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(Sample) Collaborative Practice Agreement

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(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). This Agreement shall take effect as of (date). Introduction (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 as a 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.

(Sample) Collaborative Practice Agreement This agreement sets forth the terms of the Collaborative Practice Agreement between (nurse practitioner

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