Federation of Chiropractic Licensing Boards
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e-mail: info@fclb.org   www.fclb.org 

"Protecting the public and serving our member boards by promoting excellence in chiropractic regulation."


Official Actions Database
Sample Report

The following fictitious report on Dr. Jekyll (aka Mr. Hyde) illustrates the types of information contained in a report from the FCLB's Official Actions Database. More detailed descriptions of the data fields used in the Official Actions Database follow the sample report and are denoted with an *.


 

CIN-BAD Logo

FCLB Official Actions Database - Full Report generated on 04/01/98 at 23:40 (MT)

Henry Jekyll (description)

This record was last updated: 09/07/93

This practitioner may also be known professionally as:
    Edward Hyde

Date of birth: November 07, 1815
Social Security/Social Identification #: unknown

Licensure information reported for the following jurisdictions:
CONNECTICUT -- according to report by MA
NEW YORK -- license number 13927
   
    1215 New London Court
    New York, NY 10039
MASSACHUSETTS -- license number 23645
   
    14 Beacon St.
    Boston, MA 02110

Known educational degrees are:
   
DC New York Chiropractic College (NY) 1845
    MD

Known information on licensure in other professions:
   
Mass. reports licensed as MD - #20511

================== Board actions ==================

********** Actions taken by NEW YORK **********

07/22/89 reference #89-1308:
    action: 100 - Revocation
    cause: 04 - Felony

05/15/87 reference #87-0103:
    300 - Suspension
    cause: 50 - Substance abuse (while providing serv.)

********** Actions taken by MASSACHUSETTS **********

09/07/89 reference #0096336:
    action: 100 - Revocation
    cause: 50 - Board actions taken in another regulated jurisdiction

======= Notes from the FCLB staff regarding this individual ========
The information on Dr. Jekyll and Mr. Hyde is totally fictitious, and is used for purposes of illustration only.

=================== Medicare Exclusion ===================
The US government has provided information on sanctions against the
following individual. Because of the similarity in names, the FCLB
has linked that information to this person's report.

Hyde, Edward
14 BEACON ST
BOSTON, MA 02110

Date of birth: 11/07/15

Sanction by US Department of Health & Human Services
Date sanction was imposed: 12/12/96

For violation of Social Security Act section: 1128(b) (14)
    Default on health education loan or scholarship obligations


REMEMBER: Do not take official actions without consulting
   the board(s) which took action.
Copyright 1998, Federation of Chiropractic Licensing Boards



Descriptions of data fields

The sample report above, using the fictionalized information for "Dr. Jekyll and Mr. Hyde," shows the types of information carried in the FCLB's Official Actions Database. The report format is identical to what can be seen and printed from the Internet version of the database.

NAMES: The report is headed by the practitioner's legal name. If there are known name variations (either aliases or through legal name changes), these are reported as well.

LAST UPDATED: The date that this person's records were last updated on the CIN-BAD system is given.

DATE OF BIRTH and SOCIAL SECURITY NUMBER: This information, which is so vital for guaranteeing that the report is for the correct individual, is given when available. For Canadian citizens, the Social Identification Number is given.

LICENSURE INFORMATION: All available information on chiropractic licensure is given. If available, the license number for the state or province is provided, as is the address of record reported for licensure in that state/province. If there is an indirect report of licensure, it is given as "according to report by" the appropriate board.

EDUCATIONAL DEGREES: The degree, school name, state or province, and year in which the degree was awarded are reported for all known professional degrees.

DIPLOMATE STATUS OR CERTIFICATION: If the practitioner is known to hold special certifications, that information is reported. (Dr. Jekyll does not hold any such certification.)

LICENSURE IN OTHER PROFESSIONS: If the individual is known (or believed) to be licensed in professions other than chiropractic, all available information is reported.

BOARD ACTIONS: All public board actions which have been reported to the Federation of Chiropractic Licensing Boards are listed. Board actions are grouped by the state/province taking the action, with the most recent actions listed first.

NOTES: An option is provided for free-form notes. This area of the report will be used, as necessary, to reflect information that cannot be coded into the previous fields. For example, a note here might reflect that a particular board action is under appeal.

MEDICARE (DHHS) EXCLUSIONS: This section of the report gives all the information that is provided by the US Department of Health and Human Services. Because the name used by DHHS may not exactly match the name that is reported at the top of the form, the name is repeated here.

REMINDER: Every report concludes with a reminder that this report is only a pointer toward the boards that have taken actions. No board or agency should take action on an individual based solely on this report.


 

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