| State | Physician Involvement Requirement (for Prescription) | On-Site Oversight Requirement | Quantitative Requirements for Physician Chart Review | Maximum NP-to-Physician Ratio |
|---|---|---|---|---|
| Alabama | MD Collaboration Required | 10% of the time | 10% of all charts, all adverse outcomes | 1 MD - 3 full-time NPs or max. total of 120 hours/week |
| Alaska | None | None | No | N/A |
| Arizona | None | None | No | N/A |
| Arkansas | MD Collaboration Required | None | No | None stated |
| California | MD Supervision Required | None | No | 4 prescribing NPs - 1 MD |
| Colorado | None (although preceptor and mentoring period required for prescribing during the first 3,600 hours of prescriptive practice) | None | No | 5 NPs - 1 MD; board may waive restriction |
| Connecticut | MD Collaboration Required | None | No | None stated |
| Delaware | MD Collaboration Required | None | No | None stated |
| Florida | MD Supervision Required | None | No | 1 MD - no more than 4 offices in addition to MD’s primary practice location (If MD provides primary health care services) |
| Georgia | MD Delegation Required | None | All controlled substance Rx w/in 3 mos of issuance of Rx, all adverse outcomes w/in 30 days of discovery, 10% of all other charts at least annually | 4 NPs - 1 MD |
| Hawaii | MD Collaboration Required* | None | No | None stated |
| Idaho | None | None | No | N/A |
| Illinois | MD Delegation Required | At least once per month (no duration specified) | Yes, periodic review required for Rx orders | None stated |
| Indiana | MD Collaboration Required | None | Yes, at least 5% random sample of charts and medications prescribed for patients | None stated |
| Iowa | None | None | No | N/A |
| Kansas | MD Collaboration Required | None | No | None stated |
| Kentucky | MD Collaboration Required | None | No | None stated |
| Louisiana | MD Collaboration Required | None | No | None stated |
| Maine | None (although supervision by a physician or nurse practitioner is required for first 24 months of NP practice) | None | No | N/A |
| Maryland | MD Collaboration Required | None | Yes (percentage left to MD & NP discretion) | None stated |
| Massachusetts | MD Supervision Required | None | Yes (for Rx only - once every 3 months, percentage left to MD & NP discretion) | None stated |
| Michigan | MD Delegation Required | None | No | None stated |
| Minnesota | MD Delegation Required | None | No | None stated |
| Mississippi | MD Collaboration Required | At least once every 3 months | Yes - a representative sample of either 10% or 20 charts, whichever is less, every month | None stated |
| Missouri | MD Delegation Required | NP must first practice for at least one month at same location of collaborating MD, after which time MD must be on-site once every 2 weeks | Yes - once every 2 weeks | 3 FTE NPs - 1 MD |
| Montana | None | None | 15 or 5% of charts, whichever is less, reviewed quarterly (may be reviewed by MD or NP peer) | None stated |
| Nebraska | MD Collaboration Required | None | No | None stated |
| Nevada | MD Collaboration Required | Part of a day, once a month | Yes (percentage left to MD & NP discretion) | 3 NPs - 1 MD |
| New Hampshire | None | None | No | N/A |
| New Jersey | MD Collaboration Required | None | Yes - periodic review (percentage left to MD & NP discretion) | None stated |
| New Mexico | None | None | No | N/A |
| New York | MD Collaboration Required | None | Yes at least once every 3 months (percentage left to MD & NP discretion) | 4:1 NPs to physicians (only applies if more than 4 NPs practice off-site) |
| North Carolina | MD Supervision Required | None | Yes (for initial 6 months of collaboration, must be review and countersigning by MD w/in 7 days of NP-patient contact & meetings of NP-MD on weekly basis for first month, & then at least monthly for next 5 months) | None stated |
| North Dakota | MD Collaboration Required | None | No | None stated |
| Ohio | MD Collaboration Required | None | Yes - periodic review (annually, percentage left to MD & NP discretion) | 3 NPs - 1 MD |
| Oklahoma | MD Supervision Required | None | No | 2 FTE NPs or max 4 PT NPs - 1 MD |
| Oregon | None | None | No | N/A |
| Pennsylvania | MD Collaboration Required | None | Yes (percentage left to MD & NP discretion) | 4 NPs - 1 MD |
| Rhode Island | MD Collaboration Required | None | No | None stated |
| South Carolina | MD Delegation Required | None | No | 3 NPs - 1 MD |
| South Dakota | MD Collaboration Required | No less than one half day a week or 10% of the time | Yes (percentage left to MD & NP discretion) | 4 NPs - 1 MD |
| Tennessee | MD Supervision Required | Once every 30 days (no duration specified) | 20% of all charts every 30 days | None stated |
| Texas | MD Delegation Required | For sites serving medically underserved populations: at least once every 10 days (no duration specified). 10% for designated alternative practice sites. | 10% of all charts | 3 NPs or FTE - 1 MD (for alternative practice sites, 4 - 1; can be waived up to 6 - 1) |
| Utah | MD Collaboration Required** | None | No | None stated |
| Vermont | MD Collaboration Required | None | Yes (percentage left to MD & NP discretion) | None stated |
| Virginia | MD Supervision Required | MD must “regularly practice” at location where | NP practices Yes - periodic review (percentage left to MD & NP discretion) | 4 NPs - 1 MD |
| Washington | None | None | No | N/A |
| West Virginia | MD Collaboration Required | None | Periodic and joint review of Rx practice (no percentage specified) | None stated |
| Wisconsin | MD Collaboration Required | None | No | None stated |
| Wyoming | None | None | No | None stated |
NOTES: For the purposes of this chart, “collaboration” includes all collaboration-like requirements (such as “collegial relationship,” etc.).
FTE = full-time equivalent; MD = medical doctor; NP = nurse practitioner; PT = part time; Rx = prescription.
This requirement will be altered pending new rules in 2011.
For controlled substance schedules II-III only.
SOURCE: NNCC, 2009. Reprinted with permission from Tine Hansen-Turton, NNCC. Copyright 2009 NNCC.
From: 3, Transforming Practice
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.