Initial Application This is not the PA Universal Recognition Application. See the application under PA License Application. Thank you for your interest in obtaining a license in Arizona. All licensed PAs with a DEA Registration or who intend to apply for a DEA Registration in Arizona are required to register with the Controlled Substance Prescription Monitoring Program. PA License Application Form PA Duplicate License Form Application Fee Waiver Instructions Instructions for the Application Fee Waiver Form Application Fee Waiver Fillable Form provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents. Application Fee Waiver Static Form provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents. For those first-time applicants seeking the fee waiver in Arizona Revised Statute (A.R.S.) § 41-1080, please draft a written request and email it directly to Joann Friest-White or Evangeline Webster PA Application $125.00 Regular License $370.00 Duplicate License Fee $25.00 32-2521 - Qualifications 32-2521. Qualifications A. An applicant for licensure shall: 1. Have graduated from a physician assistants educational program approved by the board. 2. Pass a certifying examination approved by the board. 3. Be physically and mentally able to safely perform health care tasks as a physician assistant. 4. Have a professional record that indicates that the applicant has not committed any act or engaged in any conduct that constitutes grounds for disciplinary action against a licensee pursuant to this chapter. This paragraph does not prevent the board from considering the application of an applicant who was the subject of disciplinary action in another jurisdiction if the applicant's act or conduct was subsequently corrected, monitored and resolved to the satisfaction of that jurisdiction's regulatory board. 5. Not have had a license to practice revoked by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. 6. Not be currently under investigation, suspension or restriction by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. If the applicant is under investigation by a regulatory board in another jurisdiction, the board shall suspend the application process and may not issue or deny a license to the applicant until the investigation is resolved. 7. Not have surrendered, relinquished or given up a license in lieu of disciplinary action by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. This paragraph does not prevent the board from considering the application of an applicant who surrendered, relinquished or gave up a license in lieu of disciplinary action by a regulatory board in another jurisdiction if that regulatory board subsequently reinstated the applicant's license. 8. Have submitted verification of all hospital affiliations and employment for the five years preceding application. Each hospital must verify the applicant's affiliation or employment on the hospital's official letterhead or the electronic equivalent. B. The board shall require an applicant to have all credentials submitted from the primary source where the document originated, either electronically or by hard copy, except that the board may accept primary-source verified credentials from a credentials verification service approved by the board. C. The board may make investigations it deems necessary to advise itself with respect to the qualifications of the applicant, including physical examinations, mental evaluations, written competency examinations or any combination of these examinations and evaluations. D. If the board finds that the applicant committed an act or engaged in conduct that would constitute grounds for disciplinary action in this state, before issuing a license the board must determine to its satisfaction that the act or conduct has been corrected, monitored and resolved. If the act or conduct has not been resolved, before issuing a license the board must determine to its satisfaction that mitigating circumstances exist that prevent its resolution. E. If another jurisdiction has taken disciplinary action against an applicant, before issuing a license the board must determine to its satisfaction that the cause for the action was corrected and the matter was resolved. If the other jurisdiction has not resolved the matter, before issuing a license the board must determine to its satisfaction that mitigating circumstances exist that prevent its resolution. F. The board may delegate to the executive director the authority to deny licenses to applicants who do not meet the requirements of this section. Go to ARS §32-2521... 32-2524 - Exemption from licensure 32-2524. Exemption from licensure This chapter does not require licensure of: 1. A student who is enrolled in a physician assistant education program approved by the board. 2. A physician assistant who is an employee of the United States government and who works on land or in facilities owned or operated by the United States government. 