Form 26 Entity Profile

Non-visible Questions
Label

PDF Name
(step)

Location

Entity
Profile(1)

Below “Is your
(entity type) a
part of a system
or network”

Text
Entry

If the user selects
Yes for “Is your
(entity type) part
of a system or
network?” the
field is displayed.

If your (entity type)’s
Entity
name was changed, what Profile(1)
was the name before the
merger or acquisition?

Below “Was
your (entity
type) acquired
by or merged
with another
organization
within the past
two years?”

Text
Entry

The field is
displayed if the
user selects Yes in
the drop list “Was
your (entity type)
acquired by or
merged with
another
organization
within the past
two years?”

Does
Entity
your organization provide Profile(1)
medical malpractice
coverage for some or all
of its health care
practitioners from a selfinsured in-house fund?

Below “If your
(entity type)’s
name was
changed, what
was the name
before the
merger or
acquisition?

Text
Entry

The field is
displayed if the
entity type may
provide medical
malpractice
coverage from a
self-insured inhouse fund (e.g.
hospitals)

Name of Entity
Responsible for These
Decisions

Below “Does
your (entity
type) make its
own (type of
decision)
decisions?”

Text
Entry

The field is
displayed if the
user selects “No”
in the drop list
“Does your
(entity type)
make its own
(type of decision)
decisions?”

Name of Network

Entity
Profile(1)

Response Visibility Trigger
Input
Item

Other

Entities that are
authorized to
query and report
to the NPDB may
have two sets of
decision
questions.

Do your (entity type)’s
decisions apply to other
(entity type)s?

Entity
Profile(1)

Below “Does
your (entity
type) make its
own (type of
decision)
decisions?”

Drop List The field is
displayed if the
user selects Yes in
the drop list
“Does your
(entity type)
make its own
(type of decision)
decisions?” and
Yes in the drop
list “Is your
(entity type) part
of a system or
network?”
Options are Yes,
No and Unknown.

Entities that are
authorized to
query and report
to the NPDB may
have two sets of
decision
questions.

Name of (entity type)

Entity
Profile(1)

Below “Do your
(entity type)’s
decisions apply
to other (entity
type)s?”

Text
Entry

The field is
displayed if the
user selects Yes in
the drop list “Do
your (entity
type)’s decisions
apply to other
(entity type)s?”

Entities that are
authorized to
query and report
to the NPDB may
have two sets of
decision
questions.

Will any other entity
submit (queries/reports)
for your (entity type)?

Entity
Profile(1)

Below Querying Drop List The field is
and Reporting to
displayed if the
the NPDB
user selects Yes in
the drop list
“Does your
(entity type)
make its own
(type of decision)
decisions?”
Options are Yes,
No and Unknown.

Entities that are
authorized to
query and report
to the NPDB may
have querying
and reporting
questions.

Who will submit
(queries/reports) to the
NPDB for your (entity
type)?

Entity
Profile(1)

Below “Will any Text
other entity
Entry
submit
(queries/reports)
for your (entity
type)?”

Entities that are
authorized to
query and report
to the NPDB may
have querying
and reporting
questions.

The field is
displayed if the
user select Yes in
the drop list “Will
any other entity
submit (queries/
reports) for your
(entity type)?”

What type of entity is it?

Entity
Below “Who will Drop List
Profile (1) submit
(queries/reports)
to the NPDB for
your (entity
type)?”

The field is
displayed if the
user select Yes in
the drop list “Will
any other entity
submit (queries/
reports) for your
(entity type)?”
Options are: a
(entity type), a
third-party agent,
neither of these.

Professions Granted
Clinical Privileges

Entity
Below the
Profile (1) decisions
questions

The list is
displayed if the
entity type is
designated as one
that grants
clinical privileges
to health care
practitioners.
The user may add
or remove
professions from
the list

Table

Entities that are
authorized to
query and report
to the NPDB may
have querying
and reporting
questions.

State Changes
Label
Add a
Profession

PDF Name
Entity Profile (1)

Item Type
Modal

Trigger
When the user selects the link “+ Add a profession”
the modal to select a profession is displayed and focus
is set on the Search text entry. The user can enter
text in the Search text box to find a specific profession
or select a profession from the list without
searching. The modal is hidden once the user selects
a profession from the list. The user's selection adds
the selected profession to the list under “Professions
Granted Clinical Privileges”