Form preview

Get the free New York State Board for Professional Medical Conduct Order - w3 health state ny

Get Form
This document serves as a consent order for Dr. Stephen Leonard Rachlin regarding the suspension of his medical license due to professional misconduct.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign new york state board

Edit
Edit your new york state board form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your new york state board form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit new york state board online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit new york state board. Replace text, adding objects, rearranging pages, and more. Then select the Documents tab to combine, divide, lock or unlock the file.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
pdfFiller makes working with documents easier than you could ever imagine. Try it for yourself by creating an account!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out new york state board

Illustration

How to fill out New York State Board for Professional Medical Conduct Order

01
Obtain the New York State Board for Professional Medical Conduct Order form from the official website or the board's office.
02
Read the instructions carefully to understand the requirements and the purpose of the form.
03
Fill in your personal information, including your full name, address, contact number, and medical license number.
04
Provide details regarding the incident or situation that prompted the need for the order.
05
Include any supporting documentation or evidence that is required, such as medical records or witness statements.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form as required.
08
Submit the form to the appropriate address provided in the instructions, ensuring that you keep a copy for your records.

Who needs New York State Board for Professional Medical Conduct Order?

01
Any licensed medical professional in New York State who is undergoing a disciplinary process or requires official documentation regarding their professional conduct.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
37 Votes

People Also Ask about

The New York State Department of Health (the Department) has been overseeing the health, safety, and well-being of New Yorkers since 1901 – from vaccinations to utilizing new developments in science as critical tools in the prevention and treatment of infectious diseases.
Health professionals study, diagnose, treat and prevent human illness, injury and other physical and mental impairments in accordance with the needs of the populations they serve.
Doctor Complaint Agency: New York State Department of Health. Division: Professional Medical Conduct. Phone Number: (800) 663-6114. Business Hours: Monday - Friday: 8 AM - 4:45 PM.
Engaging in acts of gross incompetence or gross negligence on a single occasion, or negligence or incompetence on more than one occasion. Permitting or aiding an unlicensed person to perform activities requiring a license. Refusing a client or patient service because of race, creed, color, or national origin.
1-800-663-6114 - Complaints/Inquiries (Monday-Friday 9:00 a.m - 5:00 p.m.)
Applicants must have completed at least one year of clinical residency training in an accredited program and must possess or be eligible for a full and unre- stricted New York State medical license. Licensure must be obtained by the program start date.
The Office of Professional Medical Conduct reviews all complaints of professional medical misconduct against licensed physicians, physician assistants and specialist assistants, including complaints of sexual harassment and assault.
The New York State Health Department's Office of Professional Medical Conduct (OPMC) and the state Board for Professional Medical Conduct (board) are responsible for investigating and adjudicating complaints against physicians, physician assistants, and specialist assistants*.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The New York State Board for Professional Medical Conduct Order is a legal directive issued by the Board that addresses violations of professional conduct by medical practitioners in New York State. It outlines necessary actions, penalties, and rehabilitative measures.
Medical professionals, including doctors and licensed practitioners, are required to file a report if they have any knowledge of misconduct, malpractice, or other violations related to the practice of medicine as per the regulations of the New York State Board for Professional Medical Conduct.
To fill out the New York State Board for Professional Medical Conduct Order, individuals must provide accurate information regarding the details of the complaint or incident, including identifying information about the practitioner involved, a description of the alleged misconduct, and any supporting documentation.
The purpose of the New York State Board for Professional Medical Conduct Order is to ensure the safety and welfare of the public by regulating medical practice, investigating complaints, and imposing sanctions on practitioners who violate professional standards.
The information that must be reported includes the name and contact details of the complainant and the practitioner involved, a thorough description of the alleged misconduct, dates of incidents, and any evidence or documentation supporting the claims.
Fill out your new york state board online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.