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KY Collaborative Agreement for Advanced Practice Registered Nurse Prescriptive Authority for Non‐Scheduled Drugs (CAPA‐NS) Form 2017 free printable template

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COLLABORATIVE AGREEMENT FOR ADVANCED PRACTICE REGISTERED NURSE PRESCRIPTIVE AUTHORITY FOR CONTROLLED SUBSTANCES Capacities Collaborative Agreement for APRN Prescriptive Authority for Controlled Substances
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How to fill out KY Collaborative Agreement for Advanced Practice Registered Nurse

01
Begin by obtaining the KY Collaborative Agreement template from the Kentucky Board of Nursing website or your employer.
02
Fill out your personal information, including your name, APRN license number, and contact details.
03
Provide the name and details of the collaborating physician, including their medical license number and contact information.
04
Clearly outline the scope of your practice in the agreement, specifying the services you will provide.
05
Include any specific protocols or guidelines you will adhere to in your practice.
06
Sign and date the agreement along with the collaborating physician.
07
Submit the completed agreement to the Kentucky Board of Nursing as required.

Who needs KY Collaborative Agreement for Advanced Practice Registered Nurse?

01
Advanced Practice Registered Nurses (APRNs) seeking to provide collaborative care in Kentucky.
02
APRNs pursuing prescriptive authority who must establish a formal collaborative agreement with a physician.

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The Kentucky Collaborative Agreement for Advanced Practice Registered Nurse (APRN) is a formal agreement between a licensed APRN and a physician that outlines the scope of practice, collaboration, and supervision in providing patient care.
All Advanced Practice Registered Nurses (APRNs) who wish to practice in Kentucky are required to file a collaborative agreement with a physician unless they have achieved full practice status.
To fill out the KY Collaborative Agreement, APRNs should provide their personal and professional information, specify the practice settings, describe the scope of practice, outline the collaborative requirements, and both parties must sign the document.
The purpose of the KY Collaborative Agreement is to ensure quality patient care through defined collaborative relationships between APRNs and physicians, thereby enhancing healthcare delivery and facilitating autonomy in practice.
The KY Collaborative Agreement must include details such as the names of the APRN and physician, their professional licensing information, practice location, scope of services to be provided, and provisions for consultation and referral.
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