Physician Assistants Statement Of Certification {3650}

3650 - PHYSICIAN ASSOCIATE’S STATEMENT OF CERTIFICATION. This form is used by physician associates to confirm their eligibility and agreement to treat patients with work-related injuries under Oregon’s workers’ compensation system. By completing and signing this form, the physician associate certifies that they are licensed by the Oregon Medical Board or another appropriate licensing body and have reviewed the Physician Associate’s Handbook and the accompanying informational packet. They agree to comply with Oregon laws governing the treatment of workers with compensable injuries. The form requires personal, business, and licensure information and must be submitted to the Oregon Workers’ Compensation Division’s Policy Team. www.FormsWorkflow.com