Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  01/30/2018
Application#  :  607558
Name  :  Stewart, Martha Jane
Profession  :  Medicine and Surgery, MD
Address  :  Pensacola, FL
Application Status  :  Withdrawn (Abandoned)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Oral Exam to be determined after application is completed Not Met
3/7/18: Oral exam required. Email sent to email address on file --LF;
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2/20/18: File sent to board counsel;
JR
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1/18/18: File to Board Liaison -LF;
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5/4/17: When file is complete it will be sent for review & at that time you will need to allow at least 10 business days for the review.

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Application Fee Met
$75
Application Complete Met
All activities and practice accounted for Met
All questions answered and relevant copies attached Met
Certification of Legal Status Completed Met
Affidavit of applicant, signed Met
Authorization and Waiver, signed (Form #571) Met
FLEX scores, original certification Met
FCVS
Malpractice Suits or Claims Form #2829 and copies of claims/suits and final settlement, dispositions or dismissal information Met
8/30/17 documentation rec'd. /tg;
5/4/17: Received form #2829. Need copies of initial claims/suits/complaints and dispositions/dismissals filed/resolved for all cases within the past 10 years. Docs can be email to DSPSCredMedBD@wi.gov
Physicians Profile Data Report from AOA or AMA Met
Report Date 4/11/17
Physician Data Center Practitioner Profile Report (Form #1445) Met
FCVS Report Date 5/1/17
Medical Education Verification Form (Form #2164) Met
FCVS
Certificate of Post-Graduate Training (Form #2165) Met
7/24/17: Rec'd
Scripps Clinic 7/93 - 6/94;
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5/4/17: Rec'd via FCVS.
Barnes Hosp. Wash U 7/86 - 6/89;
Gen. Card. & Research Fellowship St. Louis 7/89 - 6/93;
Received Hospital, Facility and Employer Verification Forms Met
11/28/17:
8/30/17: Schnieder Reg Med Ctr. 4/16 - 10/16 (email explanation sent to paralegal 101/10/17; -LF;
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7/26/17:
Walker Baptist Med Ctr. 3/17 - pres.;
Hospital, Facility, and Employer Verification (Form #2167) Met
1/30/18: Cardio will not answer questions; see email explanation from applicant --LF;
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11/27/17: rec'd Cardio Consultants 5/05 - 1/16, however facility only verified 1/10-4/16 and they did not answer questions 3-15. If they can't answer they must provide reason;
JR
Hospital, Facility, and Employer Verification (Form #2167) Met
11/28/17: Cannot get details from facility due to hurricane Irma/Rita. Email sent to paralegal -LF;
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11/20/17: rec'd details from applicant, however this must come from the facility;
JR
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8/30/17: Schnieder Reg Med Ctr. 4/16 - 10/16-Rec’d form but need details to “yes” answered questions 12, 14 and 15. Please have facility resubmit details for questions 12, 14 and 15. Facility may fax details, with facility fax cover sheet, to 608.261.7083 or facility may email details directly to dspscredmedbd@wi.gov. /tg;
Verification of state license(s) directly from State Board office(s) Met
7/27/17: Rec'd: MO
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5/4/17: Need; MO.
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5/4/17: Rec'd: FL, AL, IA, CA.
National Practitioner Data Bank Report/Self-query response Met
Report Date 4/5/17.