The Final Step Most Miss: Mandatory Board Submissions for NP and PA Collaborative Agreements
The landscape of healthcare delivery has fundamentally shifted. Digital health companies are expanding rapidly across state lines, independent practices are scaling operations, and nurse practitioners (NPs) and physician assistants (PAs) represent the fastest-growing segment of healthcare providers. These advanced practice providers now deliver approximately 30% of primary care services nationwide, with their scope of practice varying significantly by state.
Central to this expansion is the collaborative practice agreement—the legal document that defines the working relationship between advanced practice providers and supervising or collaborating physicians. These agreements outline scope of practice, supervision requirements, prescriptive authority, and quality assurance protocols. While the specifics vary by state, collaborative agreements serve as the foundation that allows NPs and PAs to diagnose patients, order tests, and prescribe medications within their authorized scope.
For most healthcare organizations, the collaborative agreement process appears straightforward: recruit qualified providers, negotiate terms with collaborating physicians, execute signed agreements, and begin operations. The signed document seemingly represents the final step in provider onboarding.
However, one of the last steps digital health companies and independent providers consistently miss is the requirement to actually submit these collaborative practice agreements and necessary forms to respective state boards. This isn't optional paperwork—it's a mandatory compliance step that determines whether your nurse practitioners and physician assistants can legally practice.
Failing to submit and obtain required board approval doesn't just delay your launch—it means your providers are practicing non-compliantly with an invalid agreement. The consequences extend far beyond regulatory risk: malpractice insurance may not cover services provided under non-compliant arrangements, leaving both the provider and organization exposed to significant financial liability. Professional licenses could face disciplinary action, and any prescriptions written without proper board authorization may be considered invalid.
Currently, 23 states require board submission, notification, or approval before advanced practice providers can see patients. In states like Alabama, Indiana, and Nevada, this approval is explicitly required before practice can begin. Other states, including Georgia, Florida, and North Carolina, mandate submission within 30 days but may invalidate services provided during non-compliant periods.
The financial exposure is substantial: a single malpractice claim involving services provided under an invalid collaborative agreement could result in denied insurance coverage, personal liability for damages, and potential regulatory sanctions. For digital health companies operating across multiple states, this compliance gap represents an enterprise-level risk that could jeopardize entire business models and result in immediate operational shutdowns.
State-by-State Collaborative Agreement Filing Requirements
Below is a detailed breakdown of current state-by-state requirements to help organizations understand their compliance obligations. As a reminder, these rules change frequently, this information is current as of August 2025 and should not be considered legal advice. Organizations should consult with healthcare attorneys and verify current requirements with respective state boards before implementing collaborative practice arrangements.
Board Submission + Approval Required
Alabama
Nurse Practitioner
The Board of Medical Examiners and the Board of Nursing jointly approve applications for approval of collaborative practices between qualified physicians and CRNPs and/or CNMs. This must include the Standard Protocol, the QA plan, and the commencement of collaborative practice form.
The COLLABORATING PHYSICIAN must initiate the process:
Apply for approval of an initial collaborative practice through your Licensee Portal:
Log in using your last name and last five digits of your SSN
Scroll down to "Apply for Collaborative Practice" and click the "Apply CP" button
Review instructions and rules regarding collaborative practices, click "Next" to review screen guide, and click "Next" to enter application information
Complete application and make payment
Upon successful completion, the CRNP or CNM's name will appear in the "License Information" section of your Licensee Portal
CRNP/CNM: Apply to Alabama Board of Nursing (ABN) for approval of an initial or modified collaborative agreement.
For controlled substance prescribing, NPs and PAs must obtain a QACSC.
Physician Assistant
All forms must be submitted to the Alabama Board of Medical Examiners.
The collaborating physician and physician assistant will fill out the Application for Registration of Physician Assistant (required).
The collaborating physician will fill out the Physician Assistant Core Duties and Scope of Practice (required).
