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Get Ky Rescission Of A Collaborative Agreement For The Prescriptive Authority For Controlled Substances 2024-2025
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How to fill out the KY Rescission Of A Collaborative Agreement For The Prescriptive Authority For Controlled Substances online
Filling out the KY Rescission Of A Collaborative Agreement For The Prescriptive Authority For Controlled Substances is an important step in officially rescinding a collaborative agreement in Kentucky. This guide will provide you with the necessary steps to successfully complete the form online.
Follow the steps to complete the rescission form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the date of rescission in the appropriate fields. You will need to complete the day, month, and year sections accurately.
- Print clearly the last name of the physician involved in the collaboration in the designated field.
- In the subsequent fields, enter the last name and first name of the APRN (Advanced Practice Registered Nurse) as well as their Kentucky APRN license number.
- Provide the first name of the physician and their license number in the respective fields.
- Indicate the practice name where the collaboration took place.
- Fill in the practice address, ensuring to include the city, state, and zip code.
- After completing the form, review all information for accuracy and clarity.
- This form must be uploaded through your KY Nurse Portal account at the time of submitting the rescission application.
Take action now and complete your rescission form online to ensure compliance.
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