Physician Collaboration Requirements by State
A 50-State Guide
Understanding Physician Collaboration Requirements
Physician collaboration refers to a formal professional relationship required for some nurse practitioners (NPs/APRNs) to practice or prescribe. Depending on the state, it may involve a written agreement, consultation, chart review, or prescribing conditions. Physician assistant (PA) supervision requirements are distinct and should be checked separately.
Requirements vary by state. Some NPs need an ongoing collaboration relationship, some have a transition period, and others can practice independently. Use the state summaries below as a starting point, then confirm the current requirements with the relevant state board.
Key Takeaways
- Requirements differ by state and experience. Collaboration may be ongoing, transitional, or unnecessary for an NP who meets the state’s practice requirements.
- Check the agreement and prescribing rules. Where collaboration is required, the state may specify documentation, review, ratio, and prescribing conditions.
- Check every state where care is delivered. Telehealth and multi-state operations require attention to the applicable state rules and current licenses.
Physician Collaboration Requirements by State
How to read this guide
Physician collaboration includes required collaboration, supervision or delegation. Independent practice means practicing within the NP’s authorized scope without that required relationship. It does not remove consultation, referral or other professional duties.
All entries assume appropriate NP licensure, certification and scope. Prescribing requires applicable state authority and compliance with drug laws, including controlled substance registrations and limits. Facility, employer, procedure and business ownership requirements may also apply.
AANP categories describe the statewide practice environment and may differ from an individual NP’s eligibility for independence. Categories below reflect AANP’s May 2026 map; state summaries also address subsequent changes, including Wisconsin’s September 2026 implementation. View the AANP State Practice Environment map
This guide provides general information, not legal advice or a complete statement of state law. Consult the linked official sources for eligibility, exceptions and current requirements.
Alabama Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Yes.
- Path to independent practice: No general pathway.
- Prescribing: Protocol-based; controlled substances require additional authorization.
- Agreement and filing: Written protocol and Board approval required.
Alaska Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Separate Board prescribing authorization required.
- Agreement and filing: No physician agreement required.
Arizona Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Board prescribing authority required.
- Agreement and filing: No physician agreement required.
Arizona advanced practice and prescribing requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Arizona and structures the agreement and oversight their state requires.
Arkansas Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Required for prescribing unless full independent practice authority is approved.
- Path to independent practice: Available after qualifying experience and state approval.
- Prescribing: Collaborative or independent, depending on authorization.
- Agreement and filing: Collaborative agreement until independent authority is approved.
Arkansas full independent practice rules | Arkansas advanced practice requirements
California Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Generally required unless authorized to practice without standardized procedures.
- Path to independent practice: Available through Board certification; eligibility and setting restrictions apply.
- Prescribing: Furnishing authority and controlled substance rules apply.
- Agreement and filing: Standardized procedures unless exempt under Board certification.
Colorado Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No physician specifically required; prescribing mentorship generally applies.
- Path to independent practice: Independent practice permitted; prescribing has separate transition requirements.
- Prescribing: Full prescribing authority generally follows a required mentorship.
- Agreement and filing: Written prescribing mentorship with a qualified physician or APRN.
Colorado nursing rules including prescriptive authority
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Colorado and structures the agreement and oversight their state requires.
Connecticut Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Yes, during the initial transition.
- Path to independent practice: Available after required experience and notice to the state.
- Prescribing: Written prescribing collaboration during the transition.
- Agreement and filing: Maintain the agreement; notify the state before independent practice.
Delaware Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Prescriptive authority accompanies the APRN license.
- Agreement and filing: No physician agreement required.
Florida Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes, unless registered for autonomous practice within its authorized scope.
- Path to independent practice: Available to eligible NPs for primary care.
- Prescribing: Protocol-based unless autonomous; controlled substance limits apply.
- Agreement and filing: Physician protocol or autonomous practice registration required.
Florida autonomous practice requirements | Florida APRN practice and prescribing
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Florida and structures the agreement and oversight their state requires.
Georgia Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes, for delegated medical acts and prescribing.
- Path to independent practice: No general pathway.
- Prescribing: Protocol-based; controlled substance limits apply.
- Agreement and filing: Nurse protocol agreement registered with the Medical Board.
Hawaii Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Board prescriptive authority required.
- Agreement and filing: No physician agreement required.
Idaho Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Illinois Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Generally required until full practice authority is granted.
- Path to independent practice: Available after required experience, education and state authorization.
- Prescribing: Some controlled substances still require physician consultation.
- Agreement and filing: Written agreement unless full practice authority or a setting exemption applies.
Illinois full practice authority and prescribing
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Illinois and structures the agreement and oversight their state requires.
Indiana Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Yes, for prescribing.
- Path to independent practice: No general pathway to independent prescribing.
