What form is used when supervising physicians report a change to an existing written agreement?

• A. PA Renewal Form
• B. Written Agreement Change Form
• C. Change of Name Form
• D. Practice Update Form

Answer: (B)

When a supervising physician’s written agreement with a PA is updated, there is a specific form designed to report those amendments. This is called the Written Agreement Change Form. It exists to keep the regulatory body informed of changes to the supervision arrangement—such as shifts in supervision level, scope of practice, or terms of the agreement—and to ensure the records reflect the current agreement, maintaining lawful and compliant practice.

Other forms serve different purposes: a PA Renewal Form handles license or permit renewals, a Change of Name Form covers name changes, and a Practice Update Form is generally for broader practice updates but not the formal amendment to the written supervisory agreement.