institution or facility. Respondent shall notify OPMC, in writing, within 30 days of any additions to or changes in the required information. A Respondent shall cooperate fully with. and respond in a timely manner to, OPMC requests to provide written periodic verification of Respondent's compliance with the terms of this Consent Order. Upon the request of the Director. OPMC, Respondent shall meet in person with the Directors designee. 5. Respondents failure to pay any monetary penalty by the prescribed date shall subject Respondent to all provisions of law relating to debt collection by New York State, including but not limited to; the imposition of interest, lale payment charges and collection fees; referral to the New York State Department of Taxation and Finance for collection; and non-renewal of pemnits or licenses [Tax Law 171 State Finance Law 18; CPLR 5001; Executive Law 32]. 6. The probation period shall toll when Respondent is not engaged in active medical practice in New York State for a period of 30 consecutive days or more. Respondent shall notify the Director, OPMC, in writing, if Respondent is not currently engaged in, or intends to leave. active medical practice in New York State for a consecutive 30 day period or more. Respondent shall then notify the Director again at least 14 days before returning to active practice. Upon Respondents return to active practice in New York State. the probation penod shall resume and Respondent shall fultill any unfulfilled probation terms and such additional requirements as the Director may impose as reasonably relate to the matters set forth in Exhibit or as are necessary to protect the public health. 1. The Director, OPMC, may review Respondents professional performance. This review may include but shall not be limited to: a review of office records, patient records, hospital charts, andlor electronic records; and interviews with or periodic visits with Respondent and staff at practice locations or OPMC ofices. it Respondent shall adhere to federal and state guidelines and professional standards of care with respect to infection control practices. Respondent shall ensure education. training and oversight of all office personnel involved in medical care, with respect to these practices. ?i Respondent shall maintain complete and legible medical records that accurately reflect the evaluation and treatment of patients and contain all information required by State rules and regulations conceming controlled substances. ui, Respondent shall submit to an evaluation by a board-certified licensed mental health practitioner or other health care professional or program designated by the Director (hereafter Respondent shall provide the Evaluator with a copy of this Order and copies of all previous treatment records. OPMC, at its discretion. may provide information or documentation from its investigative tiles concerning Respondent to Respondent's Evaluator, The Evaluator shall report to the Director regarding Respondent's condition and fitness or incapacity to practice medicine. Respondent shall comply with all treatment recommendations based upon the evaluation; failure to comply with such treatment recommendations shall constitute professional misconduct, Respondent shall comply with this Consent Order and all its terms, and shall bear all associated compliance costs. Upon receiving evidence of noncompliance with, or a violation of, these terms, the Director, OPMC, andlor the Board may initiate a violation of probation proceeding, andlor any other such proceeding authorized by law, against Respondent, REQUIREMENTS FOR CLOSING A MEDICAL PRACTICE FOLLOWING A REVOCATION, SURRENDER OR SUSPENSION (of six months or more) OF A MEDICAL LICENSE 1 Respondent shall immediately cease and desist from engaging in the practice of medicine (in New York State) in accordance with the terms of the Order In addition, Respondent shall refrain from providing an opinion as to professional practice or its I application and from representing himself as being eligible to practice medicine. 2. Respondent shall have delivered, to OPMC at Hedley Park Place, 433 River Street Suite 303, Troy, NY 12180-2299, Respondent's original license to practice medicine in New York State ancl current biennial registration within five (5) days of the effective date of the Order. 3. Respondent shall within fifteen (15) clays of the Order, notify all patients of the cessation of his medical practice and will refer all patients to another licensed practicing physician for their continued care, as appropriate. 