SAMPLE REPORT 5

TABB INC.

HUMAN RESOURCE SERVICES SERVICE IS OUR NUMBER ONE PRIORITY

PO BOX 10; 555 Main St., Chester, NJ 07930

TELEPHONE (908)879-2323/FAX NO.(908)879-8675

www.tabb.net

The information contained in this report is for the SOLE AND CONFIDENTIAL use of the subscriber.

PROFESSIONAL LICENSE:

The NJ Board of Medical Examiners verified that the applicant is a licensed Physician, license number 25MAxxxxxxxxx, with an expiration date of June 30, 2009. Please see below for confirmation.

EDUCATION:

XYZ University DATES GIVEN: 1982

Beijing, China DATES CONFIRMED: 6/1/1982

The Registrar confirmed the applicant received a Medical Degree on 6/1/1982

DATA BASE:

A database search conducted under the applicant's Social Security Number shows the name ……………………… and the following cities and states as addresses for the applicant: New York, NY; Pittsburgh, West Mifflin, PA.

CRIMINAL RECORDS:

A statewide criminal record search was conducted in the State of New York. There is no record of a felony or misdemeanor record found under the applicant's name and date of birth.

A statewide criminal record search was conducted in the State of Pennsylvania. There is no record of a felony or misdemeanor record found under the applicant's name and date of birth.

A Federal criminal record search was conducted at the US District Court(s) in the states where the applicant has lived and there is no record of a felony or misdemeanor conviction under the applicant's name in these jurisdictions.

EMPLOYMENT:

………………… Imaging DATES GIVEN: 1/07-10/07

………………., NJ DATES CONFIRMED: 1/16/07-10/5/07

Mr. ……, Executive Vice President, confirmed the applicant worked for the company from 1/16/07 to 10/5/07 as a Staff Physician. Mr. ……….. reported that the applicant "abandoned the position". Mr. ………… reported the applicant's job performance "met standards" though no date for the last performance evaluation was given. Mr. ……… reported that the applicant is not eligible for rehire. Mr. ………. was informed of the Health Care Professional Responsibility and Reporting Enhancement Act and verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety. Please see attached documentation. We spoke with Dr. …………, Associate Medical Director and the applicant's supervisor, who stated that the applicant went on vacation and never returned, never gave notice of resignation and never responded to their many attempts to contact him regarding whether or not he will be returning to work. Dr. ……… said the applicant has not been fired, but rather he has apparently abandoned his job with this practice. Dr. ……….. stated the applicant's duties were that of a general radiologist though the applicant was trained as a neurointervention radiologist. Dr. ………… stated the applicant "has difficulty focusing on the task at hand" and "if you can get him to work for you, you will be lucky" in the less complimentary sense. Dr. ………… stated that he likes the applicant and does not want to give a negative recommendation, but also needs to be honest in his assessment of the applicant. The applicant will work well under direct supervision but is not highly self-motivated. Dr. ……….. verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety. Dr. …………. believes the applicant to be very competent as a radiologist and recommends the applicant for employment as a radiologist but with the understanding that the applicant will likely require ongoing close and direct supervision. Dr. …………. was informed of the Health Care Professional Responsibility and Reporting Enhancement Act and verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety. Please see the attached form completed by this facility.

………….. Univ. Medical Center DATES GIVEN: 1998-2006

New York, NY DATES CONFIRMED: 3/9/00-4/30/05

Ms. ………… Compensation Manager, confirmed the applicant worked at this facility from 3/9/00 to 4/30/05 as a full-time Assistant Professor at a salary of $30,000. This source refused to provide any information regarding work performance, reason for leaving and eligibility for rehire according to policy. We called the number provided by the applicant for Dr. ……….., the applicant's former supervisor however, there was never an answer at this number and there is no voicemail. We called the number listed for Dr. ………… on the university website and left three messages to contact our office regarding the applicant. We faxed Dr. ……… a letter on two occasions to the fax number provided by the university operator requesting verification of employment and requesting additional information regarding the applicant's job performance and suitability for employment in the medical field. As of this date we have not received a reply. If we receive a reply at a future time we will forward the verification and any comments in a supplemental report.

…………… Medical Center DATES GIVEN: 3/02-7/05

……………, NJ DATES CONFIRMED: 3/3/03-7/16/05

Dr. …………… Chairman of Neuroscience, stated the applicant worked at this facility from 3/3/03 to 7/16/05 as an Attending Interventional Neuroradiologist. Dr. ………… reported that the applicant resigned voluntarily and is not eligible for rehire. Work performance was rated as "did not meet standards" although no date of last performance evaluation was provided. Dr. ……….. declined further comment regarding the statement that the applicant did not meet standards and refused to comment regarding work performance. Dr. …………… was informed of the Health Care Professional Responsibility and Reporting Enhancement Act and verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety.

Please see attached documentation.

REPORT BY: ZA