APRN Protocol Registration Forms

Please find below the complete application and additional forms needed to submit an APRN Protocol Agreeement regisitration. All Protocols that have been recieved and reviewed by the Board can be found here.

HOW TO GET YOUR FILE REVIEWED THE FIRST TIME

APRN General Information

APRN Additional Information

APRN Protocol Agreement (use this form to expedite the protocol review)

APRN Registration Form

FORM A - Designated Physician Information

FORM B - Protocol Agreement Termination

FORM C - Protocol Agreement Worksheet rev 10/2015

FORM D - APRN DEA Information

For questions about your APRN Protocol agreeement,  please contact

Dwana Robinson at dwana.robinson@dch.ga.gov or 404-463-5038 For applicants with last name beginning, A-K

Gina Jackson at gina.jackson@dch.ga.gov or 404-657-6492 For applicants with last name beginning, L-Z