Ohio physician assistant supervision agreement 2026

1. Click ‘Get Form’ to open the Ohio Physician Assistant Supervision Agreement in the editor.
2. Begin by filling in the Supervising Physician Information section. Enter your name, Ohio License Number, practice name, and address. Ensure all fields are completed accurately.
3. In the Credential Mail Address section, provide the address where all correspondence regarding this application will be sent. This is crucial for processing your application.
4. Indicate whether the Physician Assistants will be utilized solely in a hospital or licensed healthcare facility. If not, you will need to prepare a Physician Supervisory Plan.
5. Complete the Affidavit of Supervising Physician by signing and dating it. This confirms your understanding of legal liabilities and responsibilities.
6. Gather signatures from each Physician Assistant listed on the signature sheet, ensuring they include their Certificate to Practice Number.
7. Finally, submit your completed application along with a $25 fee to the State Medical Board of Ohio as instructed.

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