Medical Oversight Glossary

Physician Collaboration & Oversight

Collaborating Physician

A licensed medical doctor (MD or DO) who partners with a nurse practitioner (NP) or other healthcare provider to offer clinical oversight and ensure compliance with state regulations. Collaboration agreements define responsibilities, chart reviews, and communication expectations.

Medical Director

A physician responsible for overseeing clinical and administrative operations within a healthcare organization or MSO. Medical Directors ensure patient safety, quality assurance, and compliance with all regulatory standards.

Physician Oversight

The ongoing clinical supervision a physician provides to ensure safe, compliant care. Oversight may include chart review, approval of standing orders, consultation availability, and monitoring adherence to state scope-of-practice laws.

Supervising Physician

A physician responsible for overseeing clinicians (e.g., PAs, some NPs, and RNs in certain settings). Supervision requirements vary by state and may include chart review, co-signatures, or direct availability.

Clinical Governance

The systems and processes a medical director uses to ensure high standards of patient care, including quality assurance, protocol review, training, and risk mitigation.

Clinical Protocols

Detailed, standardized clinical procedures that outline how care must be delivered. Protocols include eligibility criteria, contraindications, dosing guidelines, documentation standards, emergency procedures, and delegation rules. Protocols must be regularly reviewed and updated.

Collaborative Practice Agreement (CPA)

A formal written agreement between a collaborating physician and an NP or PA outlining scope of practice, supervision expectations, required chart reviews, communication processes, prescriptive authority, and delegation limits. Many states require CPAs for NPs to practice.

Collaborative Agreement

A general term describing the written contract that defines responsibilities between a physician and an NP or PA. Used interchangeably with CPA in some states, though the structure and legal requirements vary widely.

Standing Orders

Pre-approved medical instructions written by a supervising physician or medical director that authorize clinicians (NPs, RNs, PAs) to perform certain procedures or administer specific treatments under defined conditions.

Delegation

The legal process by which a physician authorizes a qualified clinician (NP, PA, RN) to perform specific tasks within the clinician’s scope of practice. Delegation rules vary widely by state and require clear documentation.

Delegation of Services Agreement (DSA)

A formal document outlining which clinical tasks a physician may legally delegate to another provider, and what supervision is required. Commonly used for RNs and medical assistants.

Chart Review

A process where a collaborating physician or medical director periodically reviews a provider’s patient charts to ensure clinical accuracy, completeness, and compliance with regulations.

Chart Audit

A more formal, in-depth review of patient records used to assess compliance, evaluate quality, and identify areas needing corrective action. Often performed periodically or during a regulatory review.

Transition-to-Practice (TTP) Hours

Supervised clinical hours required for new NPs in certain states before they can practice independently or reduce required collaboration.

Incident Review

A process in which the medical director evaluates adverse events, complications, or unexpected outcomes. The review identifies root causes, necessary documentation, and corrective actions.

Compliance, Structure & Legal Terms

Corporate Practice of Medicine (CPOM)

A legal doctrine that prohibits corporations or non-physicians from controlling medical decision-making. CPOM compliance ensures that only licensed physicians oversee clinical care.

State-Specific Regulations

Each state establishes unique rules on NP collaboration, medical delegation, telemedicine, and clinic ownership. Compliance requires state-by-state alignment.

Clinical Compliance Infrastructure

The systems, processes, and regulatory frameworks that ensure a healthcare clinic operates safely, legally, and in accordance with state and federal requirements. Clinical Compliance Infrastructure includes physician oversight, protocol management, delegation standards, chart review workflows, documentation practices, telemedicine requirements, and adherence to CPOM laws. A strong infrastructure protects both the provider and the clinic by reducing risk, preventing board complaints, and ensuring all clinical activities follow established standards of care.

Professional Corporation (PC) / Professional LLC (PLLC)

A physician-owned clinical entity that employs providers and delivers medical care. PCs/PLLCs are required in most CPOM states for practicing medicine legally.

Medical Services Organization (MSO)

A business entity that provides non-clinical support — such as HR, billing, compliance, and administration — to medical practices. MSOs allow healthcare providers to focus on patient care while maintaining compliance with CPOM laws.

Management Services Agreement (MSA)

A contract between the PC and MSO outlining services the MSO provides, fee structures, and the separation of clinical vs. non-clinical responsibilities. A properly drafted MSA is central to CPOM compliance.

Fair Market Value (FMV)

The legally defensible value of MSO services. CPOM-compliant MSO fees must reflect FMV to avoid being interpreted as fee-splitting or improper financial influence over clinical care.

Fee-Splitting

Prohibited in many states, fee-splitting occurs when a non-physician receives a percentage of medical revenue. It is often flagged as a CPOM violation.

Funds Flow

The compliant movement of money in a PC/MSO structure: patient revenue goes to the physician-owned PC, which then pays the MSO under the MSA. Improper funds flow can create liability.

Cost-Plus Fee Model

An MSO billing structure where the MSO charges the PC for actual operating costs plus a reasonable markup. This structure must be defensible under FMV standards.

Percentage-Based Fee Model

A high-risk MSO fee structure where the MSO collects a percentage of clinical revenue. Legal in a few states but prohibited in many due to fee-splitting rules.

Ownership Restrictions

State laws that restrict who may own a medical practice. Most CPOM states require physician ownership of clinical entities.

