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Health Care Facility Disciplinary Action Reports

Detailed information on reporting requirements and timeframes

There are three types of Health Care Facility Disciplinary reports. The form used depends upon what type of HCFD report is being filed. All HCFD Reports are very time-sensitive. These three HCFD forms are used by all health care facilities, including nursing homes, reporting disciplinary actions against physicians.


Reports must be typed or neatly printed in permanent ink. If you need additional space, attach extra sheets. Keep a copy for your records of each report you file.

In addition to filing HCFD reports with the MA Board of Medicine, you may also be required to report the disciplinary action to the National Practitioner Data Bank (NPDB). It is the responsibility of the health care facility to report directly to the NPDB. The Board does not report to the NPDB on your behalf.

A licensed parent organization is responsible for filing reports for any subsidiary or affiliated entity that operates pursuant to that license.

Questions about your reporting obligations, or proper completion of the forms, should be directed to the Board's Data Repository Counsel at (781) 876-8200.

Mail or fax completed HCFD reports to:

Data Repository Counsel
MA Board of Registration in Medicine
200 Harvard Mill Square, Suite 330
Wakefield, MA 01880
Fax: 781-876-8380

Initial Report

Form HCFD-1 (PDF) | (DOCX)

  • A Form HCFD-1 must be filed no later than thirty (30) days after the date the disciplinary action was imposed, even if the physician is appealing the decision.
  • A separate Form HCFD-1 must be filed for each physician disciplined.
  • A separate Form HCFD-1 must be filed for each disciplinary proceeding. However, if a single disciplinary proceeding results in two or more disciplinary actions against the same physician, only one Form HCFD-1 is required.
  • Complete Part A of Form HCFD-1 when the action is based on adverse or potentially adverse events related to specific patients or specific incidents.
  • Complete Part B of Form HCFD-1 when the action is based on a physician's overall behavior or is based on general concerns, rather than specific cases or incidents.
  • Depending upon the circumstances of the disciplinary action, you may need to complete both Part A and Part B.
  • Your report will not satisfy statutory and regulatory requirements unless you also provide substantiating information. All HCFD-1 reports must contain enough specific information and allegations to support the disciplinary action taken. (There is a further discussion of "substantiation" in the " FAQ for Health Care Facility Disciplinary Action Reports" section of these instructions.)

Subsequent Report

Form HCFD-2 (PDF) | (DOCX)

Summary:  Due date varies accordingly:

30 days from date of reversal on appeal OR

30 days after completion of an ongoing action OR

60 days from date of action AND

Every 60 days for the duration of the action.

Detail:  There are two important reporting deadlines attached to Subsequent Reports.

  1. For Continuing Disciplinary Actions, (disciplinary actions that were not fully satisfied or completed at the time the Initial HCFD-1 was filed) a Subsequent Report (Form HCFD-2) must be filed with the Board every 60 days. This report must be filed at the end of each consecutive sixty (60) day period of disciplinary action. The 60 day report is mandatory even when there has been no activity during that reporting period.
    1. The first sixty (60) day period begins with the date on which the disciplinary action was imposed. Example: You file a HCFD-1 on Day 30. It is a continuing action. You would file an HCFD-2 on Day 60, then an HCFD-2 on day 120 and every 60 days thereafter until the disciplinary action is completed or satisfied.

    If a new disciplinary action is imposed during the course of an ongoing action, complete a Subsequent Report for the old disciplinary action, and submit an Initial Report regarding the new action.

  2. A shorter reporting requirement applies when any disciplinary action is reversed or completed. It is extremely important to notify the Board when a disciplinary action has been reversed or completed, especially for those actions that appear on a physician's public profile. A Subsequent Report (Form HCFD-2) must be filed with the Board no later than thirty (30) days after any of the following:
    1. When a disciplinary action is reversed or modified as a result of any internal or external appeal. An "internal appeal" is the health care facility's appeal process facility and is heard by the facility's medical or administrative staff. An "external appeal" is an appeal through the court system or through a government agency's administrative process.
    2. When a disciplinary action, not fully completed at the time of the Initial Report, is completed. (Examples of these types of continuing disciplinary actions are medical education or proctoring requirements or temporary restrictions on certain hospital privileges).

Annual Summary

Form HCFD-3 (PDF) | (DOCX)

An Annual Summary (Form HCFD-3) must be filed with the Board by January 31st of each year. This report summarizes all disciplinary actions imposed during the previous calendar year. Please note the following with respect to the Annual Summary:

  • An Annual Summary form will be mailed by the Board in December each year.
  • The report is signed under oath.
  • The report must be sent to the Board by certified or registered mail.
  • The Summary Report must be filed even if no disciplinary actions were taken in that calendar year. You must indicate on the report that no actions were taken.
  • Information reported on the Annual Summary must be consistent with that reported on Initial Reports. Inconsistencies will result in the form being returned for clarification.
  • If an action is being reported for the first time on the Annual Summary, you must complete and file an Initial Report of Disciplinary Action (a separate Form HCFD-1) at the same time.