State Medical Board Reporting Requirements Failure to comply with reporting requirements may result in disciplinary sanctions. Certain events concerning a licensee must be reported using the Medical Board Mandated Reporting Form #08-4864. You may submit the Medical Board Mandated Reporting Form by one of the following methods: Email the form (attach any required documents) to medicalboard@alaska.gov Mail the form (attach any required documents) to State Medical Board, PO Box 110806, Juneau, AK 99801-0806 The following events must be reported using the Medical Board Mandated Reporting Form: Malpractice Settlements: A report of a malpractice settlement is required by law to be submitted within 30 days of the date of settlement; the report must be submitted by the physician or physician assistant. Alaska laws that mandate reporting: AS 08.64.345 Reports relating to malpractice actions and claims 12 AAC 40.930 Requirements for reporting the outcome of malpractice claims or actions Incompetence, Negligence, or Other Unprofessional or Illegal Conduct: A licensee must report to the Board facts known to the licensee regarding incompetent or repeated negligent conduct, gross negligence, unprofessional conduct, sexual misconduct, or other illegal conduct by another licensee under AS 08.64.326; 12 AAC 40.967(20)Unprofessional Conduct Impaired Professionals: A physician who professionally treats another physician for alcoholism or drug addiction, or for mental, emotional, or personality disorders, must report it to the Board if there is probable cause that the person may constitute a danger to the health and welfare of that person’s patients or the public if that person continues in practice. The report must state the name and address of the person and the condition found. AS 08.64.336Unprofessional conduct. Duty of physicians and hospitals to report. Reporting of hospital privileges actions: Duty of licensee to report: A licensee must report to the board if the licensee’s hospital privileges have been denied, revoked, suspended, or limited by a hospital or other health care facility for disciplinary reasons. This does not apply to a temporary suspension pending completion of medical records. Alaska law that mandates reporting: 12 AAC 40.967Unprofessional conduct - section (20) Duty of hospital to report: a hospital that revokes, suspends, conditions, restricts, or refuses to grant hospital privileges to, or imposes a consultation requirement on, a physician must report it to the board within seven working days after the action is taken. A hospital must also report to the board if a physician resigns hospital staff privileges while under investigation by the hospital or a committee of the hospital and the investigation could result in the revocation, suspension, conditioning, or restricting of, or the refusal to grant, hospital privileges, or in the imposition of a consultation requirement. A report is required regardless of whether the person voluntarily agrees to the action taken by the hospital. A report is not required if the sole reason for the action is the person’s failure to complete hospital records in a timely manner or to attend staff or committee meetings. Alaska law that mandates reporting: AS 08.64.336Duty of physicians and hospitals to report Criminal, Disciplinary or Licensing Actions: A licensee must report to the board within 30 days of any disciplinary action against the licensee taken by another licensing jurisdiction, health care entity, or law enforcement agency. A licensee must report to the board within 30 days of any conviction of a crime referred to in as 08.64.326(a)(4). Alaska law that mandates reporting: 12 AAC 40.967Unprofessional conduct - section (26) Other Reporting Requirements Reporting when a physician closes a practice or retires from practice: A physician is required by law to notify the board of the location of patient records within 30 days after retiring or closing a practice. This information may be reported in an email to: medicalboard@alaska.gov. Alaska laws that mandate reporting: 12 AAC 40.967Unprofessional conduct - section (26) Reporting of Child / Vulnerable Adult Abuse and Neglect: as a health care professional in Alaska, you are required by law to formally report confirmed and suspected child abuse and neglect, and abuse of vulnerable adults. Alaska laws that mandate reporting: AS 47.17.020Child abuse or neglect must be immediately reported to the office of children’s services: reportchildabuse@alaska.gov Child sexual abuse must also be reported to the nearest law enforcement agency. AS 47.24.010Abuse of vulnerable adults must be reported to the Dept. of Health. Reporting of Certain Injuries: As a health care professional in Alaska, if you treat in individual with certain injuries you are required by law to make an oral report to the department of public safety, a local law enforcement agency, or a village public safety officer. according to AS 08.64.369. The following injuries must be reported: second or third degree burns to five percent or more of a patient’s body; a burn to a patient’s upper respiratory tract or laryngeal edema due to the inhalation of super-heated air; a bullet wound, powder burn, or other injury apparently caused by the discharge of a firearm; an injury apparently caused by a knife, axe, or other sharp or pointed instrument, unless the injury was clearly accidental; and an injury that is likely to cause the death of the patient, unless the injury was clearly accidental. Reporting of Infectious Diseases: As a health care professional in Alaska, you are required by law to report suspicion or diagnosis of infectious diseases. Alaska laws that mandates reporting: AS 18.05 and 7 AAC 27.005Suspicion of or diagnosis of infectious diseases must be reported the department of public health, epidemiology section. Additional resources: State Division of Public Health – Epidemiology This site provides information to help health care providers comply with public health reporting requirements. To report public health emergencies call (907) 269-8000 or after hours (800) 478-0084.