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Instant access to fillable Microsoft Word or PDF forms. Minimize the risk of using outdated forms and eliminate rejected fillings.6) The physician should complete the Doctor's Affidavit Regarding Capacity (541PC). Please complete this form to the best of your knowledge and ability. Each examiner must complete a. This affidavit is for Alaska residents with developmental disabilities AS 16.05. Have a true copy of the completed Petition before you complete this form. Each examiner must complete a Doctor's Affidavit. Regarding Capacity (541PC) and an Examiner's Report (538PC). 4. On the basis of endorsement you MUST BE currently licensed to practice medicine in all of its branches in another jurisdiction. 1.