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Physician assistant reference form

2021 georgia form-2025

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The document is a reference form for evaluating a Physician Assistant (PA) candidate, requiring observations from a supervising physician. It includes sections for assessing the candidate's clinical skills, professionalism, and quality of patient care. The physician must indicate their relationship to the candidate, duration of observation, and whether they have any reservations about recommending the candidate for licensure.

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Click ‘Get Form’ to open the 2021 Georgia Form in the editor.
Begin by entering the physician’s name and circling either MD or DO. This identifies the evaluator.
Fill in the physician’s specialty and indicate if they are board certified by checking 'YES' or leaving it blank for 'NO'.
Provide the candidate's last name, first name, and middle name to ensure proper identification.
Evaluate the candidate across various competencies such as clinical skills and professionalism by marking 'Above Average', 'Average', or 'Below Average' for each category.
Describe your professional relationship with the candidate, ensuring you specify how you observed their performance.
Indicate the length of time you have observed or worked with the candidate, including specific dates if possible.
State whether you have any reservations about recommending the PA for licensure by checking 'do have' or 'do not have'. If applicable, provide an explanation.
If there are concerns that need discussion, circle 'YES' or 'NO' and provide your preferred contact details for follow-up.
Finally, sign and date the form before submitting it to ensure its validity.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (191 Votes)
2022	4.8 Satisfied (88 Votes)
2021	4.8 Satisfied (121 Votes)
2020	4.9 Satisfied (47 Votes)
2020	4.4 Satisfied (41 Votes)
2020	4.2 Satisfied (57 Votes)
2020	4.7 Satisfied (53 Votes)
2019	4.9 Satisfied (29 Votes)
2018	4.2 Satisfied (65 Votes)
2017	4.2 Satisfied (26 Votes)
2016	4.8 Satisfied (212 Votes)
2016	4.6 Satisfied (53 Votes)
2016	4.8 Satisfied (236 Votes)
2016	4.9 Satisfied (53 Votes)
2016	4.6 Satisfied (22 Votes)

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Download income tax forms You can e-file directly to the IRS and download or print a copy of your tax return.

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If you mailed a tax return and havent heard from them, please check expected wait times for current IRS operations and services. Are tax forms available at my local Post Office? No, Post Offices do not have tax forms available for customers.

What is Georgia form g2 A?

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georgia physician assistant form

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Get the current filing years forms, instructions, and publications for free from the IRS. Download them from IRS.gov. Order online and have them delivered by U.S. mail. Order by phone at 1-800-TAX-FORM (1-800-829-3676)

Who must file GA form 700?

Form 700 Partnership Tax Return applies to: Businesses are required to file a Georgia Income Tax Return Form 700 if your business is required to file a Federal Income Tax Form 1065 and your business: Owns property or does business in Georgia. Has income from Georgia sources; or. Has members domiciled in Georgia.