Report a change or addition in supervising physician or work setting

Notify the Board of Registration of Physician Assistants of all information related to your supervising physician.
Send a form within 30 days of beginning employment or any change in your supervising physician or work setting.

Board of Registration of Physician Assistants

The Details of Report a change or addition in supervising physician or work setting

What you need for Report a change or addition in supervising physician or work setting

Notify the Board all information related to your supervising physician and work setting if you are a licensed Physician Assistant or temporary certificate holder in Massachusetts.

You may complete a report form to:

  • Add an initial or additional supervising physician
  • Replace your current supervising physician
  • Terminate a supervising physician
  • Change your work setting information

How to report Report a change or addition in supervising physician or work setting

Mail your completed and signed Supervising Physician and Work Setting Information Form to:

MA Board of Registration of Physician Assistants
239 Causeway St.
Suite 500
5th Floor
Boston, MA 02114

Please keep a copy for your records.

Downloads for Report a change or addition in supervising physician or work setting

Contact for Report a change or addition in supervising physician or work setting

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