To become licensed as an orthopedic physician assistant in
Tennessee, a person must comply with the following procedures and
(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
(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
(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.
An applicant shall disclose the
circumstances surrounding any of the following:
(a) Conviction of any criminal law violation
of any country, state or municipality, except minor traffic
(b) The denial of
professional licensure/certification application by any other state or the
discipline of licensure/certification in any state.
(c) Loss or restriction of
civil suit judgment or civil suit settlement in which the applicant was a party
defendant including, without limitation, actions involving malpractice, breach
of contract, antitrust activity or any other civil action remedy recognized
under the country's or state's statutory common or case law.
(e) Failure of any licensure or certification
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.
applicant shall submit the Application Fee and State Regulatory Fee as provided
in Rule 0880-10-.06.
applicants shall cause to be submitted documentation of successful completion
of the examination for licensure as governed by Rule 0880-10-.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
(13) Personal resumes
are not acceptable and will not be reviewed.
(14) Application review and licensure
decisions shall be governed by rule 0880-10-.07.
(15) All documents submitted for
qualification of licensure become the property of the State of Tennessee and
will not be returned.
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:
current, notarized passport photograph;
(b) Official college transcript from an
orthopedic physician assistant training program;
(c) Verification of N.B.C.O.P.A.
(d) Two (2) original letters
of professional recommendation;
Result of a criminal background check;
(f) Certificate of completion or Diploma from
an approved orthopedic physician assistant program; and
(g) Certification/licensure from other state
applications shall be sworn to and signed by the applicant and