Get Ky Collaborative Agreement For Advanced Practice Registered Nurse Prescriptive Authority For 2017-2026

Filling out the KY Collaborative Agreement for Advanced Practice Registered Nurse Prescriptive Authority is an essential step for any Advanced Practice Registered Nurse seeking prescriptive authority for controlled substances in Kentucky. This guide will provide you with clear, step-by-step instructions to complete the form effectively online.

Follow the steps to complete the collaborative agreement form online.

1. Click ‘Get Form’ button to access the Collaborative Agreement form and open it in your chosen document editor.
2. Begin by entering the date on the first blank line, specifying the day, month, and year of the agreement's execution.
3. In the next two blank spaces, fill in the name of the Advanced Practice Registered Nurse (APRN) followed by the physician’s name for proper identification.
4. Review the first section of the agreement, which outlines the purpose of entering into the Collaborative Agreement. Ensure that you are aware of the KRS statutes that govern this agreement.
5. Proceed to section two, which describes the types of scheduled drugs the APRN can prescribe. Outline any specific conditions or regulations you are required to adhere to.
6. In section three, specify the conditions under which you plan to prescribe scheduled drugs, confirming they fall within your scope of practice as identified by your licensing rules.
7. In section four, indicate how you and the physician will maintain communication regarding the prescribing of scheduled drugs, whether in person, by phone, fax, or electronically.
8. Review section five, ensuring you understand that this agreement does not replace your professional clinical judgment and does not transfer additional liability to the physician.
9. Complete section six by noting the process for rescinding the agreement, including the required notice period and method of notification.
10. Sign the form in the designated spaces for both the APRN and the physician, ensuring you also include your respective license numbers, specialties, practice addresses, and contact numbers.
11. Once all fields are filled out and verified for accuracy, save your changes, and you may opt to download, print, or share the completed form as needed.

Complete your collaborative agreement online today to ensure compliance and streamline your prescriptive authority.