Summary of State Laws and Regulations Requiring Physicians to Review Or Co-Sign PA Medical Record Entries
Alabama
For hospitalized patients, physician assistants may enter verbal admission orders and verbal subsequent orders for medications from the physician. All such orders must be validated by the ordering physician within 24 hours or within the time period specified in the hospital bylaws or policies.Alabama Administrative Code §540-X-7.28 (8)
Countersignature by supervising physician must conform to established policy and/or applicable legal regulations and accreditation standards.
Alabama Administrative Code §540-X-7.23
Alaska
No co-signature requirement.Arizona
A supervising physician shall develop a system for recordation and review of all instances in which the physician assistant prescribes 14-day prescriptions of schedule II or schedule III controlled substances. The board shall approve this system.Arizona Revised Statutes §32-2533 D
Arkansas
No co-signature requirement.
California
The supervising physician and surgeon shall review, countersign, and date a sample consisting of, at a minimum, 5% of the medical records of patients treated by the physician assistant functioning under the protocols within 30 days of the date of treatment by the physician assistant. The physician and surgeon shall select for review those cases that by diagnosis, problem, treatment, or procedure represent, in his or her judgment, the most significant risk to the patient.
Annotated Code of California, Business and Professions Chapter 7.7, §3502(c)(2)
Any schedule II drug order that has been issued or carried out shall be reviewed, countersigned and dated by a supervising physician and surgeon within 7 days.
Annotated Code of California, Business and Professions Chapter 7.7, §3502.1(e)
A physician assistant and the supervising physician must establish written guidelines for adequate supervision, which include one or more of the following:
(1) same day examination of patient by physician
(2) countersignature and dating of all medical records within 30 days
(3) adoption of protocols to govern a physician assistant's performance
(4) other mechanisms approved by PAC
(1) same day examination of patient by physician
(2) countersignature and dating of all medical records within 30 days
(3) adoption of protocols to govern a physician assistant's performance
(4) other mechanisms approved by PAC
The supervising physician must review, countersign and date at least 10% of medical records within 30 days for patients treated by physician assistants working under protocols.
If the physician assistant is operating under interim approval, the supervising physician must review, sign and date medical records of all patients within 7 days if the physician was on the premises when the physician assistant diagnosed or treated the patient. If the physician was not on the premises, this shall be done within 48 hours.
California Administrative Code, Title 16, §1399.545**Regulatory change to implement 2007 statute change has not yet been adopted.
Colorado
When a physician assistant performs a medical function in an acute care hospital where the supervising physician regularly practices or in a designated health manpower shortage area, the supervising physician does not have to be present, but will review the medical records of the physician assistant every 2 working days.
Colorado Revised Statutes, §12-36-106(5)(b)
"Reviewing the medical records" means review and signature by the primary physician supervisor or a secondary physician supervisor.
New physician assistant graduates:
For the first 6 months of employment and a minimum of 500 patient encounters, a physician supervisor shall review the chart for every patient seen by the physician assistant no later than 7 days after the physician assistant has performed an act defined as the practice of medicine. The physician supervisor shall document the performance of such review by signing the chart in a legible manner. In lieu of signing the chart, the physician supervisor may document the performance of such review by the use of an electronically generated signature provided that reasonable measures have been taken to prevent the unauthorized use of the electronically generated signature.
Experienced Physician Assistants New to a Practice Setting:
For the first 3 months of employment and a minimum of 500 patient encounters, a physician supervisor shall review the chart for every patient seen by an experienced physician assistant new to a practice setting no later than 14 days after the physician assistant has performed an act defined as the practice of medicine. The physician supervisor shall document the performance of such review by signing the chart in a legible manner. In lieu of signing the chart, the physician supervisor may document the performance of such review by the use of an electronically generated signature provided that reasonable measures have been taken to prevent the unauthorized use of the electronically generated signature.
All other PAs must meet with supervising physician twice yearly and physician must conduct performance assessment (to include review and initialing of selected charts).
Colorado State Board of Medical Examiners, Rule 400, §2
Connecticut
The supervising physician must co-sign a physician assistant's order for Schedule II or III drugs within 24 hours.
Supervision includes, but is not limited to:
(i) Continuous availability of direct communication either in person or by radio, telephone or telecommunications between the physician assistant and the supervising physician;
(ii) active and continuing overview of the physician assistant's activities to ensure that the supervising physician's directions are being implemented and to support the physician assistant in the performance of his or her services;
(iii) personal review by the supervising physician of the physician assistant's services through a face-to-face meeting with the physician assistant, at least weekly or more frequently as necessary to ensure quality patient care, at a facility or practice location where the physician assistant or supervising physician performs services;
(iv) review of the charts and records of the physician assistant on a regular basis as necessary to ensure quality patient care and written documentation by the supervising physician of such review at the facility or practice location where the physician assistant or supervising physician performs services
Connecticut General Statutes, Chapter 370 §20-12d
Supervision includes, but is not limited to:
(i) Continuous availability of direct communication either in person or by radio, telephone or telecommunications between the physician assistant and the supervising physician;
(ii) active and continuing overview of the physician assistant's activities to ensure that the supervising physician's directions are being implemented and to support the physician assistant in the performance of his or her services;
(iii) personal review by the supervising physician of the physician assistant's services through a face-to-face meeting with the physician assistant, at least weekly or more frequently as necessary to ensure quality patient care, at a facility or practice location where the physician assistant or supervising physician performs services;
(iv) review of the charts and records of the physician assistant on a regular basis as necessary to ensure quality patient care and written documentation by the supervising physician of such review at the facility or practice location where the physician assistant or supervising physician performs services
Connecticut General Statutes, Chapter 370 §20-12a(7)
Delaware
The relaying, transcribing, or executing specific diagnostic or therapeutic orders must be countersigned by the physician within 24 hours.
