APRN Protocol Registration

Register or amend an APRN–Physician Protocol Agreement, pay the $150 fee, and upload forms electronically via our gateway portal. Please do not mail any forms.

Click Here to File the Application: https://gateway.medicalboard.georgia.gov/

 

Application Forms

Examples

  Download this pdf file. FORM A - Designated Physician Information

  Download this pdf file. EXAMPLE Form A

  Download this pdf file. FORM C - Protocol Agreement Worksheet

  Download this pdf file. EXAMPLE Form C

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For questions regarding your APRN Protocol agreement and any supporting documentation, please contact the correct specialist.

 

Contact

Licensure Specialist Corelle Hill

Contact for APRN protocol applicants with last names J - R

NextRequest

Contact

Licensure Specialist Sherine Orrigio

Contact for APRN protocol applicants with last names S - Z

NextRequest