3. A physician assistant who is a member of the armed forces of the United States and who is on official orders or performing official duties as outlined in the appropriate regulation of that branch of military service. Go to ARS §32-2524... R4-17-202: Examination R4-17-202. Examination An applicant for a regular license as a physician assistant shall pass the PANCE or PANRE and be certified by the NCCPA at the time of application for licensure. R4-17-202 - Note(s) Historical Note Adopted effective July 8, 1986 (Supp. 86-4). Section repealed; new Section R4-17-202 renumbered from R4-17-201 and amended effective April 22, 1998 (Supp. 98-2). Amended by final rulemaking at 18 A.A.R. 2123, effective October 7, 2012 (Supp. 12-3). Amended by final rulemaking at 22 A.A.R. 3700, effective February 6, 2017 (Supp. 16-4). Go to AAC R4-17-202... R4-17-203: Regular License Application R4-17-203. Regular License Application A. An applicant for a regular license shall submit a completed application to the Board that includes: 1. The applicant’s: a. First, last, and middle name; b. Every other name used by the applicant; c. Social Security number; d. Office, mailing, e-mail, and home addresses; e. Office, mobile, and home telephone numbers; and f. Birth date and state or country of birth; 2. The name and address of the approved program completed by the applicant and the date of completion; 3. The name of each state or province in which the applicant has ever been certified, registered, or licensed as a physician assistant, including the certificate, registration, or license number, and current status; 4. Whether the applicant has practiced as a physician assistant since graduation from a physician assistant program or for 10 continuous years before the date the application was submitted to the Board and if not, an explanation; 5. A questionnaire that includes answers to the following: a. Whether the applicant has had an application for a certificate, registration, or license refused or denied by any licensing authority, and if so, an explanation; b. Whether the applicant has had the privilege of taking an examination for a professional license refused or denied by any entity, and if so, an explanation; c. Whether the applicant has ever resigned or been requested to resign, been suspended or expelled from, been placed on probation, or been fined while enrolled in an approved program in a medical school or a postsecondary educational program, and if so, an explanation; d. Whether, while attending an approved program, the applicant has ever had any action taken against the applicant by the approved program, resigned, or been asked to leave the approved program for any amount of time, and if so, an explanation; e. Whether the applicant has ever surrendered a health professional license, and if so, an explanation; f. Whether the applicant has ever had a health professional license suspended or revoked, or whether any other disciplinary action has ever been taken against a health professional license held by the licensee, and if so, an explanation; g. Whether the applicant is currently under investigation by any health profession regulatory authority, health care association, licensed health care institution, or there are any pending complaints or disciplinary actions against the applicant, and if so, an explanation; h. Whether the applicant has ever had any action taken against the applicant’s privileges, including termination, resignation, or withdrawal by a health care institution or health profession regulatory authority, and if so, an explanation; i. Whether the applicant has ever had a federal or state regulatory authority take any action against the applicant’s authority to prescribe, dispense, or Arizona Regulatory Board of Physician Assistants administer controlled substances including revocation, suspension, or denial, or whether the applicant ever surrendered the authority in lieu of any of these actions, and if so, an explanation; j. Whether the applicant has ever been charged with, convicted of, pleaded guilty to, or entered into a plea of no contest to a felony or misdemeanor involving moral turpitude or has been pardoned or had a record expunged or vacated, and if so, an explanation; k. Whether the applicant has ever been charged with or convicted of a violation of any federal or state drug statute, rule, or regulation, regardless of whether a sentence was or was not imposed, and if so, an explanation; l. Whether the applicant has been named as a defendant in a malpractice matter currently pending or that resulted in a judgment or settlement entered against the applicant, and if so, an explanation; m. Whether the applicant has ever been court-martialed or discharged other than honorably from any branch of military service, and if so, an explanation; n. Whether the applicant has ever been involuntarily terminated from a health professional position, resigned, or been asked to leave the health care position, and if so, an explanation; o. Whether the applicant has ever been convicted of insurance fraud or received a sanction, including limitation, suspension, or removal from practice, imposed by any state or the federal government, and if so, an explanation; and p. Whether the applicant, within the three years before the date of the application, has completed 45 hours in pharmacology or clinical management of drug therapy or is certified by a national commission on the certification of physician assistants or its successor; 6. A confidential questionnaire that includes answers to the following: a. Whether the applicant has received treatment within the last five years for use of alcohol or a controlled substance, prescription-only drug, or dangerous drug or narcotic or a physical, mental, emotional, or nervous disorder or condition that currently impairs the applicant’s ability to exercise the judgment and skills of a medical professional; b. If the answer to subsection (A)(6)(a) is yes: i. A detailed description of the use, disorder, or condition; and ii. An explanation of whether the use, disorder, or condition is reduced or ameliorated because the applicant receives ongoing treatment and if so, the name and contact information for all current treatment providers and for all monitoring or support programs in which the applicant is currently participating; and c. A copy of any public or confidential agreement or order relating to the use, disorder, or condition, issued by a licensing agency or health care institution within the last five years, if applicable; 7. Consistent with the Board’s