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Document forms - Web APIs MDN 2026

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4.8 out of 5

136 votes

The document is an application form for the registration of a Physician Assistant (P.A.) with the Alabama Board of Medical Examiners. It outlines the responsibilities and requirements for both the supervising physician and the P.A., including details on core duties, scope of practice, prescriptive privileges, and protocols for training and supervision. The document also includes guidelines for prescribing medications, emergency procedures, and specific skills that P.A.s are authorized to perform under supervision.

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Click 'Get Form' to open the Document forms - Web APIs MDN in the editor.
Begin by filling in the Supervising Physician's name and AL Medical License Number at the top of the form. Ensure accuracy as this information is crucial for registration.
Provide your medical specialty and indicate if you are Board Certified or Board Eligible by selecting 'Yes' or 'No'.
Enter the Principal Practice Location Address and provide a contact telephone number. If there’s a different mailing address, include it in the designated section.
List each physician assistant currently registered under you, including their names, addresses, and working hours per week. This section helps maintain clarity on your supervisory relationships.
Answer whether the physician assistant is employed by you or your group. If 'No', remember to submit a Supplemental Certificate.
Complete all sections regarding core duties and scope of practice, ensuring that all skills performed align with your qualifications and training.
Finally, review all entries for accuracy before printing, signing, and submitting the form via email, fax, or mail as instructed.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (136 Votes)

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Document forms - Web APIs MDN 2026

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