Common use of COLLABORATIVE PRACTICE AGREEMENT Clause in Contracts

COLLABORATIVE PRACTICE AGREEMENT. Under this collaborative practice agreement, UConn Health Anticoagulation Specialist(s), according to and in compliance with section 91 of Public Act 10-117 and Connecticut General Statues sec 20-631 “Collaborative Drug Therapy Management”, may design, implement, and monitor a therapeutic drug plan intended to manage anticoagulation therapies. Anticoagulation Specialists may sign patient summaries for assisted living facilities as well as orders for visiting nurses. Services offered by the Anticoagulation Specialist may include education on disease state and lifestyle modification, in addition to the drug therapy services listed above. Written educational materials and patient specific information may be provided to improve quality of care. The Anticoagulation Specialist(s) may initiate, discontinue, or adjust anticoagulation therapies in accordance with current treatment guidelines, may order laboratory tests appropriate to the disease or drug therapy. Education at office visits shall include appropriate counseling on all new medications. The results of all lab tests ordered under the protocol shall be reviewed and managed by the Anticoagulation Specialist(s) to assess efficacy of treatment and necessity for medication and/or therapeutic lifestyle change. Lab results will be relayed to clinic patients by a patient-specific predetermined method which may include face-to-face encounter, written communication, secure electronic, or telephone communication. Any lab outliers that require further investigation will be sent to the referring physician and/or PCP as appropriate and the patient will be told to contact that LIP immediately. If the LIP is not available, the patient will be sent to the UConn Health Emergency Department. A patient whose drug therapy is managed under this agreement must have established care with a provider within UConn Health and all aspects of the patient’s anticoagulation medication management will be followed in collaboration with the patient’s referring provider (or primary care as necessary). In addition, the patient must be seen by their UConn Health provider at least once per year, in addition to which cases may be reviewed with clinic medical directors as needed. All issues outside of the scope of anticoagulation medication management shall be referred to the patient’s primary care provider, daily supervising LIP or medical director(s). The Anticoagulation Specialist(s) will assure documentation of allergies and adverse drug reactions prior to initiation of the anticoagulation service and, in the course of the above mentioned therapy, shall document all activities appropriately in the medical record. The collaborating physician will review the patient’s drug therapy management at least every thirty days. Approved by Xx. Xxxxx Xxxxxxx, Anticoagulation Clinic Medical Director and UConn Health Pharmacy & Therapeutics Committee on MM/DD/YYYY. Referral to this service constitutes agreement by the referring provider with this collaborative practice agreement and satisfies all state legal requirements of a pharmacist collaborative practice agreement. Under Connecticut State Law and CMS requirement. The collaborative practice agreement and referral must be renewed yearly by each referring LIP by signing a new agreement. PCP/Referring LIP: Signature Date: (Print Name) This Collaborative Practice Agreement was enacted for:

COLLABORATIVE PRACTICE AGREEMENT. Under this collaborative practice agreement, UConn Health Anticoagulation Specialist(s), according to and in compliance with section 91 of Public Act 10-117 and Connecticut General Statues sec 20-631 sSB186/File No. 213 “An ACT Concerning Collaborative Drug Therapy ManagementManagement and Policies”, may design, implement, and monitor a therapeutic drug plan intended to manage anticoagulation therapies. Anticoagulation Specialists may sign patient summaries for assisted living facilities as well as orders for visiting nurses. Services offered by the Anticoagulation Specialist may include education on disease state and lifestyle modification, in addition to the drug therapy services listed above. Written educational materials and patient specific information may be provided to improve quality of care. The Anticoagulation Specialist(s) may initiate, discontinue, or adjust anticoagulation therapies in accordance with current treatment guidelines, may order laboratory tests appropriate to the disease or drug therapy. Education at office visits shall include appropriate counseling on all new medications. The results of all lab tests ordered under the protocol shall be reviewed and managed by the Anticoagulation Specialist(s) to assess efficacy of treatment and necessity for medication and/or therapeutic lifestyle change. Lab results will be relayed to clinic patients by a patient-specific predetermined method which may include face-to-face encounter, written communication, scheduled secure electronictelephone/video visit, or telephone written communication. Any lab outliers that require further investigation will be sent to the referring physician provider and/or PCP as appropriate and the patient will be told to contact that LIP immediately. If the LIP is not available, the patient will be sent to the UConn Health Emergency Department. A patient whose drug therapy is managed under this agreement must have established care with a provider within UConn Health and all aspects of the patient’s anticoagulation medication management will be followed in collaboration with the patient’s referring provider (or primary care as necessary). In addition, the patient must be seen by their UConn Health provider at least once per year, in addition to which cases may be reviewed with clinic medical directors as needed. All issues outside of the scope of anticoagulation medication management shall be referred to the patient’s primary care provider, daily supervising LIP or medical director(s). The Anticoagulation Specialist(s) will assure documentation of allergies and adverse drug reactions prior to initiation of the anticoagulation service and, in the course of the above mentioned therapy, shall document all activities appropriately in the medical record. The collaborating physician provider (APRN or MD) will review the patient’s drug therapy management in Epic at least every thirty days. Approved by Xx. Xxxxx Xxxxxxx, Anticoagulation Clinic Medical Director and UConn Health Pharmacy & Therapeutics Committee on MM/DD/YYYY. Referral to this service constitutes agreement by the referring provider with this collaborative practice agreement and satisfies all state legal requirements of a pharmacist collaborative practice agreement. Under Connecticut State Law and CMS requirement. The collaborative practice agreement and referral must be renewed yearly by each referring LIP by signing a new agreement. PCP/Referring LIP: Signature Date: (Print Name) This Collaborative Practice Agreement was enacted for:.

