Healthy Communities

ARSBN - Collaborative Practice

Guidelines for Collaborative Practice Agreements

An Advanced Practice Registered Nurse (APRN) with Prescriptive Authority must have a current updated Collaborative Practice Agreement (CPA) on file with the Board of Nursing. APRNs should keep their original CPA and submit a copy (PDF) to the Arkansas State Board of Nursing (ASBN) through the nurse portal message center. The APRN is responsible for ensuring this requirement is met. After review of any new CPA, the APRN will be contacted through the nurse portal that the CPA has been approved and in effect or it has been denied and the reason for the denial.

The APRN must notify the Board in writing within seven (7) days after the CPA is terminated. If the Board does not have a current CPA on file, the APRN’s Prescriptive Authority will be inactivated. When a new CPA has been approved by Board staff, Prescriptive Authority is reactivated.

The Collaborative Practice Agreement must meet the following criteria:

  1. Must be complete and legible.
  2. The collaborating physician must have a current AR license to practice under the Medical Practice Act, § 17-95-201. The collaborating physician must also have an unrestricted DEA registration number for APRNs who prescribe controlled substances.
  3. The collaborating physician must have training within the scope, specialty, or expertise of the APRN’s practice/specialty.
  4. Must include a statement that “APRN’s prescribing will be limited to the area of educational preparation and certification.”
  5. Provision addressing availability of the collaborating physician for consultation and/or referral.
  6. Method of management of the collaborative practice (include a statement regarding protocols for Prescriptive Authority)
  7. Plans for coverage of the health care needs of the patient in the emergency absence of the APRN or collaborating physician.
  8. Provision for quality assurance (attach a separate Quality Assurance Plan that has been signed by the APRN and the collaborating physician).
  9. Signatures with dates of both the APRN and the collaborating physician.
  10. If signatures are on a separate sheet from the agreement, a statement indicating that there is mutual agreement to the terms and conditions of the CPA must be included on the signature page (so that it is clear what the signature indicates).
  11. License numbers and certification specialties of both the APRN and the collaborating physician.
  12. Address and phone number of the APRN’s and physician’s practice site(s).

A sample Collaborative Practice Agreement that meets the ASBN's criteria is located under the Adv. Practice tab.  If requesting expressed permission for writing controlled substances, the APRN and collaborative physician must both initial the requested category of controlled substances.

 

Collaborative Practice Agreement for DATA2000 Waiver

Advanced Practice Registered Nurses (APRNs) with Prescriptive Authority must have a current updated Collaborative Practice Agreement (CPA) on file with the Board of Nursing. APRNs should keep their original CPA and provide the Board with a copy submitted via the Arkansas Nurse Portal. The APRN is responsible for ensuring this requirement is met.

The APRN must notify the Board in writing within seven (7) days after the CPA is terminated. If the Board does not have a current CPA on file, the APRN’s Prescriptive Authority will be inactivated. When a new CPA has been approved by Board staff, Prescriptive Authority is reactivated. After approval of any new CPA, the APRN will be contacted by mail that the CPA has been approved and in effect.

The Collaborative Practice Agreement must meet the following criteria:

1.     Must be complete and legible.

2.     The collaborating physician(s) must have a current AR license to practice under the Medical Practice Act, § 17-95-201. The collaborating physician(s) must also have an unrestricted DEA             registration number for APRNs who prescribe controlled substances.

3.     The collaborating physician’s practice must be comparable in scope, specialty, or expertise to that of the APRN’s practice/specialty.

4.     Must include a statement that “APRN’s prescribing will be limited to the area of educational preparation and certification.”

5.     Statement authorizing the APRN to request a DATA 2000 Waiver from the DEA and attests the collaborative physician associated with this agreement is the holder of a DATA 2000 Waiver.

6.     Provision addressing availability of the collaborating physician(s) for consultation and/or referral.

7.     Method of management of the collaborative practice (include a statement regarding protocols for Prescriptive Authority).

8.     Plans for coverage of the health care needs of the patient in the emergency absence of the APRN or collaborating physician(s).

9.     Provision for quality assurance (attach the Quality Assurance Plan that has been signed by the APRN and the collaborating physicians).

10.    Signatures of both the APRN and the collaborating physician(s).

11.    If signatures are on a separate sheet from the agreement, a statement indicating that there is mutual agreement to the terms and conditions of the CPA must be included on the signature page (so that it is clear what the signature indicates).

12.    License numbers and certification specialties of both the APRN and the collaborating physician(s).

13.    Address and phone number of the APRN’s and physician’s practice site(s).

14.    Do not attach the instructions.

Public Health Accrediation Board
Arkansas Department of Health
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4815 W. Markham, Little Rock, AR 72205-3867
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