KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled Substances (CAPA-CS) 2024-2025 free printable template
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RESCISSION
of a Collaborative Agreement for the
Prescriptive Authority for Controlled Substances
(CAPA CS)By signing and submitting this form to the Kentucky Board of Nursing, I hereby certify that
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KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled Substances (CAPA-CS) Form Versions
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How to fill out KY Rescission of a Collaborative Agreement for form Prescriptive
How to fill out KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled
01
Obtain the KY Rescission of a Collaborative Agreement form from the appropriate regulatory authority.
02
Fill in the personal and professional information of the parties involved in the collaborative agreement.
03
Clearly state your intention to rescind the agreement, including the date the original agreement was established.
04
Provide the reasons for rescission, if required.
05
Both parties should review the form to ensure all information is accurate and complete.
06
Sign and date the form to validate the rescission.
07
Submit the completed form to the relevant regulatory board or authority.
08
Keep a copy of the submitted form for your records.
Who needs KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
01
Healthcare professionals who wish to terminate their collaborative agreement for prescriptive authority.
02
Collaborative agreement partners who need to formalize the end of their professional collaboration.
03
Managing entities or organizations overseeing the practices of healthcare providers involved in the agreement.
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What is KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled is a formal process by which a collaborative agreement between a licensed healthcare provider and another healthcare professional is terminated, specifically regarding the authority to prescribe controlled substances.
Who is required to file KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
The healthcare provider who is ending the collaborative agreement, along with any associated licensed healthcare professionals, is required to file the KY Rescission.
How to fill out KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
To fill out the KY Rescission, the filer must provide specific information such as the names of both parties involved, their professional licenses, the date of original agreement, the effective date of rescission, and any other required signatures or certifications as per the state's guidelines.
What is the purpose of KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
The purpose of filing the KY Rescission is to officially notify the relevant authorities that a previous collaborative agreement is no longer in force, thereby terminating the prescriptive authority granted under that agreement.
What information must be reported on KY Rescission of a Collaborative Agreement for the Prescriptive Authority for Controlled?
The information that must be reported includes the names and credentials of the parties involved, date of the original collaborative agreement, date of rescission, and any necessary signatures demonstrating the agreement to terminate.
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