The Clauses a Board Requires in an NP Collaborative Agreement
Summary
No national list exists: what a nurse practitioner's collaborative practice agreement must contain is set by each state's board, and the required clauses differ by state. Most state lists share a skeleton: the parties and their license numbers, consultation and referral criteria, coverage when the collaborating physician is away, a chart review schedule, prescribing provisions, dispute resolution, and dated signatures with a review cycle. Your own board's rule is the list that binds you.
By Gale Editorial · Updated 2026-09-01. Every figure cited to a dated source. How we write.
What must a collaborative practice agreement contain?
Whatever your own state board's rule says it must contain, and no two state lists match. There is no national set of required clauses for a nurse practitioner. Ohio's rule says a standard care arrangement shall include at least the items it then enumerates, beginning with the signatures of each nurse and each collaborating physician, or the physician's designated representative 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements..
California does not use that instrument. Its Board of Registered Nursing calls the document a standardized procedure and says every one must contain all eleven elements listed in Title 16 CCR section 1474, starting with being in writing, dated and signed by the organized health care system personnel authorized to approve it, and developed collaboratively by nursing, medicine and administration 2Ref 2California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's standardized procedure as the state's equivalent instrument: the eleven required elements under Title 16 CCR section 1474, and the requirement that the document be in writing, dated, signed by the personnel authorized to approve it and developed collaboratively by nursing, medicine and administration..
Neither list travels across a state line. So the first thing to settle is which instrument your state requires, because whether you need a collaborative agreement or protocol at all is a state question, and the answer decides the words you search for.
The clause families that recur across state lists
Eight families of clause show up repeatedly under different names. Pennsylvania's rule enumerates the contents of a prescriptive authority collaborative agreement, and among them the agreement must identify the specialty in which the CRNP is certified, name at least one substitute physician, and be reviewed at least every two years 3Ref 3Pennsylvania State Board of Nursing (2026).49 Pa. Code § 21.285. Prescriptive authority collaborative agreements..Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician.. Georgia's nurse protocol agreement must carry names, addresses, telephone numbers, license numbers and the DEA registration number for all parties to it 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment..
| Clause family | A state that spells it out in its own rule |
|---|---|
| Parties and their identifiers | Georgia, down to the DEA registration number for every party 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment. |
| Signatures and dates | Ohio, from each nurse and each collaborating physician 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements.; California, dated and signed by the personnel authorized to approve it 2Ref 2California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's standardized procedure as the state's equivalent instrument: the eleven required elements under Title 16 CCR section 1474, and the requirement that the document be in writing, dated, signed by the personnel authorized to approve it and developed collaboratively by nursing, medicine and administration. |
| Consultation and referral | Ohio, inside the quality assurance provisions, alongside referral criteria 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements. |
| Coverage while the physician is away | Georgia, through a designated physician named in the agreement 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment. |
| Chart review | Georgia, on a fixed schedule 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment.; Ohio, as a chart review process where the practice includes direct patient care 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements. |
| Prescribing provisions | Ohio, including obtaining and reviewing prescription monitoring reports from OARRS 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements. |
| Dispute resolution | New York, by statute 5Ref 5New York State Legislature (2026).New York Education Law § 6902, Definition of practice of nursing.New York's statutory requirement that a written practice agreement contain explicit provisions for resolving a disagreement between the collaborating physician and the nurse practitioner over diagnosis or treatment, and the default that the physician's view prevails without them. |
| Review and amendment cycle | Pennsylvania, at least every two years 3Ref 3Pennsylvania State Board of Nursing (2026).49 Pa. Code § 21.285. Prescriptive authority collaborative agreements..Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician. |
Read what a rule leaves out as carefully as what it lists. Pennsylvania's contents list says nothing about the collaborating physician's own specialty 3Ref 3Pennsylvania State Board of Nursing (2026).49 Pa. Code § 21.285. Prescriptive authority collaborative agreements..Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician., and a template borrowed from a neighboring state tends to import a requirement your board never wrote while dropping one it did.
The two clauses a solo practice most often leaves out
Chart review and dispute resolution. Both are administrative housekeeping, both survive easily as an intention nobody wrote down, and at least two states put them in the document itself. Georgia fixes the review schedule inside the protocol agreement, in what the board calls minimum accepted standards, and the physician must review and sign 100% of patient records for patients receiving prescriptions for controlled substances, at least quarterly 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment..
The rest of that schedule is 100% of records with an adverse outcome within 30 days, and 10% of all other records at least annually 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment.. Numbers that specific belong in the agreement verbatim, because they are what a later review will be measured against.
