Get 6. For Changes In Collaborative Agreements

This guide provides a structured approach to completing the 6. For Changes In Collaborative Agreements form online. By following these clear steps, both experienced and novice users can navigate the process smoothly.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Carefully enter the name of the facility in the designated space, ensuring accuracy and clarity.
3. Input the name of the advanced practice nurse in the provided field, verifying the spelling.
4. Fill in the Indiana license number for the registered nurse and the certification details for the advanced practice nurse in the appropriate sections.
5. Select the type of request by checking the box next to either ‘New Collaborative Agreement’ or ‘Additional Collaborative Agreement’.
6. Confirm the inclusion of necessary details regarding collaborative agreements by checking the corresponding boxes.
7. For the section on changes in collaborative agreements, place a check next to the relevant types of changes applicable to your request.
8. Compose a detailed cover letter on official letterhead, specifying which physicians or locations are being added, deleted, or retained, along with the effective date of these changes.
9. Once all information is accurately filled, review the entire form for any errors or omissions.
10. Finally, save your changes, and select the option to download, print, or share the form as required.

Complete your document today to ensure compliance and maintain effective collaborative agreements.