Delegation Agreement - Minnesota.gov - mn 2026

1. Click ‘Get Form’ to open the Delegation Agreement in the editor.
2. Begin by filling in the Physician Assistant’s name, signature, license number, and specialty in the Identification section. Ensure accuracy as this information is crucial for identification.
3. In the Physician Supervision section, provide a narrative description of how supervision will be accomplished. Choose from options like on-site review or telecommunication for clarity.
4. Indicate which patient services are delegated to the physician assistant by marking 'yes' or 'no' for each service listed. This ensures that both parties understand the scope of practice.
5. For prescriptive practices, select whether the PA may prescribe medications and specify categories if applicable. This section is vital for compliance with state regulations.
6. Finally, ensure all signatures are completed at the end of the document by both the Physician Assistant and Supervising Physicians to validate the agreement.

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