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State Medical Board of Ohio


physician assistants









applications for supervising physicians

physician assistant licensure information

licensee profile & status

on-line change of address

on-line license renewal

on-line verification form

lost wallet or wall certificate

name change affidavit

certificate to practice numbers information

application for certificate to practice


national commission on certification of physician assistants (NCCPA)

treatment & compliance

supervisory plan

alternate supervising physician form

supervision agreement

addendum for multiple Physician Assistants

addendum for multiple Supervising Physicians

special services application

model supervisory plan for Cryotherapy

model supervisory plan for Orthopedic Practice



physician assistant policy committee




frequently asked questions



Physician Assistant Licensure Information

Important Notice



Please note that you cannot renew your Certificate to Prescribe unless and until you first renew your Certificate to Practice.



Failure to renew your Physician Assistant Certificate to Practice will result in the automatic suspension of your certificate to prescribe and will also inactivate any and all supervision agreements.

If your supervision agreements are inactive due to non-renewal of your certificate to practice, your supervising physician will have to reapply for the reactivation of the supervision agreement AFTER you have renewed your certificate to practice.


See chart regarding the prorated pharmacology hours for renewal of your certificate to prescribe.


Criminal Background Check required for initial license and license restoration applications received on or after March 24, 2008.

Physician Assistant Prescriptive Authority


Provisional Certificate to Prescribe

Certificate to Prescribe

Verification of Pharmacology Training (Form B)

Physician Assistant Formulary

2013 DEA Schedule II Approval

Physician Assistant Practice at Urgent Care Centers or Retail Clinics Position Statement




licensee profile & status
treatment and compliance  
position statements
Coroner's Reporting form
medical board public records policy
professional guidelines
Ohio revised code
Ohio administrative code


30 East Broad Street, 3rd Floor, Columbus, Ohio 43215-6127 | Telephone: (614) 466-3934 | Fax: (614) 728-5946
Complaint Forms: (800) 554-7717 | Licensure Verification: (800) 357-7720