No co-signature requirement.Delaware Code Annotated, Title 24, Chapter 17, §1770A(a)(3)
District of Columbia
A licensed physician assistant employed or extended privileges by a hospital may, if permissible under the bylaws, rules and regulations of the hospital, write medical orders, including those for controlled substances, for patients under the care of the physician responsible for his/her supervision. Countersignature by the supervising physician shall not be required prior to the execution of any orders, but shall be accomplished within 30 days of the execution of the order.
Physician assistants may write orders and progress notes in outpatient settings. Countersignature by the supervising physician shall not be required prior to the execution, but shall be accomplished within 10 days of the execution of the order and within 10 days of any progress note.
District of Columbia Municipal Regulations, §4916.3
Physician assistants may write orders and progress notes in outpatient settings. Countersignature by the supervising physician shall not be required prior to the execution, but shall be accomplished within 10 days of the execution of the order and within 10 days of any progress note.
District of Columbia Municipal Regulations, §4916.4
Florida
Georgia
A supervising physician must countersign prescription or medical record entry for prescription within 7 working days.
Georgia Code Annotated, §43-34-103
A copy of the prescription is maintained in the patient's medical file and the supervising physician must countersign the prescription or medical record entry for prescription within 7 working days.
Rules and Regulations of the State of Georgia, §360-5.12
In a remote site (physician is present at least 25% of the time) in an area with a shortage and maldistribution of health care services a supervising physician must be physically present at least twice a week and review patient records daily and all entries made by a physician assistant in patient medical records must be co-signed by a supervising physician within 7 days.
Rules and Regulations of the State of Georgia, §360-5-.08
Hawaii
Medical record of controlled substance prescription must be reviewed and initialed by the supervising physician within 7 working days.
Hawaii Revised Statutes, §329-38
Idaho
Delegation agreement shall include:
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iii. Periodic review of a representative sample of records and a periodic review of the patient services being provided by the licensee. This review shall also include an evaluation of adherence to the delegation of services.
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iii. Periodic review of a representative sample of records and a periodic review of the patient services being provided by the licensee. This review shall also include an evaluation of adherence to the delegation of services.
Idaho Administrative Code, §22.01.03 - 030.03(c)
Illinois
The supervising physician shall periodically review medication orders issued by a physician assistant.
It is the responsibility of the supervising physician to direct and review the work, records and practice of the physician assistant on a timely basis.
Direction and supervision must be personally rendered by supervising physician, who must be physically present or immediately available at all times. Supervising physician shall review medical services provided by a physician assistant within a reasonable time, not to exceed 24 hours.
A physician assistant may provide medical services in a remote medical site if one of the following three conditions is met:
(a) The physician assistant has a permanent license and at least one year of practice as a physician assistant; or
(b) The physician assistant with less than one year of practice has a permanent license and meets the following criteria:
(1) The physician assistant has practiced as a physician assistant for at least six months; and
(2) The physician assistant and supervising physician have worked together at the same location for a period of at least three months; and
(3) The supervising physician reviews patient care provided by the physician assistant at least weekly; and
(4) The supervising physician signs all patient charts unless the medical record documents that direct consultation with the supervising physician occurred; or
(c) The physician assistant and supervising physician provide a written statement sent directly to the board that the physician assistant is qualified to provide the needed medical services and that the medical care will be unavailable at the remote site unless the physician assistant is allowed to practice there. In addition, for three months the supervising physician must review patient care provided by the
physician assistant at least weekly and must sign all patient charts unless the medical record documents that direct consultation with the supervising physician occurred.
Illinois Compiled Statutes, Chapter 225 ILCS 95, §7.5
It is the responsibility of the supervising physician to direct and review the work, records and practice of the physician assistant on a timely basis.
Illinois Administrative Code, Title 68, Chapter VII(b), §1350.80(f)
Indiana
The supervising physician shall review all patient encounters not later than 24 hours after the physician assistant has seen the patient.
Indiana Code, §25-27.5-6-1
Direction and supervision must be personally rendered by supervising physician, who must be physically present or immediately available at all times. Supervising physician shall review medical services provided by a physician assistant within a reasonable time, not to exceed 24 hours.
Indiana Administrative Code, Title 844, §2.2-2-2(6)
Iowa
Although every chart need not be signed nor every visit reviewed, nor does the supervising physician need to be physically present at each activity of the physician assistant, it is the responsibility of the supervising physician and physician assistant to ensure that each patient has received the appropriate medical care.
Patient care provided by the physician assistant may be reviewed with a supervising physician in person, by telephone or by other telecommunicative means.
When signatures are required, electronic signatures are allowed if: (1) The signature is transcribed by the signer into an electronic record and is not the result of electronic regeneration; and (2) A mechanism exists allowing confirmation of the signature and protection from unauthorized reproduction.
Patient care provided by the physician assistant may be reviewed with a supervising physician in person, by telephone or by other telecommunicative means.
