Yes! You can use AI to fill out Illinois Advanced Practice Nurse Delegation of Prescriptive Authority for Controlled Substances (Delegation Statement)
This is a delegation statement used in Illinois to record the parties involved (collaborating physician and advanced practice nurse), verify identifying and licensing information, and specify which controlled substance schedules the APN/APRN is authorized to prescribe and/or dispense. It typically includes the nurseâs personal identifiers (name, DOB, SSN/ITIN), address, license and controlled substance numbers, and the physicianâs license/controlled substance registration details and business address, along with the delegation date and schedule selections. Completing it accurately is important for regulatory compliance and to clearly define the scope of delegated prescriptive authority. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
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Form specifications
| Form name: | Illinois Advanced Practice Nurse Delegation of Prescriptive Authority for Controlled Substances (Delegation Statement) |
| Number of pages: | 1 |
| Language: | English |
| Categories: | Illinois nursing forms, medical licensing forms, Illinois state forms, healthcare practice forms |
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How to Fill Out IL APN Prescriptive Authority Delegation Online for Free in 2026
Are you looking to fill out a IL APN PRESCRIPTIVE AUTHORITY DELEGATION form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your IL APN PRESCRIPTIVE AUTHORITY DELEGATION form in just 37 seconds or less.
Follow these steps to fill out your IL APN PRESCRIPTIVE AUTHORITY DELEGATION form online using Instafill.ai:
- 1 Go to Instafill.ai and upload the delegation statement form (or select it from the form library).
- 2 Let the AI detect and map the fields, then confirm the form type and jurisdiction (Illinois APN/APRN prescriptive authority delegation).
- 3 Enter the Advanced Practice Nurse identification details: full name (last, first, MI), maiden/given surname, date of birth (month/day/year), and SSN or ITIN.
- 4 Provide the Advanced Practice Nurse contact and licensing information: complete mailing address, APN/APRN license number, and controlled substance number.
- 5 Enter the collaborating physician details: printed name, Illinois medical license number, Illinois controlled substance registration number, and business address (street, city/state/ZIP).
- 6 Select the delegated controlled substance schedules by checking the applicable boxes for Schedule II, III, IV, and/or V, and enter the delegation date.
- 7 Review for accuracy and completeness, then generate the finalized output for e-signature/printing and submission as required.
Our AI-powered system ensures each field is filled out correctly, reducing errors and saving you time.
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Frequently Asked Questions About Form IL APN Prescriptive Authority Delegation
This form documents a delegation statement where a collaborating physician delegates prescriptive authority to an Advanced Practice Nurse (APN/APRN), including which controlled substance schedules the nurse may prescribe and/or dispense.
Itâs typically completed when an APRN is receiving delegated prescriptive authority from a collaborating physician. Both partiesâ identifying and licensing details are required, and the physicianâs delegation date must be provided.
You must provide the APRNâs full name (last, first, middle initial), maiden/given surname (if applicable), date of birth (month/day/year), and SSN or ITIN.
Enter the name in the format requested: last name, first name, and middle initial. Use the APRNâs legal name as it appears on licensing records to avoid processing issues.
Provide the APRNâs complete mailing address, including street, city, state, and ZIP code. Use an address where official correspondence can reliably be received.
You must enter the APRN license number and the APN controlled substance number. Make sure the numbers match the APRNâs official credentials exactly.
Youâll need the collaborating physicianâs full printed name, Illinois medical license number, Illinois controlled substance registration number, and business address (street and city/state/ZIP).
It means you should enter only the numeric portion (or the number itself) and omit any âCSâ or similar prefix letters. If youâre unsure, copy the number exactly as issued but remove the prefix indicated by the form.
Check only the schedules (II, III, IV, and/or V) that the physician is delegating to the APRN for prescribing and/or dispensing. If a schedule is not delegated, leave it unchecked.
If the purpose of the delegation includes controlled substances, at least one schedule (IIâV) should be selected as applicable. If no controlled substance authority is being delegated, confirm whether this form is the correct one for your situation.
Enter the date the collaborating physician officially delegated prescriptive authority to the APRN. Use the actual effective date of delegation, not the date you are filling out the form (unless they are the same).
If it doesnât apply, enter âN/Aâ or leave it blank depending on the formâs instructions and your organizationâs policy. Only provide a maiden/given surname if it exists in the APRNâs records.
Processing time depends on the receiving agency or organization and isnât specified in the fields shown. Check the submission instructions that accompany the form or contact the relevant licensing/administrative office for current timelines.
YesâAI form-filling tools like Instafill.ai can help auto-fill fields using your provided information, reducing manual typing and common errors. Always review the completed form for accuracy before submitting.
Upload the PDF to Instafill.ai, provide the APRN and collaborating physician details, and let the AI map your information into the correct fields (DOB, license numbers, addresses, and schedule checkboxes). Then review, download, and submit according to the formâs official instructions.
Instafill.ai can convert flat, non-fillable PDFs into interactive fillable forms so you can type into fields instead of handwriting. After conversion, you can auto-fill and export a clean, legible completed form.
