Supplemental Digital Appendix 1
Medical Licensure Application Questions by State: Mental Health or Substance Abuse History Questions, as Reported and Graded by Wible and Palermini17 in 2019 and Changes to Questions as of May 2021
Note: This appendix is organized by the grades originally assigned by Wible and Palermini in their 2019 publication.17 This appendix does not re-grade any changes made to the questions as of this review in May 2021.
State Questions as reported by Wible and
Palermini (2019)a Changes to Questions as of May 2021b Grade Aa,c: States with no mental health questions or one or 2 straightforward current impairment question(s) that do not mention mental health.
Connecticut No questions. No changes.
Hawaii No questions. In the past five years, have you been
addicted to, dependent on, or a habitual user of alcohol or of a narcotic,
barbiturate, amphetamine, hallucinogen, or other drug having similar effects?
Kentucky 1) Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgement or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner?
No changes.
aSource: Wible P, Palermini A. Physician-Friendly States for Mental Health: A Comparison of Medical Licensing Boards. Qualitative Research in Medicine and Healthcare. 2019;3(3).
doi:10.4081/qrmh.2019.8649. Source content is unmodified from the original version, found in the open access article that is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0), https://creativecommons.org/licenses/by-nc/4.0/legalcode. ©Copyright: the Author(s), 2019.
bAll changes indicated were researched by searching licensure applications available publicly via each state’s medical board. If licensure applications were not publicly available, then the board was contacted via email to inquire about any changes made to its mental health and substance abuse questions since 2019.
cGrading system as defined by Wible and Palermini. 2019 (see footnote a).
Maine 1) Are you physically and mentally able to perform all the essential functions or services necessary to exercise the privileges or services applied for with or without reasonable
accommodation?
2) Are you able to perform these functions without significant risk or injury to yourself or others?
1) Do you have a mental or physical condition that currently impairs your ability to safely and competently practice medicine?
2) Do you currently use any chemical substance(s), including alcohol, which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?
Note: If any of your answers to questions 9(a-b) is “Yes,” are the limitations or impairments caused by your medical, mental health, or substance misuse condition reduced or improved because you receive ongoing professional treatment (with or without medication) or because you participate in a professional
monitoring program? Current
voluntary participation in the Medical Professionals Health Program or similar program will be kept confidential.
Michigan No questions. No changes.
Nevada 1) Do you currently have a medical condition which in any way impairs or limits your ability to practice medicine with reasonable safety and skill?
2) If you currently have a medical condition which in any way impairs or limits your ability to practice medicine, is that impairment or limitation reduced or ameliorated because of the field of practice, the setting, the manner in which you have chosen to practice, or by any other reasonable accommodation?
No changes to questions 1 or 2.
Added additional question:
3) If you currently use chemical
substances, does your use in any way impair or limit your ability to practice medicine with reasonable skill and safety?
New York No questions. No changes.
Pennsylvania 1) Do you currently engage in or have you ever engaged in the intemperate or habitual use or abuse of narcotics,
No changes.
hallucinogens, or other drugs or substances that may impair judgement or coordination?
Wyoming 1) Does the applicant’s health allow for the safe and competent practice of medicine?
No changes.
Grade Bc: States with progressive mental health question(s) linked to current impairment.
California 1) Do you currently have any condition (including, but not limited to
emotional, mental, neurological or other physical, addictive, or
behavioral disorder) that impairs your ability to practice medicine safely?
Added two additional questions:
1) Are you currently enrolled, in or participating in any drug, alcohol, or substance abuse recovery program or impaired practitioner program?
2) No Changes. (Same as question 1 in previous column)
3) Do you currently have any other condition that impairs or limits your ability to practice medicine safely?
Illinois 1) Do you now have any disease or condition that presently limits your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., i) mental or emotional disease or condition; ii) alcohol or other substance abuse; iii) physical disease or condition? If yes, attach a detailed statement, including an explanation whether or not you are currently under treatment.
No Changes.
Indiana 1) Do you now have any disease or condition that presently limits your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., i) mental or emotional disease or condition; ii) alcohol or other substance abuse; iii) physical disease or condition?
1) Do you have any condition or impairment (including a history of alcohol or substance abuse) that currently interferes, or if left untreated may interfere, with your ability to practice medicine in a competent and professional manner?