When signatures are required, electronic signatures are allowed if: (1) The signature is transcribed by the signer into an electronic record and is not the result of electronic regeneration; and (2) A mechanism exists allowing confirmation of the signature and protection from unauthorized reproduction.
Iowa Administrative Code, §645-326.8(4)
A physician assistant may provide medical services in a remote medical site if one of the following three conditions is met:
(a) The physician assistant has a permanent license and at least one year of practice as a physician assistant; or
(b) The physician assistant with less than one year of practice has a permanent license and meets the following criteria:
(1) The physician assistant has practiced as a physician assistant for at least six months; and
(2) The physician assistant and supervising physician have worked together at the same location for a period of at least three months; and
(3) The supervising physician reviews patient care provided by the physician assistant at least weekly; and
(4) The supervising physician signs all patient charts unless the medical record documents that direct consultation with the supervising physician occurred; or
(c) The physician assistant and supervising physician provide a written statement sent directly to the board that the physician assistant is qualified to provide the needed medical services and that the medical care will be unavailable at the remote site unless the physician assistant is allowed to practice there. In addition, for three months the supervising physician must review patient care provided by the
physician assistant at least weekly and must sign all patient charts unless the medical record documents that direct consultation with the supervising physician occurred.
Iowa Administrative Code, §645-327.4(1)
Kansas
Direction and supervision of the physician assistant shall be considered to be adequate if the responsible physician meets all of the following requirements:
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(g) at least every 14 days, reviews all records of patients treated by the physician assistant and authenticates this review in the patient record;
(h) reviews patient records and authenticates the review in each patient record within 48 hours of treatment provided by the physician assistant if the treatment provided in an emergency exceeded the authority granted to the physician assistant by the responsible physician request form required
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(g) at least every 14 days, reviews all records of patients treated by the physician assistant and authenticates this review in the patient record;
(h) reviews patient records and authenticates the review in each patient record within 48 hours of treatment provided by the physician assistant if the treatment provided in an emergency exceeded the authority granted to the physician assistant by the responsible physician request form required
Kansas Administrative Regulations, §100-28a-10
Kentucky
A supervising physician shall:
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(10) Sign all records of service rendered by a physician assistant in a timely manner as certification that the physician assistant performed the services as delegated.
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(10) Sign all records of service rendered by a physician assistant in a timely manner as certification that the physician assistant performed the services as delegated.
Kentucky Revised Statutes, §311.856
Louisiana
A physician assistant may administer medication to a patient, or transmit orally, electronically, or in writing on a patient's record, a prescription from his or her supervising physician to a person who may lawfully furnish such medication or medical device. The supervising physician's prescription, transmitted by the physician assistant, for any patient cared for by the physician assistant, shall be based on a patient-specific order by the supervising physician. ... [T]he medical record of any patient cared for by the physician assistant for whom the physician's prescription has been transmitted or carried out shall be reviewed, countersigned and dated by a supervising physician within 72 hours, or as otherwise required by law.
The physician assistant and supervising physician shall:
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(4) insure that, with respect to each direct patient encounter, all activities, functions, services, treatment measures, medical devices or medication prescribed or delivered to the patient by the physician assistant are properly documented in written form in the patient's record by the physician assistant and that each such entry is countersigned by the supervising physician within 24 hours with respect to inpatients in an acute care setting and patients in a hospital emergency department; within 48 hours with respect to patients of nursing homes and other sub-acute settings and within 72 hours in an office, clinic and all other practice settings
Louisiana Administrative Code, Title 46, Part 45, §4505(D)
The physician assistant and supervising physician shall:
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(4) insure that, with respect to each direct patient encounter, all activities, functions, services, treatment measures, medical devices or medication prescribed or delivered to the patient by the physician assistant are properly documented in written form in the patient's record by the physician assistant and that each such entry is countersigned by the supervising physician within 24 hours with respect to inpatients in an acute care setting and patients in a hospital emergency department; within 48 hours with respect to patients of nursing homes and other sub-acute settings and within 72 hours in an office, clinic and all other practice settings
Louisiana Administrative Code, Title 46, Part 45, §4511(A)
Maine
No co-signature requirement.
Maryland
No co-signature requirement.
Massachusetts
Any prescription or medication order issued by a physician assistant for a Schedule II controlled substance, as defined in 105 CMR 700.002, shall be reviewed by his or her supervising physician, or by a temporary supervising physician designated pursuant to 263 CMR 5.05(4)(g), within 96 hours after its issuance.263 Code of Massachusetts Regulations, §5.07(3)
Michigan
A physician is not required to countersign orders written in a patient's clinical record by a physician assistant to whom the physician has delegated the performance of medical care services for a patient.
Michigan Compiled Laws, §333.17049(6) and §333.17549(6)*
*identical language appears in laws governing the practice of osteopathic medicine
*identical language appears in laws governing the practice of osteopathic medicine
Minnesota
No co-signature requirement.
Mississippi
The supervising physician shall, on at least a monthly basis, conduct a review of the records/charts of at least ten percent (10%) of the patients treated by the physician assistant, said records/charts selected on a random basis. During said review, the supervising physician shall note the medical and family histories taken, results of any and all examinations and tests, all diagnoses, orders given, medications prescribed, and treatments rendered. The review shall be evidenced by the supervising physician placing his or her signature or initials next to each of the above areas of review, and shall submit proof of said review to the Board upon request.