The collaborative physician will complete the Disclosure of Existing Supervisory and Collaborative Agreement form (required).
The president, chairman, or CEO will complete the Supplemental Certificate of Hospital/Corporate Employer (if applicable).
If the physician assistant will be prescribing medications, the collaborating physician and physician assistant will complete the Formulary for Non-Controlled Prescribing (if applicable).
The covering physician will complete the Covering Physician Agreement (if applicable).
For physician assistants practicing in Adult Gerontology, Family Medicine, General Medicine, or Primary Care, the Limited Protocol for Comprehensive Physical Exam must be completed.
Board Submission + Approval Required
Alaska
Physician Assistants
Physician Assistants must submit the collaborative plan to the board. The collaborative plan is valid when it is approved by a representative of the board and it is noted on the PA's temporary permit or permanent license. State law requires that a copy of this approval plan be available for review by the public at the place of employment.
Board Submission + Approval Required
Arkansas
Nurse Practitioner
An Advanced Practice Registered Nurse (APRN) with Prescriptive Authority must have a current updated Collaborative Practice Agreement (CPA) on file with the Board of Nursing. APRNs should keep their original CPA and submit a copy (PDF) to the Arkansas State Board of Nursing (ASBN) through the Arkansas Nurse Portal message center. The APRN is responsible for ensuring this requirement is met. After review of any new CPA, the APRN will be contacted through the Nurse Portal that the CPA has been approved or it has been denied and the reason for the denial. You may NOT practice under a CPA until you receive an approval letter.
Physician Assistant
The delegation agreement must be submitted to the Board delineating the scope of practice that the physician assistant will engage in, the program of evaluation and supervision by the supervising physician.
Prescriptive Authority Requirements
Colorado
Additional forms are required to be submitted for prescriptive authority in Colorado:
Required forms: Prescriptive Authority - New Application (Apply Online)
Prescriptive Authority - Online Application Checklist
Proposed Mentorship Form
Provisional to Full RXN Application (post 750 hour Colorado Mentorship)
Prescriptive Authority - Reinstate Expired Authority (Apply Online)
Prescriptive Authority - Online Reinstatement Application Checklist
All forms can be found here: https://dpo.colorado.gov/Nursing/APNApplications
Board Submission Required
Florida
Nurse Practitioner
A physician must submit notice to the Board when he/she enters into a formal supervisory relationship or standing orders with an emergency medical technician or paramedic licensed pursuant to s. 401.27, which relationship or orders contemplate the performance of medical acts, or an established protocol with an advanced registered nurse practitioner, which protocol contemplates the performance of medical acts identified and approved by the joint committee pursuant to s. 464.003(2) or acts set forth in s. 464.012(3) and (4), the physician shall submit notice to the board.
The physician shall file notice within 30 days of entering into the relationship, orders or protocol. Notice shall also be filed within 30 days after terminating the relationship, orders, or protocol, which can be found here in this form: APRN/EMT/Paramedic Protocol
Mail the completed Protocol Form to:
Department of Health - Division of Medical Quality Assurance
Board of Medicine
4052 Bald Cypress Way, Bin C03
Tallahassee, FL 32399-3253
(850) 488-0596 FAX
Additional information regarding protocols can be found at s. 458.348, F.S.
Physician Assistant
Florida law requires Physician Assistants (PAs) to notify the Board in writing within 30 days after employment, or after any subsequent change in the supervising physician by submitting the Supervision Data Form.
Board Submission Required
Georgia
Nurse Practitioner
All Nurse Protocol Agreements between APRNs and collaborating physicians must be submitted to the Georgia Composite Medical Board (GCMB) before the APRN begins practicing. Submission must occur within 30 days of signing by both parties.
