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PHYSICIAN ASSISTANT SUPERVISION AGREEMENT APPLICATION *For Health Care Facility Practice Only* Mail application to: State Medical Board of Ohio 30 East Broad Street, 3rd Floor Columbus, Ohio 43215 Supervising
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01
Read the instructions provided with the supervision agreement application form.
02
Gather all the necessary documents and information required to fill out the application.
03
Start by providing your personal details such as name, address, contact information, etc.
04
Next, fill in the details of the supervising entity or individual, including their contact information.
05
Carefully review the terms and conditions of the agreement and make sure you understand them.
06
Provide any additional information or supporting documents as requested in the application form.
07
Sign and date the supervision agreement application form.
08
Submit the completed application form along with all the required documents to the appropriate authority.
09
Keep a copy of the filled-out application form and the supporting documents for your records.

Who needs supervision agreement application for?

01
Individuals who are seeking supervision for a particular activity or profession.
02
Professionals who require supervision as part of their licensing or certification process.
03
Organizations or entities that need to establish a formal agreement for supervision.
04
Students or interns who are undergoing a supervised training program.
05
Any individual or group that has a legal or professional obligation to engage in supervision.
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The supervision agreement application is for requesting approval for supervisory arrangements.
Individuals or entities seeking supervision must file a supervision agreement application.
To fill out the supervision agreement application, you must provide all required information accurately and completely.
The purpose of the supervision agreement application is to ensure that supervisory arrangements meet regulatory requirements.
Information such as the names of the parties involved, the scope of supervision, and any relevant agreements must be reported on the supervision agreement application.
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