Medical
Pharmacy Collaborative Practice Agreement
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Pharmacy Collaborative Practice Agreement

1
Identify need for a Collaborative Practice Agreement (CPA)
2
Collect patient profile and medication history
3
Perform comprehensive medication review
4
Develop an appropriate treatment plan
5
Approval: Treatment Plan by Collaborating Physician
6
Document all agreements and decisions
7
Define roles and responsibilities of the pharmacist and the provider
8
Prepare a draft of the Collaborative Practice Agreement
9
Initiate the Collaborative Practice Agreement
10
Approval: Collaborative Practice Agreement by Physician
11
Review and agreement of terms by the patient
12
Approval: Patient Agreement
13
Initiate medication therapy
14
Monitor patient's response to therapy
15
Adjust treatment plan based on patient's response
16
Approval: Adjusted Treatment Plan by Physician
17
Communicate changes in treatment plan to the patient
18
Continuously review and update the agreement
19
Document all changes and updates in patient's medical record
20
Review and evaluate the healthcare outcomes of the patient