INSTRUCTIONS: ALABAMA APPLICATION FOR REGISTRATION OF PHYSICIAN ASSISTANT

To register a physician assistant in Alabama, use the application discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Application For Registration Of Physician Assistant Step 1: The first page should be completed by the physician. On the first blank line, the physician should enter their name in full.

Alabama Application For Registration Of Physician Assistant Step 2: On the second blank line, the physician should enter their Alabama medical license number.

Alabama Application For Registration Of Physician Assistant Step 3: On the third blank line, the physician should enter their date of birth.

Alabama Application For Registration Of Physician Assistant Step 4: On the fourth blank line, the physician should enter their Social Security number.

Alabama Application For Registration Of Physician Assistant Step 5: On the fifth blank line, the physician should enter their medical specialty.

Alabama Application For Registration Of Physician Assistant Step 6: The physician should indicate whether they are board certified or board eligible by circling "Yes" or "No" as appropriate.

Alabama Application For Registration Of Physician Assistant Step 7: On the sixth blank line, the physician should enter their principal practice location address. If their mailing address is different, they should enter it on the seventh blank line.

Alabama Application For Registration Of Physician Assistant Step 8: On the eighth and and ninth blank line, the physician should enter their telephone and fax numbers.

Alabama Application For Registration Of Physician Assistant Step 9: In section 1, the physician should provide the name, practice site address and designated working hours per week of each physician assistant and/or CRNP and/or CNM currently registered to them.

Alabama Application For Registration Of Physician Assistant Step 10: In section 2, the physician should indicate with a check mark whether they have ever had a physician assistant certified or registered to them by the Alabama Board of Medical Examiners. In section 3, the physician should indicate with a check mark whether the physician assistant for whom registration is sought is employed by them, their group, partnership or professional corporation. They should sign and date the bottom of the page.

Alabama Application For Registration Of Physician Assistant Step 11: Complete the second page as instructed.