Iowa 1) Do you currently have a medical condition which in any way impairs or limits your ability to practice with reasonable skill and safety?
2) Are you receiving ongoing treatment or participating in a monitoring program that reduces or eliminates the limitations or impairments caused by either your medical condition or use of alcohol, drugs, or other chemical substances?
3) Does your field of practice, or the setting or the manner in which you have chosen to practice, reduce or eliminate the limitations or
impairments caused by your medical condition or use of alcohol, drugs, or other chemical substances?
Note: The final 2 questions relate to current drug use. Medical condition is defined as any physiologic, mental or psychological condition, impairment or disorder, including drug addiction and alcoholism.
No changes.
Maryland 1) Do you currently have any condition or impairment (including, but not limited to substance abuse, alcohol abuse, or a physical, mental, emotional, or nervous disorder or condition) that in any way affects your ability to practice your profession in a safe, competent, ethical, and professional manner?
No changes.
Missouri 1) Do you currently have any condition or impairment which in any way affects your ability to practice in a professional, competent, and safe manner, including but not limited to:
i) a mental, emotional, nervous or sexual disorder, ii) an alcohol or substance abuse disorder or iii) a physical disease or condition?
No changes.
New Jersey 1) Do you have a medical condition which is any way impairs or limits your ability to practice medicine with reasonable skill and safety?
Note: The next 2 are related to current use of chemical substances and the final question asks about any diagnosis of pedophilia,
exhibitionism, and voyeurism.
Added two additional questions:
1) No changes to the question.
2) Are the limitations or impairments caused by your medical condition reduced or ameliorated because you receive ongoing treatment (with or without medications) or participate in a monitoring program?
3) Do you have a medical condition which is any way impairs or limits your ability to practice medicine with
reasonable skill and safety?
4) No changes to the question.
5) No changes to the question.
6) No changes to the question.
New Mexico 1) Do you have a physical or mental condition that would affect your ability, with or without reasonable accommodation, to provide appropriate care to patients and otherwise perform the essential functions of a practitioner in your area of practice without posing a health or safety risk to your patients?
2) If yes, what accommodations would help you provide appropriate care to patients and perform other essential functions?
1) Are you now, or were you in the past, addicted to, abusive of, or in treatment for abuse of any controlled substances, habit-forming drugs, illegal drugs, prescription medication or alcohol?
2) Are you being treated with opiates for chronic pain? If yes, please provide to the Board upon application a current evaluation from your treating pain provider (MD or DO).
3) Do you have or have you been
diagnosed with an illness or condition which impairs your judgment or affects your ongoing ability to practice medicine in a competent, ethical and professional manner?
4) If yes, please have your treating physician send the NM Medical Board a letter regarding your diagnosis, treatment, and current status.
North
Carolina 1) Do you currently have any medical, chemical dependency or psychiatric condition that might adversely affect your ability to practice medicine or surgery or to perform the essential functions of your position?
1) In the past five (5) years, have you used or consumed any controlled substance or other prescription drug that you obtained through illegal or improper means?
2) In the past five (5) years, have you used or consumed any illicit or illegal drugs including, but not limited to, cocaine, heroin, ecstasy, LSD, mescaline, psilocybin, PCP and/or marijuana?
3) In the past five (5) years, have you used alcohol or other substances in a manner that could in any way impair or limit your ability to practice medicine with reasonable skill and safety or have you been told you were impaired by your use of alcohol or other substances in a manner that could impair or limit your ability to practice medicine with reasonable skill and safety?
South
Carolina 1) Are you currently being treated for any physical, mental or emotional condition that might interfere with your ability to competently and safely perform the essential functions of practice as a physician?
Added two additional questions:
1) No change to the question.
2) Do you currently have any mental illness (e.g. bipolar disorder,
schizophrenia, paranoia or any other psychotic disorder) or any physical illness or condition that might interfere with your ability to
competently and safely perform the essential functions of practice of practice?
3) Within the past two (2) years, has your ability to practice medicine been impaired by any physical or mental illness or by the use of alcohol and/or drugs?
Tennessee 1) Do you currently have any physical or psychological limitations or impairments caused by an existing medical condition which are reduced or ameliorated by ongoing treatment or monitoring, or the field of practice, the setting or the manner in which you have chosen to practice?
