9. NOTIFICATION OF CHANGE IN OR ADDITION OF SUPERVISING PHYSICIAN
A physician assistant licensed by this Board, upon changing supervising physicians or adding an additional supervising physician, must notify the Board. Such notification shall include:
A. the name, business address, and telephone number of the new or additional supervising physician(s), and/or physicians licensed by the Board of Osteopathic Licensure.
B. the name, business address, and telephone number of the physician assistant; and
C. at least one of the following:
1. a statement from each new or additional supervising physician and/or physician licensed by the Board of Osteopathic Licensure who is permitted under rules promulgated by that Board to provide secondary supervision to physician assistants agreeing to provide supervision as defined in Section 1;
2. if a physician assistant is to be employed by or a principal in an organized health care delivery system facility, a statement from the organized health care delivery system facility certifying employment as long as a physician in the organized health care delivery system facility has been approved as a primary supervising physician; or
3. if a physician assistant is to be employed by or practice in a group practice, a statement from the primary supervising physician in the group practice agreeing to provide supervision as defined in Section 1, and which includes signatures and license numbers of all physicians in the group practice to whom supervisory responsibilities may be delegated who agree to accept such delegation as secondary supervising physicians.
A physician assistant will notify the Board of any changes or additions in supervising physicians no later than 14 days after the effective date of the change or addition, but the statement of the primary or secondary supervising physician or the certification of employment by the organized health care delivery system facility must be executed by the physician or an organized health care delivery system prior to the physician assistant's initiation of practice.
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