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How to Write a Nurse Practitioner Collaborative Practice Agreement: Templates, State Rules, and Physician Oversight

Christopher Seitz , MD on August 20, 2025

Summary

A collaborative practice agreement defines the working relationship between a nurse practitioner (NP) and a collaborating physician. It must include scope of practice, prescriptive authority, communication expectations, and supervision protocols. Requirements vary by state.

What Is a Collaborative Practice Agreement?

After you find a collaborating physician, the legal structure of the oversight needs to be established. A collaborative practice agreement (CPA) is a legal document that outlines the professional relationship between a nurse practitioner (NP) and a collaborating physician. It defines the NP’s scope of practice, consultation expectations, and prescriptive authority.

These agreements are required in many states for NPs to practice and prescribe medications—especially controlled substances—and are a key compliance document during board audits or DEA registration.

Why the Level of Detail in the Agreement Matters

Collaborative practice agreements for nurse practitioners can range from one-page forms with vague phrases like “NP can practice within scope” to detailed, multi-page documents listing specific treatments, medications, and clinical settings.

In our experience, the most defensible agreements strike a middle ground. Overly vague documents often attract board scrutiny, as they may suggest that the physician isn’t meaningfully involved. This can raise red flags about the legitimacy of the collaboration and the level of physician oversight. On the other hand, overly rigid agreements may constrain the NP’s clinical flexibility or unintentionally limit services that fall within their scope of practice.

A well-written collaborative practice agreement should provide enough specificity to demonstrate a genuine, informed relationship between the NP and the physician, while leaving room for professional judgment and practice growth. The agreement should reflect real-world clinical activities and showcase shared responsibility—not just serve as a formality to meet board requirements.

Common Mistakes to Avoid in Collaborative Practice Agreements

Even well-intentioned providers can make mistakes when drafting or managing a collaborative practice agreement. Here are some of the most common errors we see—and why they can lead to serious consequences:

1. Using Language That Is Too Vague

Statements like “NP will practice within their scope” or “follows standard guidelines” may seem sufficient, but they lack specificity. Boards reviewing these agreements may view vague language as a sign that the physician isn’t actively engaged or aware of the NP’s daily responsibilities. This can lead to fines, investigations, or delays in DEA licensing. Instead, provide concrete examples of the services the NP provides, the settings in which they work, and how oversight will be conducted.

2. Not Filing or Reporting the Agreement When Required

Some states, such as Georgia, require the agreement to be filed with the Board of Medicine or Board of Nursing before the NP can begin practicing. Others may require reporting the collaborative relationship even if the agreement itself is kept on file. Failing to submit or report this information when required can render the agreement invalid and put the NP at risk of practicing without legal authorization.

3. Documenting Oversight Requirements but Not Following Through

Many agreements outline supervision activities like chart reviews, site visits, or monthly check-ins—but in practice, these steps are skipped or forgotten. This discrepancy becomes a major liability during board investigations. If your agreement says chart reviews will occur quarterly, you must have dated documentation showing they occurred. Boards don’t just care what’s on paper—they want proof that it’s happening.

4. Missing Signatures and Dates

It may sound basic, but this is one of the most frequent issues we see. An unsigned or undated agreement may be viewed as never having gone into effect. During an audit, regulators will look at signature and effective dates to determine whether the NP was authorized to practice at a specific time. Without clear signatures and dates, the agreement may be invalid retroactively.

5. Letting the NP Start Practicing Before the Agreement Is Finalized

This happens more often than it should: the NP is ready to work, and everyone agrees on the terms, but the paperwork hasn’t been signed or filed. Allowing the NP to begin patient care before the agreement is complete and legally in effect is a major compliance risk. In states that require board approval or filing, the NP must wait until the agreement is officially accepted.

Avoiding these mistakes not only keeps you compliant but protects both the NP and the physician from legal and licensure consequences.

What Should Be Included in a Nurse Practitioner Collaborative Practice Agreement?

Here are the essential sections every CPA should include:

1. Contact Information & Licensure Details

Include the names, credentials, license numbers, and contact details for both the NP and the collaborating physician. This is foundational information for identifying both parties and ensuring their licensure is active and appropriate for the collaborative relationship.

2. Scope of Practice

Clearly define the services, procedures, and patient populations the NP is expected to manage. This could include specific treatments (e.g., chronic disease management, women’s health, urgent care), clinical settings (e.g., outpatient clinic, mobile health unit), and any service limitations. Vague phrases like “within scope” should be avoided or supported with examples. This section should reflect the NP’s training and expertise while showing that the physician understands and supports those activities.

