BEFORE THE STATE MEDICAL BOARD OF OHIO IN THE MATTER OF CASE NO. 12-CRF-086 HECTOR LUIS LOPEZ, JR., M.D. ENTRY OF ORDER On November 20, 2012, Hector Luis Lopez, Jr., M.D., executed a Surrender of his license to practice medicine and surgery in Ohio with consent to permanent revocation, which document is attached hereto and fully incorporated herein. Wherefore, upon ratification by the Board of the surrender, it is hereby ORDERED that Certificate No. 35-097641 authorizing Hector Luis Lopez, Jr., M.D., to practice medicine and surgery in the state of Ohio be permanently REVOKED. This Order is hereby entered upon the Journal of the State Medical Board of Ohio for the 12"' day of December 2012, and the original thereof shall be kept with said Journal. '(lib "mil (X A J. Craig Strafford, M.lj., M.P.H. Secretary (SEAL) December Q, 2012 Date STATE OF OHIO THE STATE MEDICAL BOARD PERMANENT SURRENDER OF CERTIFICATE TO PRACTICE MEDICINE AND SURGERY CASE NO. 12--CRF-086 Do not sign this agreement without reading it. An individual who Qermanently surrenders a certificate issuedhv the Board is forever thereafter ineligible to hold a certificate to practice or to aggly to the Board for reinstatement of the certificate or issuance of any new certificate. You are permitted to be accomganied, regresented and advised by an attorney, at your own expense, before deciding to sign this voluntary agreement. I, Hector Luis Lopez, Jr., .D., am aware of my rights to representation by counsel, the right of being formally charged and having a formal adjudicative hearing, and do hereby freely execute this document and choose to take the actions described herein. 1, Hector Luis Lopez, Jr., M.D., acknowledge that I have not been legally authorized to practice medicine and surgery in Ohio since July 1, 2012, the date upon which my license expired for non-renewal. Further, I do hereby voluntarily, knowingly, and intelligently surrender my certificate to practice medicine and surgery, License #35.09764l to the State Medical Board of Ohio [Board], thereby relinquishing all rights to practice medicine and surgery in Ohio. I understand that as a result of the surrender herein I will no longer be permitted to practice medicine and surgery in any form or manner in the State of Ohio ill the future. I agree thatl shall be ineligible for, and shall not apply for, reinstatement or restoration of certificate to practice medicine and surgery License #35.09764l or issuance of any other certificate pursuant to the authority of the State Medical Board of Ohio, on or after the date of signing this Surrender of Certificate to Practice Medicine and Surgery. Any such attempted reapplication shall be considered null and void and shall not be processed by the Board. I hereby authorize the State Medical Board of Ohio to enter upon its Journal an Order permanently revoking my certificate to practice medicine and surgery, License #35.09764l, in conjunction with which I expressly waive the provision of Section Ohio Revised Code, requiring that six (6) Board Members vote to revoke said certificate, and further expressly and forever waive all rights as set forth in Chapter 119., Ohio Revised Code, including but not limited to my right to counsel, right to a hearing, right to present evidence, right to cross- examine witnesses, and right to appeal the Order of the Board revoking my certificate to practice medicine and surgery. I, Hector Luis Lopez, Jr., M.D., hereby release the Board, its members, employees, agents, officers and representatives jointly and severally from any and all liability arising from the within matter. This document shall be considered a public record as that term is used in Section 149.43, Ohio Revised Code. Further, this information may be reported to appropriate organizations, data banks and governmental bodies. I, Hector Luis Lopez, Jr., M.D., acknowledge that my social security number will be used if this information is so reported and agree to provide my social security number to the Board for such purposes. I stipulate and agree that I am taking the action described herein in lieu of further formal disciplinary proceedings in Case No. 12-CRF -086, pursuant to Sections and Ohio Revised Code, as set forth in the Notice issued by the Board on September 12, 2012, a copy of which is attached hereto as Exhibit A and fully incorporated herein. EFFECTIVE DATE It is expressly understood that this Surrender of Certificate is subject to ratification by the Board prior to signature by the Secretary and Supervising Member and shall become effective upon the last date of signature below. 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