4np form 2026

1. Click ‘Get Form’ to open the 4np form in the editor.
2. In Section I, complete your personal information. Ensure that item 4 has your name exactly as it appears on your Application for a Certificate (Form 1).
3. Proceed to Section II, where you and your collaborating physician must fill out their details. Make sure to include their name, address, telephone number, and New York State medical license number.
4. In Section III, select an approved practice protocol text from the provided list. Document the title, publisher, and publication date of this text.
5. Finally, both you and the collaborating physician must sign and date the form in Section III before submitting it to the Office of the Professions.

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