Dl 920 2025

1. Click ‘Get Form’ to open the dl 920 in the editor.
2. Begin by entering the physician's name at the top of the form, ensuring you specify whether they are an MD or DO by circling the appropriate option.
3. Fill in the physician's specialty and indicate if they are board certified by checking 'YES' or 'NO'.
4. For the candidate section, input their last name, first name, and middle name as required.
5. Evaluate the candidate by selecting one of the options: Above Average, Average, or Below Average for each competency listed.
6. Describe your professional relationship with the candidate in the designated field.
7. Indicate how long you have known or worked with the candidate.
8. State any reservations about recommending the PA for licensure and provide explanations if necessary.
9. If applicable, indicate whether you would like to discuss any concerns via phone call and provide your availability.
10. Finally, sign and date the form before submitting it to ensure all information is complete and accurate.

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