Can this agreement be signed electronically?

Yes. Electronic signatures that satisfy intent, consent, attribution, and record retention meet the ESIGN Act standard (15 U.S.C. ch. 96) and most state UETA laws when exceptions do not apply.

Is a notary required?

Not usually for employment supervisory agreements, but some practices or states may request notarization; verify state or institutional policy before execution.

Do I need a HIPAA addendum?

If the PA will access protected health information, include a HIPAA addendum or BAA as required by 45 CFR to document permitted uses and safeguards.

What if the PA changes employers?

Terminate or amend the existing agreement per the termination clause, create a new agreement with the incoming supervising physician, and retain records per retention policy.

How long must records be retained?

Follow the longest applicable rule: HIPAA six-year baseline (45 CFR §164.530(j)), IRS minima, and any state or institutional longer retention periods.

Who enforces compliance?

State medical and PA licensing boards enforce practice act compliance; employers and credentialing organizations also review agreements during audits.

Electronic Signature
Templates
Other
Written Agreement for Physician Assistant and Physician

Written Agreement for Physician Assistant and Physician

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

What the Written Agreement for Physician Assistant and Physician Is

A Written Agreement for Physician Assistant and Physician is a formal, signed document describing the supervisory relationship, scope of practice, delegated procedures, and administrative responsibilities between a supervising physician and a physician assistant (PA). The agreement memorializes who may supervise, what clinical tasks the PA may perform, required supervision level or availability, reporting and documentation expectations, and any compensation or liability-sharing provisions. Many states require a written supervisory agreement as part of PA licensure or delegation rules; the document also supports quality assurance, credentialing, and audit readiness when retained in compliance with relevant laws and standards.

Why a Clear Written Agreement Matters

A concise written agreement reduces regulatory risk, clarifies delegation and supervision, and creates an auditable record for credentialing and compliance with state practice acts. It helps protect patient safety, supports consistent care delivery, and establishes responsibilities for documentation, indemnity, and termination procedures.

Who typically prepares and signs this agreement

A small group of clinical, administrative, and legal stakeholders usually collaborate to create and approve these agreements.

Supervising physicians or medical directors — review clinical scope and accept supervisory responsibilities.
Physician assistants — confirm delegated duties, hours, and reporting obligations in writing.
Practice managers or legal counsel — ensure the agreement meets state rules and institutional policies.

Final approval is usually retained in the PA personnel file and in any electronic records system used for credentialing and audits.

Primary signers and their roles

Supervising Physician

Typically a licensed physician authorized to delegate clinical tasks. Responsible for clinical oversight, availability expectations, periodic review of PA competence, and signing the supervisory agreement to accept legal and professional obligations.

Physician Assistant

A licensed PA who accepts delegated duties and documents scope-of-practice boundaries, training requirements, reporting pathways, and any conditions that limit independent action under the terms of the written agreement.

Core elements every professional agreement should include

A complete agreement combines clinical detail with administrative and legal protections; include the following key components to make the document enforceable, auditable, and clear.

Parties

Full legal names, licenses, credential numbers, employer or practice entity, and contact information for both the supervising physician and the PA.

Scope of Practice

Precise list of permitted clinical activities, procedures, prescriptive authority if applicable, and any settings where the PA may practice or is restricted.

Supervision Level

Define required supervision (direct, indirect, or collaborative), on-site presence expectations, and emergency availability or on-call obligations.

Delegated Procedures

Specify which procedures the PA is authorized to perform, required training or proctoring, and documentation or competency verification steps.

Compensation & Liability

Describe billing relationships, payment arrangements, professional liability coverage expectations, and indemnity or cost-sharing if applicable.

Term & Termination

Effective date, renewal process, notice requirements for termination, and obligations for patient care continuity after termination.

Step-by-step: completing the agreement

Follow these sequential steps to prepare and finalize a compliant written agreement.

01

Draft core terms: Assemble parties, scope, supervision, and termination language for review.
02

Review with counsel: Have institutional legal or compliance review for state-specific requirements.
03

Obtain signatures: Get authorized signatures from physician and PA; notarize if state requires or employer requests.
04

Store and distribute: Place final signed copy in personnel file and share copies with credentialing and billing teams.

How to configure a digital signing workflow

Set up a simple, repeatable workflow for template reuse, authentication, and retention when using an eSignature platform.

