ROBERT L. EHRLICH, JR., Governor                                Ch. 5

(i) Contains the name of each licensed physician who, during the 6
months preceding the report:

1. Is employed by the hospital or related institution;

2. Has privileges with the hospital or related institution; and

3. Has applied for privileges with the hospital or related
institution; and

(ii) States whether, as to each licensed physician, during the 6
months preceding the report:

1. The hospital or related institution denied the application of
a physician for staff privileges or limited, reduced, otherwise changed, or terminated
the staff privileges of a physician, or the physician resigned whether or not under
formal accusation, if the denial, limitation, reduction, change, termination, or
resignation is for reasons that might be grounds for disciplinary action under § 14-404
of this subtitle;

2. The hospital or related institution took any disciplinary
action against a salaried, licensed physician without staff privileges, including
termination of employment, suspension, or probation, for reasons that might be
grounds for disciplinary action under § 14-404 of this subtitle;

3. The hospital or related institution took any disciplinary
action against an individual in a postgraduate medical training program, including
removal from the training program, suspension, or probation for reasons that might be
grounds for disciplinary action under § 14-404 of this subtitle;

4. A licensed physician or an individual in a postgraduate
training program voluntarily resigned from the staff, employ, or training program of
the hospital or related institution for reasons that might be grounds for disciplinary
action under § 14-404 of this subtitle; or

5. The hospital or related institution placed any other
restrictions or conditions on any of the licensed physicians as listed in items 1 through
4 of this subparagraph for any reasons that might be grounds for disciplinary action
under § 14-404 of this subtitle.

(2)     The hospital or related institution shall:

(i) Submit the report within 10 days of any action described in
paragraph (1)(ii) of this subsection; and

(ii) State in the report the reasons for its action or the nature of the
formal accusation pending when the physician resigned.

(3)     The Board may extend the reporting time under this subsection for
good cause shown.

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