CONFIDENTIAL DOCUMENT – NOT FOR PUBLIC RELEASE

1 ATTACHMENT A - CPEP
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3 Pursuant to ORS 677.420, the Board orders Licensee to undergo a comprehensive
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4 evaluation for the purpose of determining Licensee’s fitness to practice medicine with
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5 reasonable skill and safety to patients as follows:
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6 1. Licensee shall successfully complete an evaluation at the Center for
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7 Personalized Education for Professionals in Colorado to assess whether any
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conduct, practice, or condition does or might affect Licensee’s ability to safely

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9 and skillfully practice medicine. Licensee shall enroll within 30 days of the
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10 date that this Order is signed by the Board’s chair.
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2.

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Licensee shall sign any and all releases to allow for complete communication

between the Board and evaluators. Releases must be in place at least two weeks

prior to the evaluation date.

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14 3. The costs of such an evaluation, including travel, lodging and all testing
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15 expenses, shall be borne by Licensee.
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16 4. Licensee shall complete the evaluation within 120 days of the date that this
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17 Order is signed by the Board’s chair. The report resulting from the evaluation
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18 shall be sent directly to the Board.
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19 5. Failure to comply with this Order by the dates specified will be considered a
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20 violation of ORS 677.190(17) and may result in disciplinary action by this
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21 Board.
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PAGE 1 - ORDER FOR EVALUATION – LICENSEE NAME