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COLLABORATIVE PRACTICE (Prescribing) AGREEMENT TEMPLATE Elements Summary from the SUPP Framework for Developing a Safe and Functional Collaborative Practice Agreement: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

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How to fill out collaborative practice prescribing agreement

01

Step 1: Obtain a copy of the collaborative practice prescribing agreement from your state's board of pharmacy or medical licensing board.

02

Step 2: Familiarize yourself with the relevant state laws and regulations governing collaborative practice agreements.

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Step 3: Review the agreement form carefully and ensure that you understand all the terms and provisions.

04

Step 4: Gather all the necessary information and documentation required for the agreement, such as your credentials, proof of licensure, and any required certifications.

05

Step 5: Complete the agreement form by providing all the requested information accurately and truthfully.

06

Step 6: Make sure to include any required signatures from the collaborating prescriber(s) and yourself.

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Step 7: Submit the filled-out agreement form to the appropriate authority, such as the board of pharmacy or medical licensing board.

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Step 8: Follow up with the authority to confirm receipt of the agreement and verify if any further steps or documentation are needed.

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Step 9: Once approved, keep a copy of the signed agreement for your records and ensure ongoing compliance with its terms and conditions.

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Step 10: Periodically review and update the agreement as necessary, following any changes in state laws or regulations.

Who needs collaborative practice prescribing agreement?

01

Healthcare professionals who wish to prescribe medications as part of a collaborative practice with another authorized prescriber.

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This can include pharmacists, nurse practitioners, physician assistants, and other healthcare providers who have the necessary authority and qualifications to prescribe medications.

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It is important to note that the specific requirements for collaborative practice prescribing agreements may vary by state, so individuals should consult their state's laws and regulations to determine if they are required to have such an agreement.

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What is collaborative practice prescribing agreement?

Collaborative practice prescribing agreement is a formal agreement between a physician and a pharmacist allowing the pharmacist to prescribe medications under the supervision of the physician.

Who is required to file collaborative practice prescribing agreement?

Both the physician and the pharmacist are required to file the collaborative practice prescribing agreement.

How to fill out collaborative practice prescribing agreement?

The collaborative practice prescribing agreement should be filled out by both the physician and the pharmacist, outlining the terms of their collaborative practice.

What is the purpose of collaborative practice prescribing agreement?

The purpose of the collaborative practice prescribing agreement is to ensure safe and effective prescribing of medications by pharmacists under the supervision of a physician.

What information must be reported on collaborative practice prescribing agreement?

The collaborative practice prescribing agreement must include the names and contact information of the physician and pharmacist, the scope of practice allowed, and any protocols or guidelines for prescribing medications.

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