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Collaborative Practice Agreement This agreement is for the management of the collaborative practice between: ___, APRN, and ___, MD×DO. The physician hereby agrees to be available to the Advanced
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How to fill out collaborative practice agreement with

01
Obtain a copy of the collaborative practice agreement template from your organization or regulatory body.
02
Read and familiarize yourself with the terms and requirements of the agreement.
03
Identify the collaborating provider(s) with whom you wish to enter into the agreement and obtain their willingness to collaborate.
04
Schedule a meeting with the collaborating provider(s) to discuss the terms of the agreement and negotiate any necessary changes.
05
Complete the necessary sections of the collaborative practice agreement, including personal information, scope of practice, and responsibilities.
06
Review the completed agreement for accuracy and completeness.
07
Ensure all required signatures, including both parties and any supervising physicians, are obtained.
08
Submit the signed agreement to the appropriate approving authority, such as your organization or regulatory body, for review and approval.
09
Keep a copy of the signed agreement for your records and provide a copy to the collaborating provider(s).

Who needs collaborative practice agreement with?

01
Healthcare professionals, such as physicians, nurse practitioners, physician assistants, and pharmacists, who wish to engage in collaborative practice or provide care outside of their licensed scope of practice need a collaborative practice agreement. It is usually required when a healthcare professional wants to work under the supervision or in collaboration with another licensed provider, allowing them to provide advanced or specialized care.
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Collaborative practice agreement is a formal agreement between a licensed prescriber and a licensed pharmacist that allows the pharmacist to perform certain medication management functions under the supervision of the prescriber.
A licensed prescriber and a licensed pharmacist are required to file a collaborative practice agreement with the appropriate state regulatory authority.
To fill out a collaborative practice agreement, the prescriber and pharmacist must outline the specific medication management functions that the pharmacist is authorized to perform, as well as the terms of supervision and communication between the two parties.
The purpose of a collaborative practice agreement is to improve patient care by allowing pharmacists to assist in medication management and monitoring under the supervision of a licensed prescriber.
The collaborative practice agreement must include the names and license numbers of the prescriber and pharmacist, the specific medication management functions authorized for the pharmacist, and the terms of supervision and communication between the parties.
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