How to File an Exemption

The person or entity (applicant) requesting an exemption from the background check standards for purposes of seeking or renewing state licensure or certification or for employment at a state licensed or certified health care facility shall follow the below procedures and forward the required documents to the OHCA designee for consideration:

1.  Fieldprint, Inc. is the OHCA designee for background checks.  Requests for exemptions must be submitted to Fieldprint at:

Fieldprint, Inc.
Attn: Alexander Erlam
12000 Commerce Parkway
Suite 100
Mt. Laurel, NJ 08054

2.  Requests for exemptions shall be made in writing by using form DOH 106E, “Request for Exemption from Criminal History Record or Abuse Registry Checks Standards” within thirty (30) calendar days of applicant’s receipt of fitness determination.  A copy of the applicant’s current results of a name inquiry or fingerprint inquiry into the State criminal history records check must accompany the request, if applicable. Refer to the Instructions for Form DOH 106E.

3.  The applicant is expected to use the Checklist for Exemption Request as a reminder of the documents to be submitted for each exemption request.

4.  All documents shall be submitted to the DOH designee for background checks.

5.  Upon receipt of the complete written exemption request and other required documents listed on the Checklist for Exemption Request, the DOH designee shall convene a panel consisting of three (3) professional multi-disciplinary team members to review the request.  The panel shall include individuals in at least two different professions with backgrounds in criminal justice, legal, social work and/or the therapeutic mental health field to include social work.

6.  If the request for an exemption is incomplete, the designee shall inform the applicant of the specific information that needs to be forwarded to the designee and a due date for the receipt of such information.  The due date shall be no more than twenty-one (21) calendar days of mailing the request for information.  No action on the request for an exemption will be taken until all required documents are received by the designee.

If the required documents are not received from the designee by the required due date, the entire packet shall be returned to the applicant with a letter of explanation that the required documents were not submitted and, therefore, the request for exemption is denied.

7.  The exemption panel shall consider the following:

a.  The relevance of the applicant’s conviction record to the qualifications, functions, duties and responsibilities as a licensed or certified healthcare provider;
b.  Passage of time since the crime or abuse was committed;
c.  Any evidence of rehabilitation, such as letters from counselors or therapists attesting to a sustained improvement in the applicant’s behavior, character references, and activities since conviction, such as employment.  Examples include:

  • Proof of rehabilitation documents showing completion of treatment in a licensed and/or accredited facility or an out-patient treatment program and/or a letter from a licensed or accredited rehabilitation counselor.
  • A certificate of discharge from an out-patient treatment program could be considered Proof of Rehabilitation.  A letter from a relative or friend stating that the applicant’s behavior has changed will not be accepted as Proof of Rehabilitation.
  • Professional reference or a positive testimonial from a professional counselor or clergy with whom the applicant has a professional therapeutic working relationship.  Having a personal relationship with the professional counselor or clergy will not be accepted as a professional reference.

8.  A single factor may not be evidence of rehabilitation.  If necessary, the panel shall request additional information from the applicant.

9.  Applicants shall be informed in writing of the panel’s decision within forty-five (45) calendar days from the date the panel receives all required documents.  The panel may extend the 45 day period with cause and a written explanation to the applicant.  Failure to notify the applicant within 45 days shall not automatically grant the exemption.

10.  An exemption may be granted to the applicant with specified restrictions.  For example, someone with an abuse conviction may be granted an exemption with the condition that they are not allowed unsupervised or unwitnessed access to patients, residents or clients.

11.  Retain a copy of all documents related to the exemption request for one (1) year.  Documents shall be readily accessible to the Department or its licensing or certification designee.

12.  Applicants who are dissatisfied with the panel decisions on their exemption requests may appeal the panel’s decision to the Office of Health Care Assurance (OHCA) within thirty (30) calendar days of receipt of the panel’s exemption decision.

13.  OHCA shall review the panel’s decision along with the documentation that was used by the panel and shall issue a decision to the applicant within thirty (30) calendar days of receipt of the applicant’s appeal.  OHCA shall not consider any new or additional information from the applicant nor is OHCA obligated to interview the applicant or any references.

14.  Applicants who remain dissatisfied with OHCA’s decision may request a hearing in accordance with applicable state statute or regulations which govern the licensure or certification being sought.