3. Prescriptive Authority

State whether the NP has authority to prescribe medications, including controlled substances. If the NP is prescribing Schedule II–V drugs, the agreement should specify this and include any state-specific limitations or requirements. Additionally, it should note whether the NP must obtain a DEA number and whether the physician is expected to co-sign or review prescriptions under certain conditions.

4. When and How the Physician Must Be Contacted

Outline the clinical scenarios in which the NP should consult the physician. This may include initiating complex treatments, making diagnoses that carry high risk, prescribing high-risk medications, or when uncertain about clinical decisions. Also define how contact should occur—via phone, secure messaging, email, or in-person—and expected response times. This section helps document the collaborative nature of the relationship and reinforces accountability.

5. Supervision & Chart Review Requirements

Define how the physician will review the NP’s work. Many states require a percentage of chart reviews—10% quarterly is common—but even where not mandated, regular oversight is advisable. Detail what types of encounters are reviewed (e.g., new patients, controlled substance prescriptions) and how feedback is shared. Specify how reviews are documented to protect both parties during board inquiries.

6. Backup/Alternate Physician Coverage

One of the most overlooked yet critical elements of a collaborative practice agreement is what happens when the collaborating physician is unavailable. If a physician takes a vacation, becomes ill, or is otherwise unreachable, the NP may be legally required to suspend patient care—unless a backup or “covering” physician is designated in the agreement.

This section should name the alternate physician, provide their licensure details, and outline when and how they will step in. The backup physician should agree to the same expectations around availability and oversight, even if only temporarily. Without this provision, a clinic can be forced to pause operations or risk practicing out of compliance. Including a backup shows thoughtful risk planning and a commitment to continuous patient care.

7. Renewal, Termination & Amendments

The collaborative practice agreement should be reviewed and re-signed annually. Many states require this, and even where it’s not mandatory, it’s a best practice. This annual review provides an opportunity to make updates based on changes in practice scope, clinic operations, or state regulations.

The agreement should include a termination clause (e.g., either party may terminate with 30 days’ notice) and specify how amendments should be documented. This reinforces that the agreement is a living document that should grow and evolve as the NP’s role expands.

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Can You Get a DEA License Without a Collaborative Practice Agreement?

In states that require a collaborative practice agreement, the document must be signed and in effect before an NP can apply for DEA registration. DEA applications may be delayed or denied if there’s no documentation proving the NP has been authorized to prescribe controlled substances.

The collaborative practice agreement should include specific language supporting prescriptive authority for controlled substances and indicate that the physician agrees to the NP’s use of a DEA license.

Do You Need to File a Collaborative Practice Agreement with the State?

Filing requirements vary significantly by state. Some states require the agreement itself to be filed with the Board of Nursing, Board of Medicine, or both. Others only require the relationship to be reported, while allowing the agreement to be kept on file at the practice.

For example:

  • Georgia requires a state-specific collaborative practice agreement form to be completed, signed, and submitted before the NP is legally allowed to practice.
  • Other states, like Florida or Texas, may require only notification of the collaborative relationship.

NPs and collaborating physicians must confirm their state’s specific process, including whether the agreement must be submitted, retained on-site, or reviewed by legal counsel. GuardianMD tracks all 50 state requirements to help clients stay compliant.

Can You Use One Collaborative Practice Agreement for Multiple Clinics?

In most cases, no. If a nurse practitioner works for two separate legal entities—such as a mobile IV clinic and a telehealth platform—they will typically need separate collaborative practice agreements for each.

Even if the same physician collaborates across both roles, state laws generally tie collaborative practice agreements to a specific employment or practice arrangement. A single “universal” CPA risks noncompliance and could lead to delays with licensing, audits, or insurance credentialing.

How Often Should a Collaborative practice agreement Be Reviewed or Updated?

It is best practice to revisit and re-sign the collaborative practice agreement at least once per year. This not only satisfies most regulatory requirements but provides a structured opportunity for the NP and physician to reflect on how the relationship is working.

Regular reviews allow:

  • Updates to services, procedures, or medications offered
  • Reassessment of oversight and communication expectations
  • Changes to chart review processes or coverage arrangements

Boards often ask for documentation of ongoing collaboration—especially during investigations. Reviewing and updating your CPA annually is one of the most defensible steps you can take.

Do You Need an Attorney to Draft a Collaborative Practice Agreement?

It’s not typically necessary to involve an attorney unless there are unique legal considerations. Most nurse practitioners and physicians can draft a compliant and protective agreement using a strong template and guidance from reliable sources.

