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.
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.
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)
580||Application for Licensure as a Physician Assistant|
|3217||Application for Fee Reduction (If applying for a fee reduction, this form must accompany Form #580.)|
1504||Physician Assistant Certificate of Professional Education (this must come directly from the school)|
1512||Request for temporary License for Physician Assistant (for new graduates only)|
2829||Malpractice 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|