Get Form Np-cr Collaborative Relationships Attestation Form - Op Nysed

Completing the FORM NP-CR Collaborative Relationships Attestation Form is essential for certified nurse practitioners in New York with collaborative relationships. This guide will walk you through the process of filling out the form online with clear and supportive instructions.

Follow the steps to complete the FORM NP-CR online effectively.

1. Press the ‘Get Form’ button to access the NP-CR form and open it in your editing interface.
2. Enter your full name exactly as it appears on your current New York State Education Department issued nurse practitioner registration certificate.
3. Input your nurse practitioner registration number(s) accurately.
4. Select your nurse specialty area(s) of practice from the provided options, ensuring you choose those for which you are certified.
5. Initial in the space provided to attest that you are a certified nurse practitioner in New York State with more than 3,600 hours of qualifying practice.
6. Initial again to confirm that you have collaborative relationships with one or more licensed New York State physicians or a licensed hospital.
7. Initial to attest that you maintain up-to-date documentation regarding your collaborative relationships, as specified in the instructions.
8. List the names and license numbers of the physicians you are collaborating with, and include the name and address of the hospital if applicable.
9. (Optional) Provide any additional information about your collaborative relationships in the designated space.
10. Sign and date the form at the end, ensuring that any information provided is accurate as of your signature date.
11. Once you have filled out the form, you may save changes, download, print, or share the completed form as needed.

Complete your FORM NP-CR online today to ensure compliance and maintain your practice.