50-State Guide

Medical direction requirements by state

Every state sets its own rules for who evaluates patients, who orders treatment, and how a physician oversees the work. Use this guide to see key rules in all 50 states for IV therapy, med spas and aesthetics, medical weight loss, functional and longevity medicine, primary and urgent care, and mobile healthcare.

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Understanding medical direction requirements

What is medical direction?

Medical direction is the physician oversight a clinic puts in place for the medical care it offers. A medical director typically sets protocols, reviews charts, answers clinical questions, and oversees the tasks the physician delegates. A medical director works with your whole clinic, not just one person on your team.

Only a few states have a rule that names a medical director, and those rules cover certain types of businesses, like Florida's licensed clinics or Rhode Island's med spas. In most states, the need for a physician comes from other rules. These include who can evaluate patients, who can prescribe, what can be delegated, and how supervision works. Each state sets its own rules. Which rules apply to your clinic depends on the services you offer, who provides them, and where you see patients.

Have NPs or PAs on your team? Their physician rules are different. See our physician collaboration requirements by state.

Key takeaways

The work drives the rules. Physician involvement usually comes from rules on patient exams, prescribing, and delegation, not from the title "medical director."

IV hydration and med spas get extra attention. Many state boards have issued statements on individual patient exams, standing orders, and drug mixing.

Some services need a prescriber nearby. A few states set on-site or distance rules, mostly for cosmetic procedures. Check each service you plan to offer.

Rules are changing. Several states issued new guidance, laws, or registration rules in 2025 and 2026. Check the official sources before you open or expand.

Medical direction requirements by state

How to read this guide

Each state summary lists a few key rules for clinics where RNs give treatments. Most state board guidance focuses on IV therapy and med spa services, so many bullets cover those. General rules on patient exams, orders, and delegation can also apply to medical weight loss, functional and longevity medicine, primary and urgent care, and mobile healthcare. This isn’t a full list of every rule that may apply to your clinic.

Summaries focus on RNs and clinic operations. Rules for NPs and PAs are in our physician collaboration guide. Facility, pharmacy, ownership, and business licensing rules may also apply.

Many sources are board position statements, advisory opinions, or guidance documents. Some aren’t laws, but they show how a board reads the law.

This guide gives general information, not legal advice or a complete statement of state law. Review the linked official sources and talk with a qualified attorney about your plans. State information last reviewed: November 2026.

Alabama medical direction requirements

  • IV patient exams: For retail IV therapy, a physician must personally evaluate the patient. A PA, CRNP, or CNM working under a required physician agreement may also do it. That provider writes a prescription before anyone gives the IV.
  • Standing orders: In this setting, standing orders alone don’t meet the physician’s duties to each patient.

Alabama Board IV therapy ruling

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Alaska medical direction requirements

  • RN role: RNs carry out a medical treatment plan prescribed by a person the state authorizes to practice medicine.
  • Med spa review: A state work group has studied medical spa services, including IV hydration. It can only make recommendations. It can’t adopt rules.

Alaska nursing statutes and regulations | Alaska Medical Spa Services Work Group

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Arizona medical direction requirements

  • RN role: Arizona’s nursing law defines RN practice separately from NP practice. Prescribing drugs is part of the NP definition, not the RN definition.
  • IV guidance: The Arizona Board of Nursing has an advisory opinion on IV hydration. Clinics that use RNs should read it.

ARS 32-1601 | Arizona Board of Nursing IV hydration opinion

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Arkansas medical direction requirements

  • RN role: The Board of Nursing says only licensed nurses should start the IV and give the fluids.
  • IV orders: The Board of Nursing says a provider with active prescribing authority should prescribe the fluid and any add-ins for each patient.
  • RN limits: The same guidance says RNs can’t diagnose or write a prescription.

