Procedures For Licensure

To become licensed as a physician assistant in Tennessee, a person must comply with the following procedures and requirements: (1) Physician Assistant - Licensure by examination: (a) An application packet shall be requested from the Committee’s administrative office. (b) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and rules to the Committee’s Administrative Office. It is the intent of this rule that activities necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously. (c) An applicant shall submit with his application a signed and notarized passport type photograph taken within the preceding 12 months and the photo must be affixed to the proper page of the application. (d) It is the applicant’s responsibility to request that a graduate transcript, from an education program approved by the C.A.H.E.A., C.A.A.H.E.P. or A.R.C.-P.A., be submitted directly from the program to the Committee’s Administrative Office. The transcript must show that graduation has been completed and carry the official seal of the institution. (e) An applicant shall submit evidence of good moral character. Such evidence shall be two recent (within the preceding 12 months) original letters from medical professionals, attesting to the applicant’s personal character and professional ethics on the signatory’s letterhead. (f) If the applicant intends to immediately commence practice upon licensure he or she must designate a primary supervising physician. Any change in the primary supervising physician must be reported in writing submitted directly to the Committee’s Administrative Office by the physician assistant. (g) An applicant shall disclose the circumstances surrounding any of the following: 1. Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations. 2. The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state. 3. Loss or restriction of licensure/certification. 4. Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of GENERAL RULES GOVERNING THE PRACTICE CHAPTER 1130-01 OF A PHYSICIAN ASSISTANT contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory common or case law. 5. Failure of any licensure or certification examination. (h) An applicant shall cause to be submitted to the Committee’s administrative office directly from the vendor identified in the Committee’s licensure application materials, the result of a criminal background check. (i) If an applicant holds or has ever held a license/certificate to practice any profession in any other state, the applicant shall cause to be submitted the equivalent of a Tennessee Certificate of Endorsement (verification of licensure/certification) from each such licensing board which indicates the applicant holds or held an active license/certificate and whether it is in good standing presently or was at the time it became inactive. (j) An applicant shall submit the Application Fee and State Regulatory Fee as provided in Rule 1130-01-.06. (k) All applicants shall cause to be submitted documentation of successful completion of the examination for licensure as governed by Rule 1130-01-.08 once the exam has been successfully completed. This verification must be submitted by the examining agency directly to the Committee’s Administrative Office. (l) When necessary, all required documents shall be translated into English and such translation and original document certified as to authenticity by the issuing source. Both versions must be submitted. (m) Personal resumes are not acceptable and will not be reviewed. (n) Application review and licensure decisions shall be governed by Rule 1130-01-.07. (o) All documents submitted for qualification of licensure become the property of the State of Tennessee and will not be returned. (p) The application form is not acceptable if any portion has been executed and dated prior to one year before filing with the Committee. As used in this part, application means the application form approved by the Committee and shall include, as appropriate: 1. Attached current, notarized passport photograph; 2. Official transcript from physician assistant training program; 3. Verification of N.C.C.P.A. exam; 4. Two (2) original letters of professional recommendation; 5. Result of a criminal background check; 6. Certificate of completion or diploma from an approved physician assistant program; and 7. Certification/licensure from other state boards. (q) All applications shall be sworn to and signed by the applicant and notarized. GENERAL RULES GOVERNING THE PRACTICE CHAPTER 1130-01 OF A PHYSICIAN ASSISTANT (2) Physician Assistant - Licensure by Reciprocity: (a) An application packet shall be requested from the Committee’s Administrative Office. (b) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and rules to the Committee’s Administrative Office. It is the intent of this rule that activities necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously. (c) An applicant shall submit with his application a signed and notarized passport type photograph taken within the preceding 12 months and the photo must be affixed to the proper page of the application. (d) It is the applicant’s responsibility to request that a graduate transcript, from an education program approved by the C.A.H.E.A., C.A.A.H.E.P. or A.R.C.-P.A., be submitted directly from the program to the Committee’s Administrative Office. The transcript must show that graduation has been completed and carry the official seal of the institution. (e) An applicant shall submit evidence of good moral character. Such evidence shall be two recent (within the preceding 12 months) original letters from medical professionals, attesting to the applicant’s personal character and professional ethics on the signatory’s letterhead. (f) If the applicant intends to immediately commence practice upon licensure he or she must designate a primary supervising physician. Any change in the primary supervising physician must be reported in writing submitted directly to the Committee’s Administrative Office by the physician assistant. (g) An applicant shall disclose the circumstances surrounding any of the following: 1. Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations. 2. The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state. 3. Loss or restriction of licensure/certification. 4. Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory common, or case law. 5. Failure of any licensure or certification examination. (h) An applicant shall cause to be submitted to the Committee’s administrative office directly from the vendor identified in the Committee’s licensure application materials, the result of a criminal background check. (i) If an applicant holds or has ever held a license/certificate to practice any profession in any other state, the applicant shall cause to be submitted the equivalent of a GENERAL RULES GOVERNING THE PRACTICE CHAPTER 1130-01 OF A PHYSICIAN ASSISTANT Tennessee Certificate of Endorsement (verification of licensure/certification) from each such licensing board which indicates the applicant holds or held an active license/certificate and whether it is in good standing presently or was at the time it became inactive. An applicant must hold a current physician assistant license/certificate in a state to apply by reciprocity. (j) An applicant shall submit the Application Fee and State Regulatory Fee as provided in Rule 1130-01-.06. (k) All applicants shall cause to be submitted documentation of successful completion of the examination for licensure as governed by Rule 1130-01-.08. This verification must be submitted by the examining agency directly to the Committee’s Administrative Office. (l) When necessary, all required documents shall be translated into English and such translation and original document certified as to authenticity by the issuing source. Both versions must be submitted. (m) Personal resumes are not acceptable and will not be reviewed. (n) Application review and licensure decisions shall be governed by Rule 1130-01-.07. (o) All documents submitted for qualification of licensure become the property of the State of Tennessee and will not be returned. (p) The application form is not acceptable if any portion has been executed and dated prior to one year before filing with the Committee. As used in this part, application means the application form approved by the Committee and shall include, as appropriate: 1. Attached current, notarized passport photograph; 2. Official transcript from physician assistant training program; 3. Verification of N.C.C.P.A. exam; 4. Two (2) original letters of professional recommendation; 5. Result of a criminal background check; 6. Certificate of completion or Diploma from an approved physician assistant program; and 7. Certification/licensure from other state boards. (q) All applications shall be sworn to and signed by the applicant and notarized. (3) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Committee’s Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).