Nevada State Board of Medical Examiners Required Reporting

IMPORTANT! Please read these printable instructions before completing any reporting forms below.

Use this form to report a sentinel event arising from a surgery or procedure requiring conscious sedation, deep sedation or general anesthesia performed at your office or any other facility, excluding care performed at a medical facility as defined in NRS 449.0151 or outside of Nevada.

In-Office Surgery or Procedure Report Form

To report in-office surgeries or procedures performed in 2021-2022 using conscious sedation, deep sedation or general anesthesia, complete and submit this form to comply with statutory reporting requirements.

Malpractice or Sanctions Report Form

Use this form to report malpractice actions, malpractice claims submitted to arbitration or mediation, settlements, awards, judgments or other dispositions of malpractice actions or malpractice claims submitted to arbitration or mediation, or any sanctions imposed that are reportable to the National Practitioner Data Bank.

Disciplinary Action Report Form

Use this form to report disciplinary action by another state, the Federal Government, or a foreign country.

Criminal Action Report Form

Use this form to report criminal actions or convictions, other than minor traffic violations, in this State, any other state, the Federal Government, a branch of the Armed Forces of the United States, or any local or federal jurisdiction of a foreign country.

Change in Privileges Report Form

Use this form to report changes in the privileges to practice of a physician, perfusionist, physician assistant or practitioner of respiratory care.