Nurse Practitioner Collaborative Agreement Template

A written collaborative agreement is required for all advanced practice nurses apns engaged in clinical practice outside of a hospital hospital affiliate or ambulatory surgical treatment center astc. Aprns are not required to provide the board of nursing with a copy of their collaborative practice agreement. The nurse practitioner will maintain documentation of completing 50 contact hours each year of ama or ancc approved continuing education courses.

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Sample Collaborative Practice Agreement

Collaborative Agreement Fill Out And Sign Printable Pdf

Collaborative Agreement Sm Template

Review and revision of collaborative practice agreement.

Nurse practitioner collaborative agreement template. Briefly describe the specific manner of collaboration between the licensed practitioner and advance practice registered nurse. The collaborating physician is available to consult with the apn at all times either in person or via electronic means. Identification of the means by which the advanced practice nurse and collaborating physician can be in direct communication as well as a description of arrangements which will assure that the collaborating physician or peer coverage is accessible and available. A dated signature sheet signed by the primary supervising physician and the nurse practitioner will be appended to the collaborative practice agr eement and be available for review by the boards.

The collaborating physician will arrange for peer coverage in hisher absence from the practice. 28 day waiver 2013. Nurse practitioner and main tained at the practice site. See statute 334104 rsmo collaborative practice arrangements see rule 20 csr 2200 4200 collaborative practice regarding physician advanced practice nurse collaborative practice arrangements.

The undersigned nurse practitioner and physician agree that all covered medical services billed to the michigan department of community health mdch by the nurse practitioner will be provided in collaboration with the physician pursuant to the provisions of a current collaborative practice agreement which meets the following guidelines. The advanced practice nurse is a nurse practitioner clinical nurse specialist certified nurse midwife etc with a specialized certification as a family nurse practitioner etc. An apn may provide services in a licensed hospital or hospital affiliate clinic or astc without a written collaborative agreement or delegated prescriptive authority. A copy of the collaborative practice agreement.

The review of the collaborative practice agreement shall be done at least yearly. Collaborative practice agreement cpa refers to the formal written statement addressing the parameters of the collaborative practice which are mutually agreed upon by the advanced practice registered nurse aprn and one or more licensed physicians or dentists. Briefly describe the specific manner of collaboration between the licensed practitioner and advance practice nurse. The advanced practice registered nurse is a nurse practitioner clinical nurse specialist certified nurse midwife etc with a specialized certification as a family nurse practitioner etc.

Sample collaborative practice agreement this agreement sets forth the terms of the collaborative practice agreement between nurse practitioner and specialty as listed on the state issued certificate and name of collaborating physician and specialty if any at name and address of agency or entity where practice takes place.