[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283040-105":53,"doc-detail-283040-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","collaborative-practice-agreement-sample","Collaborative Practice Agreement - Sample","","Sample Collaborative Practice Agreement text defining terms between a nurse practitioner and a collaborating physician in New York State, including scope of practice, authorized diagnostic and therapeutic actions, and prescribing provisions within the certified scope. It establishes practice protocols, consultation methods (on site or electronic), coverage responsibilities, and emergency referral steps. It also specifies quarterly record review by the collaborating physician, signed summaries retained for potential regulatory review, and a dispute resolution process with physician-authority provisions. The agreement requires annual review and amendment by signed written document.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/collaborative-practice-agreement-sample/283040/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/collaborative-practice-agreement-sample/283040.png","ImageObject",442,249,{"name":88,"@type":89},"Dipper","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-29","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of a Collaborative Practice Agreement in this sample?","Question",{"text":108,"@type":109},"It sets the terms between a nurse practitioner and a collaborating physician for collaborative practice at the named agency or designated facility and defines operational and compliance requirements.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What does the agreement cover under the nurse practitioner’s scope of practice?",{"text":113,"@type":109},"It covers diagnosis of illness and physical conditions, therapeutic and corrective measures, and prescribing medications for conditions within the authorized scope as identified on the nurse practitioner certificate, including controlled substances under a DEA number.",{"name":115,"@type":106,"acceptedAnswer":116},"How are patient records reviewed and what happens if there is a disagreement?",{"text":117,"@type":109},"The collaborating physician reviews a representative sample of patient records every three months and both parties sign summarized results for potential regulatory review. Disagreements within the scope are resolved by consensus, and if not resolved, the collaborating physician’s opinion prevails.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},283040,1790310936,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","(Sample) Collaborative Practice Agreement  \nThis agreement sets forth the terms of the Collaborative Practice Agreement between (nurse practitioner and specialty as listed on the State issued certificate) and (name of collaborating physician and specialty if any) at (name and address of agency or entity where practice takes place) . This agreement shall take effect as of (date) .  \nIntroduction  \n(YOUR NAME RN, NP) meets the qualifications and practice requirements as stated in Chapter 257 of the Laws of 1988 and Article 139 of the Education Law of New York State, holds a New York State license and is currently registered as a registered professional nurse in good standing, holds a certificate asa nurse practitioner pursuant to Sec. 6910 of the Education law and herein meets the requirement of maintaining a collaborative practice agreement with (NAME OF COLLABORATOR, MD/DO) a duly licensed and currently registered physician in good standing under Article 131 of the New York State Education Law.  \nI. Scope of Practice  \nThe practice of a registered professional nurse as a nurse practitioner may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures including prescribing medications for patients whose conditions fall within the authorized scope of the practice as identified on the college certificate. This privilege includes the prescribing of all controlled substances under a DEA number. The nurse practitioner, as a registered nurse, may also diagnose and treat human responses to actual or potential health problems through such services as case finding, health counseling, health teaching, and provision of care supportive to or restorative of life and well-being. This practice will take place at (above identified agency) or in such other facility or location as designated by (name of identified agency) or by the parties of this contract. The following exceptions to the certified scope of practice have been agreed upon by the undersigned parties: (list exception(s)) .  \nII. Practice Protocols  \nThe protocols used in this (identify specialty as listed on State issued certificate) practice are contained in (name approved protocol text with all bibliography citations) and in (cite location of any other protocols which are germane to this particular practice) .  \nIII. Physician Consultation  \nThe parties shall be available to each other for consultation either on site or by electronic access including but not limited to telephone, facsimile and email. Each party will cover for the other in the absence of oneof them or (names of third parties) who are designated by (YOUR NAME, RN, NP and NAME OF COLLABORATOR MD/DO) as appropriate for coverage in the absence of both parties. In the event that there is an unforeseen lack of coverage, patients will be referred to the appropriate emergency room.  \nIV. Record Review  \nA representative sample of patient records shall be reviewed by the collaborating physician every three months to evaluate that (name of NP)'s practice is congruent with the above identified practice protocol documents and texts. Summarized results of this review will be signed by both parties and shall be maintained in the nurse practitioner's practice site for possible regulatory agency review. Consent forms for such review will be obtained from any patient whose primary physician is other than (name of collaborating physician) .  \nV. Resolution of Disagreements  \nDisagreement between (name of nurse practitioner) and (name of collaborating physician) regarding apatient's health management that falls within the scope of practice of both parties will be resolved by a consensus agreement in accordance with current medical and nursing peer literature consultation. In case of disagreements that cannot be resolved in this manner,(name of collaborative physician's) opinion will prevail. In disagreements between the nurse practitioner and non-collaborating physicians, the","cbCaisnSI29Vyipm","https://ap.wps.com/l/cbCaisnSI29Vyipm","pdf",17054,"English","# Introduction\n# I. Scope of Practice\n# II. Practice Protocols\n# III. Physician Consultation\n# IV. Record Review\n# V. Resolution of Disagreements\n# VI. Alteration of Agreement\n# VII. Agreement","[{\"question\":\"What is the purpose of a Collaborative Practice Agreement in this sample?\",\"answer\":\"It sets the terms between a nurse practitioner and a collaborating physician for collaborative practice at the named agency or designated facility and defines operational and compliance requirements.\"},{\"question\":\"What does the agreement cover under the nurse practitioner’s scope of practice?\",\"answer\":\"It covers diagnosis of illness and physical conditions, therapeutic and corrective measures, and prescribing medications for conditions within the authorized scope as identified on the nurse practitioner certificate, including controlled substances under a DEA number.\"},{\"question\":\"How are patient records reviewed and what happens if there is a disagreement?\",\"answer\":\"The collaborating physician reviews a representative sample of patient records every three months and both parties sign summarized results for potential regulatory review. Disagreements within the scope are resolved by consensus, and if not resolved, the collaborating physician’s opinion prevails.\"}]","Collaborative Practice Agreement - Sample | PDF",1789588165]