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Official Use Onstage of Utah Department of CommerceNumber: Date Approved/Denied: Approved/Denied By:Division of Occupational and Professional LicensingPHYSICIAN ASSISTANT DELEGATION OF SERVICES AGREEMENT A
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Obtain the necessary forms and documents required for physician assistant delegation.
02
Read and understand the instructions provided with the forms.
03
Fill out the personal information section accurately, including name, contact information, and relevant identification details.
04
Provide details about your current employment or practice, including the name of the healthcare organization or institution you work for.
05
Indicate the type of physician assistant delegation you are applying for, such as full-time, part-time, temporary, or permanent delegation.
06
Provide information about your education and qualifications as a physician assistant, including documentation of your degree and any specialized training or certifications you have received.
07
Fill out the sections regarding your work experience, including the dates of employment, job responsibilities, and the name and contact information of your supervising physician.
08
Provide any additional required information or documentation as specified in the instructions.
09
Review the completed form for accuracy and make any necessary corrections.
10
Submit the completed form and all required documents to the appropriate authority or governing body for physician assistant delegation.
11
Follow up with the authority or governing body to confirm receipt of your application and to check the status of your delegation request.
12
Once approved, carefully review the delegation agreement and any associated responsibilities or conditions.
13
Follow the terms of the delegation agreement and fulfill your responsibilities as a delegated physician assistant.
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Keep a copy of the completed form and any supporting documents for your records and future reference.

Who needs physician assistant - delegation?

01
Physician assistant delegation is needed by healthcare professionals who require supervision and oversight by a licensed physician but have been granted the authority to perform certain medical tasks autonomously.
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This includes physician assistants who have completed the necessary education and training to practice medicine under the supervision of a physician, as well as other healthcare providers who may benefit from delegation in specific circumstances.
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Physician assistant delegation allows healthcare professionals to provide timely and efficient care to patients while still ensuring appropriate oversight and accountability.
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Physician assistant delegation is the process of assigning tasks and responsibilities to a physician assistant by a supervising physician.
The supervising physician is required to file physician assistant delegation.
Physician assistant delegation must be filled out by providing information about the tasks and responsibilities assigned to the physician assistant.
The purpose of physician assistant delegation is to ensure that a physician assistant is working under the supervision and direction of a licensed physician.
The information reported on physician assistant delegation must include the tasks, responsibilities, and supervising physician details.
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