APRN Protocol Registration Forms

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

Click Here to Access Our NextRequest Portal

  • Before You Apply - Important Notes
    • Complete every form online and submit via NextRequest (100% electronic).
    • You must have an active APRN Protocol Agreement before applying for a Georgia DEA.
    • Payment – $150 Protocol Registration Fee
      • Prepare a check or money order payable to “GCMB”.
      • Scan or photograph the payment and include it in your NextRequest upload.
      • Mail the original payment plus a copy of your Registration Page to:  
            Georgia Composite Medical Board  
            2 Martin Luther King Jr. Drive SE, East Tower 11th Floor  
            Atlanta, GA 30334

    Important Information about the Delegating Physician's Location

    • A delegating physician in Georgia must have an active state license and practice within the state or within 50 miles of where the patient is located when receiving services. This applies to both in-person and telehealth services provided by an APRN and is independent of the business model.
  • Submission Requirements
    • Complete & Sign your APRN Protocol Agreement (use Board template on Page 2 of the Registration Form).
    • Include Payment Proof in your portal upload.
    • Mail Payment as described above.
    • Maintain a Copy: Please note, per O.C.G.A. § 43-34-25, the APRN and Physician are responsible for maintaining a copy of the protocol and must be able to produce it upon request from the Medical Board or the Nursing Board
  • Download Forms & Examples
  • After You Submit – Review Process & Follow-Up

    How the Board reviews your protocol

    Most submissions qualify for administrative approval—they never go before the APRN Committee or the full Board. A protocol is routed for committee/Board review only when it shows one or more red flags:

    • Disciplinary action on the APRN’s or delegating physician’s license
    • Specialty mismatch between APRN and physician
    • Use of a non-standard protocol form
    • Procedures listed in Form C that fall outside the APRN’s specialty

    If no red flags appear and all statutory requirements are met, the protocol is administratively approved, and an approval letter is issued. Wait for this letter before applying for DEA registration or hospital privileges.

    Typical timeline

    Processing can take a few weeks to several months, depending on how complete and accurate your submission is. Respond promptly to any Board inquiries to keep your file moving.

    Track published approvals

    After each Board meeting, newly approved protocols are added to Nurse Protocol Agreements Reviewed by the Board (public list).

    Submit outstanding documents

    If the Board requests additional items, upload them through NextRequest and include the APRN’s full name in the subject line to avoid delays.

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

Contact

Licensure Specialist Brianna Stewart

Contact for APRN protocol applicants with last names A - I

Contact

Licensure Specialist Corelle Hill

Contact for APRN protocol applicants with last names J - R

Contact

Licensure Specialist Sherine Orrigio

Contact for APRN protocol applicants with last names S - Z