Applying – Personal History Information (Part VI)

By Adrienne Hersh, JD, ICS Legal Counsel · March 10, 20172 min read

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Editor’s Note: This is a specific segment of a full article that covers all license application issues. You can access that full article here.

An important part of the application is Part VI, or “Personal History Information.” This form consists of six questions requesting information regarding any history of: guilty pleas to criminal offenses and convictions of felonies; denial of professional license by any licensing authority; other-than-honorable discharge from armed services; and whether the applicant has a disease that limits his or her ability to perform the essential functions of the chiropractic profession, including physical and mental conditions and substance abuse. Detailed instructions entitled “PERSONAL HISTORY INFORMATION INSTRUCTIONS” for answering each of the six questions are attached to page 3 of the application and should be followed carefully.

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About the Author

Adrienne Hersh, JD, ICS Legal Counsel

Adrienne serves as Illinois Chiropractic Society general counsel and provides legal advice and support on a wide range of legal issues affecting chiropractic physicians, including licensing and other health care regulations, scope of practice, insurance and reimbursement, business structuring, labor and employment, contracts, and litigation. Adrienne previously served for 8 years as general counsel to the Illinois Department of Professional Regulation (now the Division of Professional Regulation, Department of Financial and Professional Regulation), where she was chief legal counsel responsible for overseeing all legal issues and advising the 50+ licensing and disciplinary boards, including the Medical Disciplinary Board and the Medical Licensing Board. She is a member of the Illinois State Bar Association Health Care Section, the Illinois Association of Healthcare Attorneys, and the National Association of Chiropractic Attorneys.