Get Notice Of Termination Of Plan Of Supervision - Maine.gov

The Notice Of Termination Of Plan Of Supervision is a crucial document that must be completed and submitted to the appropriate licensing boards. This guide will help you understand each component of the form and provide step-by-step instructions for successfully filling it out online.

Follow the steps to complete your form accurately and efficiently.

1. Click the ‘Get Form’ button to access the form and open it in the editor.
2. In the first section, you will need to provide the name and license number of the Physician Assistant. Ensure that you print this information clearly.
3. Next, enter the name and license number of the Supervising Physician. As with the previous field, accuracy and clarity are key.
4. Specify the date on which the Plan of Supervision was terminated. This is important for accurate record-keeping.
5. The designated Physician Assistant or Supervising Physician must sign the document in the signature field located at the bottom of the form.
6. Include the date next to the signature to confirm when the document was signed.
7. Once you have filled out all required fields, review the form for accuracy. After confirming all information is correct, you can choose to save your changes, download the form, print it, or share it according to your needs.
8. Remember to submit the completed form to the Maine Board of Osteopathic Licensure or the Maine Board of Licensure in Medicine via mail or fax as instructed at the bottom of the form.

Complete your Notice Of Termination Of Plan Of Supervision online today to ensure compliance and avoid any potential citations.