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Collaborative Agreement Sample C - Michigan Nurses Association - mmbaonline 2026

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The document outlines a collaborative practice agreement between a nurse practitioner and a physician for providing obstetrical and gynecological services. It specifies the independent and interdependent services each party will provide, establishes regular meetings for case reviews, and details consultation procedures for specific medical situations. The agreement emphasizes accountability within their respective scopes of practice and includes provisions for annual reviews of mutual goals.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the location and address where the collaborative practice will take place in the designated field.
In the section outlining services provided independently by the nurse practitioner, check all applicable services such as health maintenance and low-risk obstetrical care.
For interdependent services, ensure to include high-risk obstetrical care and gynecology surgical care as necessary.
Fill in the resources that will be utilized for consultation and referral criteria in the specified area.
Document any situations requiring consultation, such as non-stress tests or abnormal lab values, ensuring clarity for future reference.
Both parties should sign and date at the bottom of the form to finalize the agreement.

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Does Michigan require a collaborative agreement for nurse practitioners?

The state of Michigan requires nurse practitioners to collaborate with a physician. Michigan is classified as a Restricted Practice Authority state.

What is a written practice agreement?

A practice agreement, sometimes called a delegation agreement, outlines in a general way the patient problems and procedures that the physician authorizes the PA to address or perform. The agreement should be reviewed and updated periodically, as the physician-PA team evolves in the way it delivers care.

How do you write a collaboration agreement?

Here are some essentials of a business collaboration agreement template: Parties: Details of all involved parties. Purpose: A description of the project and objectives. Duration: The start date and end date of the partnership agreement. Contributions: The resources, assets, or funding each party will provide.

What is a written collaborative agreement?

A collaboration agreement should define the parties involved, the terms of the project, purpose and scope, roles and responsibilities, and financial responsibilities.

What is a collaborative agreement for nurse practitioners?

In California, the collaborative practice agreement between a Nurse Practitioner (NP) and a physician must include standardized procedures, which are agreements on the scope of practice and protocols for patient care. These procedures are crucial for NPs to legally collaborate with physicians within the state.

michigan nurse practitioner collaborative agreement

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What is a collaborative practice nurse?

Fulmer PhD, RN. Collaborative practice occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings.

How to write a collaborative practice agreement?

Here are the typical sections to include in a collaborating physician contract. Section #1: Scope of Practice. Section #2: Practice Protocols. Section #3: Physician Consultation. Section #4: Record Review. Section #5: Resolution of Disagreements. Section #6: Alteration of Agreement. Section #7: Compensation.

What does a collaborative agreement look like?

The collaboration agreement needs to define what is expected of each party. Each partys role should be defined, as should each partys responsibilities. Go into as much detail as possible to define the duties and obligations expected of each party.