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PHYSICIAN EXTENDER APPLICATION
An Independent Licensee of the Blue Cross and Blue Shield AssociationInstructions: Please PRINT or TYPE a response for each question. Please attach the copies of the
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What is physician extender application?
Physician extender application is a form that allows healthcare professionals, such as nurse practitioners and physician assistants, to apply for permission to work with supervising physicians.
Who is required to file physician extender application?
Healthcare professionals, such as nurse practitioners and physician assistants, who wish to work under the supervision of a physician are required to file physician extender application.
How to fill out physician extender application?
To fill out physician extender application, healthcare professionals need to provide personal information, education background, work experience, and details about their supervising physician.
What is the purpose of physician extender application?
The purpose of physician extender application is to ensure that healthcare professionals working under the supervision of a physician meet the necessary qualifications and are approved to practice.
What information must be reported on physician extender application?
Information such as personal details, education background, work experience, and details of supervising physician must be reported on physician extender application.
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