[ ] Patient care team physician has served with the NP pursuant on a practice
agreement
[ ] Patient care team physician routinely practiced with a patient population and
practice area for which the NP is certified and licensed
Request that an NP in any state or working for U.S. Armed Forces, U.S. Veterans Administration or the Public Health Service submit evidence that the five-year full-time equivalent collaborative requirements have been met with signature from employer, physician, practice administrator, etc.