Get Rescission Of A Capa-cs Form - Kentucky - Kbn Ky

This guide provides a step-by-step approach to filling out the Rescission Of A CAPA-CS Form in Kentucky, ensuring all necessary information is accurately completed. By following these instructions, you will effectively navigate the online process.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering the date when the form is being completed. Provide the day, month, and year in the specified fields, ensuring clarity and accuracy.
3. Clearly print the last name of the Advanced Practice Registered Nurse (APRN) in the designated field.
4. Next, print the last name of the collaborating physician in the appropriate field.
5. Continue by entering the first name of the APRN in the section provided.
6. Print the first name of the collaborating physician in the respective field.
7. Input the Kentucky APRN license number in the following field to ensure proper identification.
8. Similarly, enter the license number of the collaborating physician in the designated space.
9. Provide the practice name where the collaboration took place.
10. Fill out the practice address, including street address, city, state, and zip code, ensuring all details are correct.
11. Both the APRN and the physician must sign the form in the specified signature fields.
12. After both signatures are obtained, input the respective dates when each party signed the form.
13. Review the completed form for accuracy, and then save the changes. You can download, print, or share the completed form as needed.

Complete your documents online today for a streamlined experience.