Georgia Composite Medical Board - APRN Protocol Registration
Fee & Payment:
$150 registration fee
Submission Method:
This website outlines the process on how to submit. Be sure to follow these steps as mailed-in submissions are no longer accepted: https://medicalboard.georgia.gov/how-do-i-submit-protocol-agreement-application
Required Documentation:
Completed Nurse Protocol Agreement, including:
Delegation of medical acts
Scope of practice for the APRN
Prescriptive authority details (if applicable)
Any additional documents required by the GCMB
Nurse Protocol Agreement Form
Prescriptive Authority Registration:
If prescriptive authority is included, the agreement must specify the medications the APRN is authorized to prescribe in compliance with Georgia law.
Physician Assistants
To add or change a primary supervising physician, the applicant must submit an Add/Change Supervising Physician Assistant Application and a Basic Job Description.
Depending on the circumstances of the PA, they may also need to submit Form B (Request for Additional Duties); Form H (Separation Notification Form), or Form J (Specific Power of Attorney). These forms can either be uploaded to egov or emailed to gcmb.paandaa@dch.ga.gov.
All forms can be found here.
Board Submission Required
Hawaii
A Verification - Supervising Physician form must be mailed to:
Physician Assistant DCCA PVL Licensing Branch
PO Box 3469
Honolulu, HI 96801
Board Submission Required
Illinois
Nurse Practitioner
Notice of Delegated Prescriptive Authority for Controlled Substances (APRN-CS) must be submitted by the COLLABORATING PHYSICIAN if the collaborating physician is delegated prescriptive authority of controlled substances to the APRN.
Physician Assistant
Notice of Delegated Prescriptive Authority (PHA-CS) must be submitted by the COLLABORATING PHYSICIAN if the collaborative physician is delegating prescriptive authority of controlled substances to the physician assistant. SCHEDULE AUTHORITY IS NOT EFFECTIVE UNTIL THE LICENSE IS ISSUED.
Board Submission + Approval Required
Indiana
Nurse Practitioner
Before Initiating Prescriptive Practice APRNs must submit the Collaborative Practice Agreement to the Indiana State Board of Nursing before they begin prescribing medications. The agreement should include original signatures from both the APRN and the collaborating physician. (in.gov)
If there are any changes to the Collaborative Practice Agreement or if it is terminated, the APRN is required to notify the Indiana State Board of Nursing immediately in writing.
The APRN instructions for submission can be found here.
Mail or email the form, with the cover sheet to:
Professional Licensing Agency 402 West Washington Street Room W072 Indianapolis, IN 46204
Email: pla2@pla.IN.gov
APRNs must also apply for prescriptive authority.
Physician Assistants
Physician Assistants must submit their collaborative agreement to the Board for approval. PAs can email the agreement to the board at pla5@pla.in.gov . If they are changing or adding a new collaborative physician other than the physician initially listed on their license, they must submit a Change and Addition of Collaborating Physician Application. They will also need to submit an application fee of $50 payable to the Professional Licensing Agency and the collaborative agreement.
Board Submission Required
Kansas
Physician Assistants
Physician assistants must submit a Physician Assistant Active Practice Request Form and Written Agreement to the board.
Kentucky
Board Submission Required
Nurse Practitioner
The CAPA-NS form must be completed by the collaborating physician and the nurse practitioner.
The CAPA-CS form must be completed by the collaborating physician and nurse practitioner and be approved by the Kentucky Board of Nursing.
Physician Assistant
The collaborating physician must submit an Application to Supervise a Physician Assistant to the Kentucky Board of Medical Licensure, which must be approved by the board before the physician assistant may practice under the supervising physician.
Board Submission + Approval Required
Louisiana
Nurse Practitioner
The APRN must notify the Louisiana State Board of Nursing (LSBN) in writing within 30 days of all changes regarding prescriptive authority including requesting the addition or deletion of collaborating physician(s) or dentist(s) and sites.
This form must be submitted, along with the collaboration agreement.
Physician Assistants
Physician assistants must submit a "PA Notice of Intent to Practice" to the board and obtain approval by the board to practice. Collaborating physicians must complete a "Registration as a Supervising Physician" on the Louisiana State Board of Medical Examiners website.
