Applications/registrations - physician assistants

Both a license and registration to a supervising physician are necessary to practice as a physician assistant in Alabama.

Before beginning to complete the forms, you should thoroughly read Board Rules, Chapter 540-X-7, Assistants to Physicians.

The forms provided here may be used for your application.  At present, most are not fillable forms--you will need to print them and fill them out. You can also print this page and use it as a checklist.

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Step 1 - Licensure

The application for a P. A. license contains the following forms:

• ☐ Application for P. A. license (2 pages)
• ☐ Appendix - verification of other state licenses (1 page)
• ☐ Fingerprint cards for criminal background check 
  •     Please note: fingerprint cards must be mailed to you; please request the cards and instructions and provide your mailing address to

A complete license application will contain all of the following:

• ☐ Complete and notarized application and appropriate attachments.
• ☐ Current photograph.
• ☐ Separate response/document(s) for questions answered "yes" and calls for other documentation.
• ☐ Copy of diploma(s) reflecting graduation from approved P. A. training program
• ☐ Copy of current NCCPA certificate or original NCCPA certification of successful completion of the examination.
• ☐ Verification(s) received directly from other state(s) licensed.  P.A. should send form(s) to other state(s)
• ☐ Check for $200 to Alabama Board of Medical Examiners.
  •     (You may combine the licensing fee of $200 and the registration fee of $100 into a single check for $300).
• ☐ Documentation for Criminal History Background Check (ABI-46), including completed fingerprint cards.
  •    Please note: fingerprint cards must be requested and mailed to you; please with your request and mailing address. Instructions for obtaining fingerprints (ABI-46) will be included.
• ☐ Check for $65.00 to AL Board of Medical Examiners for criminal history background check. (Separate check).

Once your application is accepted and approved, you will receive a P. A. license number specific to you.

License renewal information:  P. A. licenses are renewed annually on a calendar year basis. Renewal applications are mailed in the month of October each year to the P. A.’s home address of record. It is the P. A.’s responsibility to notify the Board of Medical Examiners of any address changes. Licenses that are not renewed will become inactive January 1st. If the renewal is inadvertently not renewed, the P. A. is not authorized to practice until the license is reinstated.

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Step 2 - Registration

After receiving a P. A. license, before being approved to practice, a formal work relationship with a supervising physician is established by approved registration to a the physician.

The application for registration of a P. A. to a supervising physician contains the following forms:

• ☐ Application for registration of P. A. (2 pages)
• ☐ Supplemental certificate of hospital/employer (2 pages)
• ☐ P.A. job description (2 pages)
• ☐ Reference info - prescription guidelines for P.A.s (2 pages)
• ☐ Formulary for non-controlled prescribing (2 pages)
• ☐ Covering physician certification (1 page)

A complete application for registration will include:

• ☐ Application for registration (required)
• ☐ P. A. job description (required).
• ☐ Supplemental certificate of hospital/employer (if applicable).
  •     If the P. A. is to be employed by a hospital, clinic or entity that also employs the supervising physician, or the assistant works for one entity and the physician another, the supplemental certificate is required.
• ☐ Approved Formulary (if applicable).
  •     Required if non-controlled prescribing privileges are authorized. Mark “yes” only to those categories which are generally used in the physician’s particular specialty. A request for others not listed on the formulary must be accompanied by written explanation from the physician. Not required for recent graduates seeking or currently having a temporary license as they are not eligible for prescriptive privileges.
    Note: controlled prescribing privileges are granted through a QACSC application that must be requested separately after licensure and registration are complete.
• ☐ Model “covering physician” letter (if applicable). It is not required to have a covering physician, but if there is none, the P. A. may only practice when the supervising physician is readily available.
• ☐ A check for $100 payable to the Alabama Board of Medical Examiners.
  •     (You may combine the licensing fee of $200 and the registration fee of $100 into a single check for $300).

An initial P. A. license and registration may be obtained at the same time. While licensing is a “one time thing,” registration is required for each new professional relationship.

Click here for agenda deadline schedules

To place a license or registration application on the Board’s agenda, a completed document must be received by the cut-off date. Results of Board actions are generally mailed the day following the meeting.