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Physician Assistant Documentation Checklist

 

In addition to the online application, the following list is provided to help applicants ensure they have submitted all the forms necessary for their application to be processes.  Note: The list is general and should in no way be considered a complete list for any one individual applicant. 

It is advisable that all documentation be collected and submited in one packet; however, the Board realizes that some examination entities and state licensing boards will not send the documents to applicants,but will send them directly to the Board.


Applicants (excluding Relicensure and Reissuance) must submit the following:

  • Proof of Identify.  Copy of birth certificate or passport.

  • Dean's Certification (Form D). This form can be found by clicking the Supplemental Forms link to the left and selecting Licensing Forms PA.

    Request that each PA school you attended submit both of these forms to you in a sealed envelope with a signature of a PA school official across the outside envelope flap. Do not open this envelope. Send the unopened envelope to the Texas Physician Assistant Board.
  • Form L-PA/AC Physician Assistant Licensure Evaluation. You must have every supervising physician that you worked for, no matter the location, for the past 5 years fill out Form L-PA/AC. New graduates must have the PA Program Director complete this form. The Program Director or supervising physician should complete the form and return it to you in a sealed envelope with their signature across the outside envelope flap. Do not open this envelope. Send the unopened envelope to the Texas Physician Assistant Board.

  • National Practitioner Data Bank/Health Integrity Data Bank Self-Query Response.  Contact the National Practitioner Data Bank (NPDB)/Healthcare Integrity and Protection Databank (HIPDB) at http://www.npdb-hipdb.hrsa.gov and perform a self-query. Send either of the following to the TMB: (a) a copy of the paper self-query response mailed to you by HIPDB/NPDB; or, (b) a print out of the electronic version of the self-query response.

  • Documentation of NCCPA Examination Attempts. Use the NCCPA Attempt Request Form to request this information be sent to the Texas Physician Assistant Board.
  • Alternate Name.  If you have recorded an alternate name on your application you are required to submit copies of documents that will support the name change. Those documents could be a marriage certificate, divorce decree, court ordered name change, or some other official document.
  • Passing Jurisprudence (JP) Exam Score. The JP scores are sent directly to the Board by the vendor. For more information on the JP Exam use the link to the left.

  • Active Practice as a PA. All physician assistant applicants shall provide sufficient documentation to the board that the applicant has, on a full-time basis, actively practiced as a physician assistant, has been a student at an acceptable approved physician assistant program or has been on the active teaching faculty of an acceptable approved physician assistant program, within either of the last two years preceding receipt of an application for licensure. The term "full-time basis," for purposes of this section, shall mean at least 20 hours per week for 40 weeks duration during a given year.
  • DD 214.  Copy indicating the type of discharge, if applicable.
  • Fingerprints.  Physician Assistant licensure applicants are required to submit their Fingerprints for state and national criminal history background checks.  Fingerprinting services are provided by MorphoTrust USA for a fee of $41.45, payable directly to MorphoTrust USA.  Results of the fingerprinting will be sent directly to TMB both from the Texas Department of Public Safety Criminal Records and the Federal Bureau of Investigation.

Return to Active Status

If you wish to return to active status from Inactive status you may do so by:

  • submitting the licensure application and fee,

  • complying with the requirements for license renewal,

  • providing current verifications from each state in which you hold a license,

  • demonstrating current certification by NCCPA,

  • submitting evaluation Form L from each employment held after your Texas PA license was placed on inactive status, and

  • providing sufficient documentation that you have, on a full-time basis(20 hours a week for at least 40 weeks), actively practiced as a physician assistant or have been on the active teaching faculty of an acceptable approved physician assistant program, within either of the two years preceding receipt of an application for reactivation.

Relicensure Applicants

If your license has been canceled for non-payment or by request, you are required to meet current statutory requirements and board rules. Submit documentation of anything that is new or has changed since you were originally licensed, as well as documentation that is non-static, such as state board verifications.

Reissuance Applicants

If your license has been revoked by the board, you are required to meet current statutory requirements and board rules. In addition, you must furnish documentation that the reissuance of your license is in your best interest and in the best interest of the public. Submit documentation of anything that is new or has changed since you were originally licensed, as well as documentation that is non-static, such as state board verifications.