Arkansas Board of Nursing IV hydration guidance

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California medical direction requirements

  • Standardized procedures: Some RN medical tasks need written care rules called standardized procedures. These must be in place before those tasks begin.
  • Exams and telehealth: Before a physician orders a drug, the patient needs an appropriate exam and a medical reason for the drug. Telehealth may be used if it meets the standard of care.
  • Ownership: RNs can own part of a medical corporation. All eligible owners who aren’t physicians are limited to 49% of its shares in total.
  • Med spa setup: Medical Board guidance warns against a lay-owned med spa hiring a doctor as its medical director.

16 CCR section 1472 | Business and Professions Code section 2242(a) | Corporations Code section 13401.5 | Medical Board cosmetic treatment guidance

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Colorado medical direction requirements

  • Medical plans: RNs may carry out a medical plan. It can be a written plan, verbal order, standing order, or protocol, and it can include the choice of medication.
  • Level of oversight: The Board says the physician and nurse involved decide how much oversight a delegated task needs.
  • Ownership bill: A 2026 bill on med spa business ownership did not pass. It was postponed indefinitely in March 2026.

Colorado Board of Nursing practice guidance | HB26-1249 status and history

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Connecticut medical direction requirements

  • Clinician on staff: Each med spa must employ or contract with a physician, PA, or APRN who has training and experience in cosmetic procedures.
  • In-person first visit: A physician, PA, or APRN must do an in-person assessment before a patient’s first cosmetic procedure at a med spa.
  • Who performs: After that, these clinicians or an RN can perform the procedures. Other services, like IV therapy, may have their own rules.

Connecticut medical spa statute | CGS 19a-903c, legislative report

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Delaware medical direction requirements

  • IV therapy defined: The Board's rules define IV therapy as giving fluids and medications into the bloodstream. IV fluids include vitamins and nutrient preparations.
  • Medication tasks: Under the Board's delegation rules, RNs can't delegate giving medications to unlicensed assistive personnel.
  • Scope check: The Board points nurses to a scope of practice decision tree to check if a task fits their role.

Delaware Board of Nursing rules | Delaware scope of practice decision tree

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Florida medical direction requirements

  • Clinic medical director: Clinics covered by the Health Care Clinic Act must appoint a medical director. A clinic that doesn't offer physician services may appoint a clinic director instead. That person agrees in writing to take on listed duties, such as checking staff licenses and reviewing billing.
  • Clinic licensing: Covered clinics need a clinic license unless an exemption applies. Each location and each mobile clinic needs its own license.
  • RN role: RNs give medications and treatments that a licensed prescriber has ordered or authorized.

Florida medical and clinic director duties | Florida clinic licensing requirements | Florida nursing scope definitions

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Georgia medical direction requirements

  • IV orders: An RN may give IV hydration only with a valid individual order from a physician, NP, or PA. That provider must also complete a history and physical. Standing orders can't replace either one.
  • RN-only models: The Medical Board says walk-in, mobile, or drip-bar IV services can't rely on an RN as the only licensed professional evaluating and treating patients.
  • What's next: The Medical Board posted its IV statement in May 2026. In June, it said the statement explains how it already reads the law, and more updates may come.

Georgia Medical Board IV hydration position statement | Georgia Medical Board statement, June 4, 2026

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Hawaii medical direction requirements

  • RN role: RN practice includes carrying out prescribed medical orders from a physician, APRN, or supervised PA.
  • Nursing standards: RN practice is also guided by Board of Nursing rules and the nursing standards the Board recognizes.
  • Prescribing: Under Hawaii's nursing law, APRNs can prescribe only if the Board grants them that authority, and only within their specialty.

Hawaii nursing definitions, HRS 457-2 | Hawaii registered nurse scope, HRS 457-2.5 | Hawaii APRN prescribing authority

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Idaho medical direction requirements

  • RN role: RNs give medications and treatments as prescribed by providers who can prescribe.
  • Patient evaluation: Idaho's 2026 guidance on injectable lifestyle services says there should be a patient evaluation and a treatment plan made for each patient. The guidance isn't binding.
  • Delegation: Delegated tasks must stay within each license's practice act and board rules. The guidance says the person doing the task should have the right knowledge, skill, and training.

