Physician Assistant Forms
The Board requires PAs to notify it 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
Physician Assistants may use the Intent to Practice form to:
- Add another primary supervising physician
- Remove a primary supervising physician
- Change home/primary practice address
- Add additional practice site address
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 link at right to download the form. You DO NOT need to 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.