Physician assistant agreement: Fill out & sign online

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Click ‘Get Form’ to open the wa doh practice plan in the editor.
Begin by selecting whether you are a Certified or Non-Certified Physician Assistant. This is crucial for determining your eligibility and requirements.
Fill in the Physician Assistant Data section, including your name, license number, NCCPA certification number, and contact information. Ensure all details are accurate for proper identification.
Next, provide information about your Primary Supervising Physician. Include their name, license number, specialty, and contact details. This establishes the supervisory relationship essential for your practice.
If applicable, complete the Alternate Supervising Physician Data section with similar details as above. This ensures continuity of supervision.
In the Practice Site section, mark all relevant settings where you will be practicing. Specify the percentage of time spent at each site to clarify your work distribution.
Describe your general duties and supervision plan in the designated sections. Be thorough to reflect your responsibilities accurately.
Finally, ensure that both you and your supervising physician sign and date the document before submission to confirm accuracy and agreement.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (101 Votes)
2013	4.3 Satisfied (161 Votes)

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How to fill out and sign wa doh practice plan online?

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Can physician assistants practice independently in Washington state?

(2)(a) A physician assistant who has completed fewer than 4,000 hours of postgraduate clinical practice must work under the supervision of a participating physician, as described in the collaboration agreement and determined at the practice site.

Can nurse practitioners open their own practice in Washington state?

Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)