GuardianMD provides state-specific collaborative practice templates to clients and walks both parties through the key terms and legal requirements. Unless your practice setup is especially complex or involves unusual risk, you likely do not need to hire legal counsel.

FAQs

Do I need a collaborative practice agreement to get a DEA license?

Do I need a collaborative practice agreement to get a DEA license?

Can I use one CPA for multiple jobs?

Not typically. Separate jobs (legal employers) require separate agreements, and sometimes the assigned physician will only oversee you for the respective job.

Who signs the collaborative practice agreement?

Both the NP and the collaborating physician. Most boards accept electronic signatures. Some states allow you to keep a copy on file for your records and don’t require it to be submitted to the board.

How often should it be reviewed?

Your collaborative practice agreement should be reviewed at least annually, or as required by state regulation

Is legal review necessary?

Legal review is not usually required. Most NP-physician teams can complete it on their own using a solid template and board guidance.

Call to Action:

Do you need a collaborating physician or want help navigating your state’s requirements? Partner with GuardianMD for templates, oversight, and expert support in all 50 states.

About the Author

Christopher Seitz, MD is the Founder, CEO and Chief Medical Officer of GuardianMD and a national leader in medical oversight, compliance, and corporate practice of medicine structures for nurse practitioners and non-physician-owned clinics. Dr. Seitz is a board-certified Emergency Physician that holds active medical licenses in all 50 U.S. states. He is functional medicine trained as well and serves as a compliance advisor to health entrepreneurs, medical boards, and oversight organizations nationwide.

GuardianMD provides fully insured, board-ready collaborating physicians in all 50 states, along with downloadable agreement templates and ongoing support to help NPs stay compliant and grow their practice.

 

How Nurse Practitioners Can Find a Collaborating Physician in 2025: Options, Risks, and Compliance Considerations 

Christopher Seitz , MD on July 23, 2025

Introduction 

For many nurse practitioners (NPs), finding a collaborating physician is one of the most critical — and often most confusing — steps in launching or growing a practice. While more states are expanding NP independence, many still require some form of physician collaboration depending on the NP’s license, practice area, and location. And the stakes feel high because collaboration structures tie directly to licensure and practice authority. 

The good news? This process is fully manageable — and when done correctly, it allows you to operate confidently, protect your license, and focus on patient care and business growth. 

In 2025, nurse practitioners have more options than ever before for securing a collaborating physician. But with more choices comes greater complexity — and often greater risk if key compliance factors are overlooked. 

In this article, I’ll walk you through the key options nurse practitioners have in 2025 for finding a collaborating physician, along with the pros, cons, and practical realities of each. My goal is simple: help you navigate this process with clarity and confidence based on my direct experience overseeing medical oversight relationships across hundreds of NP-owned practices nationwide. 

Table of contents

How You Find Your Collaborating Physician Matters 

Over the years, I’ve worked with hundreds of nurse practitioners navigating the process of finding physician oversight. What’s often misunderstood is that this decision isn’t just about finding a physician — it’s about protecting your license, your business, and your ability to practice long-term. Your collaboration arrangement is one of the few decisions that directly affects both your clinical operations and your legal standing. 

Here’s why this decision carries increasing weight in 2025: 

  • Your collaborating physician impacts your ability to stay open. 
    If your physician becomes unavailable, retires, or exits the agreement, you may legally have to pause patient care until compliant coverage is restored. 
  • State boards are increasing oversight. 
    More boards are reviewing collaboration agreements as part of audits, patient complaints, or licensing reviews. They’re not just checking that a physician is listed — they want to ensure the structure, documentation, and compliance are in place. 
  • Your choice impacts long-term growth. 
    If you’re planning to open multiple locations or expand into different services (IV therapy, aesthetics, wellness), your collaborating physician model needs to be scalable and durable. 

In my work, I’ve seen many NPs navigate this successfully with the right structure in place — but I’ve also seen otherwise thriving practices stumble due to preventable compliance gaps that emerged during board reviews or growth transitions. 

Option 1: Finding a Collaborating Physician Through Your Own Network 

Many NPs naturally turn to physicians they know — former colleagues, mentors, or friends — when seeking a collaborator. 

Pros: 

  • Personalized relationship: You have pre-existing trust and shared clinical perspectives. 
  • Flexibility: May allow for customized arrangements that fit both parties. 
  • Potential cost savings: Friends or colleagues may charge lower fees or offer informal arrangements. 

