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Get Collaborative Practice Agreement /arrangement Change Form
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How to fill out the COLLABORATIVE PRACTICE AGREEMENT /ARRANGEMENT CHANGE FORM online
The COLLABORATIVE PRACTICE AGREEMENT /ARRANGEMENT CHANGE FORM is essential for physicians to report changes in their collaborative practice agreements. This guide offers clear instructions on how to complete the form accurately online.
Follow the steps to successfully complete the form.
- Press the ‘Get Form’ button to obtain the form and open it in the designated editor.
- In the first section, enter the physician's name and license number. Ensure this information is accurate to avoid processing delays.
- Next, for each nurse involved in the collaborative practice, provide their name and title (e.g., RN, APN) along with their license number. Repeat this for each professional as required by the form.
- Fill in the complete address for each nurse listed. Ensure all addresses are current to facilitate communication and documentation.
- After completing the form, review all entries for accuracy. Ensure there are no missing fields or typographical errors.
- Once satisfied with the completed form, you can save changes, download, print, or share the form as needed.
Complete your COLLABORATIVE PRACTICE AGREEMENT /ARRANGEMENT CHANGE FORM online today.
To have a new Collaborating Physician for prescriptive authority, you MUST submit a new CRNP Application for Prescriptive Authority. The application is available at .dos.pa.gov/nurse, Once approved, you will then receive a new Prescriptive Authority Approval Number associated with the new Collaborating Physician.
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