Both a license and registration to a supervising physician are necessary to practice as a physician assistant in Alabama.
An initial P.A. license and registration may be obtained at the same time. While licensing is a "one time thing," registration is required for each new professional relationship.
Before beginning to complete the forms, you should thoroughly read Board Rules, Chapter 540-X-7, Assistants to Physicians.
The forms provided here may be used for your application. The forms are fillable, but must be printed for original signatures and notarization where applicable. No copies will be accepted. You can print this page and use it as a checklist.
You should keep a copy for your records of all applications submitted
NOTE: you may need to refresh the page (F5) to see the latest forms
Step 1 - Licensure
The application for a P. A. license contains the following forms:
- ☐ Application for P. A. license (3 pages)
- ☐ Appendix - verification of other state licenses (1 page)
- ☐ Fingerprint cards for criminal background check
- Please note: fingerprint cards must be mailed to you; please request the cards and instructions and provide your mailing address to
A complete license application will contain all of the following:
- ☐ Complete and notarized application and appropriate attachments.
- ☐ Current color photograph.
- ☐ Separate response/document(s) for questions answered "yes" and calls for other documentation.
- ☐ Copy of diploma(s) reflecting graduation from approved P. A. training program
- ☐ Copy of current NCCPA certificate or original NCCPA certification of successful completion of the examination.
- ☐ Declaration of Citizenship with supporting document
- ☐ Verification(s) received directly from other state(s) licensed. P.A. should send form(s) to other state(s)
- ☐ Check for $200 to Alabama Board of Medical Examiners.
- ☐ Documentation for Criminal History Background Check (ABI-46), including completed
- Please note: fingerprint cards must be requested and mailed to you; please email the with your request and mailing address. Instructions for obtaining fingerprints (ABI-46) will be included.
- ☐ Check for $65.00 to AL Board of Medical Examiners for criminal history background check. (Separate check).
Once your application is accepted and approved, you will receive a P. A. license number specific to you.
License renewal information: P. A. licenses are renewed annually on a calendar year basis. Renewal reminder postcards are mailed in the month of October each year to the P. A.’s home address of record. It is the P. A.’s responsibility to notify the Board of Medical Examiners of any address changes. Licenses that are not renewed will become inactive January 1st. If the renewal is inadvertently not renewed, the P. A. is not authorized to practice until the license is reinstated.
Step 2 - Registration
Before being approved to practice, a formal work relationship with a supervising physician is established by approved registration to a physician.
The application for registration of a P. A. to a supervising physician contains the following forms:
- ☐ Application for registration of P. A. (2 pages)
- ☐ Supplemental certificate of hospital/employer (if applicable) (2 pages)
- ☐ P.A. job description (4 pages)
- ☐ Reference info - prescription guidelines for P.A.s (for physician/P.A. to keep) (2 pages)
- ☐ Formulary for non-controlled prescribing (2 pages)
- ☐ Covering physician certification (1 page)
A complete application for registration will include:
- ☐ Application for registration (required)
- ☐ P. A. job description (required).
- ☐ Supplemental certificate of hospital/employer (if applicable).
- If the P. A. is to be employed by a hospital, clinic or entity that also employs the supervising physician, or the assistant works for one entity and the physician another, the supplemental certificate is required.
- ☐ Approved Formulary (if applicable).
- Required if non-controlled prescribing privileges
are authorized. Mark “yes” only to those categories which are generally used in
the physician’s particular specialty. A request for others not listed on the formulary
must be accompanied by written explanation from the physician. Not required for recent
graduates seeking or currently having a temporary license as they are not eligible for
Note: controlled prescribing privileges are granted through a QACSC application after licensure and registration are complete. There are certain criteria that must be met before applying for a QACSC. Please see Board Rules Chapter 540-X-12 for the Board's Administrative Rules concerning QACSCs for P.A.s.
- Required if non-controlled prescribing privileges are authorized. Mark “yes” only to those categories which are generally used in the physician’s particular specialty. A request for others not listed on the formulary must be accompanied by written explanation from the physician. Not required for recent graduates seeking or currently having a temporary license as they are not eligible for prescriptive privileges.
- ☐ Model “covering physician” letter (if applicable). It is not required to have a covering physician, but if there is none, the P. A. may only practice when the supervising physician is readily available.
- ☐ A check for $100 payable to the Alabama Board of Medical Examiners.
An initial P. A. license and registration may be obtained at the same time. While licensing is a “one time thing,” registration is required for each new professional relationship.
A license or registration application will not be placed on the agenda until the application is fully complete by the cut off date, including receipt by the Board of all supporting documentation.
Note: Please be reminded that waiting to receive information from other agencies can cause delays in a licensure application being placed on the Board's agenda, i.e., license verification from other states, criminal background results.
Termination of registration
- The physician assistant and the physician are responsible for informing the Board of the effective date of the termination of employment and the reasons for such termination.
- Failure to notify the Board of termination may be considered by the Board as a violation of Board rules for the purpose of approval of future applications for registration.
- Termination must be in writing and can be accomplished using the
online P. A. registration termination form.
All rights reserved