THIS COLLABORATIVE PRACTICE AGREEMENT (“Agreement” and “CPA”) is made and entered into between me (“Prescriber”, “Provider”, “I”, “me” ) and Clinical Pharmacists team of SolvePA LLC, a Tennessee limited liability company and is effective as of the date that you click the “SUBMIT” button on the Activate/Payment screen (the “Effective Date”). By clicking the “SUBMIT” button on the Activate/ Make a Payment tab, you agree that you have read, understand, and agree to be bound by this agreement.

AUTHORITY: As a provider who holds an active license to practice from the Board of Medicine, I authorize the clinical pharmacists named herein, who hold an active license to practice from the Board of Pharmacy, to manage and/or treat my patients pursuant to written, patient-specific orders from me.

PROFESSIONAL QUALIFICATIONS: The clinical pharmacists are trained in clinical pharmacy practice and comprehensive medication management to include, but not limited to clinical pharmacokinetics, therapeutics, and clinical pharmacology. Clinical pharmacists have the unique mix of knowledge, skills, and abilities in addition to education, training and experience to function under a scope of practice. Clinical pharmacists have current unrestricted pharmacist license and are in good standing with the pharmacist’s licensing body.

CLINICAL FUNCTIONS: The clinical pharmacists with a scope of practice are individuals in a highly specialized practice area in which there is documented evidence of knowledge, skills, and abilities based on each individual clinical pharmacist’s education, training, and experience. The scope of practice, as part of collaborative medication management, allows the clinical pharmacists to function with a high level of autonomy and independent clinical decision-making for activities included in the scope of practice and collaboratively with the health care team for the overall care of the patients. Clinical pharmacists are responsible and accountable for the disease states and conditions managed under the clinical pharmacist’s scope of practice.

COLLABORATION: The clinical pharmacist with a scope of practice functions as a health care provider with a high level of autonomy and exercise independent decision making within their scope of practice. A collegial relationship with mutual consultation and referral exists with the collaborating provider(s) and the clinical pharmacist with a scope of practice. Consultation with a physician or appropriate provider is required for advanced patient care management beyond the applicant’s scope of practice, when changes occur in the patient’s condition, and when referrals to higher levels of care are required. A collaborating provider is available at all times by telephone or in person for consultation.

SCOPE OF PRACTICE: Patients who receive treatment from me will be notified that a portion of their care may be provided by clinical pharmacists working in collaboration with me or the medical director or his/her designee. This notification will take place by inclusion of the clinical pharmacists’ names and credentials with all other clinicians’ information posted in the lobby or examination room or discharge documents. This scope of practice is solely for the purpose of helping patients get the care and treatment the need with respect to prior authorizations, coverage determinations and other manage-care issues or concerns from insurance companies/health plans. Clinical pharmacists will have the authority to manage and/or treat patients in accordance with this section. In managing and/or treating patients, the clinical pharmacists may modify or discontinue drug therapy, may recommend or order laboratory tests, and may exercise other patient care management measures related to continuing therapy, monitoring or improving outcomes of drug or device therapy based on current literature and clinical judgment.

This agreement may include medications for the following conditions/disease states, but not limited to: anticoagulation, hypertension, hyperlipidemia, diabetes, pain, heart failure, mental health, hepatitis C, hypothyroidism, gout, COPD, contraception, asthma, allergy, GI, disorder of skin, arthritis, vaccines, smoking cessation, pulmonary, infectious diseases, and osteoporosis. Please note, clinical pharmacists shall not prescribe controlled substances, but if thought to be beneficial to patient, the clinical pharmacists will notify the collaborative provider and/or the patient’s PCP of the pharmacists’ recommendations for use of controlled substance.

A non-traditional direct patient care visit can be conducted over the telephone or by other electronic medium between a pharmacist and a patient. Non face-to-face care will be a core component of patient-pharmacist care; therefore, thorough documentation will remain vital.

LIABILITY AND INSURANCE: Each party shall be liable for its own acts and/or omissions. Each party to this agreement agrees that if the party is without fault and is held liable for the acts of the other, the party’s rights of indemnity or contribution as provided by applicable laws for this State may be pursued in accordance with those laws.

AGREEMENT REVIEW AND DURATION: This agreement shall be valid for a period not to exceed two years from the effective date. However, it may be reviewed and revised at any time at the request of any signatories.

RECORD RETENTION: Each signatory to this agreement shall keep a signed copy of this agreement on file at their primary place of practice. A complete copy of this agreement will be sent to each signatory with the details of each signatory provided.

RESCINDMENT OR ALTERATION OF AGREEMENT: A signatory may rescind from this agreement. The practitioner may override this agreement whenever he or she deems such action necessary or appropriate for a specific patient without affecting the agreement relative to other patients.