Collaborative Agreement Sample C - Michigan Nurses Association - mmbaonline 2026

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

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