Idaho Code 54-1402 | Idaho injectable lifestyle services guidance

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Illinois medical direction requirements

  • Ownership: The state's med spa memo says a sole owner or partnership med spa must be owned by physicians or APRNs.
  • Delegation: Delegated tasks must fit within the delegating physician's scope of practice, education, training, or experience.
  • Lasers: Ablative laser procedures need on-site physician supervision. For non-ablative procedures, the physician may be on-site or reachable by phone.
  • Infection prevention: Every med spa must make infection prevention a priority, with infection control policies and procedures.

Illinois med spa memo

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Indiana medical direction requirements

  • Responsible practitioner: Each registered medical spa must name a responsible practitioner with prescribing authority and training in the services offered. This may be an Indiana-licensed physician, APRN, or PA with prescribing authority.
  • In-person time: The responsible practitioner must be at the location in person for enough time.
  • Registration: Starting January 1, 2027, a medical spa must be registered to do business in Indiana. Registration is through the Professional Licensing Agency.

Indiana medical spa law (SEA 282, 2026) | Indiana PLA medical spa registration notice

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Iowa medical direction requirements

  • Aesthetic services: Iowa's medical spa rule covers physicians who serve as a med spa's medical director. That medical director delegates medical aesthetic services, like neurotoxin and filler injections, and is responsible for them. Only routine and technical services may be delegated. Other licensed clinicians who serve as medical director follow their own board's rules.
  • On-site time: At a medical spa, staff doing delegated aesthetic services need at least four hours a week of documented, in-person supervision. The medical director, another qualified physician, or a qualified nonphysician supervisor may provide it. The medical director must also review services on site each week and check at least 10 percent of charts.
  • Distance: The physician medical director must stay within 60 miles of where delegated services are given.

Iowa medical spa rule, 481 IAC 655.6 | Iowa medical aesthetic services guidance

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Kansas medical direction requirements

  • Delegation: A physician may delegate tasks only to people they believe can do them well. The physician must also name a qualified backup for times they are away.
  • Prescribers: Kansas APRNs may prescribe drugs that fit their role and patient group, so an APRN can be the prescriber for some services.
  • LPN IV therapy: Kansas sets training and RN supervision rules for LPNs who give IV therapy. The same law says it doesn't bar an LPN from giving IV therapy that a physician or dentist delegates.

Kansas delegation statute | Kansas APRN statute | Kansas LPN IV therapy statute

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Kentucky medical direction requirements

  • IV patient exams: A physician, PA, or APRN must personally evaluate the patient and choose the treatment. That provider writes a prescription before anyone gives the IV.
  • Standing orders: Standing orders for an RN to follow don’t meet the provider’s duties to each patient. A physician who is only “available” isn’t enough.
  • Documentation: A documented first evaluation and treatment plan must come before any treatment.

Kentucky joint statement on retail IV hydration | Kentucky RN IV hydration guidance

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Louisiana medical direction requirements

  • Cosmetic injections: RNs may give some cosmetic treatments, like neurotoxin injections, when ordered by a qualified provider. First, a qualified physician, or an NP working in collaboration with a qualified physician, must take a history, examine the patient, and confirm the treatment fits.
  • On the premises: The treatments must take place in a medical office or facility. A physician or NP must be on the premises and immediately available the whole time the RN is treating patients.
  • Fillers: Dermal fillers are outside RN scope.

Louisiana Board of Nursing aesthetics statement

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Maine medical direction requirements

  • Patient exams: In IV therapy businesses, med spas, and medical aesthetic businesses, the prescriber must generally see the patient in person. A telehealth visit can work if the technology is good enough to reach an informed diagnosis. A static online form doesn't count.
  • Standing orders: In these businesses, using standing orders in place of each patient's own assessment, diagnosis, and treatment is unprofessional conduct.
  • RN limits: An RN can't take on the prescriber's role of diagnosing and prescribing.

