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PHYSICIAN ASSISTANT ADVISORY COMMITTEE 

PHYSICIAN ASSISTANT  PRACTICE FORMS

 Physician Assistant Licensing Staff: Jodi Adcock

All requirements must be met prior to any practice at a new site and/or under a new supervising physician.

Licensees are advised not to enter irrevocable contracts, purchase or sales agreements, on the assumption that approval will be granted.


Practice Change documents must be current forms provided by the Board or they may be returned.

**Processing time is dependent on the licensee and proper submission of the required documentation.

IDAPA 22.01.03.037.02(f)(g) requires physician assistants to have a Board-approved supervising physician prior to practice and complete or maintain a current copy of the Board-approved delegation of services agreement as specified by Section 030. Failure to do so is grounds for disciplinary action.

NEW Supervising Physician Form & Delegation of Services Agreement Forms


Supervising physician registration forms and Delegation of Services Agreement forms are not confidential and may be discussed or disclosed to the public.