Strawman Arrangement

An illegal or non-compliant structure where a physician appears to “own” the clinical entity on paper but the MSO or non-clinician truly controls medical decisions. Regulators penalize strawman setups heavily.

Compliance Review

A formal evaluation of a clinic’s adherence to laws, protocols, and governance standards. May include audits, chart checks, structural reviews, or legal updates.

Board Inquiry / Board Complaint

An investigation initiated by a state medical or nursing board regarding potential violations. Proper oversight documentation is essential for defense.

Telemedicine & Digital Care

Telemedicine / Telehealth

The practice of delivering healthcare remotely via secure technology, such as video conferencing. Telemedicine enables providers to assess, diagnose, and manage patients while maintaining compliance with HIPAA and state laws.

Good Faith Exam (GFE)

An evaluation conducted by a licensed provider to confirm that a treatment or prescription is medically appropriate. Good Faith Exams are essential for patient safety and are often required for telehealth and aesthetic services.

Telehealth Platform

A secure, HIPAA-compliant digital environment used to perform virtual visits, document Good Faith Exams, and manage patient communications.

GuardianMD Connect

GuardianMD’s telemedicine platform designed for good faith exams and virtual oversight workflows. It provides secure video visits, documentation, chart routing, oversight visibility, and state-specific compliance features for clinics and physicians.

Virtual Medical Exam

A synchronous (live) telehealth evaluation performed by a licensed provider to assess medical appropriateness for treatment or prescribing.

Synchronous Telehealth

Real-time telemedicine via live video. Required for good faith exams in many states.

Asynchronous Telehealth

Store-and-forward communication or messaging not performed in real time. Using asynchronous methods for good faith exams is prohibited in many states.

Telehealth Documentation Standards

The legally required elements a provider must document during a virtual visit, including history, exam findings, consent, assessment, plan, and state-specific elements.

Healthcare Professionals

Nurse Practitioner (NP)

An advanced practice registered nurse (APRN) who can diagnose, prescribe, and manage patient care. Depending on the state, NPs may require collaboration or supervision to practice.

Independent Practice NP

A nurse practitioner authorized by state law to practice autonomously without physician collaboration.

Reduced Practice NP

A nurse practitioner who must practice with limited physician collaboration, often for specific tasks like prescribing.

Restricted Practice NP

A nurse practitioner who must maintain ongoing physician collaboration or supervision to practice.

Registered Nurse (RN)

A licensed clinician who provides patient assessment, monitoring, education, and care within the limits of state-defined scope.

Physician Assistant (PA)

A licensed provider who delivers medical care under physician supervision, with supervision levels varying by state.

Delegated Provider

Any clinician (NP, PA, RN) performing tasks under physician delegation.

Unlicensed Assistive Personnel (UAP)

Staff without clinical licensure who may assist with non-clinical tasks. UAPs must never perform clinical duties reserved for licensed providers.

Physician Matching

The process of pairing a clinic with a licensed collaborating physician or medical director aligned with their specialty and state requirements.

Credentialing

Verification of a provider’s qualifications, licensure, training, and history before joining a network or practice.

Malpractice Insurance

Professional liability coverage that protects clinicians and medical directors from claims of negligence or medical error.

Regulations & Standards

Healthcare Compliance

The set of rules and best practices that govern safe, lawful clinical operations, including CPOM, HIPAA, delegation rules, supervision standards, and documentation requirements.

HIPAA

HIPAA (Health Insurance Portability and Accountability Act of 1996) is a federal law protecting patient privacy, secure communication, and proper handling of medical data.

Standard of Care

The clinical benchmark of what a competent provider would do under similar circumstances. Medical directors and collaborating physicians must ensure that staff follow this standard.

Quality Assurance (QA)

Ongoing processes that evaluate the quality, safety, and compliance of patient care. QA includes audits, training, incident reviews, and protocol updates.

Informed Consent

A required, documented discussion that explains treatment risks, benefits, alternatives, and responsibilities. Consent must be obtained before performing most medical services.

Patient–Provider Relationship (PPR)

A legally required relationship, typically established during a GFE, that permits diagnosis, prescribing, and medical treatment.

IV Hydration, Aesthetics & Wellness

IV Hydration Therapy

The medical administration of fluids, electrolytes, vitamins, or medications via intravenous infusion. Requires a valid good faith exam, standing orders, and appropriate delegation.

Aesthetic Injectables

Cosmetic treatments such as neuromodulators, dermal fillers, Kybella, and biostimulators. All require a prescriptive order and provider oversight.

Prescriptive Authority

The legal ability to prescribe medications. RNs cannot prescribe; NPs and PAs can prescribe within statutory limits.

Compounded Medications

Medications prepared by compounding pharmacies. Medical directors must oversee use, storage, ordering, and documentation.

Pharmacy Account Oversight

The process of ensuring that only licensed prescribers order medications and that delegation rules are followed.

Contraindications / Eligibility Criteria

The medical conditions or factors that determine whether a patient is safe to receive a given treatment.

Adverse Event Management

The process for recognizing, documenting, and responding to complications or unexpected reactions.

Protocol-Driven Care

Clinical care is delivered according to standardized, physician-approved protocols and standing orders.

About GuardianMD

GuardianMD Network

A nationwide network of licensed physicians, medical directors, and healthcare providers dedicated to compliant, efficient partnerships. GuardianMD connects NPs, PAs, RNs, and healthcare organizations with the oversight and structure they need to grow safely and confidently.