Maine Chapter 15 joint rule

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Maryland medical direction requirements

  • Cosmetic procedures: For most cosmetic procedures, the prescriber must assess the patient and make a treatment plan first. The prescriber must also be physically present and immediately available.
  • Standing orders: Nurses can't do cosmetic procedures on a standing order or protocol. They also can't do the pre-procedure medical assessment.
  • Training: Nurses need training and documented skills for each procedure they perform.

Maryland cosmetic procedure rules | Maryland prohibited acts rule | Maryland cosmetic education rule

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Massachusetts medical direction requirements

  • IV settings: The Board says IV hydration in a mobile unit or wellness clinic must meet the same standard of practice as any other setting.
  • Cosmetic choices: For cosmetic procedures, an RN who isn't an APRN with prescribing authority can't choose the medication, dose, device, or device setting. Those choices come from an authorized prescriber.
  • Evaluation: Cosmetic procedures call for a documented evaluation by an authorized prescriber.

Massachusetts infusion therapy advisory | Massachusetts cosmetic nursing advisory

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Michigan medical direction requirements

  • Delegation: A physician can hand off some medical tasks to staff who are qualified by education, training, or experience. The physician must supervise.
  • Supervision: Supervision doesn't always mean being in the room. The physician must always be available to talk in person, by phone, or by other telecommunication. The physician must also review records on a set schedule and provide set procedures and drug protocols. Some tasks have stricter rules.
  • Telehealth: Michigan's Board of Medicine rules require patient consent before a telehealth visit and a record of that consent. Care must meet the same standard as an in-person visit.

MCL 333.16215 | MCL 333.16109 | Michigan medical rules, R 338.2407

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Minnesota medical direction requirements

  • Orders: An RN may carry out a patient-specific order from an authorized prescriber.
  • Protocols: An RN may also follow a condition-specific protocol. The prescriber sets the criteria, and the RN checks whether each patient fits them.
  • Renewals: An RN can't renew or extend an order without the prescriber. That counts as writing a new one.

Minnesota Board of Nursing prescribing FAQ | Minnesota Board of Nursing protocols guidance

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Mississippi medical direction requirements

  • IV patient exams: Before IV hydration, a physician, NP, or PA must complete a history and physical exam.
  • Standing orders: Standing orders don't replace individual orders and assessments.
  • Policies: Businesses offering IV services must keep on-site policies for safe IV care and emergencies.

Mississippi IV hydration position statement

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Missouri medical direction requirements

  • RN arrangements: A physician may set up a written collaborative practice arrangement with an RN. It can take the form of protocols or standing orders.
  • Delegated authority: Through that arrangement, a physician may delegate to the RN the authority to give drugs and provide treatment.
  • Limits: The care must stay within the RN’s scope and match the nurse’s skill, training, and competence.

Missouri collaborative practice statute

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Montana medical direction requirements

  • Med spa prescribing: If a med spa offers injectables or medical procedures, a qualified provider must prescribe the injectables and provide or supervise the procedures.
  • Nurse injections: RNs and LPNs may give prescribed injections with the right training, education, and supervision.
  • IV rule update: The Board of Nursing updated its IV therapy rule (ARM 24.159.1010). The changes took effect September 26, 2026.

Montana Board of Nursing med spa FAQ | Montana Board of Nursing adoption notice, MAR 2026-114

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Nebraska medical direction requirements

  • RN role: Nursing includes carrying out treatment plans prescribed by anyone lawfully allowed to prescribe.
  • IV therapy: IV therapy, including hydration, needs an order from a licensed practitioner. The patient must be assessed and watched for reactions.
  • Neurotoxins and fillers: A licensed practitioner must assess the patient and give orders for each episode of care. An episode is a series of unchanging treatments for one condition over a set period. The Board's opinion also calls for that practitioner to be on site, though not in the same room, when an RN gives them.

