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Get Wa Doh 656-127 2013
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How to fill out the WA DOH 656-127 online
The WA DOH 656-127 form is essential for establishing a physician assistant delegation agreement in Washington State. This guide will provide clear, step-by-step instructions to help you fill out the form efficiently and accurately online.
Follow the steps to complete your WA DOH 656-127 form online.
- Press the ‘Get Form’ button to access the WA DOH 656-127 and begin the process.
- Select whether you are completing the form as a certified or non-certified physician assistant by marking the corresponding checkbox.
- Provide the required information for the physician assistant data section, including their name, license number, NCCPA certification number, and primary business address details.
- Fill in the supervising physician's information, including their name, license number, specialty, state, zip code, and contact number, as required.
- If applicable, include details for an alternate supervising physician, providing their name, license number, specialty, state, zip code, and contact information.
- List the primary business name and address of the physician group. Ensure the contact name, contact phone number, and email address are filled out accurately.
- Address the responsibilities section by acknowledging the supervision relationship and clarifying the scope of practice for the physician assistant.
- Mark the practice sites where the physician assistant will be working and identify hours spent in each setting.
- Describe the general duties and plan for supervision for each practice setting selected, attaching any additional paper as necessary.
- If the supervising physician is overseeing more than five physician assistants, provide an explanation for this necessity.
- Indicate the designated alternate physician's role when the supervising MD is absent by checking the appropriate box.
- List all physician assistants and supervising physicians currently involved in your practice arrangements.
- Upon completion, ensure all required signatures and dates are included for the physician assistant, supervising physician, and any alternate physician.
- Finally, save your changes, and download, print, or share the completed form as necessary.
Start completing your WA DOH 656-127 form online today for a seamless documentation experience.
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To find your WA PAC code, you can check your previous tax documents relating to your employment or visit the Washington Employment Security Department website. Your PAC code is essential for tax and unemployment insurance reporting. Consider reviewing resources related to WA DOH 656-127 for additional guidance on how to navigate these requirements smoothly.
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