2) Have you ever been diagnosed as having or have you ever been treated
Added one additional question:
1) No changes to the question.
2) Do you currently use any chemical substances which in any way impair or limit your ability to practice medicine with reasonable skill and safety?
3) No changes to the question.
for pedophilia, exhibitionism, voyeurism or other diagnosis of a predatory nature?
Vermont 1) Do you have a medical condition that in any way impairs your ability to practice medicine in your field of practice with reasonable skill and safety?
No changes.
Virginia 1) Do you currently have any mental health condition or impairment that affects or limits your ability to perform any of the obligations and responsibilities of professional practice in a safe and competent manner?
No changes.
Wisconsin 1) Do you have a medical condition, which in any way impairs or limits your ability to practice medicine with reasonable skill and safety?
Follow-up questions are:
2) If yes, are the limitations or
impairments caused by your medical condition reduced or ameliorated because you receive ongoing treatment (with or without medications) or participate in a monitoring programs?
3) If yes, are the limitations or
impairments caused by your medical condition reduced or ameliorated because of the field of practice, the setting, or the manner in which you have chosen to practice?
4) Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism,
voyeurism?
No changes.
Note about question 1: Application now states, “Do you have a medical, physical, or mental condition”, not just “medical condition.”
Grade Cc: States with mental health question(s) spanning the last 5 years.
Arizona 1) Have you received treatment within the last 5 years for use of alcohol or a controlled substance, prescription-
No changes.
only drug, or dangerous drug or narcotic or a physical, mental, emotional, or nervous disorder or condition that currently affects your ability to exercise the judgment and skills of a medical professional?
Colorado 1) Within past 5 years, have you engaged in any conduct or exhibited any behaviors that resulted in an impairment in your ability to practice in a safe, competent, ethical and professional manner?
Added two additional questions:
1) No changes to the question.
2) Abusing or excessively using any habit-forming drug, including alcohol, or any illegal or controlled substance resulting in any discipline for
misconduct, failure to meet professional responsibilities, or
affecting your ability to practice safely and competently?
3) Claiming the illegal use of a substance as a defense, in mitigation, or as an explanation for any conduct that impairs your ability to practice in a safe, competent, ethical, and professional manner?
Minnesota 1) Have you within the past 5 years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if left untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety?
An affirmative answer requires 5
additional questions regarding current treatment, compliance, and name of treating physician.
2) Have you ever been diagnosed as having or have you ever been treated for pedophilia, voyeurism, or other sexual behavior disorders?
No changes.
Montana 1) Have you been diagnosed within the past 5 years with a physical condition or mental health disorder including potential health risk to the public?
1) Do you have any medical, physiological, mental, or
psychological condition which in any way currently (within the last 6
months) impairs or limits your ability to practice your profession or
occupation with reasonable skill and safety?
2) Do you currently (within the last 6 months) use one or more chemical substances in any way which impairs or limits your ability to practice your profession or occupation with
reasonable skill and safety?
North Dakota 1) Within the last 2 years have you been treated for any physical, mental or emotional condition which impaired or could be said to impair your ability to practice medicine safely and competently?
1) Do you currently have any condition for which you are not being treated that impairs your ability to practice your profession in a competent, ethical, and professional manner?
You may also answer not to this question if you have a current contract with the North Dakota Professional Health Program.
Ohio 1) In the past 5 years, have you been diagnosed as having, or been
hospitalized for a medical condition which in any way impairs or limits your ability to practice medicine with reasonable skill and safety?
2) Are the limitations or impairments caused by your medical condition reduced or ameliorated because you receive ongoing treatment or received treatment in the past (with or without medication) or participate in a
monitoring program?
3) Are the limitations or impairments caused by your medical condition reduced or ameliorated because of the field of practice, the setting, or the manner in which you have chosen to practice?
4) Have you ever been diagnosed as having, or have been treated for, pedophilia, exhibitionism, or voyeurism?
No changes.
Oklahoma 1) Do you currently have or have you had within the past 2 years any mental or physical disorder or condition, which, if untreated, could affect your ability to practice
competently?
