Get Ga Form D Physician Assistant Primary Care Reference Form 2021-2025

Filling out the GA Form D Physician Assistant Primary Care Reference Form is an essential step in the licensure process for physician assistants. This guide will provide you with clear, step-by-step instructions on how to complete the form accurately and efficiently online.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the candidate's details, including their last name, first name, and middle name. Accurate information is critical for proper identification.
3. In the section requiring your evaluation, assess the candidate's competence in primary care practice under various categories: clinical skills, professionalism, quality of patient care, consultation seeking, openness to criticism, and emotional stability. Rate them as above average, average, or below average.
4. Provide details about your professional relationship with the candidate. It is important to include your role (e.g., preceptor, clinical director) to establish credibility.
5. Indicate the length of time you have observed or worked with the candidate by providing dates, if available. This information supports your evaluation.
6. State whether you have any reservations about recommending the candidate for licensure. If you have concerns, please offer an explanation.
7. If you wish to discuss any reservations or concerns further, indicate 'yes' or 'no' and specify the best day and time for contact by Medical Board staff.
8. Finally, remember to add your signature and date to authenticate the form. Provide your contact address, city, state, and phone number to ensure they can reach you for any follow-up.
9. Review your completed form for accuracy before saving your changes. You can then download, print, or share the document as necessary.

Complete your GA Form D Physician Assistant Primary Care Reference Form online today to ensure a smooth licensure process.