Mississippi State Board of Medical Licensure, Rules and Regulations, Chapter 11, §705
Missouri
Supervision is defined as control exercised over a physician assistant working within the same facility as the supervising physician sixty-six percent of the time a physician assistant provides patient care, except that a physician assistant may make follow-up patient examinations in hospitals, nursing homes and correctional facilities, each such exam being reviewed, approved and signed by the supervising physician.
It is the responsibility of the supervising physician and licensed physician assistant to jointly review and document the work, records, and practice activities of the licensed physician assistant at least once every two (2) weeks. The supervising physician must review a minimum of ten percent (10%) of the physician assistant’s patients’ records every two (2) weeks and have documentation supporting the review. For nursing home practice, such review shall occur at least once a month. The documentation of this review shall be available to the Board of Registration for the Healing Arts for review upon request.
Missouri Revised Statutes, §334.735(1)(8)
It is the responsibility of the supervising physician and licensed physician assistant to jointly review and document the work, records, and practice activities of the licensed physician assistant at least once every two (2) weeks. The supervising physician must review a minimum of ten percent (10%) of the physician assistant’s patients’ records every two (2) weeks and have documentation supporting the review. For nursing home practice, such review shall occur at least once a month. The documentation of this review shall be available to the Board of Registration for the Healing Arts for review upon request.
Missouri Code of State Regulations, Title 20, §2150-7.135(12)
Montana
(1) The supervising physician shall review a minimum of 10 percent of the physician assistant charts on at least a monthly basis.
(2) Chart review for a physician assistant having less than one year of full time practice experience from the date of initial licensure must be 100 percent for the first three months of practice, and then may be reduced to not less than 25 percent for the next three months, on a monthly basis, for each supervision agreement.
(3) The supervising physician shall countersign and date all written entries that have been chart reviewed and shall document any amendments, modifications, or guidance provided.
(4) Chart review for a physician assistant who has been issued a probationary license must be 100 percent on a monthly basis, unless the board terminates the probationary period.
(2) Chart review for a physician assistant having less than one year of full time practice experience from the date of initial licensure must be 100 percent for the first three months of practice, and then may be reduced to not less than 25 percent for the next three months, on a monthly basis, for each supervision agreement.
(3) The supervising physician shall countersign and date all written entries that have been chart reviewed and shall document any amendments, modifications, or guidance provided.
(4) Chart review for a physician assistant who has been issued a probationary license must be 100 percent on a monthly basis, unless the board terminates the probationary period.
Administrative Rules of the State of Montana, §24.156.1623
Nebraska
A physician assistant may not practice at a secondary site without the personal presence of the supervising physician unless approval has been granted on an individual basis by the Board. Such approval must be granted when the following conditions are met:
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(4) The supervising physician, as a method of regular reporting, must review 100% of the charts of the patients seen by the physician assistant. A systematic documentation of these reviews must be established and maintained by the supervising physician.
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(4) The supervising physician, as a method of regular reporting, must review 100% of the charts of the patients seen by the physician assistant. A systematic documentation of these reviews must be established and maintained by the supervising physician.
Nebraska Administrative Code, Title 172, §90-006.01H
Nevada
The supervising physician shall review and initial selected charts of the patients of the physician assistant.
Nevada Administrative Code, §630.370(2)
A physician who supervises a physician assistant shall develop and carry out a program to ensure the quality of care provided by a physician assistant. The program must include, without limitation:
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(b) A review and initialing of selected charts
(b) A review and initialing of selected charts
Nevada Administrative Code, §630.370(5)
New Hampshire
A physician assistant may write orders for patients as delegated by the supervising physician or alternate. Such orders shall be countersigned by the RSP or ARSP as required by institutional policy, however, such countersignature shall not be required prior to the order being executed.New Hampshire Code of Administrative Rules, Chapter MED §603.01(c)
New Jersey
In an inpatient setting, direct supervision of a physician assistant shall include, but not be limited to:
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(3) personal review by a physician of all charts and records of patients and countersignature by a physician of all medical orders, including prescribing and administering medication, within 24 hours of their entry by the physician assistant.
In an outpatient setting, direct supervision of a physician assistant shall include, but not be limited to:
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(3) personal review by a physician of the charts and records of patients and countersignature by a physician of all medical orders, within seven days of their entry by the physician assistant, except that in the case of any medical order prescribing or administering medication, a physician shall review and countersign the order within 48 hours of its entry by the physician assistant.
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(3) personal review by a physician of all charts and records of patients and countersignature by a physician of all medical orders, including prescribing and administering medication, within 24 hours of their entry by the physician assistant.
New Jersey Revised Statutes §45:9-27.18(b)
In an outpatient setting, direct supervision of a physician assistant shall include, but not be limited to:
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(3) personal review by a physician of the charts and records of patients and countersignature by a physician of all medical orders, within seven days of their entry by the physician assistant, except that in the case of any medical order prescribing or administering medication, a physician shall review and countersign the order within 48 hours of its entry by the physician assistant.
New Jersey Revised Statutes §45:9-27.18(c)
New Mexico*
The supervising physician must review the quality of medical services rendered by the physician assistant by reviewing at least 10% of each months medical records generated by the physician assistant.
The supervising physician will review and countersign each patient's chart in which the physician assistant has prescribed more than 72 hours of Schedule II drugs in a 30 day period for that patient.
New Mexico Adminstrative Code, §18.6.8(B)
The supervising physician will review and countersign each patient's chart in which the physician assistant has prescribed more than 72 hours of Schedule II drugs in a 30 day period for that patient.