Compliance IL APN Prescriptive Authority Delegation
Validation Checks by Instafill.ai
1
Validates Date of Birth components are present and numeric
Checks that Month, Day, and Year are all provided and contain only digits (no letters or special characters). This prevents partial or non-parseable dates from entering the system. If any component is missing or non-numeric, the submission should be rejected and the user prompted to correct the DOB fields.
2
Validates Date of Birth is a real calendar date
Verifies the Month is 1â12, Day is within the valid range for the given month, and leap-year rules are applied for February 29. This ensures the DOB represents an actual date and avoids downstream errors in identity matching. If invalid (e.g., 02/30 or 13/10), the form should fail validation with a clear error message.
3
Validates Date of Birth is plausible for an APRN (age range check)
Ensures the DOB implies a reasonable age for a licensed advanced practice nurse (e.g., not in the future and not implausibly old/young such as under 18). This helps detect data entry mistakes like transposed digits in the year. If the age is outside the allowed range, the submission should be flagged for correction or manual review.
4
Validates SSN/ITIN format and length
Checks that the SSN or ITIN contains exactly 9 digits after removing hyphens/spaces, and rejects any other length or non-digit characters. This is critical for identity verification and preventing malformed identifiers from being stored. If the value is not 9 digits, validation fails and the user must re-enter the identifier.
5
Validates SSN/ITIN is not an obviously invalid pattern
Rejects known invalid SSN patterns (e.g., all zeros, 000-xx-xxxx, 666-xx-xxxx, 9xx-xx-xxxx) and optionally validates ITINs begin with '9' and have valid middle ranges per policy. This reduces fraud and prevents placeholder values from being accepted. If an invalid pattern is detected, the submission should be blocked or routed to manual review depending on business rules.
6
Ensures Advanced Practice Nurse Full Name is complete and properly structured
Validates that the APRN full name includes at minimum a last name and first name, and that the middle initial (if provided) is a single alphabetic character. This supports consistent record matching and reduces ambiguity in identity. If the name is missing required parts or contains invalid characters, the form should fail with guidance on the required format (Last, First, MI).
7
Validates Maiden/Given Surname field character rules and consistency
Checks that the maiden/given surname contains only valid name characters (letters, spaces, hyphens, apostrophes) and is not identical to the full name field entered in a way that suggests the user repeated the entire name. This improves data quality for identity matching and avoids misusing the field. If invalid characters or obvious misuse is detected, prompt the user to correct the entry.
8
Validates APRN mailing address completeness and ZIP format
Ensures the APRN address includes street, city, state, and ZIP, and that the state is a valid two-letter US state code and ZIP is 5 digits (or ZIP+4 in 9-digit format with hyphen). Complete addresses are necessary for official correspondence and licensing records. If any component is missing or ZIP/state format is invalid, the submission should be rejected.
9
Validates APRN license number is present and matches expected pattern
Checks that the APRN license number is provided and conforms to the jurisdictionâs allowed character set/length (e.g., alphanumeric, no spaces unless permitted). This prevents storing unusable license identifiers and supports verification against licensing databases. If the license number is missing or malformed, validation fails and the user must correct it.
10
Validates APN Controlled Substance Number format
Ensures the APN controlled substance number is present (if required by the workflow) and matches the expected numeric/alphanumeric format and length for the issuing authority. This is important for controlled substance delegation and compliance tracking. If the number is missing when required or does not match the expected format, the submission should be blocked.
11
Ensures Delegation Statement Parties names are present and not duplicated incorrectly
Validates that both the Collaborating Physician Name and the Advanced Practice Nurse Name are provided and that they are not identical (to prevent role confusion). This ensures the delegation is between two distinct parties and supports legal enforceability. If either name is missing or both are the same, the form should fail validation.
12
Validates Collaborating Physician Printed Name matches Collaborating Physician Name
Checks that the printed name field is present and substantially matches the collaborating physician name provided earlier (allowing minor formatting differences like middle initial or punctuation). This reduces the risk of mismatched identities within the same submission. If the names differ materially, the submission should be flagged for correction or manual review.
13
Validates Collaborating Physician Illinois Controlled Substance Number excludes prefix and matches format
Ensures the Illinois controlled substance registration number is entered without the Physician CS Prefix as instructed, and that the remaining value matches the expected length/character rules (typically numeric). This prevents systematic entry errors caused by including prefixes and supports automated verification. If a prefix is detected or the format is invalid, validation fails with a message to remove the prefix.
14
Validates Collaborating Physician Illinois License Number excludes prefix and matches format
Checks that the Illinois medical license number is provided without the Physician CS Prefix and conforms to expected formatting rules (e.g., numeric/alphanumeric length constraints). Correct formatting is necessary for license verification and regulatory compliance. If the value includes a prefix or fails pattern checks, the submission should be rejected.
15
Validates Delegation Date format and logical consistency
Ensures the delegation date is a valid date in the accepted format and is not in the future (unless explicitly allowed) and not unreasonably far in the past per policy. This supports auditability and ensures the delegation timeline is credible. If the date is invalid or outside allowed bounds, the form should fail validation or be routed to review.
