Delegation agreement 2025

1. Click ‘Get Form’ to open the Delegation Agreement in the editor.
2. Begin by filling in the date at the top of the form. Ensure you include the month, day, and year.
3. In the Identification section, enter the Physician Assistant’s name, signature, license number, and specialty. Repeat this for the Supervising Physician.
4. For Physician Supervision, provide a narrative description of how supervision will be accomplished. Select your preferred methods of review from the options provided.
5. In the Delegation of Medical Services section, indicate which services are delegated by marking 'yes' or 'no' for each item listed.
6. If applicable, complete the Delegation of Prescriptive Practice section by selecting whether prescriptive authority is granted and specifying medication categories.
7. Finally, both parties must attest by signing and dating at the end of the document to confirm understanding and compliance with state laws.

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