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How to use or fill out delegation agreement template with our platform
- Click ‘Get Form’ to open the delegation agreement template in the editor.
- Begin by entering the Physician Assistant's name and Supervising Physician's name in the designated fields. Ensure that all information is legible.
- Fill in the Utah License Numbers for both the Physician Assistant and Supervising Physician, as well as any Substitute Supervising Physicians, if applicable.
- List the practice sites by providing the name of each facility along with its address, city, state, and zip code.
- Detail the degree and means of supervision required. Specify how immediate consultation will be conducted when not under direct supervision.
- Outline the frequency and mechanism of chart review, ensuring clarity on onsite supervision expectations.
- If applicable, include procedures for prescribing controlled substances and ensure compliance with licensing requirements.
- Complete any additional sections regarding emergency procedures or considerations related to your practice.
- Finally, gather signatures from all parties involved along with their respective dates to finalize the agreement.
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