statutory authority, other information the Board may deem necessary to evaluate the applicant fully; and 8. A sworn statement that complies with A.R.S. § 32-2522(C). B. In addition to the requirements in subsection (A), an applicant shall submit the following to the Board: 1. Documentation of citizenship or alien status that conforms to A.R.S. § 41-1080; 2. Documentation of a legal name change if the applicant’s legal name is different from that shown on the document submitted in accordance with subsection (B)(1); 3. A form provided by the Board and completed by the applicant that lists all current or past employment with health professionals or health care institutions within five years before the date of application or since graduation from a physician assistant program, if less than five years, including each health professional’s or health care institution’s name, address, and dates of employment; 4. Verification of any medical malpractice matter currently pending or resulting in a settlement or judgment against the applicant, including a copy of the complaint and either the agreed terms of settlement or the judgment and a narrative statement specifying the nature of the occurrence resulting in the medical malpractice action. An applicant who is unable to obtain a document required under this subsection may submit a written request for a waiver of the requirement. The applicant shall include the following information in a request for waiver: a. The document for which waiver is requested; b. Detailed description of efforts made by the applicant to provide the required document; and c. Reason the applicant’s inability to provide the required document is due to no fault of the applicant; and 5. The fee required in R4-17-204. C. In addition to the requirements in subsections (A) and (B), an applicant shall have the following directly submitted to the Board: 1. A copy of the applicant’s certificate of successful completion of the PANCE or PANRE and the applicant’s examination score provided by the NCCPA; 2. An approved program form provided by the Board, completed and signed by the director or administrator of the approved program that granted the applicant a physician assistant degree, that includes the: a. Applicant’s full name, b. Type of degree earned by the applicant, c. Name of the physician assistant program completed by the applicant, d. Starting and ending dates, and e. Date the applicant’s degree was granted. D. The Board’s issuance of a regular license to an applicant also approves the applicant to issue prescriptions and dispense or issue schedule II or schedule III controlled substances subject to the limits and requirements specified in A.R.S. § 32-2532. R4-17-203 - Note(s) Historical Note Adopted effective July 8, 1986 (Supp. 86-4). Section repealed; new Section adopted effective April 22, 1998 (Supp. 98-2). Amended by final rulemaking at 18 A.A.R. 2123, effective October 7, 2012 (Supp. 12-3). Amended by final rulemaking at 22 A.A.R. 3700, effective February 6, 2017 (Supp. 16-4). Go to AAC R4-17-203... There are no Faqs available Evidence List Legal Evidence documents must be provided in accordance with A.R.S. § 41-1080 and 8 U.S.C 1621. Citizenship Statement This form is to be completed by the applicant and is to be submitted for every application, permit or registration that is offered by the Arizona Regulatory Board of Physician Assistants, with the exception of the renewal of license if citizenship has previously been established with the Board. PA License Application Form PA Duplicate License Form Application Fee Waiver Instructions Instructions for the Application Fee Waiver Form Application Fee Waiver Fillable Form provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents. Application Fee Waiver Static Form provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Physician Assistant, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents. For those first-time applicants seeking the fee waiver in Arizona Revised Statute (A.R.S.) § 41-1080, please draft a written request and email it directly to Joann Friest-White or Evangeline Webster PA Application $125.00 Regular License $370.00 Duplicate License Fee $25.00 32-2521 - Qualifications 32-2521. Qualifications A. An applicant for licensure shall: 1. Have graduated from a physician assistants educational program approved by the board. 2. Pass a certifying examination approved by the board. 3. Be physically and mentally able to safely perform health care tasks as a physician assistant. 4. Have a professional record that indicates that the applicant has not committed any act or engaged in any conduct that constitutes grounds for disciplinary action against a licensee pursuant to this chapter. This paragraph does not prevent the board from considering the application of an applicant who was the subject of disciplinary action in another jurisdiction if the applicant's act or conduct was subsequently corrected, monitored and resolved to the satisfaction of that jurisdiction's regulatory board. 5. Not have had a license to practice revoked by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. 6. Not be currently under investigation, suspension or restriction by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. If the applicant is under investigation by a regulatory board in another jurisdiction, the board shall suspend the application process and may not issue or deny a license to the applicant until the investigation is resolved. 