Physician Assistant Forms

The Board requires PAs to notify it of certain information prior to beginning active clinical practice, and when certain aspects of their status change. The most frequently used forms are listed below and may be accessed by clicking the appropriate button at right.

Intent to Practice
If you are already licensed with the North Carolina Medical Board as a Physician Assistant, the Intent to Practice form will allow you to do the following:

Please note that the Intent to Practice form is an electronic form that allows you to submit information to the Board via this website. Click the button at right to begin.

Backup Supervising Physician
Licensed physician assistants are required to keep a list of all backup supervising physicians on file at all their practice locations. For your convenience, the NC Medical Board provides a form to assist with this. Click the button at right to download the fomr. Do NOT send this form to the Board.

PA Site Checklist

The Board conducts periodic random site audits to ensure compliance with Board rules regarding supervision of mid-level practitioners. Download the checklist at right for guidance on what the Board expects PAs and their supervisors to have available for review.