4. Respondent shall make arrangements for the transfer and maintenance ofthe medical records of his patients. Within thirty days of the effective date of the Order, Respondent shall notify OPIVIC of these arrangements including the appropriate and acceptable contact person's name, address, and telephone number who shall have access to these records. Original records shall be retained for at least six years after the last date of service rendered to a patient or, in the case of a minor, for at least six years after the last date of service or three years after the patient reaches the age of majority, whichever time period is longer. Records shall be maintained in a safe and secure place that is . reasonably accessible to former patients. The arrangements shall include provisions to ensure that the information on the record is kept confidential and made avaliable only to authorized persons. When a patient andlor his/her authorized representative requests a copy of the patients medical record, or requests that the original medical record be forwarded to another health care provider, a copy of the record shall be provided or forwarded at a reasonable cost to the patient (not to exceed seventy-five cents per page.) Radiographic, sonographic, and like materials shall be provided at cost. A qualified person shall not be denied access to patient infomation solely because of his/her inability to pay. 5. ln the event that Respondent holds a Drug Enforcement Agency (DEA) certificate, Respondent shall, within fifteen (15) days of the Order's effective date, advise the DEA, in writing, of the licensure action and shall surrender hislher DEA controlled substance privileges to the DEA. Respondent shall surrender any unused DEA #222 U.S. Official Order Forms Schedules Respondent shall within fifteen (15) days of the Orders effective date, return any unused New York Stale official prescription forms to the Bureau of Narcotic Enforcement, New York State Department of Health at 433 River Street. Suite 303, Troy, NY 12180-2299 Respondent shall cause all prescription pads bearing his/her name to be destroyed lf no other licensee is providing services at Respondent's practice location. all medications shall be properly disposed of 7. Respondent shall not share, occupy or use office space in which another licensee provides health care services. Respondent shall cause all signs to be removed within Hfteen (15) days and stop all advertisements, professional listings whether in telephone directories, on the internet or othenivise, professional stationery or billings by which eligibility to practice is represented. 8 Respondent shall not charge, receive or share any fee or distribution of dividends for professional services rendered (by Respondent or others) while barred from engaging in the practice of medicine. Respondent may be compensated for the reasonable value of services lawfully rendered and disbursements incurred on a patients behalf prior to the effective date of this Order. 9. If Respondent is a shareholder in any professional service corporation organized to engage in the practice of medicine and if Respondents license is revoked, surrendered or suspended for a term of six months or more under the terms of this Order, Respondent shall divest himselflherself of all financial interest in the professional services corporation in accordance with New York Business Corporation Law. Such divestiture shall occur within ninety (90) days of the effective date of this Order. if Respondent is the sole shareholder in a professional services corporation, the corporation must be dissotved or sold within ninety (90) days of the effective date of this Order. 10. Failure to comply with the above directives may result in a civil penalty or further criminal penalties as may be autnonzed pursuant to the law. Under Section 6512 of the Education Law it is a Ctass Felony, punishable by of up to 4 years, to practice the profession of medicine when such professional license has been suspended, revoked or annulled. Such punishment is in addition tothe penalties for professional misconduct set forth in Section 230?a of the Public Health Law, which includes fines of up to for each specification of charges of which Respondent is found guilty and may include revocation of a suspended license. 0ct.28. 2010 NJ BOARD MED EXAMINER No.4353 P. 2 ANNEMILGRAM 3 ATTORNEYGENERALOFNEWJERSEY I A 124Ha1s?yStn?t I I JANUARY 15 2010 Br NEWW RD OF MEDICAL EXAMINERS STATEOFNEWJERSEY . 0 DIVISIONOPOONSIJMBRAFFADIS . A i I ORREVOCATIONOFTHEHCBISEOP i . . CONSENT ORDEI ZSIADGMDI I 4 INTHZESTATEOFNEWJERSEY I . . A Dr. Thi? mural turpitudn in violation . =r I GER 1 IFIED TRUE COPY 1 0 0ct.2B. 2010 NJ BOARD MED EXANIINER M4353 P. 3 0 . THEREFORE HBREBYORDEREDANDAGRBEDTHAT: 1. 4 np?iod?fpmbodon.N?m?dit??wth? 0 2. 3. c?m??t0theB0ardOCT. 28. 2010 NJ BOARD MED EXAMINER . I. N0. 4353 P, 4 0 5. ?i?i Th?Bc?druefV?S111c1igh! 6. li?c?Si?8 2 7. . OFMEDI I Boasdmsidm I I Oci.28. 