New Mexico Administrative Code, §18.7.9(A)(2)
*These regulations apply only to PAs licensed by the NM Board of Osteopathic Medical Examiners
*These regulations apply only to PAs licensed by the NM Board of Osteopathic Medical Examiners
New York
A registered physician assistant employed or extended privileges by a hospital may, if permissible under the bylaws, rules and regulations of the hospital, write medical orders, including those for controlled substances, for inpatients under the care of the physician responsible for his supervision. Countersignature of such orders may be required if deemed necessary and appropriate by the supervising physician or the hospital, but in no event shall countersignature be required prior to execution.
New York Codes, Rules and Regulations, Title 10, §94.2(e)(6)
North Carolina
Entries by a physician assistant into patient charts of inpatients (hospital, long term care institutions) must comply with the rules and regulations of the institution.
North Carolina Administrative Code, Title 21, §32S.0110(c)
North Dakota
No co-signature requirement.
Ohio
During the course of the provisional period, each supervising physician who supervises the physician assistant in the exercise of physician-delegated prescriptive authority shall review and evaluate the physician assistant’s competence, knowledge, and skill in pharmacokinetic principles and the application of these principles to the physician assistant’s area of practice. The review and evaluation shall be documented by the supervising physician’s signing of patient charts in a legible manner. In lieu of signing the patient charts, the supervising physician may document the review and evaluation by the use of an electronically generated signature provided that reasonable measures have been taken to prevent the unauthorized use of the electronically generated signature.
(1) During the first five hundred hours of the provisional period, the review and evaluation shall be completed and documented on every chart by each supervising physician who provided supervision within a reasonable period of time after the physician assistant rendered service to a patient.
(2) During the remainder of the provisional period, the review and evaluation shall be completed and documented on at least fifty percent of the patient charts by each supervising physician who provided supervision within a reasonable period of time after the physician assistant rendered service to a patient.
(1) During the first five hundred hours of the provisional period, the review and evaluation shall be completed and documented on every chart by each supervising physician who provided supervision within a reasonable period of time after the physician assistant rendered service to a patient.
(2) During the remainder of the provisional period, the review and evaluation shall be completed and documented on at least fifty percent of the patient charts by each supervising physician who provided supervision within a reasonable period of time after the physician assistant rendered service to a patient.
Ohio Administrative Code, §4730-2-04(D)
Oklahoma
In all patient care settings, the supervising physician shall provide appropriate methods of supervising the health care services provided by the physician assistant including:
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(b) regularly reviewing the health care services provided by the physician assistant and any problems or complications encountered
Physician supervision shall be conducted in accordance with the following standards:
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(2) The supervising physician regularly reviews the health care services provided by the physician assistant and any problems or complications encountered.
(a) Office setting
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(2) It is assumed that the physician regularly and systematically checks the charts and notes of the patients seen by the physician assistant, checking for accuracy and completeness of such records, and in particular, the suitability of the plan of management. It is assumed that this type of review is conducted within 48 hours of the care being delivered.
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(b) Hospital setting
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(3) Initial workup of patients upon admission is often delegated to the physician assistant. This is an appropriate function if checked and countersigned by the supervising physician on his/her next visit to the hospital, which should usually occur within 24 hours.
(4) Initial orders may be delegated to a physician assistant. These activities are very important in that they involve the function of others, such as the R.N. and L.P.N. assigned to the ward. Copies of all standing orders that the physician has delegated to the physician assistant to order on his/her behalf should be on file in the hospital and available to the nurse accepting such orders as a means of assurance that these orders are emanating from the responsible physician and that they are within the authority which the physician has delegated to the physician assistant. All orders should be checked and countersigned by the responsible physician at his/ her next visit to the hospital, which should usually occur within 24 hours.
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(b) regularly reviewing the health care services provided by the physician assistant and any problems or complications encountered
Oklahoma Statutes Annotated, Title 59, §519.6(b)
Physician supervision shall be conducted in accordance with the following standards:
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(2) The supervising physician regularly reviews the health care services provided by the physician assistant and any problems or complications encountered.
Oklahoma Administrative Code, §435:15-9-2(b)
(a) Office setting
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(2) It is assumed that the physician regularly and systematically checks the charts and notes of the patients seen by the physician assistant, checking for accuracy and completeness of such records, and in particular, the suitability of the plan of management. It is assumed that this type of review is conducted within 48 hours of the care being delivered.
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(b) Hospital setting
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(3) Initial workup of patients upon admission is often delegated to the physician assistant. This is an appropriate function if checked and countersigned by the supervising physician on his/her next visit to the hospital, which should usually occur within 24 hours.
(4) Initial orders may be delegated to a physician assistant. These activities are very important in that they involve the function of others, such as the R.N. and L.P.N. assigned to the ward. Copies of all standing orders that the physician has delegated to the physician assistant to order on his/her behalf should be on file in the hospital and available to the nurse accepting such orders as a means of assurance that these orders are emanating from the responsible physician and that they are within the authority which the physician has delegated to the physician assistant. All orders should be checked and countersigned by the responsible physician at his/ her next visit to the hospital, which should usually occur within 24 hours.
Oklahoma Administrative Code, §435:15-9-4
Oregon
No co-signature requirement.
