You can open the Nurse Practitioner Collaborative Agreement Template Florida in multiple formats, including PDF, Word, and Google Docs.
Nurse Practitioner Collaborative Agreement Template Florida Printable | Editable FormSample
[Name of the Nurse Practitioner]
[NP License Number]
[NP Address]
[NP Phone]
[NP Email]
[Name of the Collaborating Physician]
[Physician License Number]
[Physician Address]
This document formalizes the collaborative agreement between the Nurse Practitioner and the Collaborating Physician in accordance with Florida state law, effective as of [Effective Date].
The Nurse Practitioner shall provide health care services within the following parameters: [Specify services, including prescriptive authority, patient assessments, and any limitations].
Both parties agree to work collaboratively to ensure optimal patient care. Responsibilities include: [Detail responsibilities, including communication protocols and supervisory measures].
The terms of compensation for services rendered by the Nurse Practitioner are as follows: [Specify payment terms and conditions].
This agreement shall commence on [Start Date] and may be terminated by either party upon [Specify notice period or conditions for termination].
Both parties shall participate in ongoing quality assurance and improvement initiatives to enhance patient care outcomes.
Both parties commit to maintaining the confidentiality of patient information in compliance with HIPAA regulations.
This agreement shall be governed by and construed in accordance with the laws of the State of Florida.
[Signature of the Nurse Practitioner]
[Name of the Nurse Practitioner]
[Signature of the Collaborating Physician]
[Name of the Collaborating Physician]
[Name of the Nurse Practitioner]
[NP License Number]
[NP Address]
[NP Phone]
[NP Email]
[Name of the Collaborating Physician]
[Physician License Number]
[Physician Address]
This agreement constitutes a collaborative practice relationship as required by Florida law, effective from [Effective Date].
Collaborative practice includes but is not limited to: [Define the collaborative practice setting, including patient types treated and procedures performed].
The Nurse Practitioner agrees to: [Enumerate key responsibilities, including patient assessment, diagnosis, and treatment].
The Collaborating Physician agrees to: [Specify responsibilities related to oversight, consultations, and referrals].
Both parties agree on the hours of operation for collaborative practice, which are: [Specify hours and any variations].
Regular performance evaluation sessions shall be held to assess the quality of care provided and adherence to professional standards.
Both parties agree to indemnify and hold each other harmless from claims arising out of negligent acts performed within the scope of this agreement.
This agreement may be modified only by a written agreement signed by both parties.
[Signature of the Nurse Practitioner]
[Name of the Nurse Practitioner]
[Signature of the Collaborating Physician]
[Name of the Collaborating Physician]
Form
Please complete the form below to create the Nurse Practitioner Collaborative Agreement Template for Florida. All fields must be filled out to ensure a clear and complete agreement. We provide examples to guide you through each step. Nurse Practitioner Collaborative Agreement Template for Florida 1. Nurse Practitioner Information 2. Collaborating Physician Information 3. Agreement Purpose 4. Scope of Practice 5. Responsibilities of the Nurse Practitioner 6. Responsibilities of the Collaborating Physician 7. Record Keeping and Documentation 8. Supervision and Oversight 9. Term and Termination 10. Signatures and Acceptance 11. Declaration and Signatures
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WORD
Nurse Practitioner Collaborative Agreement Template Florida Printable | Editable FormPrintable
