[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-171957-105":53,"doc-detail-171957-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-template-clinical-pharmacist","Collaborative Practice Agreement Template - Clinical Pharmacist","","Collaborative Practice Agreement Template for a clinical pharmacist defines how pharmacists participate in collaborative drug therapy management (CDTM) within a physician-led healthcare team. It provides guidance to review state practice acts and institutional policies, and includes configurable sections for collaborating provider numbers and ratios, patient referral criteria, agreement duration, and pharmacist qualifications and competence maintenance. It also outlines delegated scope of practice such as assessments, initiation of evidence-based pharmacotherapy, and requirements for data access, documentation, communication, agreement review, and record retention.",{"@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-template-clinical-pharmacist/171957/",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-template-clinical-pharmacist/171957.png","ImageObject",442,249,{"name":88,"@type":89},"Quinn","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-23","2026-09-01",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 should be reviewed before completing the CPA template?","Question",{"text":108,"@type":109},"The agreement’s rules and regulations, including statutes governing both pharmacy and medicine practice, should be comprehensively reviewed because state practice acts vary widely.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the template define pharmacist authority in CDTM?",{"text":113,"@type":109},"The CPA establishes authority for pharmacists to participate in CDTM within a physician-led care team and specifies requirements, procedures, and guidelines governing mutually agreed patient care.",{"name":115,"@type":106,"acceptedAnswer":116},"What qualification and competence requirements does the template include for participating pharmacists?",{"text":117,"@type":109},"It requires an active pharmacist license and either specified residency training or at least three years of relevant clinical practice experience, plus ongoing competence via continuing education and board certification or organization-specific requirements.","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},171957,1791158997,{"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":15,"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":79},962075114765,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Clinical Pharmacist\nCollaborative Practice Agreement Template\n© 2025 AMERICAN COLLEGE OF CLINICAL PHARMACY\n\u000f\nCollaborative Practice Agreement Template Instructions and Guidance\nPrior to completing the template, state rules and regulations including statutes governing both the practice of pharmacy and the practice of medicine should be comprehensively reviewed. State practice acts vary widely.  It may be prudent to include reference to specific state regulations (by name/number) that govern the agreement within the agreement’s introductory text. Common areas that differ across states are called out in highlighted brackets throughout the document and include:\nNumber and ratio of collaborating providers\nIn addition to the number and ratio of providers, some states require that an agreement be in place for each patient.\nConsider also regulations related to geographical location of/distance between the pharmacist and the referring provider.\nDuration of collaboration agreement\nReferral and/or prescription requirements\nPharmacist qualifications and maintenance of competence requirements\nSome states require pharmacist certification or designation(s) to participate in CPA/CDTM.\nPharmacist scope of practice\nData access, documentation, and communication requirements\nAgreement review frequency\nRecord retention requirements\nSome states require filing the agreement/protocol with the state board of pharmacy.\nInsurance requirements\nThis section may be subject to state-based variations but is more likely to be dictated by institutional rules and regulations (if at all).\nAppendices\nAppendix A - Pharmacotherapy  – degree of detail varies widely per state with some requiring no specification of medications, some requiring all specific medications and dosages be listed, some requiring medication classes be listed and others requiring general information referencing standard guidelines.\nAppendix B – Institution-specific treatment protocols/guidelines.  This would be most commonly used in large health systems but may not be necessary for many agreements.\nAppendix C – Orders and point of care testing – similar to the Pharmacotherapy details, the degree of detail required in this section will vary based upon state regulations and institutional policies.\nThis template provides a starting point from which practitioners can evaluate the need for revisions and alterations based upon state laws. Additional details may need to be included based on state-specific requirements.\nAgreements between practitioners employed by different systems/institutions/practices may require the addition of professional liability insurance coverage requirements.\nHealth-system or institutional policies should also be reviewed and incorporated into the CDTM in both the main body and appendices, where appropriate.\n[organization name]\nThis collaborative practice agreement (CPA) establishes the authority for pharmacists to participate in collaborative drug therapy management (CDTM) within the physician-led health care team.  The requirements, procedures, and guidelines contained within this document constitute an agreement between [one or more] physicians and [one or more - insert relevant number/ratio of collaborators based upon state rules and regulations] pharmacists for the care of patients that are mutually agreed upon through the processes described herein.\nCollaborative practice will be granted for a period of [1 year – or insert alternative agreement duration as determined by state/region/organization] from the date of signature, unless rescinded in writing.\nDIAGNOSES AND referral criteria\nThis CPA authorizes team-based care for patients with documented diagnoses including [insert diagnoses as determined by organization/participating collaborators; this may be a list with checkboxes to allow selection by collaborating/referring physician] that are identified through:\nDirect referral by a participating physician [note - some states may require written prescription], or\n[Inse","cbCaiq8wCrByeEdi","https://ap.wps.com/l/cbCaiq8wCrByeEdi","docx",103559,"English","# Collaborative Practice Agreement Template Instructions and Guidance\n## State-Regulation Review Guidance\n## Agreement Structure Overview\n## Appendices\n## CPA Core Provisions\n## Diagnoses and Referral Criteria\n## Pharmacist Qualifications\n## Pharmacist Scope of Practice","[{\"question\":\"What should be reviewed before completing the CPA template?\",\"answer\":\"The agreement’s rules and regulations, including statutes governing both pharmacy and medicine practice, should be comprehensively reviewed because state practice acts vary widely.\"},{\"question\":\"How does the template define pharmacist authority in CDTM?\",\"answer\":\"The CPA establishes authority for pharmacists to participate in CDTM within a physician-led care team and specifies requirements, procedures, and guidelines governing mutually agreed patient care.\"},{\"question\":\"What qualification and competence requirements does the template include for participating pharmacists?\",\"answer\":\"It requires an active pharmacist license and either specified residency training or at least three years of relevant clinical practice experience, plus ongoing competence via continuing education and board certification or organization-specific requirements.\"}]","Collaborative Practice Agreement Template - Clinical Pharmacist | DOCX",1788288202]