Board Submission Required
Maine
Nurse Practitioners
For Nurse Practitioners practicing for under the twenty-four month supervision requirement, the Board must receive the Application for Approval of a Supervising Relationship with a Licensed Physician or Nurse Practitioner, fee, and letter from the physician /nurse practitioner of his/her intent to supervise you within 15 days of beginning employment. The letter must be on letterhead, include information on what services you will be providing, patient population, hours per week and anticipated start date. If you are terminating a supervisory relationship, or modifying/changing a supervisory relationship an Application for Approval of a Supervising Relationship with a Licensed Physician or Nurse Practitioner must also be filed.
Physician Assistants
Physician assistants with more than 4,000 hours of documented clinical practice as determined by the Board and who are the principal clinical provider without a physician partner or who own and/or operate an independent practice must have the following in order to render medical services under their Maine license:
(1) A Board-approved practice agreement with a Maine physician holding an active, unrestricted physician license.
Physician Assistants must submit an Application for Approval of Collaboration or Practice Agreement.
Physician assistants with more than 4,000 hours of documented clinical practice as determined by the Board and are employed with a health care facility or with a practice that includes a physician partner - regardless of whether or not the facility or practice have a system of credentialing and granting of privileges - are not required to have either a collaborative agreement or practice agreement.
Submission Required (PAs)
Maryland
PAs are required to inform the Maryland Board of Physicians about the executed Collaboration Agreement before starting their practice. This notification is done via the Licensed Practitioner Portal: mbp.state.md.us
Instructions:
To access the portal, visit the Maryland Board of Physicians' website.
Log in using your full 8-character license number (e.g., D0012345) and password.
If you haven't registered yet, select "New Registration" to create an account.
View the instructions from the Board of Physicians in Maryland here.
Board Submission + Approval Required: Prescriptive Authority
Massachusetts
Nurse Practitioners
Nurse practitioners must apply for prescriptive authority in Massachusetts.
Board Submission Required
Mississippi
Nurse Practitioner
The collaborating physician is required to complete the "Collaboration Information Form" for each APRN they collaborate with. This form captures essential details about the physician, the APRN, and the practice setting. The form can be accessed here.
Completed forms should be submitted via the MSBML's online licensure gateway.
Physician Assistant
Before practicing in Mississippi, a Physician Assistant (PA) must submit their practice information to the Board through MELS website.
Here are directions on how to do so.
Submission Required
Missouri
Nurse Practitioner
For Nurse Practitioners who will be prescribing controlled substances in Missouri, the collaborative physician must submit a Notice of Delegated Prescriptive Authority for Controlled Substances.
The Nurse Practitioner must submit a Controlled Substance Prescriptive Authority Application to the Missouri Board of Nursing. The nurse practitioner must also submit a Statement of Preceptorial Experience and Statement of Practice in APRN Category to the Board of Nursing.
Collaborative Physicians must submit Collaborative Practice Agreement/Arrangement Change Form for new NP collaborations. Please email kristy@singleaimhealth.com for a copy of the form.
Physician Assistant
For physician assistants who will be prescribing controlled substances in Missouri, the collaborative physician and physician assistant must submit an Application for Certificate of Controlled Substances for Prescriptive Authority for approval by the board.
Within thirty days of any change and on each renewal, the state board of registration for the healing arts shall require every physician to identify whether the physician is engaged in any collaborative practice arrangement, including collaborative practice arrangements delegating the authority to prescribe controlled substances, and also report to the board the name of each physician assistant with whom the physician has entered into such arrangement through the Physician Assistant Collaborative Practice Arrangement Form .
Board Submission + Approval Required
Nevada
Nurse Practitioner
A physician intending to collaborate with an APRN must notify the Nevada State Board of Medical Examiners before the collaboration begins. This notification should include the names and practice locations of both the physician and the APRN, as well as details about the collaborative practice. The notification form requires signatures from both parties.
