Get Ak 08-4226d 2014-2025

The AK 08-4226d form is essential for physician assistants in Alaska to create a collaborative plan with their supervising physician. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the AK 08-4226d form online.

1. Press the ‘Get Form’ button to download the AK 08-4226d form and open it in your preferred editor.
2. Carefully read the instructions at the top of the form, and ensure you complete all required sections legibly. Incomplete plans will not be accepted.
3. Provide the names, addresses, and license numbers for both the physician assistant and the primary collaborating physician in their respective fields.
4. If applicable, indicate the remote site location where the physician assistant will practice, ensuring the location is within the requirements set out in the form.
5. Attach the necessary documents, including a copy of the PA’s current NCCPA certificate, the valid DEA registrations for both the PA and the collaborating physician, and a detailed curriculum vitae if the PA is practicing at a remote site.
6. Ensure to complete the prescriptive authority section by the physician checking the appropriate boxes that apply.
7. Both the physician assistant and the primary collaborating physician must sign and date the form, confirming their agreement to the collaborative plan.
8. Once the form is completed, save it, and prepare it for submission, including a check for the collaborative plan fee.
9. Mail the completed AK 08-4226d form with all attachments to the State Medical Board at the specified address. Retain a complete copy for your practice records.

Complete and file your AK 08-4226d form online to ensure compliance and effective collaboration.