Get the free SUPERVISING PHYSICIAN FORM

This form is used to designate a supervising physician and an alternate directing physician for medical students or residents, and to ensure compliance with the Idaho State Board of Medicine rules.

How to fill out supervising physician form

How to fill out SUPERVISING PHYSICIAN FORM

1. Obtain the SUPERVISING PHYSICIAN FORM from the relevant authority or organization.
2. Fill in your personal details such as name, address, and contact information at the top of the form.
3. Provide information for the supervising physician, including their name, medical license number, and contact information.
4. Specify the nature of the supervision and the type of services that will be provided.
5. Indicate the duration of the supervising agreement, including start and end dates.
6. Include signatures from both the supervising physician and the individual being supervised.
7. Review the form for completeness and accuracy before submission.
8. Submit the completed form to the designated office or authority as instructed.

Who needs SUPERVISING PHYSICIAN FORM?

1. Physician assistants who require supervision to perform medical tasks.
2. Nurse practitioners who operate under the supervision of a licensed physician.
3. Medical interns or residents who are under the guidance of an attending physician.
4. Any healthcare professional mandated by law to have a supervising physician.

People Also Ask about

What is a supervising physician?

Understanding the Role of a Collaborating Physician A collaborating physician provides essential clinical oversight and support to an NP, allowing them to practice with greater independence. This collaboration is often required by law, and it can involve different levels of interaction and guidance.

Can you bill for a PA under the supervising physician?

Under indirect billing, an NP or PA independently evaluates and treats the patient, but the bill is submitted under the supervising physician. The payment for such a visit is 100 percent of what is paid to a physician for the same service.

Do supervising physicians get paid?

How much does a Supervising Physician make? As of Jun 5, 2025, the average annual pay for a Supervising Physician in the United States is $217,445 a year. Just in case you need a simple salary calculator, that works out to be approximately $104.54 an hour. This is the equivalent of $4,181/week or $18,120/month.

What is the difference between collaborating physician and supervising physician?

Supervision originated in laws that defined physician-led teams, requiring a physician to have the final say on diagnoses, treatments, and prescriptions. Collaboration emerged as a more flexible term in the 1990s and 2000s, as states recognized the increasing role of NPs and PAs in providing primary and specialty care.

What is the role of a collaborative physician?

Attending physicians are sometimes the 'rendering physician' listed on the patient's official medical record, but if they are overseeing a resident or another staff member, they are 'supervising. '

What are the duties of a supervising physician?

The supervising physician holds the ultimate responsibility for all medical decisions made by the PA. This includes the review and approval of treatment plans, the prescription of medications, and the ordering of diagnostic tests.

What is the difference between an attending physician and a supervising physician?

In urgent care settings, physicians are often responsible for supervising and overseeing a team of other healthcare employees, including nurse practitioners (NPs), physician assistants (PAs), and medical assistants (MAs). If any member of this team is found to be negligent, the doctor may be held liable.

For pdfFiller’s FAQs

What is SUPERVISING PHYSICIAN FORM?

The Supervising Physician Form is a document used to designate and report the supervisory relationship between a physician and a healthcare provider such as a physician assistant or nurse practitioner.

Who is required to file SUPERVISING PHYSICIAN FORM?

The form is typically required to be filed by licensed physicians who supervise physician assistants, nurse practitioners, or other healthcare professionals.

How to fill out SUPERVISING PHYSICIAN FORM?

To fill out the form, provide complete and accurate information including the supervising physician's details, the details of the healthcare provider being supervised, and a description of the supervisory relationship.

What is the purpose of SUPERVISING PHYSICIAN FORM?

The purpose of the Supervising Physician Form is to ensure compliance with state regulations regarding supervisory relationships, promote patient safety, and establish a clear framework for oversight.

What information must be reported on SUPERVISING PHYSICIAN FORM?

Information that must be reported includes the supervising physician's name, license number, the healthcare provider's name, their qualifications, the nature of the supervisory duties, and the settings in which the supervision will occur.