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APPLICATION: ADD NEW COLLABORATION ALABAMA RN SL Last___ First___ Middle___ DOB: ___ SSN: ___ AL CROP/CNM #: 3___ Telephone: ___ Email: ___ Return completed application, with all required documentation
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How to fill out nurse practitioner collaborative agreement
01
Obtain a copy of the nurse practitioner collaborative agreement template.
02
Review the template and ensure you understand all the terms and requirements.
03
Fill out all necessary information such as your name, contact information, collaborating physician's name and contact information, and any other required details.
04
Have the collaborating physician review and sign the agreement.
05
Keep a copy of the signed agreement for your records.
Who needs nurse practitioner collaborative agreement?
01
Nurse practitioners who practice in states that require a collaborative agreement with a physician.
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What is nurse practitioner collaborative agreement?
Nurse practitioner collaborative agreement is a formal document that outlines the relationship and responsibilities between a nurse practitioner and collaborating physician.
Who is required to file nurse practitioner collaborative agreement?
Nurse practitioners are required to file nurse practitioner collaborative agreement.
How to fill out nurse practitioner collaborative agreement?
Nurse practitioners must fill out the agreement by filling in all required information and ensuring it is signed by both the nurse practitioner and collaborating physician.
What is the purpose of nurse practitioner collaborative agreement?
The purpose of nurse practitioner collaborative agreement is to ensure that nurse practitioners are working within their scope of practice and have oversight from a collaborating physician.
What information must be reported on nurse practitioner collaborative agreement?
Information such as names of nurse practitioner and collaborating physician, scope of practice, agreement terms, and signatures must be reported on nurse practitioner collaborative agreement.
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