1. (a) The patients' full name, address, date of birth, social security number, medical record number, and the physical location of the medical record.
2. (b) The full name, license number, practice specialty and the American Board of Medical Specialties certification or certification by a board-approved specialty board, if any, of the physician who performed the surgery.
3. (c) The date of the surgery; the name and address of the outpatient setting where the surgery was performed; and the circumstances of the patient's death.
4. (d) The full name of each entity which licenses, certifies or accredits the outpatient setting where the surgery was performed and the types of outpatient procedures performed at that setting.
5. (e) The name and address of the hospital or emergency center to which the patient was transferred or admitted.
6. (f) The date of the report and the full name of the person who completed the report.

The reporting of a patient death that is required by Section 2240(a) of the code shall include the following information:

Note: Authority cited: Section 2018, Business and Professions Code. Reference: Section 2240, Business and Professions Code.

History

1. New section filed 10-31-2000; operative 11-30-2000 (Register 2000, No. 44).