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NewOnlineProcessforUpdatingTNBMECommitteeonPhysicianAssistants’
Attachment4&5–AuthorizationforPrescribingforPAs
AsofMay2017,the“AuthorizationforPrescribingforPhysicianAssistants”fordocumentingprescribing
formularyandphysiciansupervisionisnownamedthe“PASupervisingPhysicianForm”.
NoLongerAccepted–BoardofMedicalExaminerswillsendbacktoyouifsubmittedafterMay1st
TableofContents
Accessingtheonlinesystem............................2LicenseandRegulatorySystemSign‐in.................3Creatinganonlineaccount.............................4Linkingprofiletolicenses..............................7Matchinglicenseresults...............................7PASupervisoryRequest...............................8 Verifyacurrentphysician.......................12 Addasupervisingphysician.....................13Classdrugselection....................................15Controlleddrugselection...............................16Review&editApplicationsummary....................17Attestation.............................................17Applicationsummarypdf...............................17
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1. NewPhysicianAssistants(PAs)applyingforaTNlicenseandcurrentlylicensedPAsupdatingtheirformularyorsupervisingphysicianinformationwillnowberequiredtousetheonlinesystem.Inpreparationtoupdateyourinformation,haveaccessto:
o adesktopcomputerorlaptop(donotusephonesortablets)o theemailtowhichyouhaverequestedallcorrespondencebesento yourDEAnumbero physician’slicensenumber,ifaddingacollaborating/supervisingphysician
Tobegin,gototheTNDepartmentofHealthwebsite:https://tn.gov/health/topic/PA‐board
2.Clickon“Applications”(redarrow).
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3.Afterclickingon“Applications”,thepagecontainingCommitteeapplicationswillappear.Scrolldowntoandclickonthelinktitled“PASupervisingPhysicianForm”(yellowarrow).
4.ThiswillopentheLicensureandRegulatorySystemsign‐inpage.
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5.Gotothe“NewUser”boxandclick“BeginHereforSign‐up”(redarrow)tocreateanonlineaccountwithaUserIDandpassword.
ForALLUSERS:EvenifyouhavepreviouslyusedtheBoard’sonlineservicesbefore,youmustcreateanewaccountinthisnewsystem.
6.Provideallrequestedinformationtobeginnewaccountregistration.Indicatetheemailtowhichyouwantallboardcommunicationssend.Under“Communication”(yellowarrow),wesuggestselecting“Yes”toE‐mailCommunicationtoassuretimelyreceiptofnotices/informationfromTNDepartmentofHealth.
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Press“Next”topreviewandsaveyourregistrationinformation
7.Afteryouregisterandcreateanewaccount,[email protected].
**Onlyadesktopcomputerorlaptop(notphonesortablets)shouldbeusedtoaccessthisemailaddressandactivatelinkscontainedwithinitscontents.*Pleasecheckspamorjunkfoldersifyoudonotreceivetheemailwithinafewminutes.
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8.TheLARSemailwillcontainatemporarypasswordwithalink. a.Copyornotethetemporarypasswordsoyoumaypasteorprovidewhenrequested.b.ClickonthelinkthatwillredirectyoubacktotheLicensureandRegulatorySystem.
c.AsaReturningUser(redarrow),provideyouruserID(emailpreviouslyidentified)andthetemporarypassword.Click“SignIn”.
9.TheDefaultRegistrationpageshownbelow(redarrow)willnowappear.Thetemporarypasswordyouwereprovidedwillbethe“OldPassword”.
Createanewpasswordforyouraccount.
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10.Afteryouregisteredandcreatedyournewsystemaccount,youwillbeaskedtolinkyourprofiletoexistinglicenses.
Followtheinstructionsprovidedtomatch/linkyourlicense(s).
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11.Onceyou’vematchedyourlicense,the“QuickStartMenu”willappear(yellowarrow).
12.The“QuickStartMenu”willallowyoutoreviewandupdateyourinformation.Toreviewyourinformationand/orupdateyourcollaborating/supervisingphysicians,goto: a.“Manageyourlicenseinformation” b.Clickon“SelectApplication”(redarrow)topromptadropdownmenu c.Withinthedropdownmenu,select“PASupervisoryRequest”
d.Clicktheblue“Select”button(purplearrow)
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Ifthereisanexistingrequestalreadyopen,whichhasnotbeencompleted(redarrow),youwillhavetheoption(yellowarrow)toproceedwiththeincompleterequestortostartanewapplication.Ifyouchoosetostartanewapplication,yourexistingincompleterequestwillbecancelled.
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13.Subsequentscreensinthe“PASupervisoryRequest”section,willenableyoutoreviewandupdateinformation.
Beginningwiththefirstpage,“Introduction”(yellowarrow),click“Next”inthelowerrightcorner(redarrow)tosequentiallyreviewandeditinformation,asneeded.
Althoughtabslocatedintheleftmargin(bluearrow)mayalsobeusedtonavigatepagecontent,itissuggested,foraninitialinformationreview,pagesbereviewedintheorderlisted.
Subsequentreturnstothesystemtoupdateinformationmaybefacilitatedbyuseofleftmarginnavigationtabs.
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SPECIALNOTE:Fromthe“PASupervisoryRequest–ContactInformation”screen,youwillhavetheoptiontoenterallyouraddressrecords.InordertoproceedyouMUSThavethefollowingrecordsonfile:
Mailingaddress Practiceaddress
Ifyouhavemorethanonepracticeaddresses,youmaylistotheraddresses.AtthebottomoftheContactInformationpage,under“AddAnotherContact”(yellowarrow),select“PracticeAddress”(purplearrow)asshownbelow.Emergency,practicefaxandmailingfaxaddressareoptional.
