Nurse Practitioner Collaborative Practice Agreement 012019 2026

1. Click ‘Get Form’ to open the Nurse Practitioner Collaborative Practice Agreement 012019 in the editor.
2. Begin by filling in the names of the nurse practitioner and collaborating physician at the top of the document. Ensure that you include their specialties as listed on their state-issued certificates.
3. In the introduction section, provide the name of the nurse practitioner and confirm their qualifications as per New York State laws. This includes entering their license status and registration details.
4. For the Scope of Practice section, outline any exceptions to the certified scope of practice agreed upon by both parties. Be specific about what these exceptions are.
5. In Practice Protocols, cite any approved protocol texts relevant to your practice. If there are additional protocols, indicate them clearly or mark N/A if not applicable.
6. Complete sections regarding Physician Consultation, Record Review, Resolution of Disagreements, and Alteration of Agreement by providing necessary details as required.
7. Finally, both parties should print their names, sign, and date at the bottom of the agreement to finalize it.

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