|(a) The board shall develop a Profile Update and Correction Form (the "Form") which allows for corrections and/or updates to the profile information to be made by the physician. The physician must submit all changes to profile information upon this Form, or indicate on the Form that no changes are necessary. The Form shall contain the date the information will be made available to the public and will allow the physician to request a copy of the physician's profile. Upon such request, and when the profile information has been updated, the board shall provide a copy to the physician. The Form will be made available in hard copy and on the Internet. (b) Compliance with the request for information from the board is mandatory. Failure to return the completed Form to the board shall be considered non-compliance. Non-compliance shall result in nonrenewal of the physician's license until such time as the physician provides the requested information. (c) Submission of false or misleading information or omission of required information by the physician shall be considered grounds for disciplinary action. (d) All data contained in the profile shall indicate the source of the data and the last update date.