Get Form C Advanced Practice Registered Nurse (aprn) Protocol Worksheet - Medicalboard Georgia

Filling out the Form C Advanced Practice Registered Nurse (aprn) Protocol Worksheet is an essential step for practitioners in Georgia seeking to establish protocols with collaborating physicians. This guide provides clear, step-by-step instructions to assist users in completing the form online effectively.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the worksheet and open it for editing.
2. Complete the top of the form by providing your full name, date of birth, registered nurse license number, and DEA number. Make sure all entries are legible.
3. Fill in your contact details, including street address, city, state, zip code, and phone number. This information helps ensure you can be reached easily.
4. In the certification information section, select the appropriate box to indicate your certification, such as certified nurse midwife, psychiatric/mental health specialist, or nurse practitioner.
5. List the specific medications you commonly prescribe, remembering that schedule II medications are not permitted. Include at least 20 drugs as necessary.
6. If you perform any procedures, list them under the routines performed procedures section. If no procedures are done, check the indicated box.
7. Identify the protocol reference sources. Include relevant texts or resources but exclude reference textbooks.
8. Ensure to sign the form where indicated for both the physician and the APRN. Include dates next to each signature.
9. Review the completed form for any errors or omissions. Make necessary corrections to ensure all information is accurate.
10. Once satisfied, save changes to your document. You can download, print, or share the form as needed.

Begin completing your Form C online today to streamline your protocol establishment process.