Pennsylvania
A separate statement shall be made for each satellite location. The statement must demonstrate that:
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(4) The supervising physician will visit the satellite location at least once every 10 days and devote enough time onsite to provide supervision and personally review the records of selected patients seen by the physician assistant in this setting. The supervising physician shall notate those patient records as reviewed.
Recordkeeping requirements are as follows:
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(3) The physician assistant shall report, orally or in writing, to the supervising physician within 36 hours, a drug prescribed or medication dispensed by the physician assistant while the supervising physician was not physically present, and the basis for each decision to prescribe or dispense in accordance with the written agreement.
(4) The supervising physician shall countersign the patient record within 10 days.
An appropriate degree of supervision includes:
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(C) Personal and regular review within 10 days by the supervising physician of the patient records upon which entries are made by the physician assistant.
(a) A physician assistant may execute a written or oral order for a medical regimen or may relay a written or oral order for a medical regimen to be executed by a health care practitioner subject to the requirements of this section.
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No physician assistant may be permitted to be utilized in an office or clinic separate and apart from the supervising physician's primary place for meeting patients unless the supervising physician has obtained specific approval from the Board. ... The criteria for granting approval is that the supervising physician demonstrate the following to the satisfaction of the Board:
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(4) That the supervising physician will visit the remote office at least weekly and spend enough time on-site to provide supervision and personally review the records of each patient seen by the physician assistant in this setting.
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(4) The supervising physician will visit the satellite location at least once every 10 days and devote enough time onsite to provide supervision and personally review the records of selected patients seen by the physician assistant in this setting. The supervising physician shall notate those patient records as reviewed.
Pennsylvania Code, Title 49, §18.155(b)
Recordkeeping requirements are as follows:
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(3) The physician assistant shall report, orally or in writing, to the supervising physician within 36 hours, a drug prescribed or medication dispensed by the physician assistant while the supervising physician was not physically present, and the basis for each decision to prescribe or dispense in accordance with the written agreement.
(4) The supervising physician shall countersign the patient record within 10 days.
Pennsylvania Code, Title 49, §18.158(d)
An appropriate degree of supervision includes:
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(C) Personal and regular review within 10 days by the supervising physician of the patient records upon which entries are made by the physician assistant.
Pennsylvania Code, Title 49, §18.122
(a) A physician assistant may execute a written or oral order for a medical regimen or may relay a written or oral order for a medical regimen to be executed by a health care practitioner subject to the requirements of this section.
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(c) The physician assistant shall record, date and authenticate the medical regimen on the patient's chart at the time it is executed or relayed. ... The supervising physician shall countersign the patient record within a reasonable amount of time not to exceed 10 days, unless countersignature is required sooner by regulation, policy within the medical care facility or the requirements of a third-party payor.
Pennsylvania Code, Title 49, §18.153
An appropriate degree of supervision includes:
...
(iii) Personal and regular - at least weekly - review by the supervising physician of the patient records upon which entries are made by the physician assistant.
...
(iii) Personal and regular - at least weekly - review by the supervising physician of the patient records upon which entries are made by the physician assistant.
Pennsylvania Code, Title 49, §25.141*
*This provision applies only to PAs licensed by the State Board of Osteopathic Medicine
*This provision applies only to PAs licensed by the State Board of Osteopathic Medicine
No physician assistant may be permitted to be utilized in an office or clinic separate and apart from the supervising physician's primary place for meeting patients unless the supervising physician has obtained specific approval from the Board. ... The criteria for granting approval is that the supervising physician demonstrate the following to the satisfaction of the Board:
...
(4) That the supervising physician will visit the remote office at least weekly and spend enough time on-site to provide supervision and personally review the records of each patient seen by the physician assistant in this setting.
Pennsylvania Code, Title 49, §25.175(a)*
*This provision applies only to PAs licensed by the State Board of Osteopathic Medicine
*This provision applies only to PAs licensed by the State Board of Osteopathic Medicine
Rhode Island
No co-signature requirement.
South Carolina
For off-site practice ... [t]he supervising physician or alternate must review, initial, and date the off-site physician assistant's charts not later than 5 working days from the date of service if not sooner as proportionate to the acuity of care and practice setting.
South Carolina Code of Laws, §40-47-955(C)
South Dakota
No co-signature requirement.
Tennessee
(1) Supervision requires active and continuous overview of the physician assistant's activities to ensure that the physician's directions and advice are in fact implemented, but does not require the continuous and constant physical presence of the supervising physician. The board and the committee shall adopt, by September 19, 1999, regulations governing the supervising physician's personal review of historical, physical and therapeutic data contained in the charts of patients examined by the physician assistant.
(7) Within ten (10) business days after the physician assistant has examined a patient who falls in one of the following categories, the supervising physician shall make a personal review of the historical, physical, and therapeutic data gathered by the physician assistant on that patient and shall so certify in the patient's chart within thirty (30) days:
(a) when medically indicated;
(b) when requested by the patient;
(c) when prescriptions written by the physician assistant fall outside the protocols;
(d) when prescriptions are written by a physician assistant who possesses a temporary license; and
(e) when a controlled drug has been prescribed.
(8) In any event, a supervising physician shall personally review at least twenty percent (20%) of charts monitored or written by the physician assistant every thirty (30) days.
