This government document is issued by Board of Registration in Medicine for use in Massachusetts
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https://www.mass.gov/doc/commonwealth-of-massachusetts-board-of-registration-in-medicine-complaint-form/download?_ga=2.189897704.2131647840.1762759951-1659763251.1762759951&_gl=1*19ju7ew*_ga*MTY1OTc2MzI1MS4xNzYyNzU5OTUx*_ga_MCLPEGW7WM*czE3NjI5MjEzNjQkbzkkZzEkdDE3NjI5MjEzODIkajQyJGwwJGgw