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Application for Registration of Anesthesiologist Assistant

Application for Registration of Anesthesiologist Assistant

 

INSTRUCTIONS: ALABAMA APPLICATION FOR REGISTRATION OF ANESTHESIOLOGIST ASSISTANT

 

 

Alabama physicians register an anesthesiologist assistant by filing the form discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 1: The first page should be completed by the supervising physician. Enter your name on the first blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 2: Enter your Alabama medical license number on the second blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 3: Enter your date of birth on the third blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 4: Enter your Social Security number on the fourth blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 5: Enter your medical specialty on the fifth blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 6: Indicate whether you are board certified by circling "Yes" or "No" as applicable.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 7: Indicate whether you are board eligible by circling "Yes" or "No" as applicable.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 8: Enter your principal practice location address on the sixth blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 9: If your mailing address is different from your principal practice location address, enter it on the seventh blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 10: Enter your telephone number, including the area code, on the next blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 11: Enter your fax number, including the area code, on the next blank line.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 12: In section 1, enter the name, practice side and designated working hours per week of every anesthesiologist assistant currently registered to you.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 13: In section 2, indicate with a check mark whether you have ever had an anesthesiologist assistant certified or registered to you by the Alabama Board of Medical Examiners. If yes, list their names.

 

Alabama Application For Registration Of Anesthesiologist Assistant Step 14: In section 3, indicate whether the anesthesiologist assistant for whom registration is sought is employed by you, your group, your partnership or professional corporation. Have the assistant complete the second page before filing.

 

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