Collaborative Prescribing Agreement Sample Contracts

Trelegy Ellipta®) and budesonide/glycopyrronium/formoterol fumarate (Breztri Aerosphere®) for moderate to very severe Chronic Obstructive Pulmonary Disease (COPD)
Collaborative Prescribing Agreement • November 7th, 2022

This Collaborative Prescribing Agreement (the "Agreement") is entered into by the Pharmaceutical Services Division, BC Ministry of Health, and the undersigned respirologist.

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Collaborative Prescribing Agreement
Collaborative Prescribing Agreement • January 8th, 2014

This COLLABORATIVE PRESCRIBING AGREEMENT (the CPA or "Agreement") is entered into by the Medical Beneficiary and Pharmaceutical Services Division, Ministry of Health, B.C., and the undersigned orthopaedic surgeon.

Contract
Collaborative Prescribing Agreement • April 10th, 2017

KBN & KBML Approved Collaborative Agreement for Advanced Practice Registered Nurse Prescriptive Authority for Non-Scheduled Drugs (CAPA-NS)

Collaborative Prescribing Agreement
Collaborative Prescribing Agreement • November 25th, 2019

For the prevention of acute and delayed nausea and vomiting due to highly-emetogenic cancer chemotherapy in combination with dexamethasone, for up to a maximum number of standard, planned treatment cycles of

Collaborative Prescribing Agreement
Collaborative Prescribing Agreement • July 11th, 2016

This COLLABORATIVE PRESCRIBING AGREEMENT (the "Agreement") is entered into by the Medical Beneficiary and Pharmaceutical Services Division (MBPSD), Ministry of Health, B.C., and the undersigned orthopedic surgeon.

Contract
Collaborative Prescribing Agreement • November 17th, 2010

Collaborative Prescribing Agreement BUPRENORPHINE PLUS NALOXONE for SubstitutionTreatment of Opioid Dependence in Adults This COLLABORATIVE PRESCRIBING AGREEMENT (the "Agreement") is entered into by the Pharmaceutical Services Division (PSD), Ministry of Health Services, B.C., and the undersigned methadone maintenance prescriber. To obtain PharmaCare coverage on my patients’ behalf for buprenorphine plus naloxone (Suboxone®), I, , a methadone maintenance prescriber,Name of physician (please print)agree to prescribe according to the following Limited Coverage criteria: Treatment of opioid dependence where methadone is contraindicated (e.g., for patients at high risk of, or with QTc prolongation or those with a hypersensitivity to methadone) OR where there is an inadequate response or intolerance to methadone.Patients being considered for buprenorphine plus naloxone are at low risk for drug diversion. Notes: 1. The College of Physicians and Surgeons of British Columbia limits the prescri

Collaborative Prescribing Agreement
Collaborative Prescribing Agreement • July 14th, 2017

This Collaborative Prescribing Agreement (the "Agreement") is entered into by the Pharmaceutical Services Division, BC Ministry of Health, and the undersigned prescriber.

Collaborative Prescribing Agreement
Collaborative Prescribing Agreement • June 17th, 2011

This COLLABORATIVE PRESCRIBING AGREEMENT (the "Agreement") is entered into by the Pharmaceutical Services Division (PSD), Ministry of Health, B.C., and the undersigned prescriber.

Kentucky Board of Nursing and Kentucky Board of Medical Licensure Approved Collaborative Agreement for Advanced Practice Registered Nurse
Collaborative Prescribing Agreement • July 10th, 2015

WHEREAS, this Collaborative Prescribing Agreement is entered by and between the APRN and the Physician for the sole purpose of defining the scope of prescriptive authority to be exercised by the APRN, all in compliance with the applicable sections of KRS Chapter 314; and

Contract
Collaborative Prescribing Agreement • August 9th, 2017

Common Collaborative Agreement for Advanced Practice Registered Nurse Prescriptive Authority for Non-Scheduled Drugs (CAPA-NS) Form

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