Get Model Standard Care Arrangement The Name Store Platform Enables You To Easily Register Cctld

Filling out the Model Standard Care Arrangement form is an essential step for advanced practice nurses and collaborating physicians to ensure compliance and effective healthcare delivery. This guide will walk you through each section of the form to help you complete it accurately and efficiently.

Follow the steps to fill out the Model Standard Care Arrangement form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by entering the effective date at the top of the form. This is the date when the arrangement will be officially in effect.
3. Fill in the name of the Advanced Practice Nurse (APN) and their certification as a Certified Nurse Practitioner (CNP) along with their employment details.
4. Insert the name of the Collaborating Physician (M.D. or D.O.) who will collaborate with the APN, ensuring that they are also an employee of Mercy Medical Associates, LLC.
5. In Section I, provide details about the services that the CNP is authorized to provide, making sure they align with the nurse's education, certification, and nursing specialty.
6. Document the incorporation of new technology or procedures that will be utilized in the APN's practice in Section II.
7. Follow the outlined quality assurance provisions in Section III, detailing the criteria for referral and consultation, as well as procedures for regular reviews.
8. Complete Section IV by confirming adherence to ethical and religious guidelines, if applicable.
9. Specify the term of the arrangement in Section V, including the effective duration and conditions for termination.
10. If applicable, fill out Section VI regarding prescribed drugs, ensuring all details align with the current formulary.
11. Finally, have both the APN and the Collaborating Physician sign and date the form, and ensure any additional collaborating physicians are also documented.
12. After completing and reviewing the form, save the changes, and choose to download, print, or share the final version as necessary.

Complete the Model Standard Care Arrangement form online to ensure compliance and effective healthcare practices.