COLLABORATIVE PRACTICE AGREEMENT. Under this collaborative practice agreement, UConn Health Anticoagulation Specialist(s), according to and in compliance with section 91 of Public Act 10-117 and Connecticut General Statues sec 20-631 sSB186/File No. 213 “An ACT Concerning Collaborative Drug Therapy ManagementManagement and Policies”, may design, implement, and monitor a therapeutic drug plan intended to manage anticoagulation therapies. Anticoagulation Specialists may sign patient summaries for assisted living facilities as well as orders for visiting nurses. Services offered by the Anticoagulation Specialist may include education on disease state and lifestyle modification, in addition to the drug therapy services listed above. Written educational materials and patient specific information may be provided to improve quality of care. The Anticoagulation Specialist(s) may initiate, discontinue, or adjust anticoagulation therapies in accordance with current treatment guidelines, may order laboratory tests appropriate to the disease or drug therapy. Education at office visits shall include appropriate counseling on all new medications. The results of all lab tests ordered under the protocol shall be reviewed and managed by the Anticoagulation Specialist(s) to assess efficacy of treatment and necessity for medication and/or therapeutic lifestyle change. Lab results will be relayed to clinic patients by a patient-specific predetermined method which may include face-to-face encounter, written communication, scheduled secure electronictelephone/video visit, or telephone written communication. Any lab outliers that require further investigation will be sent to the referring physician provider and/or PCP as appropriate and the patient will be told to contact that LIP immediately. If the LIP is not available, the patient will be sent to the UConn Health Emergency Department. A patient whose drug therapy is managed under this agreement must have established care with a provider within UConn Health and all aspects of the patient’s anticoagulation medication management will be followed in collaboration with the patient’s referring provider (or primary care as necessary). In addition, the patient must be seen by their UConn Health provider at least once per year, in addition to which cases may be reviewed with clinic medical directors as needed. All issues outside of the scope of anticoagulation medication management shall be referred to the patient’s primary care provider, daily supervising LIP or medical director(s). The Anticoagulation Specialist(s) will assure documentation of allergies and adverse drug reactions prior to initiation of the anticoagulation service and, in the course of the above above-mentioned therapy, shall document all activities appropriately in the medical record. The collaborating physician provider (APRN or MD) will review the patient’s drug therapy management in Epic at least every thirty days. Approved by Xx. Xxxxx Xxxxxxx, Anticoagulation Clinic Medical Director and UConn Health Pharmacy & Therapeutics Committee on MM/DD/YYYY. Referral to this service constitutes agreement by the referring provider with this collaborative practice agreement and satisfies all state legal requirements of a pharmacist collaborative practice agreement. Under Connecticut State Law and CMS requirement. The collaborative practice agreement and referral must be renewed yearly by each referring LIP by signing a new agreement. PCP/Referring LIP: Signature Date: (Print Name) This Collaborative Practice Agreement was enacted for:.

COLLABORATIVE PRACTICE AGREEMENT. Under this collaborative practice agreement, UConn Health Anticoagulation Specialist(s), according to and in compliance with section 91 of Public Pubic Act 10-117 and Connecticut General Statues sec 20-631 “Collaborative Drug Therapy Management”, may design, implement, and monitor a therapeutic drug plan intended to manage anticoagulation therapies. Anticoagulation Specialists Specialist(s) may sign patient summaries for assisted living facilities as well as orders for visiting nurses. Services offered by the Anticoagulation Specialist Specialist(s) may include education on disease state and lifestyle modification, in addition to the drug therapy services listed above. Written educational materials and patient specific information may be provided to improve quality of care. The Anticoagulation Specialist(s) may initiate, discontinue, or adjust anticoagulation therapies in accordance with current treatment guidelines, may order laboratory tests appropriate to the disease or drug therapy. Education at office visits shall include appropriate counseling on all new medications. The results of all lab tests ordered under the protocol shall be reviewed and managed by the Anticoagulation Specialist(s) to assess efficacy of treatment and necessity for medication and/or therapeutic lifestyle change. Lab results will be relayed to clinic patients by a patient-patient- specific predetermined method which may include face-to-face encounter, written communication, secure electronic, or telephone communication. Any lab outliers that require further investigation will be sent to the referring physician and/or PCP as appropriate and the patient will be told to contact that LIP immediately. If the LIP is not available, the patient will be sent to the UConn Health Emergency Department. A patient whose drug therapy is managed under this agreement must have established care with a provider within UConn Health and all aspects of the patient’s anticoagulation medication management will be followed in collaboration with the patient’s referring provider (or primary care as necessary). In addition, the patient must be seen by their UConn Health provider at least once per year, in addition to which cases may be reviewed with clinic medical directors as needed. All issues outside of the scope of anticoagulation medication management shall be referred to the patient’s primary care provider, daily supervising LIP or medical director(s). The Anticoagulation Specialist(s) will assure documentation of allergies and adverse drug reactions prior to initiation of the anticoagulation service and, in the course of the above mentioned therapy, shall document all activities appropriately in the medical record. The pharmacist will report at least every thirty days to the collaborating physician will review regarding the patient’s drug therapy management at least every thirty daysmanagement. Approved by Xx. Xxxxx Xxxxxxx, Anticoagulation Clinic Medical Director and UConn Health Pharmacy & Therapeutics Committee on MM/DD/YYYY. Referral to this service constitutes agreement by the referring provider with this collaborative practice agreement and satisfies all state legal requirements of a pharmacist collaborative practice agreement. Under Connecticut State Law state law and CMS requirement. The collaborative practice agreement and referral must be renewed yearly by each referring LIP by signing a new agreement. PCP/Referring LIP: Signature Date: (Print Name) This Collaborative Practice Agreement was enacted for:.