*TEMPLATE* Collaborative Practice Agreement for Advanced ... - in 2026

1. Click ‘Get Form’ to open the *TEMPLATE* Collaborative Practice Agreement in the editor.
2. Begin by entering the complete names, home and business addresses, zip codes, and telephone numbers for both the licensed practitioner and the advanced practice nurse in the designated fields.
3. List all locations where prescriptive authority is authorized by this agreement. Ensure to include business street addresses and contact information.
4. Detail the specialty or board certifications of both practitioners. Clearly specify their qualifications and areas of expertise.
5. Describe how collaboration will occur between the licensed practitioner and advanced practice nurse, including coverage arrangements during absences.
6. Outline any limitations on the advanced practice nurse’s prescriptive authority as set by the licensed practitioner.
7. Provide a description of how often and in what manner the licensed practitioner will review prescribing practices, ensuring compliance with documentation requirements.
8. List any other written practice agreements that exist between both parties, if applicable.
9. Finally, indicate the duration of this agreement and ensure both parties sign and date at the bottom of the form.

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