14.UpdatingSupervisingPhysicianinformation.
NOTE:The“SupervisorSelection”tab(redarrow)willallowthefollowingfunctions: VERIFYaphysician DELETEaphysician ADDaphysician.
*YoumayonlyaddONEphysicianintheexistingform.Ifyouneedtoaddmorethanonephysician,youwillneedtocompleteandexittheexistingform,andstartanew“PASupervisoryRequest”.
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a.VERIFYacurrentsupervisingphysician.Fromthe“PASupervisoryRequest–RelatedLicenses
Listing”existingphysiciansupervisorsonfileforyouwillbelisted.
Clicktheradiobuttontoconfirmanexistingsupervisoryrelationship.
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b.ADDasupervisingphysicianFromthe“PASupervisoryRequest–RelatedLicensesListing”screen,scrolltothebottomandselect“Add”(yellowarrow).YoumayonlyaddONEphysicianintheexistingform.Ifyouneedtoaddmorethanonephysician,youwillneedtocompleteandexittheexistingform,andstartanew“PASupervisoryRequest”form.
Fromthe“PASupervisoryRequest–RelatedParty‐Add”screenbelow,select“SupervisorofPhysicianAssistant”(yellowarrow)fromthe“TypeofRelationship”.Next,under“LicenseType”,specifywhetherthesupervisingphysicianisanMDorDO(redarrow).
Youwillalsoneedyoursupervisingphysician’slicensenumberinordertoaddthem(bluearrow).Onlyenterthenumbers(NOLETTERS).Seebelowinstructionstoobtainaphysician’slicensurenumberonline.
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Toobtainaphysician’sTennesseemedicallicensurenumberonlineGotoTNDepartmentofHealth’sLicenseVerification:https://apps.health.tn.gov/Licensure/
Ataminimum,providefirst/lastnameandprovidednumeric/lettercode.Click“Submit”.
Onceallrequiredinformationhasbeensubmittedandyouhaveselected“Next”,yoursupervisorwillbeaddedtoyoursupervisorylist.Select“Next”againtoproceedtothe“PASupervisoryRequest–SupervisorSelection”screenshownbelow.Selectthemostrecentlyaddedsupervisorandclick“Next”.Thenextpagewillincludealistofallpracticeaddressesonfileforyou.Selecttheaddresswherethenewlyaddedphysicianwillbeprovidingsupervisoryservices.Click“Next”.
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15.UpdateyourClassDrugSelection(redarrow).a.Usingthedropdownmenu(yellowarrow),diligentlyreviewandselecteachclassofdrug yoursupervisingphysicianhasagreedyoumayprescribeunderhis/herdelegation.Atthistime,youarerequiredtomakeaselectionandclick“Add”foreachclassofdrug.
Enhancementsarependingsoyoumaymakemultipleselectionsfromadropdownmenu.Whenallclassesofdrugshavebeenadded,select“Next”tocontinue.
b.Alistingofyourselections(purplearrow)willbeimmediatelyavailableforyourreview.
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16.UpdateyourControlledDrugSelection(yellowarrow).a.Usingthedropdownmenu(bluearrow),diligentlyreviewandselecteachtypeandscheduleofcontrolleddrugsyoursupervisingphysicianhasagreedyoumayprescribeunderhis/herdelegation.Click“Add”aftereachtypeandscheduleiscompleted
b.Acomprehensivelistingofselectedtypeandscheduleofcontrolleddrugs(redarrow)willbeavailableforyourreviewand/orediting.
c.ProvideyourDEAcertificatenumber
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17.Finally,asummaryofyourapplicationwillbeprovidedforyourreviewandedits.Whenreviewiscomplete,click“Submit”.
18.Whenyouhavecompletedandsubmittedallupdates,youwillbeaskedcompleteanElectronicattestationstatement.Click“Submit”.
19.Followingattestation,youwillbeprovidedwithanoptiontoviewandprintyourApplicationSummaryinpdfformat.
ExampleofpdfApplicationSummary
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20.Additionally,youwillalsoimmediatelyreceiveanemail,tothee‐mailaddressonfile,[email protected].
**Ifyoudonotreceiveacopywithinafewminutes,pleasecheckyourspamorjunkfolders.Alsoconsiderconfirmingthatthecorrectemailaddresswasprovidedwithouttypographicalerrors.
Yoursupervisingphysicianwillalsoreceiveanemailtoconfirmthecollaborativeagreement.PLEASENOTE:Yoursupervisoryrelationshipwillbenotbevalidatedunlessanduntilyoursupervisingphysicianvalidatestherelationship.Anoticeofyourpendingrequestwillbesenttoyouandyoursupervisorat15,30and45daysaftertheinitialrequest.Requestsnotvalidatedwithin60dayswillexpire.
21.Submitacopyofyourcompleted“PASupervisingPhysicianForm”(pdf)withyourinitialcredentialingpacketor“OnePacket”toProviderSupportServices([email protected]).Ifyouevermakechangestoyourformularyorsupervisingphysician(s),pleasesubmitanupdatedcopyofyourcompleteddocumenttoProviderSupportServices.
Ifyouhaveanyquestionsorconcerns,pleasereachouttoyourAdvancedPracticeleaderoremailtheOfficeofAdvancedPracticeatwww.vanderbiltoap.comforassistance.