Tennesse Code, §63-19-106
(7) Within ten (10) business days after the physician assistant has examined a patient who falls in one of the following categories, the supervising physician shall make a personal review of the historical, physical, and therapeutic data gathered by the physician assistant on that patient and shall so certify in the patient's chart within thirty (30) days:
(a) when medically indicated;
(b) when requested by the patient;
(c) when prescriptions written by the physician assistant fall outside the protocols;
(d) when prescriptions are written by a physician assistant who possesses a temporary license; and
(e) when a controlled drug has been prescribed.
(8) In any event, a supervising physician shall personally review at least twenty percent (20%) of charts monitored or written by the physician assistant every thirty (30) days.
Rules and Regulations of the State of Tennessee, §0880-2-.18
Texas
Physician supervision at site serving medically underserved populations. Physician supervision of a physician assistant or an advanced practice nurse at a site serving a medically underserved population will be adequate if a delegating physician:
...
(B) visits the clinic in person at least once every ten business days during regular business hours during which the advanced practice nurse or physician assistant is on site providing care, in order to observe and provide medical direction and consultation to include, but not be limited to:
...
(iii) verifying that patient care is provided by the clinic in accordance with a written quality assurance plan on file at the clinic, which includes a random review and countersignature of at least 10% of the patient charts by the physician
...
(B) visits the clinic in person at least once every ten business days during regular business hours during which the advanced practice nurse or physician assistant is on site providing care, in order to observe and provide medical direction and consultation to include, but not be limited to:
...
(iii) verifying that patient care is provided by the clinic in accordance with a written quality assurance plan on file at the clinic, which includes a random review and countersignature of at least 10% of the patient charts by the physician
Texas Administrative Code, Title 22, Part 9, §193.6(b)(2)
Utah
A physician assistant, in accordance with a delegation of services agreement, may prescribe or administer an appropriate controlled substance if:
...
(c) the supervising physician cosigns any medical chart record of a prescription of a Schedule 2 or Schedule 3 controlled substance made by the physician assistant.
The [delegation of services] agreement defines the working relationship and delegation of duties between the supervising physician and the physician assistant as specified by division rule and shall include:
...
(iii) the frequency and mechanism of chart review
The supervising physician shall review and co-sign sufficient numbers of patient charts and medical records to ensure that the patient's health, safety, and welfare will not be adversely compromised. The Delegation of Services Agreement, maintained at the site of practice, shall outline specific parameters for review that are appropriate for the working relationship.
...
(c) the supervising physician cosigns any medical chart record of a prescription of a Schedule 2 or Schedule 3 controlled substance made by the physician assistant.
Utah Code Annotated, §58-70a-501(2)
The [delegation of services] agreement defines the working relationship and delegation of duties between the supervising physician and the physician assistant as specified by division rule and shall include:
...
(iii) the frequency and mechanism of chart review
Utah Code Annotated, §58-70a-102(2)(b)
The supervising physician shall review and co-sign sufficient numbers of patient charts and medical records to ensure that the patient's health, safety, and welfare will not be adversely compromised. The Delegation of Services Agreement, maintained at the site of practice, shall outline specific parameters for review that are appropriate for the working relationship.
Utah Administrative Code, §R156-70a-501(3)
Vermont
The scope of practice document shall cover at least the following:
...
(b) Supervision:
...
(5) Provisions for retrospective review of PA charts:
(A) the frequency with which these reviews will be conducted
(B) the methods to be used to document this review
...
(b) Supervision:
...
(5) Provisions for retrospective review of PA charts:
(A) the frequency with which these reviews will be conducted
(B) the methods to be used to document this review
Vermont Rules of the Board of Medical Practice, Section II Rules for Physician Assistants, §7.3
Virginia
Prior to initiation of practice, a physician assistant and his supervising physician shall submit a written protocol which spells out the roles and functions of the assistant. Any such protocol shall take into account such factors as the physician assistant's level of competence, the number of patients, the types of illness treated by the physician, the nature of the treatment, special procedures, and the nature of the physician availability in ensuring direct physician involvement at an early stage and regularly thereafter. The protocol shall also provide an evaluation process for the physician assistant's performance, including a requirement specifying the time period, proportionate to the acuity of care and practice setting, within which the supervising physician shall review the record of services rendered by the physician assistant.
Virginia Administrative Code, Title 18, §85-50-101
Washington
A physician assistant and supervising physician shall ensure that, with respect to each patient, all activities, functions, services and treatment measures are immediately and properly documented in written form by the physician assistant. Every written entry shall be reviewed and countersigned by the supervising physician within two working days unless a different time period is authorized by the commission.
It shall be the responsibility of the certified physician assistant and the sponsoring physician to ensure that appropriate consultation and review of work are provided.
(5) The osteopathic physician assistant and supervising osteopathic physician shall ensure that:
...
(d) The supervising osteopathic physician provides adequate supervision and review of the osteopathic physician assistant's practice. The supervising osteopathic physician or designated alternate physician shall review and countersign:
(i) All charts of the licensed osteopathic physician assistant within seven working days for the first thirty days of practice and thereafter ten percent of their charts, including clinic, emergency room, and hospital patients within seven working days.
(ii) Every chart entry of an interim permit holder within two working days
Washington Administrative Code, §246-918-130(4)*
*This provision applies only to PAs who are not certified
*This provision applies only to PAs who are not certified
It shall be the responsibility of the certified physician assistant and the sponsoring physician to ensure that appropriate consultation and review of work are provided.
Washington Administrative Code, §246-918-140(3)*
*This provision applies only to PAs who are certified (PA-C)
*This provision applies only to PAs who are certified (PA-C)
(5) The osteopathic physician assistant and supervising osteopathic physician shall ensure that:
...
