Addendum supervision agreement application 2025

1. Click ‘Get Form’ to open the addendum supervision agreement application in the editor.
2. Begin by filling in the supervising physician's name and their supervision agreement number. This information is crucial for linking the new physician assistant to the existing agreement.
3. Next, provide the physician assistant's details, including their Ohio Certificate to Practice Number. Ensure accuracy as this will be verified by the State Medical Board.
4. Each supervising physician must sign the affidavit section, confirming their commitment to supervise the listed physician assistants. Make sure all signatures are dated appropriately.
5. Review all entered information for completeness and accuracy before finalizing your document. Utilize our platform’s editing tools to make any necessary adjustments.
6. Once satisfied, save your completed application and follow the instructions for submission to ensure it reaches the State Medical Board of Ohio promptly.

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