Get Collaborative Practice Agreement 2023-2026

Filling out a Collaborative Practice Agreement is a vital step for nurse practitioners and collaborating physicians to formalize their partnership. This guide provides clear and detailed steps to help you navigate the online filling process efficiently.

Follow the steps to complete the Collaborative Practice Agreement online.

1. Click ‘Get Form’ button to obtain the Collaborative Practice Agreement form and open it in your online editor.
2. Begin by filling in the full name of the nurse practitioner along with their specialty as indicated on the state-issued certificate. Make sure to provide accurate details to ensure compliance.
3. Next, enter the name of the collaborating physician along with their specialty, if applicable. This establishes the professional relationship between the parties involved.
4. Proceed to fill in the name and address of the agency or entity where the collaborative practice will take place; this information is essential for transparency and regulation compliance.
5. Specify the effective date of the agreement, ensuring this is accurate as it marks when the agreement commences.
6. In the 'Scope of Practice' section, indicate the privileges and responsibilities of the nurse practitioner as outlined, including the ability to prescribe medications and manage patient care.
7. Detail any exceptions to the certified scope of practice that have been agreed upon by both parties. This ensures clarity over any limitations that might apply.
8. In the 'Practice Protocols' section, outline the protocols that will guide the practice, referencing the approved protocol text and any additional relevant documents.
9. Provide information on physician consultation methods, ensuring to include available communication channels and the names of individuals who will provide coverage when necessary.
10. Describe the record review process, including the schedule for record evaluations and how the results will be documented and maintained.
11. In the 'Resolution of Disagreements' section, state how disagreements regarding patient management will be resolved and clarify who will have the final say in disputes.
12. Complete the 'Alteration of Agreement' section, noting the protocol for annual reviews and amendments to the agreement as needed.
13. Finally, both parties must thoroughly read the agreement, sign, and date it. Ensure to enter their printed names and the relevant license information in the designated fields.
14. Once all fields are filled accurately, save your changes, and you may choose to download, print, or share the completed form.

Complete your Collaborative Practice Agreement online today and foster effective professional collaboration.