COLLABORATIVE PRACTICE AGREEMENT (Use if you are collaborating with a single physician physician and backup physician must sign) This agreement is for the management of the collaborative practice.
Loading
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the COLLABORATIVE PRACTICE AGREEMENT - Arkansas - Arsbn Arkansas online
Filling out the Collaborative Practice Agreement is essential for ensuring proper collaboration between an advanced practice nurse and a physician in Arkansas. This guide will help you navigate the online form with clear, step-by-step instructions.
Follow the steps to complete your agreement online.
- Press the ‘Get Form’ button to access the document and open it in your preferred editing tool.
- Begin by entering the names of the advanced practice nurse (APN) and the collaborating physician (MD) at the top of the form.
- In the subsequent section, both the APN and MD must provide their signatures to indicate their agreement to the collaboration.
- Fill in the APN's license number, area of certification, and practice site details, including the name of the business and clinic address.
- Next, complete the physician's information by entering their AR license number, specialty, practice site, and business details.
- Ensure the date of signing is recorded correctly next to both signatures.
- Review the entire form for accuracy and completeness before finalizing.
- Once completed, you have the option to save your changes, download the file, print it, or share it as needed.
Start filling out your Collaborative Practice Agreement online today!
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
The Collaborative Practice Agreement must meet the following criteria: Must be complete...
testing national practice guidelines as well as collaborating in clinical trials. Further...
Get answers to your most pressing questions about US Legal Forms API.
How do you write a collaborative practice agreement?
Writing a CPA Explanation of the purpose of the agreement. A list of the parties to the agreement. The patients who are included in the agreement (either a specific list of patients or a group of patients) Care functions authorized by the agreement. Training and education requirements for the pharmacist.
Can nurse practitioners prescribe Schedule 2 in Arkansas?
The APRN is authorized to prescribe Schedule II drugs that are classified as stimulants once the following criteria are met: Page 10 ARKANSAS STATE BOARD OF NURSING RULES 4-10 (1) The prescription was originally initiated by a physician; (2) The physician has evaluated the patient within six (6) months before the APRN ...
Can nurse practitioners prescribe in Arkansas?
Full Practice: State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing.
What are the requirements for collaborative practice agreement in Arkansas?
Must be complete and legible and on the current, unmodified form. The collaborating physician must have a current AR license to practice under the Medical Practice Act, § 17-95-201. The collaborating physician must also have an unrestricted DEA registration number for APRNs who prescribe controlled substances.
What is a collaborative practice agreement for nurse practitioners?
A collaborative practice agreement is a written statement that defines the joint practice of a physician and an APN in a collaborative and complementary working relationship. It provides a mechanism for the legal protection of the APN and sets out the rights and responsibilities of each party involved.
Can a nurse practitioner practice independently in Arkansas?
Full Independent Practice for Certified Nurse Practitioners Applications shall be submitted through the Arkansas Nurse Portal. Once all required documents have been received, applications will be sent for review by the Full Independent Practice Credentialing Committee (FIPCC).
What elements should be included in a collaborative practice agreement?
Required components of the CPA are: The drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner.
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.