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Pdf fillable capa form 2025

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The document is a notification form for Advanced Practice Registered Nurses (APRNs) in Kentucky to certify their prescriptive authority for controlled substances under the Collaborative Agreement for the Advanced Practice Registered Nurse Prescriptive Authority for Controlled Substances (CAPA-CS). It requires APRNs to confirm their national certification, good standing licensure, and includes sections for personal and practice information, as well as signatures from both the APRN and a collaborating physician.

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