Assignment: The Physicians or Dentists
developed practice guidelines, professionally developed guidelines, text books, etc. Do not send these references
to the Board of Nursing.)
B. The conditions for which the ARNP may initiate treatment include, but are not limited to:
Otitis media and externa
Upper respiratory tract infections Sinusitis
C. Treatments that may be initiated by the ARNP, depending on the patient condition and judgment of the ARNP:
Suture of simple and complex lacerations not requiring ligament or tendon repair.
Incision and drainage of abscesses.
Removal of ingrown toenail
ARNP Protocol – (format example does not have to be followed in total or in part) The ARNP and supervising physician determine the content of the protocol agreement.
D. Drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order
ARNPs can prescribe or dispense a controlled substance as defined in Section 893.03, Florida Statutes, if the ARNP
graduated from a program with a master’s or doctoral degree in a clinical nursing specialty area with training in
specialized practitioner skills (authority granted by law on January 1, 2017).
V. Duties of the Physician
The physician shall provide general supervision for routine health care and management of common health problems, and
provide consultation and/or accept referrals for complex health problems. The physician shall be available by telephone or
by other communication device when not physically available on the premises. If the physician is not available, his
associate, (Name of Backup Physician), title, Florida license number/DEA #999999 (or other description of designated
authorized supervising physician), will serve as backup for consultation, collaboration and/or referral purposes.
VI. Specific Conditions and Requirements for Direct Evaluation With respect to specific conditions and procedures that require direct evaluation, collaboration, and/or consultation by the
physician, the following will serve as a reference guide:
Clinical Guidelines in Family Practice, X Edition, by Constance R. Uphold, ARNP, PhD, and Mary Virginia Graham, ARNP, PhD
(or other reference text or practitioner created reference guide)
The physician will be consulted for the following conditions:
3rd degree lacerations
Severe hypertension determined by _
Etc. (list appropriate conditions)
VII. All parties to this agreement share equally in the responsibility for reviewing treatment protocols as needed. (At practice locations where multiple physicians or dentists are supervising the same ARNPs, the practice may delegate to one of the
supervising physicians or dentists the authority to sign the protocol for the physicians or dentists listed on the protocol)
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