A. The signatories to an agreement shall be a practitioner involved directly in patient care and a pharmacist involved directly in patient care. Within the agreement, the pharmacist may designate alternate pharmacists, provided the alternates are involved directly in patient care at a single physical location where patients receive services.

B. An agreement shall only be implemented for an individual patient pursuant to an order from the practitioner for that patient. A patient who meets the criteria for inclusion in the category of patients whose care is subject to a collaborative agreement and who chooses to not participate in a collaborative procedure shall notify the prescriber practitioner of the patient's refusal to participate in such collaborative procedure.

1. The patient may decline to participate or withdraw from participation at any time.

2. The patient shall be informed by the practitioner or the pharmacist of the collaborative procedures that will be used pursuant to an agreement, and such discussion shall be documented in the patient record.

3. The practitioner and the pharmacist shall provide written disclosure to the patient of any contractual arrangement with any other party or any financial incentive that may impact one of the party's decisions to participate in the agreement.

A. Signatories to an agreement shall keep a copy of the agreement on file at their primary places of practice.

B. An order for a specific patient from the prescribing practitioner authorizing that authorizes the implementation prescribing of drug therapy management pursuant to the agreement shall be noted in the patient's medical record and kept on file by the pharmacist.

C. The patient's documented informed consent shall be retained by the practitioner in the patient record.