New York makes dispute resolution a required clause. The written practice agreement must contain explicit provisions for resolving a disagreement between the collaborating physician and the nurse practitioner over diagnosis or treatment, and without them the physician's diagnosis or treatment prevails 5Ref 5New York State Legislature (2026).New York Education Law § 6902, Definition of practice of nursing.New York's statutory requirement that a written practice agreement contain explicit provisions for resolving a disagreement between the collaborating physician and the nurse practitioner over diagnosis or treatment, and the default that the physician's view prevails without them.. That section also carries a later-effective version, so read the version note on the page before quoting it.
Ohio adds the maintenance clause almost everyone forgets. Modify the body of the arrangement and it has to be reapproved, and superseded arrangements are retained by the nurse for three years and provided to the board on request 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements.. Keep the signed originals, not only the current one.
Who signs it, who files it, and when it comes back up
In some states the filing is not yours to make. Georgia's APRN protocol registration is accessible and submittable online only by delegating physicians, through the physician's Gateway account, on a $150 non-refundable filing fee, and the board states that, depending on the complexity of the agreement, it is currently experiencing processing times averaging 30 business days, as of September 2026 6Ref 6Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's filing mechanics for an APRN protocol agreement: the $150 non-refundable fee, online submission only by the delegating physician through Gateway, and the board's currently stated average processing time..
That changes the sequence of your own setup. If the physician holds the filing, the physician also holds the calendar, and an agreement signed in your office is not yet on file anywhere.
Amendments carry their own clocks. Georgia requires an amendment to be filed with the board within 30 days of execution 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment., and Pennsylvania requires the agreement itself to be reviewed at least every two years 3Ref 3Pennsylvania State Board of Nursing (2026).49 Pa. Code § 21.285. Prescriptive authority collaborative agreements..Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician.. Calendar the review date and the collaborative agreement renewal the day the document is signed, in the same place you keep license renewals, rather than in the document nobody opens between reviews.
How to find your own board's required contents
Start in the administrative code, not on the board's homepage. Three lookups usually finish the job: your state's nurse practice act section on advanced practice, the board rule chapter that implements it, and the board's forms page. Search the rule text for the phrase shall include, which is exactly how Ohio's list of required items opens 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements., and read every item that follows it.
- Search the instrument's name before searching the phrase collaborative agreement. Ohio's is a standard care arrangement 1Ref 1Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements., California's a standardized procedure 2Ref 2California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's standardized procedure as the state's equivalent instrument: the eleven required elements under Title 16 CCR section 1474, and the requirement that the document be in writing, dated, signed by the personnel authorized to approve it and developed collaboratively by nursing, medicine and administration., Pennsylvania's a prescriptive authority collaborative agreement 3Ref 3Pennsylvania State Board of Nursing (2026).49 Pa. Code § 21.285. Prescriptive authority collaborative agreements..Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician., Georgia's a nurse protocol agreement 4Ref 4Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment., New York's a written practice agreement 5Ref 5New York State Legislature (2026).New York Education Law § 6902, Definition of practice of nursing.New York's statutory requirement that a written practice agreement contain explicit provisions for resolving a disagreement between the collaborating physician and the nurse practitioner over diagnosis or treatment, and the default that the physician's view prevails without them..
- Read the neighboring sections while the chapter is open. They are where the renewal cycle sits, and in some states where required not-a-physician signage sits.
- Establish whether the board approves the document, receives a filing of it, or never sees it unless it investigates. Georgia's is filed by the physician for a fee 6Ref 6Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's filing mechanics for an APRN protocol agreement: the $150 non-refundable fee, online submission only by the delegating physician through Gateway, and the board's currently stated average processing time., and a state that never sees the agreement still holds you to its contents.
- Read the delegated acts you are about to list against your state's scope-of-practice section. An agreement cannot grant authority the license does not already carry.
- Expect nothing about billing. Modifier SA, incident-to and the rest are payer policy and a separate lookup, and no board contents rule resolves them.
States where no agreement is required at all
Some states replace the agreement with a filing about you. Illinois is one: an APRN seeking full practice authority files a notarized attestation with the Department of Financial and Professional Regulation, after 250 hours of continuing education and 4,000 hours of clinical experience, and practices without a written collaborative agreement 7Ref 7Illinois General Assembly (2024).225 ILCS 65/65-43, Nurse Practice Act, Sec. 65-43. Full practice authority..Illinois full practice authority as the pathway that replaces a written collaborative agreement with a notarized attestation to IDFPR, its continuing-education and clinical-hour thresholds, the surviving Schedule II consultation relationship, and the section's scheduled repeal date..
