052-5 Wyo. Code R. § 5-6 - [Effective 4/4/2024] License required, application, and supervision agreement
(a) No person may practice as a physician
assistant or represent that he or she is a physician assistant without a
license granted by the board.
(b)
An application form, provided or approved in advance by the board, must be
submitted to the advisory council and board. The application form must be
complete in everydetail. For an application to be deemed complete and be
considered, the following items must be received in the board office not less
than 15 business days prior to the licensure interview date, should an
interview be required of the applicant, or the supervising physician or
supervising physician assistant, if one is required pursuant to
W.S.
33-26-504(c):
(i) The application form, complete in every
detail and properly executed by the applicant;
(ii) The required fee, as set forth in
Section 12 of this
chapter;
(iii) Three (3) original
references, submitted on a form approved by the board. A minimum of two (2)
references must be from physicians with whom the applicant has practiced; the
third reference may be from a physician or PA-C with whom the applicant has
practiced. References from physicians or physician assistants with whom the
applicant has a current or prospective financial, business or family
relationship are not acceptable;
(iv) Proof of legal presence in the United
States, pursuant to 8 U.S.C.
1621, on a form approved or prescribed by the
Board;
(c) If a
supervising physician or supervising physician assistant is required pursuant
to W.S.
33-26-504(c), a supervising
agreement form, provided by the Board, must be submitted to the advisory
council and the board by the supervising physician or supervising physician
assistant. This form shall include, at a minimum:
(i) The supervising physician's or
supervising physician assistant's name, degree, license number, medical
specialty (if any), and medical practice address and telephone
number;
(ii) A detailed description
of the medical practice and the duties of the physician assistant under the
supervising physician's or supervising physician assistant's scope of practice,
as well as the method(s) of supervision (e.g., over-the-shoulder, same office
suite, radio, telephone, video, etc.) the supervising physician or supervising
physician assistant will utilize.
Notes
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No prior version found.