A Collaborative Practice Agreement (CPA) is more than just a legal contract—it's the foundation of the professional relationship between a physician and an advanced practice provider (APP), such as a nurse practitioner (NP) or physician assistant (PA). It sets clear expectations, outlines roles and responsibilities, ensures compliance with state regulations, and establishes a structured approach to patient care.

Whether you're entering a new collaboration or refining an existing agreement, a well-structured CPA helps prevent misunderstandings, protects both parties, and supports high-quality clinical care.

This guide breaks down the key elements of a CPA, provides best practices for drafting, and offers practical tips for implementation.

The Purpose and Intent of a Collaborative Practice Agreement

A CPA serves several important functions:

• Defines the relationship between the physician and practitioner, ensuring alignment on patient care, supervision, and responsibilities.
• Outlines state-mandated requirements, including necessary approvals, documentation, and oversight.
• Establishes clinical expectations, such as prescribing authority, chart review processes, and patient populations covered.
• Prevents misunderstandings by setting clear guidelines for communication, escalation, and compliance.
• Ensures legal and regulatory compliance, avoiding potential risks, fines, or disruptions to patient care.

Each state has different rules regarding what must be included in a CPA. Some states require official approval from a medical board, while others only require the agreement to be documented and available upon request. Always verify your state’s specific regulations before finalizing an agreement.

Key Elements of a Collaborative Practice Agreement

Every CPA should include four core components to ensure clarity, compliance, and operational efficiency.

1. Cover Sheet – Essential Information Exchange

The cover sheet provides a snapshot of key identifying details for both the physician and the practitioner. This ensures that each party has immediate access to critical licensing and credentialing information.

What should be included:

• Practitioner Information
  
  • Full name
  • License number and expiration date
  • NPI number
  • DEA number and expiration date (if applicable)
  • Contact information (phone and email)
  • Practice location(s)
  • Hours of practice
• Collaborating Physician Information
  • Full name
  • License number and expiration date
  • NPI number
  • DEA number and expiration date (if applicable)
  • Contact information (phone and email)
  • Oversight responsibilities (as required by the state)

Best Practice: If the state provides a standard CPA form, always use it to ensure compliance with regulatory requirements. If no form exists, a structured cover sheet like this ensures all critical information is included.

2. Legal Collaboration Agreement

This section formalizes the agreement between the physician and the practitioner, defining their roles, responsibilities, and legal requirements. It serves as a contract that aligns expectations and ensures compliance with state laws.

What should be included:

• Start date of the agreement
• Methods and frequency of communication (in-person, telephonic, virtual meetings)
• Chart review requirements (percentage of patient charts reviewed per month)
• Delegation of prescriptive authority (what drug schedules, if any, can be prescribed)
• State submission process (if the agreement must be filed with a medical board)
• Termination clause (conditions under which the agreement can be ended)
• Malpractice coverage details (who is responsible for professional liability insurance)
• Compliance requirements and any additional state-mandated provisions

Best Practice:

• Maintain a minimum 5% chart review for practitioners prescribing medications as this ultimately protects the physician, even if there are no state mandated requirements.
• Schedule at least one meeting per month for clinical case discussions and oversight.
• Clearly outline the process for sharing charts and communication expectations.

3. Delegation Summary – Clinical Scope & Customization

This section clarifies the scope of clinical care, including what services are covered, what medications can be prescribed, and which patients can be treated under the agreement.

What should be included:

• Permitted Prescriptions – Define which drug classes (including any restrictions on Schedule II medications) are allowed.
• Patient Population – Specify whether the agreement applies to a general practice, a specialty, or a particular setting (e.g., urgent care, primary care, behavioral health).
• Practice Setting – Indicate whether the practitioner works in-person, hybrid, or telemedicine.
• Clinical Supervision Requirements – Define expectations for oversight, such as follow-ups for new prescriptions or review of complex cases.

Best Practice:

• Always cross-check state regulations to confirm prescribing limitations.
• Define how often prescribing privileges should be reviewed to ensure ongoing compliance.

4. Clinical Protocols & Standard Operating Procedures (SOPs)

Clinical protocols serve as guidelines for patient care, assessment, and escalation. These documents ensure that both parties are aligned in how care is delivered.

What should be included:

• Patient assessment and diagnostic guidelines
• Treatment plans and escalation criteria (when to refer to a physician)
• Emergency response protocols
• Documentation and record-keeping requirements
• Compliance procedures for specific conditions and treatments
• Any state-specific clinical requirements

Best Practice: Always attach a draft clinical protocol to the agreement so both parties can align on clinical responsibilities before finalizing the CPA.

Best Practices for Drafting a Collaborative Practice Agreement

• Use pre-filled forms whenever possible, completing key details like license numbers, NPI, DEA, and contact information in advance.
• Provide customization options for the practitioner to specify their patient population, prescribing preferences, and workflow.
• Attach relevant clinical protocols to ensure alignment on care delivery expectations.
• Clearly define expectations for communication, prescribing, and compliance oversight.
• Review and update agreements annually to reflect changes in regulations, practice settings, or clinical responsibilities.

Methods for Signing & Storing CPAs

Electronic signing platforms can simplify the execution of a CPA. Some options include:

• DocuSign – Widely used, integrates with compliance tracking systems
• JotForm Sign – A flexible, cost-effective alternative
• Adobe Sign – Offers advanced authentication and compliance tracking
• HelloSign – A simple and user-friendly option for small practices

After signing, store the completed CPA in a credentialing system or a compliance tracker to ensure easy access and audit readiness.

Collaborative Practice Agreement Checklist

Cover Sheet

☐ Practitioner and physician names included
☐ All license numbers and expiration dates recorded
☐ NPI and DEA numbers listed (if applicable)
☐ Contact information for both parties
☐ Practice location(s) and hours of practice defined

Legal Agreement

☐ Agreement includes start date and termination clause
☐ Methods and frequency of communication defined
☐ Percentage of chart reviews specified (minimum 5% recommended if prescribing)
☐ Prescriptive authority outlined (including drug schedules allowed)
☐ Compliance with state submission requirements confirmed
☐ Malpractice coverage details included

Delegation Summary

☐ Scope of practice and services covered
☐ Permitted prescriptions and any limitations defined
☐ Patient population and setting specified

Clinical Protocols & SOPs

☐ Patient assessment and treatment guidelines outlined
☐ Escalation criteria for complex cases or emergencies included
☐ Documentation and compliance tracking methods specified

Finalization & Storage

☐ Signed using an approved electronic platform
☐ Stored in credentialing or compliance tracking system
☐ Agreement reviewed annually for updates

A well-structured CPA is the key to a successful collaboration. By ensuring that agreements are clear, compliant, and aligned with clinical best practices, both physicians and practitioners can maintain a smooth working relationship while delivering high-quality care.