Get Prescription Authority Agreement Sample Form - Tafp

Filling out the Prescription Authority Agreement Sample Form - Tafp online is a straightforward process that allows healthcare professionals to delegate and manage prescriptive authority efficiently. This guide provides a detailed overview of each section of the form and clear instructions to help users navigate the process with confidence.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the delegating and supervising physician's details, including their name, license number, and address.
3. Next, enter the advanced practice registered nurse (APRN) or physician assistant (PA) details to whom prescriptive authority is being delegated. Include their name, license number, and address.
4. Specify the nature of practice, such as primary care or OB-Gyn, along with the specific practice locations.
5. Indicate the types of drugs or devices that may be prescribed. Choose between ‘All dangerous drugs (nonschedule)’ or ‘All schedule III-V controlled substances’, or provide a list of permitted drugs or devices.
6. Detail any limitations regarding the prescribing authority.
7. Describe the general plan for addressing consultation and referral of patients, as well as the process for handling patient emergencies.
8. Outline the communication process regarding patient care, ensuring clarity about consultation and physician availability.
9. Provide a description of the prescriptive-authority quality assurance and improvement plan, including chart review methods.
10. Indicate the frequency of quality assurance meetings with the delegating and/or alternate supervising physician (monthly, quarterly, etc.).
11. Complete the section on the alternate supervising physician(s) if applicable, providing names and license numbers.
12. Ensure the APRN or PA acknowledges their license status and any prior disciplinary actions, as well as the physician’s acknowledgment of their own disciplinary history.
13. Finalize the document by filling in the date of the agreement, and ensuring all parties sign in the appropriate sections.
14. Save your changes, then download, print, or share the completed form as necessary.

Complete your documents online to ensure compliance and efficiency in your practice.