But full practice authority does not clear the field. Illinois keeps a consultation relationship in place for Schedule II narcotics, and the section carries its own scheduled repeal date, so confirm it is still in force before you rely on it 7Ref 7Illinois General Assembly (2024).225 ILCS 65/65-43, Nurse Practice Act, Sec. 65-43. Full practice authority..Illinois full practice authority as the pathway that replaces a written collaborative agreement with a notarized attestation to IDFPR, its continuing-education and clinical-hour thresholds, the surviving Schedule II consultation relationship, and the section's scheduled repeal date..
The lesson for the reader in a state with an enumerated list is smaller and more useful: check which pathway you qualify for before drafting anything, since the hours you have already logged may put you on a track that needs an attestation instead of clauses.
What the board's list does not cover
The commercial terms. A board's contents rule tells you which clauses make the agreement valid for licensure. It says nothing about what a collaborating physician is paid, who carries which professional liability policy, how much notice either side gives before terminating, or what becomes of your panel if the physician leaves. None of the boards cited here publishes a rate for the arrangement, so treat any figure you are quoted as a negotiation rather than a benchmark.
Those terms are the ones that bind you personally, and they are ordinarily drafted by counsel who has read your state's rule alongside the contract. A common arrangement in solo practice is to keep the board-mandated clauses and the business terms in separate documents, so that a renegotiated fee does not force a refiling of the clinical protocol.
It is also not the direct agreement a direct-pay practice signs with its patients, which is a different document under different rules.
Have counsel read the termination and indemnity language before signing, and hold the board's list beside it: one keeps your license clean, the other decides what happens on the day the relationship ends.
Common questions
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- 1.Ohio Board of Nursing (2026). Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist.. Ohio Administrative Code (codes.ohio.gov). link ✓Ohio's enumerated 'shall include at least' contents of a standard care arrangement: signatures of each nurse and collaborating physician, the quality assurance provisions covering reapproval on modification, referral criteria, a consultation process and chart review, the prescribing provisions including OARRS, and three-year retention of superseded arrangements.
- 2.California Board of Registered Nursing (1998). An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice. California Board of Registered Nursing (rn.ca.gov), document NPR-B-20. link ✓California's standardized procedure as the state's equivalent instrument: the eleven required elements under Title 16 CCR section 1474, and the requirement that the document be in writing, dated, signed by the personnel authorized to approve it and developed collaboratively by nursing, medicine and administration.
- 3.Pennsylvania State Board of Nursing (2026). 49 Pa. Code § 21.285. Prescriptive authority collaborative agreements.. Pennsylvania Code (pacodeandbulletin.gov). link ✓Pennsylvania's enumerated contents of a prescriptive authority collaborative agreement: identifying the specialty in which the CRNP is certified, naming at least one substitute physician, review at least every two years, and the absence of any specialty requirement for the collaborating physician.
- 4.Georgia Composite Medical Board (2026). Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25. Georgia Rules and Regulations, Secretary of State (rules.sos.ga.gov). link ✓Georgia's required identifiers for all parties to a nurse protocol agreement including the DEA registration number, the record-review schedule the board sets as minimum accepted standards, the designated physician for absence coverage, and the 30-day filing of an amendment.
- 5.New York State Legislature (2026). New York Education Law § 6902, Definition of practice of nursing. The New York State Senate (nysenate.gov). linkNew York's statutory requirement that a written practice agreement contain explicit provisions for resolving a disagreement between the collaborating physician and the nurse practitioner over diagnosis or treatment, and the default that the physician's view prevails without them.
- 6.Georgia Composite Medical Board (2026). APRN Protocol Registration. Georgia Composite Medical Board (medicalboard.georgia.gov). link ✓Georgia's filing mechanics for an APRN protocol agreement: the $150 non-refundable fee, online submission only by the delegating physician through Gateway, and the board's currently stated average processing time.
- 7.Illinois General Assembly (2024). 225 ILCS 65/65-43, Nurse Practice Act, Sec. 65-43. Full practice authority.. Illinois Compiled Statutes, Illinois General Assembly. link ✓Illinois full practice authority as the pathway that replaces a written collaborative agreement with a notarized attestation to IDFPR, its continuing-education and clinical-hour thresholds, the surviving Schedule II consultation relationship, and the section's scheduled repeal date.
https://www.gale.care/for-providers/pq-collaborative-agreement-required-contents · 7 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.