A supervising physician must:
(1) hold an unrestricted and active license as a physician in this state;
(2) notify the medical board of the physician's intent to supervise a physician assistant;
(3) submit to the medical board a statement that the physician will:
(A) supervise the physician assistant according to medical board rule; and
(B) retain professional and legal responsibility for the care provided by the physician assistant; and
(4) receive approval from the medical board to supervise the physician assistant.