MN PA Delegation Agreement 2009 free printable template

Physician ? Physician Assistant Delegation Agreement (formerly Supervising Agreement) MINNESOTA BOARD OF MEDICAL PRACTICE University Park Plaza ? 2829 University Avenue SE, Suite 500 Minneapolis,

How to fill out MN PA Delegation Agreement

How to fill out MN PA Delegation Agreement

1. Obtain the MN PA Delegation Agreement form from the appropriate state website or authorized agency.
2. Review the instructions provided with the form for any specific requirements or guidelines.
3. Fill out the personal information section, including names, addresses, and credentials of both the delegating physician and the physician assistant.
4. Specify the scope of practice and duties that the physician assistant will be authorized to perform.
5. Include any limitations or conditions related to the delegation of authority.
6. Sign and date the Agreement by both the delegating physician and the physician assistant.
7. Submit the completed Agreement to the designated state board or agency as instructed.

Who needs MN PA Delegation Agreement?

1. Physicians who wish to delegate medical tasks to a physician assistant.
2. Physician assistants who require formal authorization to perform specific medical functions under a physician's supervision.
3. Healthcare facilities that employ physician assistants and require compliance with state regulations.

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What is MN PA Delegation Agreement?

The MN PA Delegation Agreement is a formal document that allows a licensed physician assistant (PA) in Minnesota to practice under the supervision of a delegating physician, outlining the scope of practice and responsibilities.

Who is required to file MN PA Delegation Agreement?

The MN PA Delegation Agreement must be filed by any physician assistant who will be practicing under the supervision of a physician in Minnesota.

How to fill out MN PA Delegation Agreement?

To fill out the MN PA Delegation Agreement, both the supervising physician and the physician assistant must complete the required sections, including details about their credentials, practice setting, and the specific procedures and treatments the PA is authorized to perform.

What is the purpose of MN PA Delegation Agreement?

The purpose of the MN PA Delegation Agreement is to establish the supervisory relationship between the physician and the physician assistant, ensuring clarity regarding the PA's scope of practice and ensuring compliance with state regulations.

What information must be reported on MN PA Delegation Agreement?

The MN PA Delegation Agreement must report the names and licenses of both the physician and physician assistant, the settings in which the PA will be practicing, and specific treatments, procedures, or tasks that the PA is permitted to perform.