FORM NP-CR Collaborative Relationships Attestation Form - op nysed 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name exactly as it appears on your New York State Education Department issued nurse practitioner registration certificate.
3. Next, provide your nurse practitioner registration number(s) in the designated field.
4. Identify your specialty area(s) of practice by selecting from the provided options such as Acute Care, Family Health, or Pediatrics.
5. Initial the attestation statements confirming your certification and experience, ensuring you have more than 3,600 hours of qualifying practice.
6. Continue by initialing the section that confirms your collaborative relationships with licensed physicians or hospitals.
7. List the names and license numbers of physicians you are currently engaged with in collaborative relationships.
8. Optionally, provide any additional information regarding your collaborative relationships in the space provided.
9. Finally, sign and date the form to complete your submission.

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