7. Not have surrendered, relinquished or given up a license in lieu of disciplinary action by a regulatory board in another jurisdiction in the United States for an act that occurred in that jurisdiction that constitutes unprofessional conduct pursuant to this chapter. This paragraph does not prevent the board from considering the application of an applicant who surrendered, relinquished or gave up a license in lieu of disciplinary action by a regulatory board in another jurisdiction if that regulatory board subsequently reinstated the applicant's license. 8. Have submitted verification of all hospital affiliations and employment for the five years preceding application. Each hospital must verify the applicant's affiliation or employment on the hospital's official letterhead or the electronic equivalent. B. The board shall require an applicant to have all credentials submitted from the primary source where the document originated, either electronically or by hard copy, except that the board may accept primary-source verified credentials from a credentials verification service approved by the board. C. The board may make investigations it deems necessary to advise itself with respect to the qualifications of the applicant, including physical examinations, mental evaluations, written competency examinations or any combination of these examinations and evaluations. D. If the board finds that the applicant committed an act or engaged in conduct that would constitute grounds for disciplinary action in this state, before issuing a license the board must determine to its satisfaction that the act or conduct has been corrected, monitored and resolved. If the act or conduct has not been resolved, before issuing a license the board must determine to its satisfaction that mitigating circumstances exist that prevent its resolution. E. If another jurisdiction has taken disciplinary action against an applicant, before issuing a license the board must determine to its satisfaction that the cause for the action was corrected and the matter was resolved. If the other jurisdiction has not resolved the matter, before issuing a license the board must determine to its satisfaction that mitigating circumstances exist that prevent its resolution. F. The board may delegate to the executive director the authority to deny licenses to applicants who do not meet the requirements of this section. Go to ARS §32-2521... 32-2524 - Exemption from licensure 32-2524. Exemption from licensure This chapter does not require licensure of: 1. A student who is enrolled in a physician assistant education program approved by the board. 2. A physician assistant who is an employee of the United States government and who works on land or in facilities owned or operated by the United States government. 3. A physician assistant who is a member of the armed forces of the United States and who is on official orders or performing official duties as outlined in the appropriate regulation of that branch of military service. Go to ARS §32-2524... R4-16-204. Licensure by Endorsement R4-16-204. Licensure by Endorsement A. An applicant for licensure by endorsement may make a written request of the Board, for an extension of the seven-year period provided by A.R.S. § 32-1426(B)(4) to pass one of the combinations of specified examinations. The applicant shall submit the written request to the Board with evidence that: 1. The applicant meets all requirements for licensure and for taking the United States Medical Licensing Examination, 2. The combination of examinations cannot be passed in the time required by law, and 3. The applicant is: (a) A full-time student in an approved school of medicine, as defined in A.R.S. § 32-1401(5); (b) A participant in an approved hospital internship, residency, or clinical fellowship program, as defined in A.R.S. § 32-1401(4); or (c) A full-time student in a recognized medical degree program, as defined in subsection (E), concurrently or consecutively with medical school or postgraduate training. B. If the Board determines that the applicant satisfies the requirements of subsection (A), the Board shall grant the extension. C. An extension shall not exceed 10 years from the date on which the applicant successfully completes the first part of the combination of examinations. D. If the Board denies the request for extension, the applicant may request a hearing by filing a written notice with the Board no later than 30 days after receipt of notice of the Board's action. A hearing shall be conducted according to A.R.S. Title 41, Chapter 6, Article 10. E. In this Section, a "recognized degree program" means an education program offered by a college or university approved by the New England Association of Schools and Colleges, Middle States Association of Colleges and Secondary Schools, North Central Association of Colleges and Schools, Northwest Association of Schools and Colleges, Southern Association of Colleges and Schools, or Western Association of Schools and Colleges or accredited by the United States Department of Education, Council on Postsecondary Accreditation, Association of American Medical Colleges, the Association of Canadian Medical Colleges, or the American Medical Association. F. An applicant for licensure by endorsement under A.R.S. § 32-1426(C) who provides proof of passing an examination specified in A.R.S. § 32-1426(A) more than ten years before the date of filing shall: 1. Hold a current certification in an American Board of Medical Specialty ("ABMS"), or 2. Take and pass the Special Purposes Examination (SPEX). There are no Faqs available Evidence List Legal Evidence documents must be provided in accordance with A.R.S. § 41-1080 and 8 U.S.C 1621. Citizenship Statement This form is to be completed by the applicant and is to be submitted for every application, permit or registration that is offered by the Arizona Regulatory Board of Physician Assistants, with the exception of the renewal of license if citizenship has previously been established with the Board.
