Documentation Requirements

Department of Health and Addicition Services
Division of Quality Medical Assurance

Documentation Requirements

Applicants must arrange for submission of the following:

  1. A completed, notarized application with photograph and fee of $150.00. The fee must be in the form of a certified check or money order, made payable to “Treasurer, State of Connecticut”;
  2. official verification, sent directly from the NCCPA to this Department, of certification status;
  3. official verification, sent directly from the educational institution, NCCPA or American Academy of Physician Assistants to this Department, of completion of not less than sixty hours of didactic instruction in pharmacology for physician assistant practice;
  4. official verification, sent directly from each state licensing authority where a license or certification is or has ever been help (form enclosed);
  5. a disciplinary inquiry form sent directly from the Federation of State Medical Boards (FSMB);
  6. if applicable, an official transcript, sent directly form the educaitonal institution to this Department, verifying the award of the baccalaureate or higher degree (if the applicant attended more than one institution, an official transcript must be received from each institution where any coursework leading toward the baccalaureate degree was undertaken);
  7. if applicable, an official transcript sent directly from the educational institution to this Department, verifying graduation from an accredited physician assistant program (if you attended more than one institution, an official transcript must be received from each institution where any physician assistant coursework was undertaken).
  8. applicants who do not hold a baccalaureate or higher degree and/or who have not graduated from an accredited physician assistant program as specified above, must arrange for the submission of letters sent directly from the appropriate resources (ie., employing physician or institution) to this office verifying exact dates of employment, position held and duties. Such letters must account for the time period from December 31, 1985, to present.

The NCCPA may be contacted at:
NCCPA
12000 Findley Road
Suite 200
Duluth, GA 30097

678-417-8100