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Form ac1 pa adding alternate physicians form fillable 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Primary Sponsoring Physician’s Name, followed by their signature and license number. Ensure all details are accurate.
- Fill in the Practice Address and the Physician Assistant's name, including their first, middle, and last names along with their license number.
- The PA must sign and date the form in the designated areas provided.
- For each alternate physician, complete every line with their name, license number, signature, and date signed. Remember that all fields must be filled; otherwise, your submission may be returned.
- Once completed, save a copy for your records and ensure a copy is provided to the PA before submission.
- Finally, return this form to the Georgia Composite Medical Board at the specified address.
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