Get the free Naloxone Collaborative Practice Agreement (CPA) Template for Provider Use.docx

A COLLABORATIVE PRACTICE AGREEMENT FOR OPIOID OVERDOSE PREVENTION AND RESPONSE NALOXONE KIT PRESCRIBING, DISPENSATION, AND DISTRIBUTION PROTOCOLPurpose: To reduce morbidity and mortality from opioid

How to fill out naloxone collaborative practice agreement

How to fill out naloxone collaborative practice agreement

1. Gather all necessary information and documentation.
2. Review the requirements and guidelines provided by your state's pharmacy or medical board.
3. Contact a collaborating physician or healthcare provider who is willing to enter into the collaborative practice agreement with you.
4. Discuss the terms and conditions of the agreement with the collaborating physician, including the roles and responsibilities of both parties.
5. Draft the naloxone collaborative practice agreement, ensuring that it complies with your state's regulations and includes all required elements.
6. Share the draft agreement with the collaborating physician for review and amendment if necessary.
7. Once both parties are satisfied with the agreement, sign it and keep a copy for your records.
8. Submit the signed agreement to the appropriate authority or agency as per your state's regulations.
9. Follow any additional steps or requirements specified by your state's pharmacy or medical board.
10. Periodically review and update the agreement as needed to ensure compliance with changing regulations or circumstances.

Who needs naloxone collaborative practice agreement?

1. Naloxone collaborative practice agreement is typically required for healthcare professionals, such as pharmacists and nurse practitioners, who want to dispense or administer naloxone to patients in certain states.
2. It may also be required for individual pharmacists or healthcare providers who wish to provide naloxone without a direct prescription from a physician.
3. The specific requirements vary by state, so it is important to check the regulations and guidelines provided by your state's pharmacy or medical board.
4. In general, anyone who is involved in the dispensing or administration of naloxone and falls within the scope of practice defined by their state's regulations may need a naloxone collaborative practice agreement.

For pdfFiller’s FAQs

What is naloxone collaborative practice agreement?

The naloxone collaborative practice agreement is a formal arrangement between a pharmacist and a prescriber that allows the pharmacist to dispense naloxone without an individual prescription.

Who is required to file naloxone collaborative practice agreement?

Both the pharmacist and the prescriber are required to file the naloxone collaborative practice agreement.

How to fill out naloxone collaborative practice agreement?

To fill out the naloxone collaborative practice agreement, both the pharmacist and the prescriber must agree on the terms and conditions for dispensing naloxone.

What is the purpose of naloxone collaborative practice agreement?

The purpose of the naloxone collaborative practice agreement is to increase access to naloxone and improve the response to opioid overdoses.

What information must be reported on naloxone collaborative practice agreement?

The naloxone collaborative practice agreement must include details such as the names and contact information of the pharmacist and prescriber, as well as the terms of the agreement.

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