Nebraska Nurse Practice Act | Nebraska IV infusion advisory | Nebraska aesthetic nursing opinion

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Nevada medical direction requirements

  • RN role: RN practice includes giving drugs and treatments prescribed by a physician, an APRN, a PA, or certain other licensed providers.
  • IV orders: For IV therapy outside a hospital, the practitioner must assess the patient before giving the order. The nurse may carry only the fluids and drugs ordered for that patient.
  • Records: The nurse must check for allergies and keep a patient record with the assessments and orders.

NRS 632.018 | Nevada IV hydration practice decision

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New Hampshire medical direction requirements

  • RN role: RNs assess patients, carry out the prescribed medical plan, and evaluate how patients respond.
  • Prescribers: Under RSA 326-B:11, APRNs, such as NPs, can prescribe within their scope.
  • Board guidance: The Board of Nursing has scope guidance on IV therapy and cosmetic services for RNs.

RSA 326-B:12 | RSA 326-B:11 | New Hampshire Board of Nursing scope of practice

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New Jersey medical direction requirements

  • RN role: RN practice includes carrying out medical treatment plans prescribed by a licensed or otherwise legally authorized physician or dentist.
  • Scope check: The Board of Nursing's scope model asks if a valid order and established protocols, policies, and procedures support the task. It also asks if the nurse has the skills to do it safely and is ready to be accountable.

New Jersey Board of Nursing statutes and regulations | New Jersey Board of Nursing scope decision model

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New Mexico medical direction requirements

  • Med spa physician: The Medical Board's med spa policy calls for a New Mexico-licensed MD or DO as medical director or supervising physician.
  • Presence: The policy lists being physically present or readily available during procedures as part of that physician's role.
  • Ownership: The policy allows owners who aren't physicians. Medical procedures still need a supervising physician.

New Mexico Medical Board med spa policy

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New York medical direction requirements

  • RN role: RN practice includes carrying out medical treatment plans prescribed by a licensed physician or other licensed provider.
  • Patient-specific orders: Most RN orders must be for a specific patient. The prescriber who writes them must have examined that patient.
  • Standing orders: Standing orders for RNs are limited to a short list of services, like shots and some tests. IV hydration and cosmetic treatments aren't on that list.

NY Education Law 6902 | NYSED guidance on orders and protocols

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North Carolina medical direction requirements

  • IV orders: Each IV hydration client needs an individual order from a licensed prescriber. The nurse confirms the order exists and assesses whether the treatment is right for the client.
  • On-site presence: An RN giving IV hydration doesn't need a physician, NP, or PA on-site. An LPN does need supervision.
  • Policies: The business must keep on-site policies for IV care and emergencies.

NC Board of Nursing IV hydration statement

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North Dakota medical direction requirements

  • RN role: Nursing doesn't include medical diagnosis or treatment. RNs carry out care prescribed by a licensed practitioner.
  • Retail IV: A physician, PA, or APRN with prescribing authority must do a documented history and physical first. A general medical clearance isn't enough.
  • Med spa: The Board's aesthetics guidance sets similar steps for med spa treatments. Each client needs a prescriber's exam and a specific order.

ND Board of Nursing retail IV guidance | ND Board of Nursing aesthetics guidance

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Ohio medical direction requirements

  • Protocols: Ohio's boards say the law doesn't allow protocols for choosing, mixing, or giving IV drugs in retail IV clinics. A physician, PA, or APRN may do the patient evaluation by telehealth if it meets the in-person standard of care.
  • Drug mixing: Adding vitamins or drugs to an IV bag counts as compounding. The clinic then needs a terminal distributor of dangerous drugs license from the Ohio Board of Pharmacy.
  • On-site check: If a nurse checks a drug mixed for immediate use, a prescriber must be on-site.

Ohio joint retail IV therapy statement | Ohio Admin. Code 4729:7-3-04

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Oklahoma medical direction requirements

  • IV patient exams: Before an RN gives IV hydration, a physician, APRN, PA, or other licensed prescriber must complete a history and physical and write an individual order. Standing orders can't replace either one. A physician's first evaluation can be in person or by telemedicine.
  • Med spa orders: For med spa services like neurotoxins, fillers, and lasers, the nurse also needs an individual order.
  • Policies: The clinic must keep on-site policies for treatment and emergencies.