(d) The supervising osteopathic physician provides adequate supervision and review of the osteopathic physician assistant's practice. The supervising osteopathic physician or designated alternate physician shall review and countersign:
(i) All charts of the licensed osteopathic physician assistant within seven working days for the first thirty days of practice and thereafter ten percent of their charts, including clinic, emergency room, and hospital patients within seven working days.
(ii) Every chart entry of an interim permit holder within two working days
Washington Administrative Code, §246-854-015*
*This provision applies to PAs who are supervised by osteopathic physicians, whether the PA is certified or not.
No physician assistant may be utilized in an office or clinic separate and apart from the supervising physician's primary place for meeting patients unless the supervising physician has obtained specific approval from the Board. ... The criteria for granting the approval is that the supervising physician demonstrate the following to the satisfaction of the Board:
...
(d) That the supervising physician visits the remote office at least once every fourteen (14) days and demonstrate that he or she spends enough time on site to provide supervision and personal and regular review of the selected records upon which entries are made by the physician assistant. Patient records shall be selected on the basis of written criteria established by the supervising physician and the physician assistant and shall be of sufficient number to assure adequate review of the physician assistant's scope of practice.
An appropriate degree of supervision includes:
...
(3) Personal and regular (at least monthly) review by the supervising physician of selected patient records upon which entries are made by the physician assistant. The supervising physician shall select patient records for review on the basis of written criteria established by the supervising physician and the physician assistant and shall be of sufficient number to assure adequate review of the physician assistant's scope of practice
Supervision requires the availability of the supervising osteopathic physician. An appropriate degree of supervision includes:
...
c. Personal and regular (at least monthly) review by the supervising osteopathic physician of selected patient records upon which entries are made by the osteopathic physician assistant. The supervising osteopathic physician shall select patient records for review on the basis of written criteria established by the supervising osteopathic physician and the osteopathic physician assistant and these records shall be of sufficient number to assure adequate review of the osteopathic physician assistant's scope of practice
*This provision applies to PAs who are supervised by osteopathic physicians, whether the PA is certified or not.
West Virginia
A physician assistant may sign orders to be countersigned later by his or her supervising physician
West Virginia Code of State Rules, § 11-1B-7.6
No physician assistant may be utilized in an office or clinic separate and apart from the supervising physician's primary place for meeting patients unless the supervising physician has obtained specific approval from the Board. ... The criteria for granting the approval is that the supervising physician demonstrate the following to the satisfaction of the Board:
...
(d) That the supervising physician visits the remote office at least once every fourteen (14) days and demonstrate that he or she spends enough time on site to provide supervision and personal and regular review of the selected records upon which entries are made by the physician assistant. Patient records shall be selected on the basis of written criteria established by the supervising physician and the physician assistant and shall be of sufficient number to assure adequate review of the physician assistant's scope of practice.
West Virginia Code of State Rules, § 11-1B-13.8
An appropriate degree of supervision includes:
...
(3) Personal and regular (at least monthly) review by the supervising physician of selected patient records upon which entries are made by the physician assistant. The supervising physician shall select patient records for review on the basis of written criteria established by the supervising physician and the physician assistant and shall be of sufficient number to assure adequate review of the physician assistant's scope of practice
West Virginia Code of State Rules, § 11-1B-2.1(f)
Supervision requires the availability of the supervising osteopathic physician. An appropriate degree of supervision includes:
...
c. Personal and regular (at least monthly) review by the supervising osteopathic physician of selected patient records upon which entries are made by the osteopathic physician assistant. The supervising osteopathic physician shall select patient records for review on the basis of written criteria established by the supervising osteopathic physician and the osteopathic physician assistant and these records shall be of sufficient number to assure adequate review of the osteopathic physician assistant's scope of practice
West Virginia Code of State Rules, §24-2-2.5.2*
*This provision applies only to PAs supervised by osteopathic physicians
*This provision applies only to PAs supervised by osteopathic physicians
Wisconsin
No co-signature requirement*
*New regulations have been adopted that eliminate co-signature requirements, effective 9/1/2009. Until then, the regulations below are in effect:
A physician assistant may issue a prescription order only if all the following conditions apply:
...
(e) The supervising physician either:
1. Reviews and countersigns the prescription order prepared by the physician assistant, or
2. Reviews and countersigns within 72 hours the patient record prepared by the physician assistant practicing in the office of the supervising physician or at a facility or a hospital in which the supervising physician has staff privileges, or
3. Reviews by telephone or other means, as soon as practicable but within a 72-hour period, and countersigns within one week, the patient record prepared by the physician assistant who practices in an office facility other than the supervising physician's main office of a facility or hospital in which the supervising physician has staff privileges.
...
(e) The supervising physician either:
1. Reviews and countersigns the prescription order prepared by the physician assistant, or
2. Reviews and countersigns within 72 hours the patient record prepared by the physician assistant practicing in the office of the supervising physician or at a facility or a hospital in which the supervising physician has staff privileges, or
3. Reviews by telephone or other means, as soon as practicable but within a 72-hour period, and countersigns within one week, the patient record prepared by the physician assistant who practices in an office facility other than the supervising physician's main office of a facility or hospital in which the supervising physician has staff privileges.
Wisconsin Administrative Code, Chapter Med 8, §8.08(2)
Wyoming
No co-signature requirement
8/09
