Physician Assistant

Pursuant to 2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record.  To apply for a predetermination, please fill out Form #3085 and submit all required documentation specified on the form.  Pursuant to Wis. Stat. § 111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.


License Information

Fee Reduction

Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee.  Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.

Per Wisconsin State Statutes 440.08 (2), the required renewal date for the Physician Assistant credential is 02/28 or 29/even years.  Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.

Temporary License (only applicable to new graduates waiting to sit for the PANCE exam)

An applicant for permanent licensure may apply for a temporary license at the same time by paying both fees and meeting the following conditions

  • Graduate from an approved educational program for physician assistants AND be scheduled to take the national examination OR awaiting examination results
  • Complete and submit Application for Licensure as a Physician Assistant
  • Complete and submit Request for Temporary License for Physician Assistant

Pre-Credential Education Information

Graduate from an approved educational program for physician assistants. The Medical Examining Board only approves educational programs accredited and approved by the committee on allied health education and accreditation of the American Medical Association.  The Medical Examining Board only approves accredited educational programs and recognizes accreditation by the following agencies: American Medical Association (AMA), AMA Council on Medical Education, Committee on Allied Education and Accreditation (CAHEA), Commission on Accreditation of Allied Health Education Programs (CAAHEP).


Application for Licensure (including for a license expired 5 or more years)

FormDescription
580Application for Licensure as a Physician Assistant
​3217​Application for Fee Reduction (This form must accompany the application for the credential)
1504Physician Assistant Certificate of Professional Education (this must come directly from the school)
1512Request for temporary License for Physician Assistant (for new graduates only)
2829Malpractice Suits or Claims Form (if applicable)
​3085​Application for Predetermination
2252​Convictions and Pending Charges
3071​Fax Payment Form
2594​Change in Supervising Physician Form
​2147​Physician Requirements and Guidelines
2450​​The Amphetamine Rule

Renewal Information 

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding current Supervising Physician.  Supervisor must have an active WI physician license.)
  • If your legal status as a qualified alien or nonimmigrant lawfully present in the United States has changed since the issuance of your credential or your last renewal, please contact the Wisconsin Department of Safety and Professional Services at (608) 266-2112 or dsps@wisconsin.gov.

Renewal Methods

  • Online Log In: License Renewal Online
  • Request a Paper Renewal Form: (888) 506‑4239 or (608) 261‑4460 for the Madison area
FormDescription
RDAFRenewal Dates and Fees
R210Active Duty/Discharge Renewal Extension

Wisconsin Act 210 (effective June 1, 2012) 

This Act extends the license of a service member if the license expires while they are on active duty from 90 days to 180 days from the date of discharge. The same applies to a spouse of a service member if the spouse does not practice under their license while the service member is on active duty and does not practice because the service member is on active duty.

This Act repeals a provision of prior law that required a service member to meet all of the requirements for license extension or renewal, except for continuing education requirements, in order to have the license extended.

Service members and spouses may request extensions of licenses beyond 180 days from discharge and may request a waiver or extension of time to complete continuing education requirements due to hardship. Please view Active Duty/Discharge Renewal Extension Form #R210 for further information.