Oklahoma IV hydration guidelines | Oklahoma cosmetic procedure guidelines

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Oregon medical direction requirements

  • IV prescribing: Only licensed prescribers may prescribe IV products. These include physicians, PAs, and APRNs with prescribing authority. RNs can't prescribe them.
  • RN scope: Before an RN does an IV hydration task, the RN must check that it fits their own scope, using the Board's criteria.
  • What physicians keep: The Medical Board tells its licensees not to hand off diagnosis, informed consent, or prescribing for IV hydration to staff who aren't properly licensed, trained, or qualified.

Oregon Board of Nursing IV hydration statement | Oregon Medical Board IV hydration statement

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Pennsylvania medical direction requirements

  • RN role: RN practice doesn't include medical diagnosis or prescribing.
  • IV orders: IV hydration needs a written order. A physician, or a CRNP or PA acting within their prescribing authority and agreements, may write it. The RN also needs instruction and supervised practice.
  • Delegation: A physician may delegate a medical task only when it fits accepted medical standards and no law or Board rule bars it. The physician stays responsible for the task.

Pennsylvania Professional Nursing Law | 49 Pa. Code 21.12 | Pennsylvania Board notice on orders from other practitioners | Pennsylvania Medical Practice Act, Section 17

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Rhode Island medical direction requirements

  • Med spa medical director: Each medical spa must appoint a medical director. That person is responsible for delegating and supervising cosmetic procedures.
  • Standing orders: Standing orders don't create the required provider-patient relationship. Using them in place of a patient assessment can lead to discipline.
  • Facility license: Your business may need a facility license. It depends on who owns it, what you offer, and the owners' licenses.

R.I. Gen. Laws 23-105-2 | Rhode Island Department of Health med spa and IV therapy guidance

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South Carolina medical direction requirements

  • IV patient exams: Before an RN gives IV hydration, a physician, PA, or APRN must personally evaluate the patient and write a prescription. Standing orders aren't enough because they aren't specific to each patient.
  • On-site presence: An RN doesn't need a physician, PA, or NP on-site to give the prescribed IV hydration.
  • Neurotoxins: For cosmetic neurotoxins, an RN may inject only with a physician or APRN supervising on site.

South Carolina retail IV therapy joint opinion | South Carolina joint opinion on neurotoxins

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South Dakota medical direction requirements

  • Elective IV orders: An authorized provider, such as a physician, NP, or PA, writes the order. It's not within RN scope to prescribe, order, or obtain the drugs.
  • Protocols: The Board's elective IV guidance says written protocols or standing orders should be signed, dated, and reviewed each year.
  • Drug sourcing: The Board's guidance says IV drugs must come from a South Dakota-licensed wholesale drug distributor or a South Dakota-licensed 503B outsourcing facility.
  • Med spa: RNs may give neurotoxin and temporary filler injections with a medical order or protocol, plus added training and proven skill.

SD Board of Nursing elective IV guidelines | SD Board of Nursing dermatological procedures guidance

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Tennessee medical direction requirements

  • Med spa medical director: A med spa's medical director needs an active Tennessee medical license. The doctor must also practice at a physical site in the state. A telemedicine-only practice doesn't count.
  • Registration: Each med spa address must be registered on its own.
  • Pop-ups: Med spa services must take place at the registered site. Pop-ups and door-to-door visits aren't allowed.

Tennessee Medical Spa Registry | Tennessee med spa FAQs

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Texas medical direction requirements

  • Elective IV therapy: A physician, or a PA or APRN under physician supervision, orders elective IV hydration. An RN or higher-level licensee gives it.
  • Where the IV law applies: Texas's elective IV law doesn't apply in physician offices or licensed health facilities.
  • Cosmetic procedures: The Texas Medical Board treats nonsurgical cosmetic procedures, like neurotoxin injections, as medical acts. A physician, PA, or APRN must be on-site or immediately available for emergency consultation. If needed, a physician must be able to see the patient for an emergency appointment.