1) Are you now or have you within the past two years been addicted to or used in excess any drug or chemical substance, including alcohol?
2) Have you obtained an assessment or been treated for the use of any drug or chemical substance, including
alcohol?
3) No changes to the question.
Oregon 1) Within the past 2 years, have you participated in a program (other than the Oregon PHP) for evaluation, monitoring, or treatment for any issue in lieu of or as a condition of
resolving a matter before a health care program or facility or a
regulatory or licensing board or has such action been pending or
proposed?
2) Do you currently have, or have you had within the past 2 years, any physical, mental, or emotional condition which impaired or does impair your ability to practice your health care profession safely and competently?
3) Within the past 2 years, have you been admitted to any hospital or other treatment facility for any physical, mental or emotional condition or substance use disorder which impaired or does impair your ability to practice your health care
profession safely and competently?
1) Within the past six months, have you entered into a program other than the Oregon Health Professionals Services Program (HPSP) for evaluation, monitoring, or treatment for ANY issue in lieu of or as a condition of resolving a matter before a health care program or facility or a regulatory or licensing board or has such action been pending or proposed?
2) Do you currently have, or have you had within the past six months, any physical, mental, or emotional condition which impaired or does impair your ability to practice your health care profession safely and competently?
3) Within the past six months, have you been admitted to any hospital or other treatment facility for any physical, mental, or emotional condition or substance use disorder which impaired or does impair your ability to practice your health care profession safely and competently?
4) Do you currently engage in the
excessive or habitual use of alcohol or drugs or do you currently have, or have you had within the past six months, a dependency on the use of alcohol or drugs which impaired or does impair your ability to practice your health care profession safely and competently? “Excessive” as used in this question includes, but is not
limited to, the use of alcohol or drugs that leads to disturbances, fights, arrest, injury, accident, illness, loss of consciousness, or other adverse consequences.
5) Within the past six months, have you been the subject of any chemical substance screening test which resulted in an indication of the presence in your body of any drug or of an alcohol level above .08% BAC?
This does not include those drugs taken by you for a legitimate health care diagnosis and prescribed for you in good faith by another licensed health care professional, unless the test was conducted as part of a criminal investigation such as DUII.
Texas 1) Within the past 5 years, have you been diagnosed with or treated for any: psychotic disorder, delusional disorder, mood disorder, major depression, personality disorder, or any other mental health condition which impaired or does impair your behavior, judgment, or ability to function in school or work?
2) If you answered Yes are the limitations caused by your mental condition or substance
abuse/dependency problem reduced or ameliorated because you receive ongoing treatment (with or without medication) or because you
participate in a monitoring program?
1) Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner?
Utah 1) If you are licensed in the
occupation/profession for which you are applying, would you pose a direct threat to yourself, to your patients or clients, or to the public health, safety, or welfare because of any
circumstance or condition?
2) Have you ever been declared by any court or competent jurisdiction
Question 1 has been removed from the application.
No changes to Question 2.
incompetent by reason of mental defect or disease and not restored?
Grade Dc: States with have-you-ever questions related to mental health, mental health questions beyond 5 years, or a requirement for peer reference on applicant’s mental health.
Arkansas 1) Are you currently suffering from any condition for which you are not being appropriately treated that impairs your ability to practice medicine or to perform professional or medical staff duties in a competent, ethical, and professional manner? If yes, explain.
2) Are you currently, or have you ever been monitored by a Physician Health Committee in any state? If yes,
explain, and ask the Physician Health Committee to send documentation of your status.
No changes.
District of
Columbia 1) Do you have a medical condition or have you become aware of any medical condition that impairs or limits your ability to practice your profession?
2) Have you ever engaged in any conduct that either indicated an impairment, or actually impaired, your ability to practice your profession?
3) Have you ever entered into a monitoring program for purposes of monitoring your abuse of alcohol, drugs, or other controlled substances?
4) Have you ever entered into a monitoring program for purposes of monitoring your professional behavior including recordkeeping, billing, boundaries, quality of care or any other matter related to the
practice of your profession?
No changes.
Georgia 1) Does this physician have, or has this physician had in the past, any mental or physical illnesses or personal problems that interfere with his/her medical practice?
1) Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and
professional manner? NOTE: If you are currently enrolled in GAPHP, you may check NO.
