Before the
New Hampshire Board of Medicine
Concord, New Hampshire 03301

In the Matter of:
Anna M. Konopka, M.D., D.P .A.A.P.
Licensee No.2 4254'  
VOLUNTARY SURRENDER OF LICENSE

In order to avoid the delay and expense of further proceedings before the New
Hampshire Board of Medicine (?Board?), 1, Anna M. Konopka, M.D., D.P., F.A.A.P, per
Med 412.03, do hereby voluntarily surrender my New Hampshire license (#4254) to practice
medicine, effective on October 13, 2017.

By voluntarily surrendering my license, I understand that:

1. I relinquish all rights and privileges to practice medicine in the State of New
Hampshire as of October 13, 2017. The additional time is to allow me to
provide scheduled and emergency treatment.

2. After October 13, 2017, I can no longer legally treat any patients in New
Hampshire, to include, but not limited to, examining and diagnosing patients
and prescribing any medications to patients.

3. I may take until October 27, 2017 to wind up my practice, facilitate any
referrals of patients to a new provider and the transfer of patient records, and
notify my patients that as of October 13, 2017, I am no longer practicing

medicine in New Hampshire.

New Hampshire Board of Medicine
In the Matter ofArma M. Konopka, MD, D.P., RA.A.P.
Voluntary Surrender of License

4.

The Board has commenced an investigation into my practice pursuant to RSA
329:18, but a notice of hearing has not issued as of the date that I sign this
document.

This license surrender has occurred in settlement of pending allegations
regarding my record keeping, prescribing practices and medical decision
making.

I dispute the pending allegations and admit to no violations of RSA 329:17, VI
or any administrative rules or ethics provisions adopted by the Board.

Should I again seek licensure in the State of New Hampshire, I must meet, and
shall bear the burden of proving compliance with, all of the standards and
prerequisites then required by the Board for new applicants, including
professional character requirements.

The pending allegations shall be resolved in any future licensure application I
may submit in New Hampshire. I hereby speci?cally waive any statute of
limitations or laches defense, which might then be available, including, but not
limited to, those based on RSA and 9. I also waive any potential
issues regarding a lack of a speedy hearing or spoliation of the evidence.

Once this this document goes into effect, it will be reported as discipline and
distributed to all relevant licensing authorities and professional societies in the
same manner as a ?nal decision making speci?c ?ndings of professional

misconduct.

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New Hampshire Board of Medicine
In the Matter ofAnna M. Konopka, MD, D.P., FA.A.P.
Voluntary Surrender of License

10. This document shall become a permanent part of my ?le, and will be
maintained by the Board as a public document.

11. I voluntarily submit this surrender of license to the Board and state that no
promises or representations have been made to me other than those terms and
conditions expressly stated herein.

12. I have had the opportunity to seek and obtain the advice of an attorney of my
choosing in connection with my decision to sign this document.

13. I am of sound mind and not under the in?uence of any substance that would

impair my judgment at the time I sign this document.

FOR RESPONDENT



Anna  Konopka, D.P., 

 

 

Date i?Ehael A. Esq.
Counsel for Respondent

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New Hampshire Board of Medicine
In the Matter ofAnnaM. Konopka, MD, D.P., FA.A.P.
Voluntary Surrender of License

FOR THE BOARD 

       

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THE BOARD, OF 7 day of 7
2017. -

Date: 9?6?  '7 Lily->6] Li (7

(Siignature) 
"1 .

[Pi 

(Print or Type Mame) 

Authorized-Representative of the

New Hampshire Board of Medicine

Board members not participating:

Frame 

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