PA Initial, Add/Change and Reinstatement Licensure Application Information
The following documents are required when applying for initial licensure as a Physician Assistant (including Anesthesia Assistants) in the State of Georgia:
GENERAL INFORMATION & CHECKLIST
NEW PA/AA GRADUATE LICENSURE APPLICATION INFORMATION
New
Grad Information and Checklist Document
FORM
A - Affidavit of Applicant
FORM
B - Request for Additional Duties
FORM
D - Primary Care Reference
FORM
E - Anesthesia Basic Job Description
FORM
F - Primary Care Basic Job Description
FORM
I - Verification of Other State License
FORM
K - Certificate of Education
PRIOR PA/AA LICENSEE (ANY STATE) LICENSURE APPLICATION INFORMATION
PRIOR
PA/AA INFORMATION AND CHECKLIST DOCUMENT
PRIOR PA/AA LICENSURE APPLICATION FORM
FORM
A - AFFIDAVIT OF APPLICANT
FORM
B - REQUEST FOR ADDITIONAL DUTIES
FORM
C - ANESTHESIA REFERENCE FORM
FORM
D - PRIMARY CARE REFERENCE FORM
FORM
E - ANESTHESIA JOB DESCRIPTION
FORM
F - PRIMARY CARE JOB DESCRIPTION
FORM
I - VERIFICATION OF LICENSURE
FORM
K - CERTIFICATE OF EDUCATION
ADD/CHANGE OF PRIMARY SUPERVISING MD
ADD/CHANGE
INFORMATION AND CHECKLIST DOCUMENT
FORM
AC1 - ADDING AN ALTERNATE
FORM B - REQUEST FOR ADDITIONAL DUTIES
FORM E - ANESTHESIA JOB DESCRIPTION
FORM F - PRIMARY CARE JOB DESCRIPTION
FORM
H - SEPARATION NOTIFICATION
PHYSICIAN ASSISTANT REINSTATMENT LICENSURE APPLICATION INFORMATION
Physician
Assistant Reinstatement Checklist
Physician Assistant Reinstatement Application
FORM
A - Affidavit of Applicant
FORM
A2 - Affidavit of Citizenship Status
FORM
B - Request for Additional Duties
FORM
D - Primary Care Reference
FORM
E - Anesthesia Basic Job Description
FORM
F - Primary Care Basic Job Description
FORM
I - Verification of Other State License