Idaho 1) Have you ever been diagnosed and/or treated for any mental, physical, cognitive condition including
substance use disorder that may affect your ability to practice medicine with reasonable skill and safety?
1) Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to
practice your medical profession with reasonable skill and safety?
Kansas 1) Within the last 2 years have you been diagnosed or treated for any physical, emotional or mental illness or
disease, including drug addiction or alcohol dependency, which limited your ability to practice the healing arts with reasonable skill and safety?
2) Within the last 2 years have you used controlled substances, which were obtained illegally, or which were not obtained pursuant to a valid
prescription order or which were not taken following the directions of a licensed health care provider?
3) Have you ever practiced your profession while any physical or mental disability, loss of motor skill or use of drugs or alcohol impaired your ability to practice with
reasonable safety?
4) Do you presently have any physical or mental problems or disabilities which could affect your ability to competently practice your
profession?
1) Do you have any physical or mental health condition (including alcohol or substance use) that currently impairs your ability to practice your
profession in a competent, ethical, and professional manner?
Louisiana 1) In the last 10 years prior to this application have you had any physical injury or disease or mental illness or impairment, which could reasonably be expected to affect your ability to practice medicine or other health profession?
No changes to question 1.
Added one additional Question:
2) In the 10 years prior to this
application have you been referred to or obtained treatment for a substance abuse disorder including alcohol abuse?
Nebraska 1) Do you currently, or have you had, any physical, mental, or emotional condition which impaired, or does impair your ability to practice your health care profession safely and competently?
2) Within the last 5 years, has any licensing agency or credentialing organization initiated any inquiry into your physical, mental or emotional health?
1) Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner?
New Hampshire 1) Have you ever had any physical, emotional, or mental illness which has impaired or would be likely to impair your ability to practice medicine?
1) Are you currently suffering from any condition, mental or physical that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner?
2) Are you currently or have you in the past been monitored or treated by a private, state, medical society or hospital physician health program, other than through the NH board approved physician health program?
South Dakota 1) Do you have a physical, mental or emotional condition which may adversely affect your practice?
2) Have you been treated for or do you have a diagnosis for any Mental Health condition?
No Changes.
West Virginia 1) Have you had any interruption in your practice of medicine which might reasonably be expected by an objective person to currently impair your ability to carry out the duties and responsibilities of the medical profession in a manner consistent with standards of conduct for the medical profession?
2) Have you ever had anything occur which might reasonably be expected by an objective person to currently impair your ability to carry out the duties and responsibilities of the
1) Have you in the last five (5) years, in any jurisdiction been addicted to, or received treatment for the use or misuse of, prescription drugs and/or illegal chemical substances, or been dependent upon alcohol or received treatment for alcohol dependency?
2) Have you in the last five (5) years, in any jurisdiction had any interruption in your practice of medicine which might reasonably be expected by an objective person to currently impair your ability to carry out the duties and responsibilities of the medical
medical profession in a manner consistent with standards of conduct for the medical profession?
profession in a manner consistent with standards of conduct for the medical profession?
3) Have you in the last five (5) years, in any jurisdiction had anything occur which might reasonably be expected by an objective person to currently impair your ability to carry out the duties and responsibilities of the medical profession in a manner consistent with the standards of conduct for the medical profession?
Grade Fc: States with highly invasive mental health questions unlinked to current impairment that contain confusing, punitive, or adversarial language.
Alabama 1) Within the past 5 years, have you ever raised the issue of consumption of drugs or alcohol or the issue of a mental, emotional, nervous, or behavioral disorder or condition as a defense, mitigation, or explanation for your actions in the course of any administrative or judicial proceedings or investigation; any inquiry or other proceeding; or any proposed
termination by an educational institution; employer; government agency; professional organization; or licensing authority?
2) Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism, or voyeurism?
3) Are you currently engaged in the excessive use of alcohol, controlled substances, or the illegal use of drugs, or received any therapy or treatment for alcohol or drug use, sexual boundary issues or mental health issues?
No changes.
Alaska 1) Has your ability to practice medicine in a competent and safe manner ever been impaired or limited by any condition, behavior, impairment, or
1) In the past two years, have you been diagnosed as having, or been
hospitalized for, a medical condition which in any way impairs or limits
limitation of a physical, mental, or emotional nature?
