The undersigned nurse practitioner and physician agree that all covered medical services billed to the michigan department of community health mdch by the nurse practitioner will be provided in collaboration with the physician pursuant to the provisions of a current collaborative practice agreement which meets the following guidelines. Care services provided by the nurse practitioner will include health maintenance management of acuteepisodic illnesses and management of stable chronic illnesses.
Examples of what the above should look like.
Nurse practitioner collaborative agreement template michigan. The undersigned nurse practitioner and physician agree that all covered medical services billed to the michigan department of community health mdch by the nurse practitioner will be provided in collaboration with the physician pursuant to the provisions of a current collaborative practice agreement which meets the following guidelines. The undersigned licensed physician assistant or nurse practitioner and physicians agree to the following collaborative practice agreement for provision of health care services at the sterling area health center. I am a new grad and i want to make sure that all is well for.
The undersigned nurse practitioner and physician agree to the following collaborative practice agreement for provision of health care services to clients at location address. Collaborative and prescriptive authority agreement. Collaborative practice agreement for nurse practitioner sample a.
Aprn practice guidelines collaborative agreement follow this template. Hello everyone the practice that i have just joined has not used employment contracts ro collaborative agreements in the past and i need to build one but i have no idea how. Jane doe family nurse practitioner american academy of nurse practitioners aanp john doe family psychiatric mental health nurse practitioner american nurses credentialing center jane doe certified nurse midwife.
The purpose of this document is to describe the scope of practice for the nurse practitioner np who signs this agreement as well as provide written authorization by the supervising physician for the np to initiate and provide psychiatric and medical care for the consumers of agency. Article 139 of new york education law holds a certificate as a nurse practitioner pursuant to 6910 of new york education law and herein meets the requirements of maintaining a collaborative practice agreement with md a duly licensed and currently registered physician in good standing under article. I need a template or some hard factors in which to include.
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