2010 NJ BOARD MED EXAMINER N0.4353 P. 5 I i Kem i Cmwy& P.C., 4DMOct.2B. 20lD l:4lPM NJ BOARD MED EXANIINER No.4353 P. 6 2 DIRECTIVES APPLICABLE T0 ANY MEDICAL BOARD LICENSEE . WHO IS DISCIPLINED OR WHOSE SURRENDEFI OF LICENSURE I HAS BEEN ACCEPTED APPROVED BY THE BOARD ON MAY 10, 2000 All licensees who are the subject of a disciplinary order of the Board are required to provide the infomation required on the addendum to these chreotives. The infomation 2 provided will be maintained separately and will public document tiledwith i the Board. Failure to provide the information required my result in further disciplinary action for failing to %rate with the Board, as required by 18:450-1 i Paragraphs 1 through 4 below shall apply when a license ls suspended or revoked or I permanently surrendered. with prejudice. Paragraph Sapplies to licensees who are the subject of an order which, while permitting continued practice, contains a probation or monitoring requirement 1. Document Ftetum and Agency Notification The licensee shall forward to the Board chico at Post Office Box 183, 140 East . Front Street, 2nd floor, Trenton, New Jersey 08825-0183, the original license, current i biennial registration and, if applicable, the original CDS registration. ln addition, if the licensee holds a Drug Enforcement Agency (DEA) registration, he or she shall advise the DEA of the licensure action. (With respect to suspensions of finite term, at the conclusion of the temi. the licensee may contact the Board office for the retum of the . documents previously surrendered to the Board. In addition, at the conclusion ofthe term, the licensee should contact the DEA to advise of the resumption of practice and to ascertain the impact of that change upon his/her DEA registration.) 2. Practice Cessation 1'he licensee shall cease and desist from engaging in the practice of medicine State. This prohibition not only bars a licensee from rendering professional services, but also from provichng an opinion as to professional practice or its application. or representing . him/herself as being eligible to practice. (Although the licensee need not advise patients or others of the revocation, suspension or surrender. the licensee must truthfully disclose his/her licensure statue in response to inquiry.) The disciplined licensee i is also prohibited from occupying, sharing or using office space in which another licensee provides health care services. The rhsciplinod licensee may contract Tor, accept payment i from another licensee for or rent at fair market value office premises and/or equipment. In no case may the disciplined licensee authorize, allow or condone the-use of his/her provider number by any health care practice or any other licensee or health care provider. 3 (ln situations where the licensee has been suspended for less than one year, the licensee may accept Payment from another professional who is using his/her office during the period that the licenses is suspended, for the payment of salaries for office staff employed at the time ofthe Board action.) I EXHIBIT A i I Ocl.28. 2010 NJ BOARD Mw EXAMINER lw.4353 7 . A licensee whose license has been revoked, suspended for one (1) year or more surrendered must remove signs and take affirmative action to stop A advertisements by which his/her eligibility to practice is represented The licensee must also take steps to remove his/her name from professional listings. telephone directories, professional stationery, or billings. If the licensee? name is utilized in a group practice title, it shall be deleted. Prescription pads bearing the licensee': name shall D9 destroyed. A destruction report form obtained from the Office of Drug Control (973-504-6558) must be filed. ?lf no other licensee is providing services at the location, all medications must be removed and retumed to the manufacturer, it possible, destroyed or safeguarded. (ln situations where a license has been suspended for less than one year, prescription pads and medications need not be destroyed but musr bo secured in locked place lor i safekaaping.) 