2) Since completing your postgraduate training, have you ever been
physically or mentally unable to practice medicine for a period of 60 days or longer?
3) Have you ever been diagnosed with, treated for, or do you currently have:
followed by a list of 14 mental health conditions including depression, seasonal affective disorder, and any condition requiring chronic medical or behavioral treatment.
your ability to practice medicine with reasonable skill and safety?
2) Do you currently have a medical condition which in any way impairs or limits your ability to practice medicine with reasonable skill and safety?
3) Are you currently engaged in the illegal use of drugs, or the use of illegal drugs?
4) In the past two years, have you used or are you currently using any
chemical substance(s), legal or illegal, that in any way impaired or limited, or is currently impairing or limiting, your ability to practice medicine in a safe and competent manner?
5) Are you currently taking a controlled substance that limits your ability to practice medicine in a fully competent and professional manner with safety to patients?
6) Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that presently interferes with your ability to practice your profession?
Delaware 1) Within the past 5 years, have you ever raised the issue of consumption of drugs or alcohol or the issue of a mental, emotional, nervous, or behavioral disorder or condition as a defense, mitigation, or explanation for your actions in the course of any administrative or judicial proceedings or investigation; any inquiry or other proceeding; or any proposed
termination by an educational
No changes.
institution; employer; governmental agency; professional organization; or licensing authority?
2) Are such current conditions or impairments reduced or ameliorated because of ongoing treatment (with or without medication) or participation in a monitoring program or because of the field of practice, the setting, or the manner in which you have chosen to practice medicine?
3) Do you have a mental or physical disability that limits your ability to practice medicine in a fully
competent and professional manner with safety to patients?
4) If yes, are you willing to accept a conditional or limited license to practice medicine if it is possible to accommodate such disability?
5) Do you agree to submit to an examination at your own expense if the Executive Director of the Board of Medical Licensure and Discipline deems it necessary to determine whether your physical and/or mental impairment presents a significant risk to the health or safety of patients or otherwise causes you not to be fully qualified to practice medicine in a competent and professional manner with safety to patients without limitations or accommodations?
Florida 1) In the last 5 years, have you been admitted or referred to a hospital, facility or impaired practitioner program for the treatment of a diagnosed mental disorder or impairment?
2) During the past 5 years, have you been treated for or had a recurrence of a diagnosed mental health disorder that has impaired your ability to practice medicine?
1) During the last two years, have you been treated for or had a recurrence of a diagnosed physical or mental
disorder that impaired or impairs your ability to practice?
2) During the last five years, have you been treated for or had a recurrence of a diagnosed substance-related (alcohol or drug) abuse disorder that impaired or impairs your ability to practice?
Massachusetts 1) Do you have a medical or physical condition that currently impairs your ability to practice medicine?
2) Have you ever refused to submit to a test to determine whether you had consumed and/or were under the influence of chemical substances?
No changes to questions 1 and 2.
Added one additional question:
3) Have you engaged in the use of any substance(s) with the result that your ability to practice medicine is
currently impaired?
Mississippi 1) Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism, or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia or other psychiatric disorder?
1) Are you now, or have you ever used any controlled substances or other drugs having addiction-forming or addiction-sustaining liability to the extent that it affects your ability to practice medicine with reasonable skill and safety to patients?
2) Have you ever prescribed to yourself any controlled substance or other drug having addiction-forming or
addiction-sustaining liability, or obtained said medications for your own use and consumption through any sources, other than by prescription or order of a licensed physician?
Rhode Island 1) During any Professional/Medical Education were you ever dismissed, suspended, restricted, put on
probation, or otherwise acted against or did you take a leave of absence for medical reasons?
2) During any Post Graduate Training, were you ever dismissed, suspended, restricted, put on probation, or otherwise acted against or did you take a leave of absence for medical reasons?
No changes.
Washington 1) Do you have a medical condition which in any way impairs or limits your ability to practice your
profession with reasonable skill and safety? If yes, please attach
explanation.
2) Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your
No changes.
profession with reasonable skill and safety? If yes, please explain.
3) Have you ever been diagnosed with, or treated for, pedophilia,
exhibitionism, voyeurism or frotteurism?
