The following is provided for your use in applying for reactivation of your Oregon physician assistant license.
The Board is charged with protecting the public. Before granting reactivation, the Board must ensure that there is no information of a derogatory or questionable nature in the licensee's background. If you wish to return to active practice in Oregon, or if you wish to practice under a status where you can receive remuneration for your services, you are required to reactivate your license.
Please submit your affidavit at least 90 days before you wish to change your status. This will allow time for Board staff to receive the required documents and process the application.
Please read the following instructions carefully as omissions or incorrect information will delay the processing of the application, which will in turn delay the beginning date of your practice in Oregon.
DOCUMENTS TO BE SUBMITTED BY THE LICENSEE
Affidavit: Please submit the original copy of the notarized Physician Assistant Reactivation Affidavit to the Board.
Fees: The $98 reactivation fee includes fees for application processing and for fingerprint processing. Please note that back fees such as renewal and late fees may be applicable and will be evaluated and communicated to you at the time your application is initially processed.
Fingerprints: Fingerprinting requirements can be found at: http://www.oregon.gov/omb/licensing/Pages/Fingerprint-Requirements.aspx.
DOCUMENTS TO REQUEST FROM OTHER SOURCES
Health Related Employment Verification: Request a verification of employment directly from any health related employer you have worked for since the time you last renewed your Oregon license or during the past 5 years, whichever is most recent. The verification must show the beginning and ending dates of employment as well as answers to questions regarding performance during the period of employment or staff membership. Please use the Verification of Health Related Employment Form.
Personal History Documentation: For affirmative answers to Personal History Questions, if applicable.
DOCUMENTS OBTAINED BY STAFF
OMB staff will obtain the following documentation for your reactivation:
- National Practitioner DataBank Report
- Federation of State Medical Boards (FSMB) Disciplinary Report
- Verification of Other State Licensure
- Verification of NCCPA Certification
CLINICAL COMPETENCY AND RE-ENTRY TO PRACTICE
If you have been out of practice for 12 or more consecutive months immediately prior to applying for reactivation of Oregon licensure, additional requirements may apply. Please review OAR 847-050-0043 for further details.
OTHER SUPPLEMENTAL FORMS
Chronology of Activities
Malpractice/Medical Professional Claims Information
Written Explanation of Affirmative Responses to Personal History Questions
Once you submit and pay for your reactivation application, you may access your status report by logging in to our Applicant/Licensee Services at: https://omb.oregon.gov/login. Your status report provides up-to-date information regarding outstanding items. You may also contact the Licensing Call Center with any questions:
9 AM to 12 PM and 1 PM to 3 PM (Pacific Standard Time)
In all correspondence with the Call Center, please include your license number, date of birth, and ONLY the last 4 digits of your Social Security Number to ensure confidentiality.
The Board looks forward to receiving your reactivation application and helping you through the process. Please take a moment to Comment Online. Your comments enable us to improve the application process.