3. Practice income o1Equ|ty interest in Professional Service Corporations and United Compani A licensee shall not charge, receive or share ln any fee for professional services rendered by him/herself or others while barred from engaging in the professional practice. The licensee may be compensated for the reasonable value of services lawfully rendered and i disbursements incurred on a patienrs behalf pricrto the effective date ofthe Board action. A licensee who is shareholder in professional service corporation organized to engage in the professional practice, whose license is revoked. surrendered or suspended for a term of one (1)?yeer ormoreshallbe from the practice within the meaning of the Professional Service Corporation Act. 1). A disqualified licensee shall dlvest him/herself of all financial interest in the professional service corporation pursuant to A licensee who is a member of a limited liability company organized pursuant to 42:1-44. shall dives! him/herself of all financial interest. Such divestiture shall occur within 90 days following the the entry ofthe Order rendering the licensee disqualified to participate in the applicable fomn of ownership. Upon divestiture, licensee shell formrd to the Board a copy of documentation 4 to the Secretary of State, Commercial Reporting Division. demonstrating that the interest has been terminated. lf the licensee is the sole shareholder in professional service corporation. the corporation must D6 dissolved within 90 days of the licensees i disqualification. 4. Medical Records I lf. as a result of the Boards aciion. practice is closed or transferred to another location. the licensee shall ensure that during the three (3) month period following the effective date i uf the disciplinary order, a message will be delivered io patients ceiling the former office i premises, advising where records may be obtained. The message should inform patients . 5 of the names and telephone numbers of the licensee (or his/her attorney) assuming custody of the records. The same information shall also be disseminated by means oi a notice to be published at least once per month for three (3) months in a newspaper of . 1 4 Oct.28. 2010 NJ BOARD MED EXAMINER 8 general circulation in the geographic vicinity in whidt the practice was conducted. At the end of the three month period, the licensee shall tile with the Board the name and telephone number of the contact person who will have access to medical records of former patients. Any change in that individual or his/her f6'$Ph0l'lS number shall be reported to the Board. when a patient or his/har representative requests a copy of his/her medical record or asks that record be forwarded to another health care provider, the licensee shall provide the record without charge to the patient. 5. Conditions With respect to any licensee who is the subject of any Order imposing a probation or monitoring requirement or_a stay of an active suspension, in whole or ln part, which is conditioned upon compliance with aprobationor monitoring requirement, the licensee i snail fully cooperate with the Board and its designated representatives. including the Enforcement Bureau ofthe Division ot Consumer Affairs, in ongoing monitoring of the licensees statusand practice. Such monitoring shell be at the expense ofthe rhsciplined practitioner. . Monitoring ofpractioe conditions may include, but is not limited to, inspection ofthe professional premises and equipment. and inspection and copying olpatiant records i to verify compliance with the Board Order and accepted standards of practice. . . Monitoringof status conditions foran impaired practitioner maytnolude. but is not limited toQ practitioner cooperation in providing releases permitting unrestricted access to records and other infomtation to the extent permitted by law from any treatment ?f facility, other treating practitioner, support group or other indivlduallfacility involved in the education, treatment. monitoring or oversight of the practitioner, or maintained by a rehabilitation program for impaired practitioners. lfbodlly substance monitoring has been 3 ordered, the practitioner shall fully cooperate by responding to a demand for breath, blood, urine or other sample in a timely manner and providing the designated sample. . . .. . 2 P. 9 i Oct. 28. 2010 NJ BOARD MED EXAMINER No 435 Pureuentlo ell orders of the New JoreeyStateBoard ol'Mec?cel Examine Au . crproleseiornloormcroperation of lew. voluntary surrender. or otherwise. orany other negative action or i i laces lnaccordaneewlth en agreement withlheFederallon of State Medbel Boerdsof the unrteu Slates.e list oiell disciplinary following ol an order, a summary, of the appear cn the furthe next and is lorwerdedto those members of the public requesting a oopy. in same summary will appear in the minutesol that Board meeting. which are also made avaliable tolhose requesting aoopy. Within the month following entry oi an order, a summary of the order will appear In a 0 Disciplinary Action Listing which is made avaliable to those members ot the public requesting a copy. On a period: basis the Board disseminate: to its licensees a newsletter which includes a brief From time to lime. the Press Otfce of the Division ol Consumer Affairs may issue messes including the summaries of-the content of public orders. Nothing herein is intended ln any way to limit the Board. the Division or the Attorney General from disclosing anypublic document. . . .