Delegation agreement 2026

1. Click ‘Get Form’ to open the Delegation Agreement in the editor.
2. Begin by entering the date at the top of the form. Ensure you fill in the month, day, and year accurately.
3. In the Identification section, input the Physician Assistant’s name, signature, license number, and specialty. Repeat this for the Supervising Physician.
4. For Physician Supervision, describe how supervision will be accomplished. Choose from options like on-site review or telecommunication.
5. Indicate which patient services are delegated by marking 'yes' or 'no' for each item listed under Delegation of Medical Services.
6. If applicable, specify any prescriptive practices in the Delegation of Prescriptive Practice section by selecting appropriate medication categories and controlled substances.
7. Complete the Attest section by having both the Physician Assistant and Supervising Physician sign and date where indicated.

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