A collaborative practice agreement (CPA) is a legal document that outlines the collaboration between a healthcare provider and a collaborating physician. In Indiana, healthcare providers, such as nurse practitioners, may engage in collaborative practice under the supervision of a licensed physician. If you are a healthcare provider in Indiana, it is important to create a CPA that meets the state`s legal requirements and ensures a smooth working relationship with your collaborating physician.

Here is a sample collaborative practice agreement for Indiana healthcare providers:

I. Purpose

This collaborative practice agreement (CPA) is established between [Name of healthcare provider] and [Name of collaborating physician] to provide quality healthcare services to patients in accordance with the laws and regulations of the state of Indiana.

II. Qualifications

[Name of healthcare provider] is a licensed healthcare provider in Indiana and is allowed to perform medical services within the scope of their license under the supervision of a collaborating physician. [Name of collaborating physician] is a licensed physician in Indiana with the experience and ability to provide supervision and support to [Name of healthcare provider].

III. Scope of Practice

[Name of healthcare provider] is authorized to perform the following medical services within their scope of practice:

[List of medical services]

IV. Supervision and Consultation

[Name of collaborating physician] agrees to provide supervision, consultation, and collaboration to [Name of healthcare provider] as required by Indiana law. The collaborating physician must be available for consultation with the healthcare provider on a routine basis.

V. Record Keeping and Maintenance

Both parties agree to maintain accurate and complete records of patient care services provided under this CPA. [Name of healthcare provider] is responsible for maintaining their own patient records, and [Name of collaborating physician] is responsible for providing written documentation of supervision and consultation as required by Indiana law.

VI. Termination

This CPA may be terminated by either party upon written notice to the other party. This CPA will also be terminated automatically if either party`s license to practice in Indiana is revoked or suspended.

VII. Confidentiality

Both parties agree to maintain the confidentiality of patient information in accordance with HIPAA regulations and Indiana state laws.

VIII. Indemnification

Both parties agree to indemnify and hold harmless the other party against any and all claims, damages, or liabilities arising from the performance of this CPA.

IX. Governing Law

This CPA will be governed by and construed in accordance with the laws of the state of Indiana.

X. Execution

This CPA is executed by both parties as of the date set forth below. Both parties acknowledge that they have read and understand the terms of this agreement.

[Name of healthcare provider]

[Name of collaborating physician]


In conclusion, a collaborative practice agreement is a vital legal document for healthcare providers in Indiana. By following the above sample CPA, you can ensure that your collaborative practice is in compliance with the state`s laws and regulations. Collaborating with a licensed physician can expand your practice and improve patient care, so it is essential to have a clear and concise CPA in place.