Common Contracts
1 similar Additional Collaborative Agreement for Nurse-Midwife License contracts
ContractAdditional Collaborative Agreement for Nurse-Midwife License • March 3rd, 2017
Regular Mailing Address STATE BOARD OF MEDICINEP.O. BOX 2649 HARRISBURG, PA 17105-2649717-783-1400/717-787-2381Email: st-medicine@pa.gov Courier Delivery Address STATE BOARD OF MEDICINE 2601 NORTH THIRD STREET HARRISBURG, PA 17110 ADDITIONAL COLLABORATIVE AGREEMENT FOR NURSE-MIDWIFE LICENSE 1. This application is only used for entering into an additional collaborative agreement. If this is the first collaborative agreement, complete the application titled, Initial Collaborative Agreement for Nurse-Midwife License. If making changes to or terminating an existing collaborative agreement, complete and submit the Collaborative Agreement Change Form. 2. This application may be used to request an additional collaborative agreement with an allopathic or osteopathic physician licensed by the State Boards of Medicine or Osteopathic Medicine. The physician must have hospital privileges (or a formal arrangement for patient admission to a hospital) and shall practice in the specialty area of th