- Prescribing: Requires Board prescriptive authority and physician collaboration.
- Agreement and filing: File a written agreement for prescriptive authority.
Iowa Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Kansas Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Kentucky Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Required for prescribing unless the applicable exemption is met.
- Path to independent practice: Prescribing agreement exemptions are available after qualifying experience.
- Prescribing: Separate agreement rules for noncontrolled and controlled drugs.
- Agreement and filing: Maintain prescribing agreements until properly discontinued or exempted.
Louisiana Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Required for medical diagnosis and prescribing; a dentist may qualify.
- Path to independent practice: No general pathway.
- Prescribing: Within the approved collaborative practice.
- Agreement and filing: Written collaborative agreement and Nursing Board approval required.
Maine Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial supervision required; a qualified NP may serve instead.
- Path to independent practice: Available after the required supervised practice period.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: Register supervision and document its completion with the Board.
Maryland Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No physician specifically required; an initial physician or NP mentor applies.
- Path to independent practice: Independent practice permitted with initial mentorship requirements.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: New NPs identify a mentor when applying for certification.
Massachusetts Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial prescribing supervision required; a qualified NP may serve instead.
- Path to independent practice: Independent prescribing available after qualifying experience.
- Prescribing: Supervised until independent prescriptive practice requirements are met.
- Agreement and filing: Prescribing guidelines during transition; attest and update registration for independence.
Michigan Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Physician delegation required for controlled substance prescribing.
- Path to independent practice: No general pathway to independent controlled substance prescribing.
- Prescribing: Noncontrolled drugs without delegation; controlled drugs require delegation.
- Agreement and filing: Written physician authorization for controlled substance prescribing.
Michigan APRN prescribing statute | Michigan physician delegation rules
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Michigan and structures the agreement and oversight their state requires.
Minnesota Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial collaboration required; a qualified APRN may serve instead.
- Path to independent practice: Available after required collaborative practice experience.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: Transition agreement and completion evidence; setting rules vary by specialty.
Mississippi Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Yes.
- Path to independent practice: No general pathway.
- Prescribing: Within collaborative protocols and prescribing requirements.
- Agreement and filing: Maintain protocols and register the collaboration with the Medical Board.
Missouri Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes, for delegated medical acts and prescribing.
- Path to independent practice: No general pathway.
- Prescribing: Physician-delegated; controlled substance limits apply.
- Agreement and filing: Written collaborative arrangement and required Board reporting.
Montana Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Board prescriptive authority endorsement required.
- Agreement and filing: No physician agreement required.
Nebraska Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial collaboration required; a qualified NP may serve instead.
- Path to independent practice: Available after required transition experience.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: Written transition agreement or evidence of qualifying experience submitted to DHHS.
Nevada Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Required for Schedule II prescribing before the experience threshold is met.
- Path to independent practice: Independent practice permitted; Schedule II prescribing has an experience threshold.
- Prescribing: Schedule II requires qualifying experience or a physician protocol.
- Agreement and filing: Physician protocol for Schedule II prescribing when required.
Nevada Schedule II prescribing protocol and experience threshold
New Hampshire Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
New Jersey Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Required for prescribing unless an exemption applies.
- Path to independent practice: Available to eligible primary or behavioral health APNs; excludes general obstetrics and elective aesthetics.
- Prescribing: Independent when exemption requirements are met; otherwise joint protocol.
- Agreement and filing: Joint protocol unless exempt; independent practice reporting requirements apply.
New Mexico Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Prescribing authorization required; training or preceptorship requirements apply.
- Agreement and filing: No physician agreement required.
New Mexico CNP licensing | New Mexico APRN prescribing requirements
New York Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Yes, during the initial practice period.
- Path to independent practice: Available after required NP practice experience.
- Prescribing: Within NP specialty and prescribing requirements.
- Agreement and filing: Written agreement and protocols during the initial practice period.
New York NP practice requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in New York and structures the agreement and oversight their state requires.
North Carolina Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes.
- Path to independent practice: No general pathway.
- Prescribing: Under the collaborative agreement and prescribing requirements.
- Agreement and filing: Signed agreement and approval to practice required.
North Carolina NP collaborative practice requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in North Carolina and structures the agreement and oversight their state requires.
North Dakota Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Board prescriptive authority required.
- Agreement and filing: No physician agreement required.
Ohio Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Physician or podiatrist collaboration required.
- Path to independent practice: No general pathway.
- Prescribing: Under a Standard Care Arrangement and prescribing requirements.
- Agreement and filing: Maintain the arrangement and report the collaborating provider.
Ohio Standard Care Arrangement requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Ohio and structures the agreement and oversight their state requires.
Oklahoma Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Required for prescribing unless independent authority is approved.
