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Changing Your Supervisor

Procedure to change your Primary Supervising Physician either within the same practice, at a new practice, or to add an additional Primary Supervising Physician:

 

1.  Print the Change/Additional Primary Supervisor form from the LLR website.
2.  Check the appropriate box on the form and fill it out completely.
3.  Attach a signed copy of your Scope of Practice
4.  Mail to the address on the top of the form.
5.  If the primary supervising physician leaves the practice, the PA must stop working until he/she has written approval from the Board for another physician to serve as his/her supervising physician. An alternate supervising physician may not assume this role without approval from the Board.
6.  When or if you no longer have a working relationship with your initial Primary Supervising Physician, print and fill out the Primary Supervisor Termination Notification form.

 

Procedure to add alternate Physicians:

 

1.  Print the Adding Alternate Physicians Form from the LLR website:

2.  The physician may not begin serving as an alternate supervisor until he/she has received written approval from the Board.


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