Cons: 

  • Limited legal expertise: 
    Most individual physicians are not trained in state-specific collaboration laws, supervision requirements, or CPOM restrictions that govern NP-physician collaborations and ownership models. Even well-meaning arrangements may accidentally fall out of compliance. 
  • No built-in regulatory support: 
    In the event of a board inquiry, the physician may not know how to respond or may feel unprepared to defend the arrangement — leaving the NP to manage legal defense alone. 
  • Strained personal relationships: 
    Business conflicts (fees, liability concerns, availability) can create tension that affects both the professional relationship and personal friendship. 
  • Continuity risk: 
    If the physician moves, retires, or resigns unexpectedly, the NP may face immediate practice interruptions while searching for a replacement. 

Many NPs successfully launch with a trusted physician collaborator, but it’s essential to ensure proper legal agreements, documentation, and contingency plans are established from the start. 

Option 2: Recruiting Physicians Through Job Boards (Indeed, ZipRecruiter, LinkedIn) 

Some NPs attempt to cast a wider net by posting job listings seeking collaborating physicians. 

Pros: 

  • Access to more candidates: 
    Many physicians are interested in serving in these types of roles, so posting on recruitment job boards can give you access to a large pool of physicians across various specialties and geographies. 
  • Quick initial responses: 
    You may receive multiple inquiries shortly after posting as we see more and more physicians interested in joining these roles. 

Cons: 

  • Vetting burden: 
    You are solely responsible for vetting each candidate and verifying: 
  • State licensure 
  • Board certifications 
  • Malpractice coverage 
  • Knowledge of collaboration laws 
  • Willingness to engage in true supervision (not just passive sign-offs) 
  • Uncertain compliance knowledge: 
    Some applicants may see collaboration as a quick side income, without fully appreciating their legal responsibilities under state law. 
  • Ongoing management complexities: 
    Contracts, compliance documentation, supervision protocols, and regulatory monitoring fall entirely on the NP since most physicians do not have the expertise to handle these things on your behalf.  
  • Continuity risks: 
    As with personal relationships, you risk being left without coverage if the physician exits unexpectedly. 

Boards often focus heavily on these arrangements during investigations, particularly when it’s unclear whether proper oversight, documentation, or physician duties were truly being fulfilled. 

Option 3: Partnering With a Medical Oversight Platform (e.g. GuardianMD, Collaborating Docs, Zivian) 

In recent years, professionally managed oversight platforms have become an increasingly common — and often more secure — option for NPs seeking collaborating physicians. 

Pros: 

  • Centralized compliance management: 
    Platforms like GuardianMD are built to actively manage: 
  • State-specific collaboration law updates 
  • Supervision documentation standards 
  • CPOM-compliant business structures 
  • Credentialing, licensure tracking, and renewal monitoring 
  • Audit readiness 
  • Board defense support: 
    If a board inquiry or investigation occurs, professional platforms provide both NPs and physicians with direct regulatory, legal, and administrative support. 
  • Business continuity safeguards: 
    Platforms maintain networks of credentialed physicians, ensuring that backup coverage is available if your assigned physician exits, minimizing clinical downtime. 
  • Transparent, predictable pricing: 
    Eliminates ad-hoc negotiations or confusing financial terms. 
  • Administrative relief: 
    Physician payments, supervision logs, contracts, and credentialing are fully managed. 
  • Hands-off structure for qualified NPs: 
    Many experienced NPs prefer collaborations where the physician provides the legally required oversight without unnecessary involvement in daily operations. 

Cons: 

  • Less personalized relationship: 
    While platforms ensure legal compliance, some NPs may desire more direct personal collaboration in highly specialized practice areas. 
  • Subscription fees: 
    Ongoing costs may be higher than informal private arrangements, but are often outweighed by compliance protections and operational stability. 

Having personally overseen board investigations, I’ve seen firsthand how NPs operating under structured platforms like GuardianMD have far stronger legal protection and continuity during board reviews than those in ad-hoc private arrangements. 

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Regulatory shifts, board rule changes, and legal precedent adjustments happen every year. What may have been acceptable even 24 months ago may no longer suffice in today’s environment. In my experience, even highly skilled and well-intentioned NPs sometimes miss subtle legal details that become major issues down the road. The most common include: 

  • Outdated or incomplete collaboration agreements 
  • Failure to document chart reviews or required supervision meetings 
  • Misunderstanding of how CPOM affects business ownership models 
  • Collaborating physicians unaware of their own legal obligations 
  • Inadequate contingency plans if the physician leaves 
  • Lack of clear scope-of-practice boundaries across multi-state telemedicine practices 

Again — none of these are insurmountable. They simply require upfront planning, proper structures, and periodic legal review. 