- Path to independent practice: Independent prescribing available after qualifying experience and Board approval.
- Prescribing: Supervised or approved independent prescribing; drug limits remain.
- Agreement and filing: Supervision agreement until independent prescriptive authority is approved.
Oregon Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Pennsylvania Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Yes, for medical diagnosis, treatment and prescribing.
- Path to independent practice: No general pathway.
- Prescribing: Board prescriptive approval and physician collaboration required.
- Agreement and filing: Maintain practice agreement; file the prescribing agreement.
Pennsylvania CRNP practice requirements | Pennsylvania prescribing agreement requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Pennsylvania and structures the agreement and oversight their state requires.
Rhode Island Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
South Carolina Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes.
- Path to independent practice: No general pathway.
- Prescribing: Agreement-based; controlled substance limits apply.
- Agreement and filing: Written practice agreement required.
South Carolina practice agreement guidance | South Carolina prescribing requirements
South Dakota Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial collaboration required; a qualified NP or nurse midwife may serve instead.
- Path to independent practice: Available after required collaborative practice experience.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: Board-approved transition agreement until qualifying hours are verified.
Tennessee Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Physician or qualified podiatrist supervision required.
- Path to independent practice: No general pathway.
- Prescribing: Protocol-based with required prescribing authorization.
- Agreement and filing: Maintain written protocols and required supervision documentation.
Texas Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes, for medical aspects of care and prescribing.
- Path to independent practice: No general pathway.
- Prescribing: Physician-delegated; Schedule II authority is limited.
- Agreement and filing: Prescribing agreement or qualifying facility protocol; register delegation.
Texas APRN practice and delegation requirements
Need a collaborating physician? GuardianMD matches nurse practitioners with a collaborating physician in Texas and structures the agreement and oversight their state requires.
Utah Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Vermont Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: Initial collaboration required; a qualified APRN may serve instead.
- Path to independent practice: Available after transition requirements for the role and population focus.
- Prescribing: Within NP scope and prescribing requirements.
- Agreement and filing: Signed transition agreement; notify the Board when requirements are met.
Virginia Physician Collaboration Requirements
- AANP practice category: Restricted practice
- Physician collaboration required: Yes, unless authorized for autonomous practice.
- Path to independent practice: Available after qualifying experience and Board authorization.
- Prescribing: Under practice agreement or autonomous practice rules.
- Agreement and filing: Written practice agreement until autonomous authorization.
Washington Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Board prescriptive authority required.
- Agreement and filing: No physician agreement required.
West Virginia Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Required for prescribing until independent authority is granted.
- Path to independent practice: Independent prescribing available after qualifying experience and Board approval.
- Prescribing: Collaborative or approved independent prescribing; drug limits remain.
- Agreement and filing: File collaboration verification until independent prescribing is approved.
West Virginia prescribing collaboration and exemptions | West Virginia prescribing limits
Wisconsin Physician Collaboration Requirements
- AANP practice category: Reduced practice
- Physician collaboration required: Physician or dentist collaboration required unless independent practice is approved.
- Path to independent practice: Available after qualifying experience and Board verification.
- Prescribing: Requires prescriptive eligibility; controlled substance rules apply.
- Agreement and filing: Document collaboration or obtain Board approval for independent practice.
Wyoming Physician Collaboration Requirements
- AANP practice category: Full practice
- Physician collaboration required: No.
- Path to independent practice: Independent at licensure.
- Prescribing: Within NP scope and required prescribing authority.
- Agreement and filing: No physician agreement required.
Physician Collaboration and Supervision vs Medical Direction
These terms are often used interchangeably—but they are not the same from a compliance perspective.
Physician Collaboration and Supervision
- Models of physician oversight range from collaborative (shared responsibility) to supervisory (higher level of control)
- Often requires a formal written agreement outlining roles and responsibilities
- May include chart review, on-site visits, or physician-to-provider ratio requirements depending on state law
- In collaborative models, the physician is typically available for consultation rather than daily oversight (common for NPs/APRNs)
- In supervisory models, the physician maintains greater oversight and accountability, often with increased liability exposure (more common for PAs)
Medical Direction
- Broader clinical oversight role
- Common in medspas, IV therapy, and specialty clinics
- May include protocol approval, staff training, and quality assurance
- Often layered on top of collaboration or delegation requirements
Common Compliance Mistakes Across States
- Using outdated or expired agreements
- Exceeding a state’s physician-to-provider ratio where one applies
- Assuming telehealth removes the need to check state requirements
- Missing required documentation or renewals
Frequently Asked Questions
Manage Physician Collaboration Across States
GuardianMD helps clinics and multi-location organizations coordinate collaborating physicians, state-specific agreements, license and ratio tracking, and audit-ready documentation.