16
Validates Collaborating Physician business address completeness and ZIP/state format
Checks that the business street address and the city/state/ZIP are provided, that state is a valid two-letter code, and ZIP is 5 digits (or ZIP+4). A complete business address is required for official records and enforcement actions. If any component is missing or improperly formatted, the submission should be rejected.
17
Ensures at least one delegated controlled substance schedule is selected
Validates that at least one of Schedule II, III, IV, or V is checked to indicate what authority is being delegated. Without a selected schedule, the delegation scope is undefined and may be legally insufficient. If none are selected, the form should fail validation and prompt the user to choose applicable schedules.
Common Mistakes in Completing IL APN Prescriptive Authority Delegation
People often enter the full date in one field, swap month and day, or use two-digit years (e.g., â01/02/90â) when the form requires separate Month, Day, and Year entries. This can cause identity mismatches during verification and delay processing. Avoid this by entering numeric values in the correct fields (MM in Month, DD in Day, YYYY in Year) and double-checking against a government ID; AI-powered tools like Instafill.ai can validate date formats and prevent field swaps.
Applicants frequently include punctuation (e.g., 123-45-6789), add spaces, or accidentally enter an employer ID or another personâs number. Incorrect formatting or an invalid identifier can trigger rejections, manual review, or compliance issues. Use the APRNâs own SSN or ITIN only, enter all digits exactly as required (often digits-only), and confirm the number before submission; Instafill.ai can auto-format and validate SSN/ITIN length and structure.
A common error is entering âFirst Lastâ instead of âLast, First MI,â omitting the middle initial, or using nicknames in one field and legal names in another. Inconsistencies can cause credentialing and licensing cross-check failures, leading to delays or requests for correction. Always use the legal name exactly as it appears on the license and ID, follow the specified order, and keep it identical in both âAdvanced Practice Nurse Full Nameâ and âAdvanced Practice Nurse Nameâ; Instafill.ai can standardize name formatting across fields.
Many people leave the maiden/given surname blank, enter a married name again, or misunderstand the field and put a middle name there. Missing or incorrect prior surnames can prevent record matching with licensing boards or background checks. Provide the true maiden name or birth/given surname (or follow the formâs instructions if âN/Aâ is acceptable) and ensure it aligns with any historical licensing records; Instafill.ai can prompt for missing identity fields and reduce mismatches.
Applicants often forget apartment/suite numbers, enter city/state in the wrong place, or provide an address that doesnât match where they receive mail. Incomplete addresses can cause returned mail, missed notices, and processing delays. Enter the full street address, city, state abbreviation, and ZIP (and ZIP+4 if known), and confirm itâs the APRNâs correct mailing address; Instafill.ai can validate address components and standardize USPS formatting.
People sometimes paste an NPI instead of a state license number, include labels/prefixes, or mistype digits (especially when copying from a card or portal). An incorrect license number can invalidate the delegation documentation and delay approval. Copy the license number exactly as issued by the state board, exclude any non-number text unless explicitly required, and re-check each digit; Instafill.ai can flag suspicious lengths/patterns and reduce transcription errors.
This field is frequently left blank or filled with a DEA number, NPI, or a facility registration number because applicants arenât sure which credential is being requested. Missing or incorrect controlled substance registration information can prevent authorization for prescribing/dispensing and may require resubmission. Confirm the exact âAPN Controlled Substance Numberâ required by the jurisdiction and enter it precisely; Instafill.ai can help map the right credential to the right field and validate expected formats.
The form explicitly says to enter the Illinois controlled substance registration number and Illinois license number without the Physician CS Prefix, but many people include the prefix anyway. Including the prefix can cause automated validation failures or mismatches with state records, delaying processing. Carefully remove any leading prefix letters/symbols and enter only the number portion as instructed; Instafill.ai can automatically strip disallowed prefixes and enforce field-specific formatting rules.
Because the form asks for multiple name fields for both parties, itâs common to accidentally repeat the APRNâs name in the physician field (or vice versa) or to use a signature-style name instead of a clearly printed full name. This can create ambiguity about who is delegating authority and may invalidate the delegation statement. Enter the collaborating physicianâs full legal name in both physician name fields as required, and ensure the APRNâs name appears only in the APRN fields; Instafill.ai can cross-check party roles to prevent swapped entries.
Applicants sometimes leave the delegation date blank, use an ambiguous format (e.g., 3/4/24), or enter a date that doesnât align with the effective period of licensure/registration. An incorrect date can raise compliance questions and may require correction or re-execution of the delegation statement. Use a clear, consistent date format (preferably MM/DD/YYYY unless otherwise specified) and ensure it reflects the actual date prescriptive authority was delegated; Instafill.ai can enforce date formatting and flag future/illogical dates.
People often check all schedules by default, forget to check any, or select schedules that donât match the intended delegation or legal scope. Incorrect schedule selection can lead to unauthorized prescribing authority or rejection for noncompliance. Only check Schedule IIâV boxes that are explicitly being delegated and permitted, and confirm alignment with the APRNâs and physicianâs registrations; Instafill.ai can prompt for confirmation and reduce accidental over-selection.
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