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MARYLAND BOARD OF PHYSICIANS P.O. BOX 2571 Baltimore, MD 21215 410-764-4775 www.mbp.state.md.us DESIGNATED ALTERNATE SUPERVISING PHYSICIAN FOR ATHLETIC TRAINERS Instructions and Important information: ?

How to fill out alternate supervising physician designation

How to fill out alternate supervising physician designation:

1. Obtain the necessary forms: To fill out the alternate supervising physician designation, you will need to obtain the specific forms provided by your institution or regulatory body. These forms can usually be found on their website or requested through their administrative offices.
2. Fill in your personal information: Begin by filling in your personal information such as your name, contact details, and any identification numbers that may be required. This will ensure that the form is correctly associated with you as the requesting physician.
3. Provide details about your primary supervising physician: In this section, you will need to provide information about your primary supervising physician. Include their name, contact details, and any relevant identification or license numbers. This section is crucial as it establishes the existing supervisory relationship.
4. Identify the physician designated as an alternate: In this section, you need to clearly state the name, contact details, and relevant identification or license numbers of the physician you are designating as an alternate supervising physician. It is important to choose someone who is qualified and willing to assume this role when needed.
5. Specify the circumstances for alternate supervision: State the circumstances under which the alternate supervising physician would step in and provide supervision in your absence. This could include situations such as vacation, illness, or any other specified periods of leave. Be as clear and specific as possible to avoid any confusion.
6. Sign and date the form: Once you have completed all the required sections, carefully review the form for accuracy and completeness. Sign and date the form where indicated, certifying that the information provided is true and accurate to the best of your knowledge.
7. Submit the form: After completing the form, submit it as per the instructions provided by your institution or regulatory body. This may involve mailing it, submitting it online, or delivering it in person. Make sure to follow the designated submission process to ensure that your request is processed efficiently.

Who needs alternate supervising physician designation?

1. Physicians in training: Physicians who are still undergoing training, such as residents or fellows, often require alternate supervising physician designation. This is because they may need temporary supervision or guidance in the absence of their primary supervising physician.
2. Physicians with planned absences: Physicians who know in advance that they will be absent from their regular duties, such as for vacation, medical leave, or conferences, may need an alternate supervising physician designated. This ensures that patient care and supervision can continue seamlessly during their absence.
3. Urgent situations: Even physicians who do not foresee any planned absences may benefit from having an alternate supervising physician designated in case of unexpected emergencies or urgent situations. This allows for continuity of patient care and supervision in unforeseen circumstances.

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