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Form collaborating physician 2026
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- Click ‘Get Form’ to open the form collaborating physician in the editor.
- Begin by entering the 'Name of Nurse Practitioner' and their 'NPI' number in the designated fields. Ensure accuracy as this information is crucial for identification.
- Next, fill in the 'Name of Collaborating Physician' and their corresponding 'NPI'. Remember, the physician must be enrolled in NY Medicaid for this agreement to be valid.
- Indicate the 'Effective Date of Collaborating Agreement'. This date marks when the collaboration officially begins.
- Both parties must sign in the provided signature fields. Ensure that signatures are original; stamps are not accepted. Include the date next to each signature for verification.
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