20 CSR 2150-7.122
Collaborative Practice Arrangements, Name and Address Change Requirements, Retirement Affidavits
PURPOSE: This rule provides the requirements and time frames
licensees must follow in reporting a change in collaboration,
name and/or address change, or to document retirement from
practice.
(1) Licensed physician assistants who have a change in a
collaborative practice arrangement, for any reason, must
submit written notification and the required form to the board
within fifteen (15) days of such occurrence.
(2) Licensed physician assistants must submit written
notification of any address change to the board within fifteen
(15) days of such occurrence.
(3) Licensed physician assistants whose names have changed
since licensure was issued must submit a copy of the legal
document verifying the name change to the board, within
fifteen (15) days of such occurrence.
(4) Licensed physician assistants who retire from practice as a
physician assistant shall file an affidavit, on a form furnished
by the board, stating the date of retirement. The licensee shall
submit any other documentation requested by the board to
verify retirement. Licensees who reengage in practice as a
physician assistant after submitting an affidavit of retirement
shall reapply for licensure as required in sections 334.735 and
334.738, RSMo and pursuant to the provisions of rule 20 CSR
2150-7.125.
AUTHORITY: sections 334.125, 334.738, and 334.743, RSMo 2016,
and section 334.735, RSMo Supp. 2021.* This rule originally filed
as 4 CSR 150-7.122. Original rule filed Jan. 3, 1997, effective July 30,
1997. Amended: Filed July 25, 2000, effective Dec. 30, 2000. Moved
to 20 CSR 2150-7.122, effective Aug. 28, 2006. Amended: Filed Dec.
14, 2007, effective June 30, 2008. ** Amended: Filed Nov. 9, 2021,
effective June 30, 2022.
*Original authority: 334.125, RSMo 1959, amended 1993, 1995, 2014; 334.735, RSMo
1989, amended 1996, 1997, 1998, 2005, 2007, 2008, 2009, 2010, 2013, 2014, 2017, 2018,
2019; 334.738, RSMo 1989, amended 1998; and 334.743, RSMo 1989, amended 1993,
1995, 1998.
**Pursuant to Executive Order 21-07, 20 CSR 2150-7.122, section (4) was suspended from April 3,
2020 through April 23, 2021.