(a) At the time of periodic renewal, the Board shall require the licensee to demonstrate to its satisfaction the licensee's continuing qualification for medical licensure. The application form for license renewal shall be designed to require the licensee to update and add to the information in the Board's file relating to the licensee and the licensee's professional activity. It shall also require the licensee to report to the Board the following information:
(1) Any action taken against the licensee by:
(A) any jurisdiction or authority (United States or foreign) that licenses or authorizes the practice of medicine;
(B) any peer review body;
(C) any specialty certification board;
(D) any health care organization;
(E) any professional medical society or association;
(F) any law enforcement agency;
(G) any court; or
(H) any governmental agency or any Federally Qualified Community Health Center (FQHC) for acts or conduct similar to acts or conduct described in the Medical Practice Act as grounds for disciplinary action;
(2) Any adverse judgment, settlement or award against the licensee arising from a professional liability claim;
(3) The licensee's voluntary surrender of or voluntary limitation on any license or authorization to practice medicine in any jurisdiction, including military, public health and foreign;
(4) Any denial to the licensee of a license or authorization to practice medicine by any jurisdiction, including military, public health and foreign;
(5) The licensee's voluntary resignation from the medical staff of any health care organization or voluntary limitation of his or her staff privileges at such an organization if that action occurred while the licensee was under formal or informal investigation by the organization or a committee thereof for any reason related to possible medical incompetence, unprofessional conduct or mental or physical impairment;
(6) The licensee's voluntary resignation or withdrawal from a national, state or county medical society, association or organization if that action occurred while the licensee was under formal or informal investigation or review by that body for any reason related to possible medical incompetence, unprofessional conduct or mental or physical impairment;
(7) Whether the licensee has abused or has been addicted to or treated for addiction to alcohol or any chemical substance during the registration period;
(8) Whether the licensee has had any physical injury or disease or mental illness within the registration period that affected or interrupted his or her practice of medicine; or
(9) The licensee's completion of continuing medical education or other forms of professional maintenance and/or evaluation, including specialty board certification or recertification, within the registration period.
(b) The Board may, at its discretion, require continuing medical education for license renewal and require documentation of that education.
(c) The licensee shall be required to sign the application form for license renewal. Failure to report fully and correctly shall be grounds for disciplinary action by the Board.
(d) The Board shall establish an effective system for reviewing renewal forms. The Board may also initiate investigations or disciplinary proceedings based on information submitted by licensees for license renewal.