This form, along with the collaboration agreement must be notarized and submitted.
Physician Assistant
A physician intending to collaborate with a physician assistant in Nevada must submit a Notification to Nevada State Board of Medical Examiners of Supervision of Physician Assistant and must be notarized.
Board Submission Required
New York
Newly certified nurse practitioners (NPs) are required to file with the New York State Education Department (SED) FROM 4NP ; "Verification of Collaborative Agreement and Practice Protocol" within 90 days after starting professional practice.
Board Submission + Approval Required
North Carolina
Nurse Practitioner
Nurse practitioners who have not practice in North Carolina in the past must submit an "Initial Approval to Practice". This is an online application that must be completed and approved by the North Carolina Medical Board and Board of Nursing prior to beginning employment as a NP. An approval number will be given to the NP, and must be included on all prescriptions written by the NP. If the NP is working with a new collaborative physician they must submit a "Renewal Approval to Practice" for approval.
Every NP who prescribes controlled substances must enroll and utilize the Controlled Substances Reporting System (CSRS) within 30 days after obtaining an initial or renewal approval to practice that confers the authority to prescribe a controlled substance for providing medical care for a client.
Physician Assistant
Physician assistants must submit an online Intent to Practice form via NCMB's online Licensure Gateway portal to designate the primary supervising physician.
Board Submission Required
Ohio
Nurse Practitioner
Nurse Practitioners must update the board with the name and business address of each collaborative physician within 30 days.
Board Submission Required
Oklahoma
Advanced Practice Registered Nurses (APRNs) seeking prescriptive authority must submit their collaborative agreement to the board.
Instructions:
Complete the "Agreement for Physician Supervision Advanced Practice Prescriptive Authority" form.
The completed agreement must be notarized.
Upload the completed form to your Nurse Portal account for each current Supervising Physician when:
Renewing prescriptive authority every two years
Adding supervising physician(s) for previously granted prescriptive authority
Applying for new prescriptive authority
Reinstating prescriptive authority
File any changes to the written statement with the Board within thirty (30) days of the change
Submission + Approval Required
Pennsylvania
Nurse Practitioner
In Pennsylvania, Certified Registered Nurse Practitioners (CRNPs) must file their prescriptive authority collaborative agreement with the Bureau of Professional and Occupational Affairs.
Instructions:
Keep the original agreement at the CRNP's primary practice location.
File a copy with the Bureau of Professional and Occupational Affairs.
Notify the Board in writing whenever the agreement is updated or terminated.
When appropriate, file the "Change Of Prescriptive Authority Collaborative Agreement" form and the amended agreement with the Board.
All forms can be found here: Certified Registered Nurse Practitioner and Prescriptive Authority
Physician Assistant
The physician assistant or collaborative physician can initiate the Written Agreement. If the physician assistant is initiating the agreement, they will go into the PALS website using their User ID and Password.
Under Professional License Details, click on the green pencil icon next to your license number.
On the Change Options (License) pop-up, select Written Agreement.
Complete the application and enter the Primary Supervisor License Number.
Once the PA confirms the agreement, it will be sent to the supervising physician.
The supervising physician must approve the application, and then the application must be submitted to the board.
Applications will remain in "Submitted" status until they are evaluated and approved by the board.
Board Submission + Approval Required
South Carolina
Nurse Practitioner
APRNs in South Carolina must submit an APRN Change of Practice Form for any new employment, change of practice, or new collaborating physician.
To obtain prescriptive authority, the APRN must submit an APRN Prescription Authority Application by mail to the South Carolina Board of Nursing.
110 Centerview Drive, Columbia, SC, 29210
Physician Assistant
Physician Assistants must submit a Supervisory Agreement Form and Scope of Practice Guidelines Addendum Form through the portal for approval by the Board.
Board Submission Required - Prescriptive Authority
Tennessee
Nurse Practitioner
Prior to prescribing medications, APRNs are required to submit the "Notice and Formulary" form to the Tennessee Board of Nursing. This form provides details about the APRN, the collaborating physician, and the agreed-upon prescriptive authority. The form must be signed by both the APRN and the supervising physician.
