As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Medical Office Policy and Procedure Manual includes this customizable template, Delegation of Services Agreement Between Supervising Physician and Physician Assistant. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

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Here is some sample content from Delegation of Services Agreement Between Supervising Physician and Physician Assistant:

	DELEGATION OF SERVICES AGREEMENT BETWEEN SUPERVISING PHYSICIAN AND PHYSICIAN ASSISTANT Physician Assistant Name: graduated from the physician assistant training program, on He/she took or is to take the licensing examination for physician assistants recognized by the State of , e.g., Physician Assistant National Certifying Examination or a specialty examination given by the state of on . He/she was first granted licensure by the Physician Assistant Examining Committee on , unless renewed. Or was granted interim approval by the Physician Assistant Examining Committee on , which expires...
Second excerpt:
	...perform all the tasks set forth in subsections a, d, e, f, and g of Section 1399541 of the Physician Assistant Regulations, when acting under the supervision of the herein named physician. The PA is authorized to perform the following laboratory and screening procedures: The PA is authorized to assist in the performance of the following laboratory and screening procedures: The PA is authorized to perform the following therapeutic procedures: The PA is authorized to assist in the performance...