Loading
Get Wa Doh 656-127 2015-2026
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the WA DOH 656-127 online
Filling out the WA DOH 656-127 form is essential for establishing a physician assistant delegation agreement in Washington State. This guide offers comprehensive and clear instructions to assist users in correctly completing the form online.
Follow the steps to successfully complete the WA DOH 656-127 form.
- Click the ‘Get Form’ button to access the WA DOH 656-127 form online.
- Select your certification status by checking either the 'Certified' or 'Non-Certified' option. This section reflects whether you have passed the NCCPA examination.
- Fill in the Physician Assistant Data section. Enter your name, license number, NCCPA certification number, state, zip code, primary business address, city, email address, and contact phone number (10 digit).
- Complete the Primary Supervising Physician Data (MD Only) section. Provide the physician's name, license number, specialty, state, zip code, primary business address, city, email address, and phone number.
- If applicable, provide details for the Alternate Supervising Physician Data section by entering their name, license number, specialty, state, zip code, primary business address, city, email address, and phone number.
- Complete the Physician Group section by entering the business name, primary business address, city, state, zip code, contact name, contact phone number, contact email address, and medical staff office phone number.
- Describe the practice settings where the physician assistant will be working, marking all that apply. Include the percentage of time or hours spent in each setting.
- Provide a description of the general duties the physician assistant will perform in each of the selected practice settings.
- Detail the plan for the supervision of the physician assistant, including methods like face-to-face discussions, chart reviews, or performance evaluations.
- Indicate whether there will be a designated alternate MD supervising during periods of the primary MD's absence, ensuring clarity on supervision continuity.
- List any current physician assistants sponsored by the supervising physician, as well as any current delegation agreements with other MDs.
- After all sections are completed, ensure that both the supervising physician and the physician assistant provide their signatures and dates in the certification of the document section.
- Once completed, save the document, and you have options to download, print, or share the form as necessary.
Complete your WA DOH 656-127 form online today for efficient processing.
Writing a collaborative practice agreement involves outlining roles, scope of practice, and parameters for care delivery between the physician and the physician assistant. It should reference relevant regulations, such as WA DOH 656-127, to ensure compliance. Platforms like uslegalforms can provide templates and guidance to help you create a clear, effective agreement.