You can find a copy of the required form here: ADVANCED PRACTICE NURSE NOTICE AND FORMULARY
It can be mailed here:
Tennessee Board of Nursing 665 Mainstream Drive Nashville, TN 37243.
If you are prescribing controlled substances, you must also register for the Controlled Substance Monitoring Database, and the supervisory relationship must be confirmed in the CSMD. The supervisee must enter the supervisor's driver's license number. The physician to whom the driver's license belongs will be notified at the time of their next log0in to the CSMD that there are supervisees awaiting approval.
Physician Assistant
The supervising physician must complete Attachment 4 and 5 and submit to the State of Tennessee Department of Health. You may mail it to:
665 Mainstream Drive, Nashville TN, 37243.
If you are prescribing controlled substances, you must also register for the Controlled Substance Monitoring Database, and the supervisory relationship must be confirmed in the CSMD. The supervisee must enter the supervisor's driver's license number. The physician to whom the driver's license belongs will be notified at the time of their next log0in to the CSMD that there are supervisees awaiting approval.
Portal Submission Required
Texas
Nurse Practitioner
The supervising physician is responsible for registering the APRN in the TMB’s Online Supervision and Prescriptive Delegation Registration System.
No paper forms are accepted—all registrations must be completed online.
Confirm APRN Delegation
The physician enters details about:
The APRN’s name, license number, and specialty
The practice location(s)
The scope of delegated prescriptive authority
Required supervision and oversight
Complete and Submit the Registration
Once the supervising physician submits the delegation, it becomes official, and the APRN can begin practicing with prescriptive authority under the agreement.
Physician Assistant
Physician assistants can register a new supervising physician through the Online Supervisions and Prescriptive Delegation Registration System. This is a two step process and requires that the supervising physician must complete the registration.
Board Submission + Approval Required
Wyoming
Physician Assistant
The Supervising Physician must complete the Supervising Physician Application and submit the form along with "Application Form for Change in Supervision for Physician Assistant." Once the form has been submitted, allow 10 business days for the supervising agreement to be approved by the Physician Assistant Advisory Council and Board officers.
The physician assistant must submit a "Changes or Additions in Supervision" form along with their NCCPA certificate, the Supervising Application Form, and a $100 fee, if applicable. This form must be notarized. This application must be approved by the board before the physician assistant can practice.
Board Submission + Approval Required
West Virginia
Nurse Practitioner
Nurse Practitioners must submit the Collaborative Agreement Form Provided by the WV Nursing Board to the Board. The agreement must be notarized by the APRN and the Collaborative Physician. The original agreement must be mailed to the board office.
WV Board of Examiners for Registered Professional Nurses, 5001 MacCorkle Avenue SW, South Charleston, WV 25309.
Prescriptive Authority:
Eligibility requirements are:
A.) the successful completion of an advanced pharmacology graduate level course approved by the Board of not less than 45 pharmacology contact hours
B.) documentation of the use of pharmacology in clinical practice in the education program
C.) evidence of 15 graduate level pharmacology contact hours in advanced pharmacology completed within 2 years prior to application for prescriptive authority
D.) a collaborative agreement on forms provided by the Board with a licensed physician holding an unencumbered West Virginia license or an unencumbered license from a contiguous state or the Veterans Administration for the first 3 years (36 months) of active prescriptive authority OR documentation evidencing at least 3 years (36 months) of active prescriptive authority in WV or another state.
Physician Assistant
Physician Assistants must notify the board within writing within 10 days through a Practice Notification of the collaborative relationship. A Practice Notification shall be completed on a form provided by the Board and shall be accompanied by an appropriate. The fee for practice notification is $100. The physician assistant may not commence practice until the board provides written notification to the physician assistant that a complete practice notification has been filed with the Board.
