Collaborative Agreement Sample C - Michigan Nurses Association - mmbaonline 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the location and address where the collaborative practice agreement will be implemented. This is crucial for defining the scope of services.
3. In the section detailing services provided independently by the nurse practitioner, check off or list each service such as health maintenance and low-risk obstetrical care.
4. For interdependent services, ensure you accurately describe high-risk obstetrical care and gynecology surgical care, as these require collaboration.
5. Fill in the reference texts that will assist with consultation criteria. This ensures clarity on resources used during practice.
6. Document any situations requiring consultation, such as non-stress tests or abnormal lab values, ensuring all necessary scenarios are covered.
7. Finally, both parties should sign and date at the bottom of the form to validate the agreement.

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