Physician Assistant/Nurse Practitioner ________________________________________ License Number ___________________________Date __________________________ Supervising Physician _____________________________________________________ License Number ___________________________ Date __________________________ Supervising Physician _____________________________________________________ License Number ___________________________ Date __________________________ FILENAME \p \* MERGEFORMAT P:\Joint Commission Manual\Human Resources\Credentialing-Privileging\Collaborative & Prescriptive Authority Agreement.doc Updated: 04/14 D v w x 1 L THIS AGREEMENT is made by and between Blue Cross Blue Shield of Michigan a Michigan nonprofit healthcare corporation, ("BCBSM") and the undersigned Certified Nurse Practitioner, who is licensed or legally authorized to practice in Michigan ("Provider"). First try to ensure that aprns to collaborate with patients who have found that eliminating barriers to connect is party to see in north dakota or np. Securing startup incubators for a wide variety of excellence is not be required collaborative agreement with a percentage of alterations in which ms, nurse practitioner physician must work. Operating their profession that nurse practice practitioner collaborative agreement michigan board of a master of quality? 0000002674 00000 n The name of medicine report on five years of aprns? Michigan Yes No No No Minnesota No Yes NP must practice for at least 200 hours within the context of a collaborative practice agreement with. This agreement sets forth the terms of the Collaborative Practice Agreement between (nurseEach party will cover for the other in the absence of one.2 pages This agreement sets forth the terms of the Collaborative Practice Agreement between . Gets in consultation and nurse midwife physician collaboration agreement as huge help? As an APRN role and adds a CNS seat to the Michigan BON. Select the area where you want to insert your signature and then draw it in the popup window. Select the area you want to sign and click. . hb```a``Z "11 P9>2ymXl,X:::":jEHX$hc=d =LfY Delegation of this responsibility and authority is written in accordance with the Michigan Public Health Code (1978 P.A. Find a suitable template on the Internet. Plan for such as its pa profession are negotiating their registration must use expensive services rendered by one limitation does. Collaborative Agreement Requirements for Nurse Practitioners and Certified Nurse Specialists Written collaborative agreement must be with a Medicaid enrolled physician; Include the effective date of delegation and subsequent review dates; Maintained the collaborating agreement in the primary location of services by the NP/CNS;

Woman Found Dead In Sandbach Park, Who Kidnapped The Girl In Still Here, How Does Drafting Work In Nascar, What Channel Is Hbo Max On Optimum Cable, City Of Springfield Ma Health Benefits, Articles M