Get Prescriptive Authority & Protocol Agreement

Filling out the Prescriptive Authority & Protocol Agreement is an essential step for advanced practice registered nurses and physician assistants in Texas. This guide will help you complete the form accurately and efficiently, ensuring compliance with state regulations.

Follow the steps to successfully complete the Prescriptive Authority & Protocol Agreement.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the physician information in the designated fields. This includes their name, license number, and primary practice site address. If applicable, add information for any additional practice sites.
3. Next, fill in the advanced practice registered nurse (APRN) or physician assistant (PA) information. Include the practitioner’s name, license number, and select the type of practitioner. If applicable, provide the DEA Permit number and expiration date.
4. In the delegation of prescriptive authority section, specify which non-prescription drugs, dangerous drugs, and CIII-CV controlled substances the APRN or PA is authorized to prescribe, making selections as appropriate.
5. Complete the supervision and documentation of supervision section. Acknowledge the process for consultation with the physician when needed and document any alternative supervising physicians if applicable.
6. Ensure the medical records section is documented clearly, indicating the responsibilities for maintaining patient encounters.
7. Verify qualifications in the education, training, certification, licensure, and authorization practice section, ensuring all necessary documents are referenced.
8. Complete the evaluation of clinical care section, detailing the activities and frequency of meetings for assessing care.
9. Finally, sign and date the agreement where indicated, ensuring all parties, including any alternative physicians, complete their signatures. Maintain a copy of the signed agreement as required.
10. After completing the form, you may save changes, download, print, or share the completed Prescriptive Authority & Protocol Agreement as necessary.

Start filling out your Prescriptive Authority & Protocol Agreement online today for efficient document management.