Get Authorization For Prescribing Advanced Practice Nurse - Health Tn

Filling out the Authorization For Prescribing Advanced Practice Nurse form is an essential step for advanced practice nurses in Tennessee to ensure compliance with state regulations. This guide will walk you through the necessary steps to complete the form accurately and efficiently, promoting a smooth online submission process.

Follow the steps to complete the Authorization For Prescribing Advanced Practice Nurse form online.

1. Press the ‘Get Form’ button to access the Authorization For Prescribing Advanced Practice Nurse form. This will open the document in your preferred online editor.
2. Begin by filling in the advanced practice nurse's name in the designated field. Ensure the spelling is correct, as this information is vital for identification.
3. Next, enter your DEA number. This number is required for prescribing controlled substances and should be accurate to prevent any legal issues.
4. Input your TN Advanced Practice Nurse License Number in the appropriate box. This verification assists in validating your licensure status.
5. Include your TN or multistate registered nurse license number. This information supports the credentials required for practice within Tennessee.
6. If you need to delete any supervising physician(s) or practice/clinic(s), fill in the respective sections accordingly. If additional space is necessary, attach further sheets with the required information.
7. Select the category of legend drugs you are authorized to prescribe by checking the appropriate boxes. Ensure to select controlled legend drugs only if you possess a valid DEA number for Schedule II-V.
8. If you are including initial or new practice sites and supervising physicians, enter their names and site addresses as instructed on the form.
9. Provide the printed name and signature of the supervising physician for each listed site, along with their DEA number and MD/DO license number.
10. In the attestation section, print your name and sign to confirm that all provided information is true and correct. This is a necessary legal affirmation.
11. After reviewing the completed form for accuracy, you can save changes, download a copy, or print it directly from your online editor.
12. Finally, submit the original form to the Tennessee Board of Nursing at the address provided on the document.

Take the necessary steps today to complete and submit your Authorization For Prescribing Advanced Practice Nurse form online.