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Point of Care Toolkit: Sample Collaborative Practice Agreements and Follow Up Protocols

Sample CPA's

Anti-coagulation

This example of an anti-coagulation management agreement comes from Duquesne University Center for Pharmacy Care.

Please click here to see this sample agreement.

 

This example of an anti-coagulation protocol comes from the Duquesne University Center for Pharmacy Care.

Please click here to see this sample protocol.

 

Flu Testing

This example of influenza screening services protocol comes from the Duquesne University Center for Pharmacy Care.

Please click here to see a sample of this protocol.

 

Sample Protocols

The following are templates of critical laboratory value protocols used in CLIA Waived testing with a collaborating physician.   Test results that fall significantly outside the normal range and/or may represent life-threatening values, even from routine tests, require rapid communication of results to the responsible physician and patient. These parameters are defined by the laboratory indice and agreement with the consultant physician.  **Please note: these templates are for reference only.  All protocols and practice agreements used for direct patient care should be reviewed by and agreed upon by a practicing physician.

Click here for a critical laboratory template.

Click here for a sample letter to send to the patient upon an abnormal reading.

 

 

Click here to return to the POC Toolkit.

 

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