Change Collaborator Guide

Step 1

• Select the three dots by your APRN to view your list of Actions available
• Select the Change Collaborator Action

Step 2

• Select from the 2 options that best meets your needs (defined below);
• Review your current list of Collaborator(s) if you have any currently assigned; and
• Enter Name, license number, and the date of termination for any collaborator(s) you wish to remove.

PLA Provided Standard Collaborative Practice Agreement: This option will allow you to complete the entire agreement via separate sections within this form, entirely electronically.

Upload Collaborative Practice Agreement: This option will allow you to complete some basic information online and then upload the collaborative agreement document (do not upload multiple documents separately.)  This option will not require Step 3 with a Physician Affirmation.

**Special Note: If any Change of Collaborator(s) request results in a change to a CSR location, you must submit a separate request on the CSR via the Change CSR Location Action item.

Step 3

• Dependent upon the option you have selected, you will proceed through each section until the Physician Affirmation.
• The Physician Affirmation must be completed by the Practitioner. The APRN must select the FINISH button to proceed to the summary page and final step.

**If in Step 2, you selected the Upload Collaborative Practice Agreement, Step 3 is NOT required.

Step 4

• You must select the SUBMIT button in order to send the request to to the requested collaborator(s).

**If the Collaborator Change Request is approved by the Practitioner, the APRN will receive an email indicating the Practitioner has affirmed to be their collaborator and the Board will process the request.

Step 1

• Locate your Activity Panel in your MyLicense One account
  • This may be located on the right OR you may need to scroll to the bottom

Step 2

• Select the buttons on the bottom of each section of the request to proceed through and review each page until you get to the Physician Affirmation.
• Once on the Physician Affirmation page, if you approve the association, you will enter your electronic signature and select FINISH

**If after reviewing the request and you do not agree to one of the terms on the agreement, please work with the APRN to submit a revised Collaborative Agreement.

Step 3

• You must select the SUBMIT button in order to send the approved request to the Board for processing.