Nurse practitioner and main tained at the practice site. Jane doe family nurse practitioner american academy of nurse practitioners aanp john doe.
Illinois rn license number.
Collaborative agreement nurse practitioner template. Illinois mid level practitioner controlled substance license number. This collaborative practice agreement will be reviewed revised if indicated and signed by the nurse practitioner and supervising physician on an annual basis. The advanced practice registered nurse is a nurse practitioner clinical nurse specialist certified nurse midwife etc with a specialized certification as a family nurse practitioner etc.
Briefly describe the specific manner of collaboration between the licensed practitioner and advance practice registered nurse. The review of the collaborative practice agreement shall be done at least yearly. Illinois apn license number.
A dated signature sheet signed by the primary supervising physician and the nurse practitioner will be appended to the collaborative practice agr eement and be available for review by the boards. It is the intent of this document to authorize. Collaborative practice agreement cpa refers to the formal written statement addressing the parameters of the collaborative practice which are mutually agreed upon by the advanced practice registered nurse aprn and one or more licensed physicians or dentists.
Advanced practice nurse information 1. Briefly describe the specific manner of collaboration between the licensed practitioner and advance practice nurse. Sandy mccoy nurse practitioner practicing at northstar surgery center a 23 hour outpatient surgery center located at 5920 forest park ste 700 dallas texas 75235 to practice under these protocols without direct supervision as specified in the medical practice act texas civil statutes article.
Nurse practitionerphysician assistant collaborative and prescriptive authority agreement 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. Template for aprn practice guidelines collaborative agreement follow this template all elements must be present for approval. Federal mid level practitioner dea number.
The collaborative practice agreement is not intended to be nor should it be a substitute for the exercise of professional judgment by the nurse practitioner. Written collaborative agreement a. Examples of what the above should look like.
Sample collaborative practice agreement this 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. The advanced practice nurse is a nurse practitioner clinical nurse specialist certified nurse midwife etc with a specialized certification as a family nurse practitioner etc.
0 Response to "Collaborative Agreement Nurse Practitioner Template"
Post a Comment