Field	Configuration
Signer sequence	Physician signs first, then PA; include witness or notary steps if required.
Authentication	Email plus SMS code or ID check for stronger signer identity when needed.
Template reuse	Create a reusable template with conditional fields for specialty-specific tasks.
Notifications	Enable completion notices to HR, credentialing, and the supervising physician.

Typical eSubmission and routing flow

A standard eSignature route minimizes delay and preserves an audit trail for compliance and credentialing.

Upload document: Sender uploads the template or completed draft to the eSignature platform.
Place fields: Define signature, initials, date, and conditional fields for delegated procedures.
Send to signers: Email or secure link is delivered to physician and PA in the prescribed order.
Archive copy: Platform stores signed PDF and audit trail for retrieval and audit.

Technical considerations for digital completion

Choose a platform that supports secure PDFs, audit trails, conditional fields, and the authentication level your institution requires.

File formats: PDF and DOCX support for editable templates and finished signed PDFs.
Integrations: Integrate with HR, credentialing, or EHR systems such as NetSuite or Microsoft 365 when available.
Compliance: Platform should offer ESIGN/UETA compliance and HIPAA-safe workflows when handling PHI.

Confirm that your chosen vendor supports required authentication, retention, and any BAA needed for protected health information.

Typical eSignature vendor pricing and capability snapshot

Compare common plan-level indicators relevant to executing and storing written agreements. signNow is listed first per platform comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by promotion	Varies by promotion	Varies by promotion	Varies by promotion
Bulk Send	Yes (Premium tier)	Yes (paid tiers)	Yes (paid tiers)	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA required)	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Security and compliance features to verify

Encryption: TLS 1.2/1.3; AES-256 at rest

Certifications: SOC 2 Type II; ISO 27001

HIPAA Support: BAA available for protected health information

Audit Trail: Full timestamped signer activity log

ESIGN / UETA: Compliance with ESIGN and UETA frameworks

21 CFR Part 11: Support for FDA-regulated electronic records

Risks when the agreement is incomplete or incorrect

Regulatory Action: State board discipline or sanctions

Malpractice Exposure: Unclear delegation increases liability risk

Credentialing Delay: Incomplete records can impede network enrollment

Audit Findings: Missing signed agreements can trigger compliance citations

HIPAA Violations: Improper PHI handling may incur fines

Operational Disruption: Care continuity problems during termination

Common preparation errors to avoid

Using vague language about duties or supervision that leaves interpretation to auditors or third parties.
Failing to match signer names and license numbers exactly to state licensing records, causing credentialing rejections.
Omitting effective dates, renewal clauses, or notice periods, which creates disputes over when supervision terminated.
Neglecting to document required training, proctoring, or competency checks for delegated procedures.

Real-world examples of digital agreement use

Organizations use eSignature and template workflows to reduce turnaround time and maintain audit-ready records.

Optica Ventures

A small multispecialty group digitized supervisory agreements to speed onboarding

Reduced administrative lag by centralizing templates and signatures
The organization maintained consistent, auditable copies and shortened credentialing timelines.

Fertility Centers of Illinois

A regional practice adopted secure eSignature and template automation

Used audit trails and retention policies to meet compliance
The team reported easier retrieval during audits and consistent signer authentication.

Frequently asked questions about these agreements

Answers to common practical and legal questions when preparing, signing, and storing a written agreement for a physician assistant.

Need help? Contact support

Can this agreement be signed electronically?
Yes. Electronic signatures that satisfy intent, consent, attribution, and record retention meet the ESIGN Act standard (15 U.S.C. ch. 96) and most state UETA laws when exceptions do not apply.
Is a notary required?
Not usually for employment supervisory agreements, but some practices or states may request notarization; verify state or institutional policy before execution.
Do I need a HIPAA addendum?
If the PA will access protected health information, include a HIPAA addendum or BAA as required by 45 CFR to document permitted uses and safeguards.
What if the PA changes employers?
Terminate or amend the existing agreement per the termination clause, create a new agreement with the incoming supervising physician, and retain records per retention policy.
How long must records be retained?
Follow the longest applicable rule: HIPAA six-year baseline (45 CFR §164.530(j)), IRS minima, and any state or institutional longer retention periods.
Who enforces compliance?
State medical and PA licensing boards enforce practice act compliance; employers and credentialing organizations also review agreements during audits.

Explore Templates

Workers' Compensation Form Maine Workers' Compensation Board Request for COA or Order for Appearance Maine Motion and Affidavit Maine MJSC 001 Affidavit and Agreement Maine Minor Name Change

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now