For your convenience, both sample forms in one document - A sample prescriptive authority agreement and sample facility protocols. This combo for TNP members is $45 (TNP members save $5 by both samples at one time) and for non-members $80.

Sample Prescriptive Authority Agreement

Updated in 2022 - TNP is pleased to provide a fillable pdf template that can be used as a Prescriptive Authority Agreement (PAA). This PAA is between the physician and the Advanced Practice Registered Nurse (APRN) listed on the agreement and should be reviewed, dated and signed by all parties to the Agreement at least annually.

Sample Facility Protocols

A facility-based protocol is a written authorization whereby a physician delegates authority to an Advanced Practice Registered Nurse (APRN) to initiate medical aspects of patient care, including delegation of the act of prescribing or ordering a drug or device at a facility-based practice. This resource includes a sample facility-based protocol as well as practice notes & examples. Last updated December 2019.

NOTICE: Texas Nurse Practitioners (TNP) provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TNP nor its attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TNP cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought. Any legal forms are only provided for the use of physicians in consultation with their attorneys.