Clinical Practice and Prescription Guidelines Date: Physician Assistant Name: Board Registered and Approved Supervising Physicians: 1) Primary Supervising Physician 2) Primary Supervising Physician 3) Primary Supervising Physician 1) Locum Tenens Physician 2) Locum Tenens Physician 3) Locum Tenens Physician Type of clinical/hospital practice: Clinical Guidelines: 1) Practice location(s): (List all locations where the PA will be working. A copy of this guideline must be kept on file at each location.) 2) List SP delegation/approval of medical procedures/duties to be performed by the PA that are indentified as core competencies by the National Commission on Certification of Physician assistants under general supervision per section 1503.A. (i.e. Scope of Practice, which the delegation of medical tasks and authority must be appropriate to the PA’s level of competency) Procedures/Activities Requires SP Requires prior consultation with SP presence (Check if applicable) (Check If applicable) H&P Ordering of Radiological Studies Ordering of Lab Assessments
Clinical Practice and Prescription Guidelines Date: Physician Assistant Name: Board Registered and Approved Supervising Physicians: 1) Primary Supervising Physician 2) Primary Supervising Physician 3) Primary Supervising Physician 1) Locum Tenens Physician 2) Locum Tenens Physician 3) Locum Tenens Physician Type of clinical/hospital practice: Clinical Guidelines: 1) Practice location(s): (List all locations where the PA will be working. A copy of this guideline must be kept on file at each location.) 2) List SP delegation/approval of medical procedures/duties to be performed by the PA that are indentified as core competencies by the National Commission on Certification of Physician assistants under general supervision per section 1503.A. (i.e. Scope of Practice, which the delegation of medical tasks and authority must be appropriate to the PA’s level of competency) Procedures/Activities Requires SP presence (Check If applicable) Requires prior consultation with SP (Check if applicable) H&P Ordering of Radiological Studies Ordering of Lab Assessments
PA%20Clinical%20Practice%20and%20Prescription%20Guidelines%20%206%2020%202017.docx