Collaborative practice agreement template and checklist

A collaborative practice agreement template should cover parties, scope, prescribing rules, consultation, chart review, pay, insurance, privacy and how the relationship ends. State law decides what is required. Use the checklist below, then have a lawyer adapt it to your state. If you are still choosing a physician, start with how to find a collaborating physician as a nurse practitioner. Cosign prepares state-specific agreements and tracks chart reviews.

What goes in a collaborative practice agreement?

A collaborative practice agreement (CPA) sets out how an NP and a physician work together. State law decides what must be in it. Use this outline to check that nothing is missing, then have a lawyer adapt it to your state.

Parties and effective date

• Names, licenses and contact details for the NP and the physician
• Practice locations and the states covered
• Start date and term

Scope of practice

• The services the NP provides
• Patient populations and settings
• Limits on what the NP will not do

Prescriptive authority

• What the NP may prescribe
• Limits on controlled substances, including schedules and quantities
• Protocols the NP follows

Collaboration and consultation

• How the physician is available, and how quickly they respond
• How urgent questions are handled
• Backup physician if the primary is unavailable

Chart review and meetings

• How many charts are reviewed and how often
• Meeting schedule and format
• How reviews are documented

Quality and safety

• Process for adverse events
• Referral and escalation criteria
• Annual agreement review

Compensation

• Fee, billing schedule and what it covers
• A statement that payment is for services, not for referrals

Liability and insurance

• Each party's malpractice coverage
• Responsibility for claims

Records and privacy

• Access to records
• HIPAA obligations
• Business associate agreement where needed

Termination

• Notice period
• Patient care during transition
• Records handoff

Signatures

Both parties sign and date. Keep a copy on file for the board of nursing if required.

Review checklist

1. Confirm parties, licenses, locations, start date and term.
2. Define scope of practice, populations and settings.
3. Set prescriptive authority and controlled-substance limits.
4. Document collaboration, consultation and backup coverage.
5. Agree on chart review volume, meeting schedule and documentation.
6. Cover compensation, liability, privacy and termination notice.
7. Both parties sign and date; file with the board if required.
8. Confirm the draft matches your state's required elements before counsel review.

Checked October 2026. Sources: AANP State Practice Environment map; state boards of nursing and medicine. Confirm current rules with your board. General information only, not legal advice.

Frequently asked questions

Do I file the agreement with the state?

Some states require filing. Check your board.

Can I use a form template?

Yes as a starting point, but have it reviewed for your state.

How Cosign helps

Cosign prepares state-specific agreements and tracks chart reviews. Tell us where you practice.

General information only, not legal advice.

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