Texas elective IV therapy law | Texas Medical Board IV hydration guidance | Texas Medical Board cosmetic procedures guidance

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Utah medical direction requirements

  • Patient exams: For nonablative cosmetic procedures other than hair removal, a physician, NP, or PA must evaluate the patient first. The visit can be in person or by live telemedicine.
  • Distance: When an RN performs these procedures, the supervisor must be able to respond in person in a timely way and be within 60 minutes or 60 miles of the facility.
  • Posting: The facility must post the supervisor's name and license. Patients need a follow-up phone number that is answered within 24 hours.

Utah Code 58-1-506

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Vermont medical direction requirements

  • Standing orders: Standing orders from an IV clinic's medical director aren't valid prescriptions.
  • RN limits: RNs can't prescribe IV fluids, even if a medical director asks them to. RNs can give IV treatment with a valid prescription.
  • Add-ins: Adding vitamins or other add-ins to saline counts as compounding. Patients also can't just pick an IV mix from a menu.

Vermont IV therapy and medical spa statement

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Virginia medical direction requirements

  • Prescriber relationship: Before prescribing, the prescriber must have the patient's history, explain risks and benefits, and make sure a proper exam is done. The exam may happen in person or with electronic tools.
  • Standing protocols: Virginia's drug law lists certain uses for RN standing protocols. The listed uses don't include elective IV hydration.
  • New guidance: The Department of Health Professions posted guidance on IV hydration clinics and med spas, effective October 8, 2026. Clinics that use RNs should read it.

Virginia Code 54.1-3303 | Virginia Code 54.1-3408 | Virginia DHP Guidance Document 76-1

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Washington medical direction requirements

  • Infusion orders: For infusion therapy, the RN needs an order from an authorized prescriber. Standing orders may be an option.
  • Cosmetic injections: For cosmetic injections a physician delegates, the physician must examine the patient and make a record first. A written office protocol is also required.
  • Physician availability: The physician must be on-site if the drug or use isn't FDA-approved for that purpose. For approved uses, the physician must be reachable by phone and able to respond within 30 minutes.
  • Work group: The Department of Health has a work group looking at med spa services, so watch for updates.

Washington nursing board infusion therapy opinion | WAC 246-919-606 | Department of Health med spa work group

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West Virginia medical direction requirements

  • RN role: RNs give medications and treatments as prescribed by a licensed physician, dentist, or APRN.
  • Individual plans: Each patient needs an individual assessment and a personal treatment plan, not generic standing orders.
  • Monitoring: During IV therapy, trained healthcare professionals must watch vital signs and reactions. Providers also need a plan for emergencies.

W. Va. Code 30-7-1 | West Virginia Board IV and med spa guidance

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Wisconsin medical direction requirements

  • Assessment first: Each patient must be assessed before any IV hydration treatment is ordered.
  • RN care: Once there's an order, an RN may give the treatment. The RN should check vital signs and watch for reactions, and is expected to document care.
  • Standing orders: Standing orders may be allowed, but only after a real patient relationship with an individual assessment and diagnosis.

Wisconsin joint IV hydration opinion

Need a medical director? GuardianMD provides clinics with a medical director in Wisconsin and structures the oversight and protocols their services require.

Wyoming medical direction requirements

  • Orders: An RN or LPN needs a provider's order for IV therapy, including hydration, in any setting. A physician, PA, or APRN does the exam and writes the order.
  • Telehealth: The provider's first visit can be in person or by telehealth. The boards' retail IV statement says a physician or PA must use audio and video, not just a form.
  • On-site: For RN infusion and aesthetic care, the provider must be available in person or electronically during the procedure. The aesthetics opinion says the provider doesn't need to be on-site. LPNs need an on-site provider, and they can't do injectable aesthetic procedures.
  • Board guidance: The opinions aren't law, but they are the Board of Nursing's official view of Wyoming nursing standards. The retail IV statement is a joint statement from the medical, nursing, and pharmacy boards.

