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How to fill out the Notice Of Termination Of Supervision And/or Delegated Authority online
Completing the Notice Of Termination Of Supervision And/or Delegated Authority is essential for physician assistants who are no longer under the supervision of a designated supervising physician. This guide provides clear, step-by-step instructions to help you effectively fill out this important form online.
Follow the steps to complete your termination notice accurately.
- Click the 'Get Form' button to access the form and open it in the form editor.
- Begin by filling in the physician assistant's name and license number in the designated fields. Ensure all information is accurate and legible.
- Next, provide the primary supervising physician's name and license number. This information is crucial as it identifies the supervising physician responsible for the oversight.
- Complete the section with the name and address of the hospital or facility where the supervising physician practices. Include the full street address, city, state, and zip code.
- Enter the business telephone number and fax number of the primary supervising physician, including the area code for both.
- Indicate the date when the primary supervisory control was terminated. This date is vital for compliance and must be entered accurately.
- The primary supervising physician must sign the form to validate the termination notice. Make sure they provide their signature in the designated space.
- If applicable, complete the Notification of Termination of Delegated Prescriptive Authority section to officially terminate any delegated authority. Check the appropriate boxes for legend drugs and controlled substances.
- Enter the date of termination of prescriptive authority, if applicable. This should correspond to the termination of supervision.
- Lastly, obtain the signature of the delegating physician for the termination of the delegated prescriptive authority. This is important for legal compliance.
- Once all sections are completed and verified for accuracy, save any changes made to the form. You can then download, print, or share the completed form as necessary.
Complete your Notice Of Termination Of Supervision And/or Delegated Authority online today.
Rule 1631 E in Pennsylvania pertains to the procedures for managing the Notice Of Termination Of Supervision And/or Delegated Authority. It ensures that all actions taken respect the established legal guidelines, protecting both individuals and the justice system. Familiarizing yourself with this rule can be crucial for effectively navigating legal proceedings related to supervision and authority.
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