PDF
Word
Form HFS3411C Advance Practice Nurse (Apn) Certification and Collaborative Agreement Form - Illinois
What Is Form HFS3411C?
This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the HFS3411C form?
A: The HFS3411C form is the Advance Practice Nurse (APN) Certification and Collaborative Agreement Form in Illinois.
Q: What is an Advance Practice Nurse (APN)?
A: An Advance Practice Nurse (APN) is a registered nurse with advanced clinical training and education.
Q: What is the purpose of the HFS3411C form?
A: The purpose of the HFS3411C form is to certify an APN's qualifications and establish a collaborative agreement with a physician or healthcare provider.
Q: Who needs to complete the HFS3411C form?
A: APNs in Illinois who want to practice in an advanced role need to complete the HFS3411C form.
Q: What information is required on the HFS3411C form?
A: The HFS3411C form requires personal information, educational background, certification details, and details of the collaborative agreement.
Q: What is a collaborative agreement?
A: A collaborative agreement is a written agreement between an APN and a collaborating physician or healthcare provider that outlines the scope of their practice together.
Q: Are there any fees associated with the HFS3411C form?
A: Yes, there may be fees associated with the HFS3411C form. It's best to check with the licensing board or the Illinois Department of Healthcare and Family Services for the current fee schedule.
Q: How often do APNs need to renew their collaborative agreement?
A: APNs in Illinois need to renew their collaborative agreement every 2 years.
Q: Can an APN practice without a collaborative agreement?
A: No, an APN in Illinois must have a collaborative agreement in place in order to practice in their advanced role.
Form Details:
- Released on March 1, 2006;
- The latest edition provided by the Illinois Department of Healthcare and Family Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HFS3411C by clicking the link below or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.