Wyoming Board of Nursing practice resources | Wyoming infusion therapy opinion | Wyoming aesthetics and med spa opinion | Wyoming retail IV joint statement

Need a medical director? GuardianMD provides clinics with a medical director in Wyoming and structures the oversight and protocols their services require.

Frequently asked questions

A few states use the title for certain types of businesses. Florida clinics covered by the Health Care Clinic Act must name a medical director, or a clinic director in some cases. Rhode Island requires each medical spa to appoint a medical director. Iowa’s medical spa rule and Tennessee’s med spa rules also set duties or qualifications for a medical director. In most other states, the need for a physician comes from rules on patient exams, prescribing, and delegation.

In many states, not in place of an individual patient exam. Boards in states such as Alabama, Georgia, Kentucky, Maine, Mississippi, Ohio, South Carolina, Vermont, and West Virginia have said standing orders or protocols can’t replace an individual assessment or order. A few states allow standing orders in limited ways. Wisconsin allows them only after an individual assessment and diagnosis. Plan a prescriber’s evaluation and order for each patient.

In many states, yes, if it meets the standard of care. Rules or guidance in Oklahoma, Ohio, South Carolina, Utah, and Virginia allow a telehealth evaluation for some services. Other states are stricter. Connecticut requires an in-person assessment before a patient’s first med spa cosmetic procedure. Maine’s rule says the exam must generally be in person at IV and med spa businesses. GuardianMD Connect supports telehealth medical clearance exams 7 days a week where the state and service allow it.

A few states set on-site or distance rules, mostly for cosmetic procedures. Examples include Iowa (at medical spas, four hours a week of on-site supervision, which another qualified clinician may provide, plus a weekly on-site review by the medical director), Maryland (most cosmetic procedures), Louisiana (RN cosmetic treatments), Utah (within 60 minutes or 60 miles), and Illinois (ablative lasers). Ohio requires a prescriber on-site when a nurse checks certain drugs mixed for immediate use. GuardianMD provides remote oversight only. If a service needs a physician or other prescriber on-site, our remote service won’t meet that need on its own.

It can. Ohio and Vermont treat adding vitamins or drugs to an IV bag as compounding. In Ohio, that means the clinic needs a terminal distributor of dangerous drugs license. South Dakota’s Board of Nursing says IV drugs must come from a South Dakota-licensed wholesale distributor or 503B outsourcing facility. Review how your clinic mixes, stores, and sources drugs before you open.

Yes. Tennessee requires each med spa address to be registered. Indiana requires medical spas to be registered starting January 1, 2027. Rhode Island may require a facility license, depending on ownership, services, and the owners’ licenses. Florida requires a clinic license for businesses covered by its Health Care Clinic Act. Ask a qualified attorney which licenses apply to your business.

Some do. Tennessee says med spa services must take place at the registered site, so pop-ups and door-to-door visits aren’t allowed. Florida requires each mobile clinic covered by its clinic law to have its own license. Georgia’s Medical Board says walk-in, mobile, or drip-bar IV services can’t rely on an RN as the only licensed professional. Plan orders, drug transport, records, and emergency care for each setting.

Often. In 2026, Georgia’s Medical Board issued an IV hydration position statement, Indiana passed a medical spa law, Virginia issued guidance on IV clinics and med spas, and Montana updated its IV therapy rule. A Colorado bill on med spa ownership did not pass. Alaska and Washington have work groups studying med spa services. Check the official sources for your state before you launch a new service or location.

Plan medical direction for every state you serve

Whether you run an IV clinic, med spa, medical weight loss program, functional or longevity clinic, primary or urgent care clinic, or mobile healthcare business, GuardianMD provides a state-licensed physician to serve as medical director for your clinic. We build oversight around your services, team, and locations. That includes protocols, chart reviews, and DocTalk, our communication hub monitored 7 days a week. Physician fees and the physician's malpractice coverage are included in your monthly plan.

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