Information for Physician Assistants: Completing the Supervision Data Form

Posted in Latest News on March 6, 2014.

Florida law requires Physician Assistants (PAs) to notify the Board in writing within 30 days after employment, or after any subsequent change in the supervising physician. This means when a PA begins employment, ends employment and when there are changes to the supervising physician (adding one or deleting one). PAs can be disciplined for failing to perform this legal obligation.

Notification should be completed by using the Supervision Data Form, Form DH-MQA 2004, which is available on the web page at , under the Resources tab. Florida law requires specific information be provided when notifying the Board about changes in employment and/or supervising physicians. The required information includes the supervising physician’s full name, Florida medical license number, specialty and the supervising physician’s address.

A common error that occurs when completing the Supervision Data Form is failure to complete the form in its entirety. Specifically, the complete beginning and ending dates of employment must be provided – the month, date and year.

A physician may delegate only those tasks and procedures to the PA that are within the supervising physician’s scope of practice, and are tasks and procedures which the supervising physician is qualified by training and experience to perform. The decision to permit a PA to perform a task or procedure, whether under direct or indirect supervision, is based on the patient and the PA’s knowledge and skills in performing said tasks and procedures. Rule 64B8-30.012, Florida Administrative Code lists duties that cannot be delegated to a PA unless expressly permitted by statute. The rule also lists duties that are not to be performed under indirect supervision. All tasks and procedures performed by a PA must be documented in the patient’s medical record.

In the event of an emergency, the PA can act in accordance with his/her training and knowledge to maintain life support until a physician assumes responsibility for the patient.

Pertinent laws:
s. 458.347, Florida Statutes – Physician Assistants

Pertinent rules:
Rule 64B8-30.003, Florida Administrative Code – Physician Assistant Licensure
Rule 64B8-30.012, Florida Administrative Code – Physician Assistant Performance

For more information, please visit the Board’s web site at Also find the Board on its newly created Twitter account – @FLBoardofMED.

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