Get Me Uniform Application For Physician Assistant Registration 2018-2025

Completing the ME Uniform Application for Physician Assistant Registration online is a crucial step toward securing your practice in the state of Maine. This guide will provide you with a clear, step-by-step approach to effectively navigate each section of the application.

Follow the steps to accurately complete your application.

1. Click ‘Get Form’ button to access the application and open it in your online document management system.
2. Provide your personal information, including your name, Maine license number, proposed practice name, and address. Ensure that all entries are accurate and updated.
3. Specify your primary supervising physician's name, license type (MD or DO), and their business contact information. It is essential that the supervising physician agrees to the responsibilities outlined in the application.
4. Detail the proposed practice site, including the name, address, city, state, and zip code. Include relevant contact information for the practice.
5. Describe the medical services and procedures that the physician assistant will provide. This description should align with the plan of supervision and reflect the capabilities of the assistant.
6. List any licensed facilities where the physician assistant will provide medical services, including the facility names, addresses, and contact information.
7. Identify covering supervising physicians responsible for supervision during the primary supervising physician's absence. Ensure that these physicians acknowledge their responsibilities.
8. Include the details of any secondary supervising physicians if applicable, along with their specialties and contact information.
9. Outline the processes for evaluating the performance of the physician assistant. This should document regular meetings and assessments to ensure ongoing quality of care.
10. Indicate the prescribing authority for scheduled drugs, if applicable. Specify which schedules the physician assistant is authorized to prescribe.
11. Gather required signatures from the physician assistant, primary supervising physician, and any covering physicians. Ensure all signatories understand the responsibilities and compliance requirements.
12. Once all sections are completed and verified for accuracy, you can save changes, download, print, or share the finished form as needed.

Complete your ME Uniform Application for Physician Assistant Registration online now to ensure timely processing of your application.