PA Reinstatement Information

When making application for reinstatement of your Physician Assistant (including Anesthesia Assistant) license, please utilize the following forms:

Reinstatement of AA/PA Licensure Application- General Information and Checklist

Reinstatement Application Form

FORM A - Affidavit of Applicant

Citizenship Affidavit

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