Rules & Regulations of the State of Tennessee
Title 1130 - Board of Physician Assistants
Chapter 1130-02 - General Rules Governing the Practice of an Orthopedic Physician Assistant (Transferred from 0880-10)
Section 1130-02-.05 - PROCEDURES FOR LICENSURE

(1) An application packet shall be requested from the Committee's administrative office.

(2) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and rules to the Committee's Administrative Office. It is the intent of this rule that activities necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

(3) An applicant shall submit with his application a signed and notarized passport type photograph taken within the preceding 12 months and the photo must be affixed to the proper page of the application.

(4) It is the applicant's responsibility to request that a graduate transcript, from an orthopedic physician assistant education program approved by the Committee and Board, be submitted directly from the program to the Committee's Administrative Office. The transcript must show that graduation has been completed and carry the official seal of the institution.

(5) An applicant shall submit evidence of good moral character. Such evidence shall be two recent (within the preceding 12 months) original letters from medical professionals, attesting to the applicant's personal character and professional ethics on the signator's letterhead.

(6) If the applicant intends to immediately commence practice upon licensure he or she must designate a primary supervising orthopedic physician and shall submit directly to the Committee's Administrative Office a letter attesting to the status. Any change in the primary supervising orthopedic physician must be reported in the same manner by the orthopedic physician assistant.

(7) An applicant shall disclose the circumstances surrounding any of the following:

(8) An applicant shall cause to be submitted to the Committee's administrative office directly from the vendor identified in the Committee's licensure application materials, the result of a criminal background check.

(9) If an applicant holds or has ever held a license/certificate to practice any profession in any other state, the applicant shall cause to be submitted the equivalent of a Tennessee Certificate of Endorsement (verification of licensure/certification) from each such licensing board which indicates the applicant holds or held an active license/certificate and whether it is in good standing presently or was at the time it became inactive.

(10) An applicant shall submit the Application Fee and State Regulatory Fee as provided in Rule 1130-02-.06.

(11) All applicants shall cause to be submitted documentation of successful completion of the examination for licensure as governed by Rule 1130-02-.08 once the exam has been successfully completed. This verification must be submitted by the examining agency directly to the Committee's Administrative Office.

(12) When necessary, all required documents shall be translated into English and such translation and original document certified as to authenticity by the issuing source. Both versions must be submitted.

(13) Personal resumes are not acceptable and will not be reviewed.

(14) Application review and licensure decisions shall be governed by rule 1130-02-.07.

(15) All documents submitted for qualification of licensure become the property of the State of Tennessee and will not be returned.

(16) The application form is not acceptable if any portion has been executed and dated prior to one year before filing with the Committee. As used in this part, application means the application form approved by the Committee and shall include, as appropriate:

(17) All applications shall be sworn to and signed by the applicant and notarized.