Physician assistant collaborative plan 2014 form-2026

1. Click ‘Get Form’ to open the physician assistant collaborative plan 2014 form in the editor.
2. Begin by filling in the Physician Assistant's name and details, ensuring all information is printed legibly or typed.
3. Complete the Primary Collaborating Physician section with their name, address, and license number. Make sure to check if this is a change of address.
4. Indicate whether the practice location is a remote site and provide specific details about the location.
5. Fill out the prescriptive authority section by checking the appropriate boxes based on what authority is being granted.
6. Attach necessary documents such as NCCPA certificate, DEA registrations, and curriculum vitae if applicable.
7. Review all sections for completeness before signing. Ensure that both the Physician Assistant and Primary Collaborating Physician sign and date the form.
8. Finally, mail the completed plan along with attachments to the State Medical Board, keeping a copy for your records.

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