Key takeaway: 
The strongest NP-owned practices are those that design compliance into their business model, rather than hoping to correct issues after growth has occurred. 

What Happens If Your Collaborating Physician Leaves? 

This is a scenario every NP should be prepared for — and one I’ve seen catch many by surprise. 

  • In most states, if your collaborating physician exits, you may not legally continue to practice until a new compliant relationship is in place. 
  • Even short gaps in coverage can trigger board scrutiny. 
  • Insurance carriers and credentialing bodies may suspend contracts if proper physician coverage lapses. 
  • Patient care disruptions can harm your practice’s reputation and revenue. 

The solution is to build redundancy into your model — either by contracting with a platform that maintains physician bench depth or by having pre-arranged backup agreements in place. This single step dramatically reduces your operational vulnerability. 

Comparison Summary 

Option  Pros  Cons 
Personal Network  Personalized, potential cost savings  High compliance risk, relationship strain, no board support, continuity risk 
Job Boards  Large candidate pool, quick responses  High vetting burden, unclear qualifications, management complexity, same continuity risk 
Medical Oversight Platforms (e.g. GuardianMD)  Compliance expertise, board defense, business continuity, admin support  Less personalized, subscription cost 

What If You’re Realizing You Might Need to Make a Change? 

If you’ve made it this far and are thinking, “Uh oh… I’m not sure I set this up right” — you’re not alone. This is actually one of the most common realizations NPs have after they’ve launched their practice and learned more about how oversight and compliance actually work. 

The good news? It’s never too late to reevaluate and course-correct. Making a change now could prevent serious issues later. 

Here are common signs it’s time to revisit your collaborating physician arrangement: 

  • You’re unsure what’s in your agreement — or don’t have one at all. 
    If your arrangement was casual, verbal, or copy-pasted from someone else, it’s worth reviewing with fresh eyes. 
  • Your practice has changed. 
    Maybe you’ve added IV therapy, aesthetics, telehealth, or expanded to a new state. What worked before might no longer be compliant or sufficient. 
  • Your physician is less involved or harder to reach. 
    This can leave you vulnerable during audits, insurance reviews, or board inquiries — especially if documentation isn’t being maintained. 
  • You’re growing — and need a more scalable structure. 
    As your patient volume or clinic footprint expands, your oversight model needs to grow with you. 
  • You’re not confident you’d be prepared if the board asked questions. 
    That alone is reason enough to take action. 

So what should you do? 

Start by reviewing your current agreement, your state’s requirements, and asking yourself: “If I were audited tomorrow, do I feel fully protected?” If the answer is no — consider transitioning to a more structured, compliant, and support-driven model. 

The goal isn’t to create fear — it’s to give you peace of mind. When your physician relationship is set up correctly, it becomes one less thing to worry about and one more foundation for long-term success. 

The Encouraging Reality 

While there are real compliance factors to navigate, thousands of NPs successfully launch and grow independent practices every year by approaching collaboration decisions intentionally. You don’t need to feel overwhelmed — you simply need the right structures and partners in place from the start. 

  • When structured correctly: 
  • You protect your license. 
  • You avoid unnecessary legal exposure. 
  • You position your practice to scale with confidence. 
  • When structured loosely or informally: 
  • Small gaps today can become major issues tomorrow, often surfacing during board inquiries, insurance audits, or practice transitions. 

Why Many NPs Are Choosing Platform Models in 2025 

The rise of platforms like GuardianMD reflects a broader shift happening across NP-led healthcare: 

  • NPs want independence without hidden legal risk. 
  • Compliance expectations are increasing. 
  • State regulations are evolving faster than many private physicians can keep up with. 

By choosing professionally managed oversight solutions, NPs gain: 

  • Long-term stability 
  • Board defense preparation 
  • Scalable compliance infrastructure 
  • Freedom to focus on patient care and business growth 

Interested in learning how GuardianMD helps NPs find a collaborating physician, protect their license, and scale confidently? Learn more here. 

About the Author 

Christopher Seitz, MD is the Founder, CEO and Chief Medical Officer of GuardianMD and a national leader in medical oversight, compliance, and corporate practice of medicine structures for nurse practitioners and non-physician-owned clinics. Dr. Seitz is a board-certified Emergency Physician that holds active medical licenses in all 50 U.S. states. He is functional medicine trained as well and serves as a compliance advisor to health entrepreneurs, medical boards, and oversight organizations nationwide.