State by State Requirements
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      Collaborating in Alabama

      This outlines the requirements for collaborating in Alabama.

      State Regulations for Nurse Practitioners

      General 

      • In which category does Alabama fall: NP independent practice, transition to independence, or collaboration required?
        • Collaboration Required

      Delegation Authority/Process

      • Is an agreement required?
        • Yes.
      • What form of agreement is required and what are the requirements for the substance of the agreement (is use of state template required?)
        • The Alabama State Board of Nursing requires specific forms for both the written standard protocol and written quality assurance plan. The forms may be found on the board website here. The physician must also submit to the board of medicine (instructions here). Specific protocol for prescribing is also required.
      • Where must the agreement be stored?
        • The agreement must be maintained at each practice site.
      • Does the agreement need to be filed with the state?
        • Yes. The written agreement (“standard protocol”) must be filed with the Board of Nursing and Board of Medical Examiners.
      • Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?
        • They must also notify the Board of Medical Examiners within fourteen (14) days when collaborative practice is terminated by filing a “Terminate Existing Collaborating Form.”
      • Who must sign the agreement?
        • NP, Collaborating Physician, and (if applicable) the Alternate Collaborating Physician.
      • How often must the agreement be reviewed/reauthorized?
        • Prescriptive authority agreements and any amendments to it must be reviewed and signed at least once annually by the parties to the agreement.

      Qualifications

      • What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
        • To qualify as a collaborating physician, the physician must possess a current, unrestricted license to practice medicine in the State of Alabama and meet specific experience criteria.
      • What are the qualifications for the NP?
        • Refer to the state checklist here.
      • Is an alternate collaborating physician required?
        • Yes. In the event the collaborating physician is not readily available, provisions shall be made for professional medical oversight and direction by a covering physician who is readily available, who is pre-approved by the Board of Medical Examiners, and who is familiar with these rules. The collaborating physician shall certify to the Board of Medical Examiners at least annually that any approved covering physician continues to agree to serve in that capacity and shall inform the Board of Medical Examiners of the termination of a covering physician within ten (10) days of the termination.
        • In the event of an unanticipated, permanent absence of a collaborating physician, a previously approved covering physician may be designated as a temporary collaborating physician for a period of up to sixty (60) days. During the sixty (60) day time period, a new "Notice of Commencement" designating a new collaborating physician should be submitted for approval.

      Collaboration Requirements

      • Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
        • 1 supervisor: 9 FTE APRNs (or any mid-level practitioner). 
        • A physician in collaborative practice may request approval from the Joint Committee for additional full-time certified registered nurse practitioner positions.
      • Is there an express requirement to review a certain number/percentage of charts?
        • All medical records of adverse outcomes must be reviewed and a “meaningful” sample of all others must be reviewed.
      • Are there location-specific requirements? (e.g., that collaborator must go to practice site at some frequency)
        • The collaborating physician must be physically present for at least 10% of the APRN is scheduled on-site hours until the APRN has 2 years (4,000 hours) of experience since initial certification or in the practice specialty. After the APRN has 2 years (4,000 hours) of collaborative practice experience, the collaborating physician must “visit remote practice sites” at least 2x annually and must meet with the APRN at least quarterly.
      • Are there proximity requirements? (e.g., between the NP/collaborator or practice site)
        • No, but see the answer to the next question.
      • Is remote supervision allowed/are there limitations on remote supervision?
        • Remote supervision is permitted, provided the collaborating physician is “readily available” for direct communications by telephone or telecommunications.
      • Outside of filing the collab agreement, must the physician and/or NP file any separate forms? NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc. 
        • “[A] physician shall disclose to the Board of Medical Examiners the existence of all collaborative and supervisory agreements to which the physician is a party, including collaborative and supervisory agreements in other states, and shall not be eligible to collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding [360] hours per week ([or nine (9) FTEs]), inclusive of collaborative and supervisory agreements existing in other states.”
        • The collaborating physician must complete a quarterly assurance review with each NP, documentation of which must be maintained for the duration of the collaborative practice and for three (3) years following the termination of the collaborative practice agreement. The collaborating physician must also “maintain an updated copy” of the plan for quality assurance for each NP on file with the Board of Medical Examiners
      • What are the prescription requirements?
        • The legend and controlled drugs a nurse practitioner is authorized to prescribe are specified in the collaboration agreements and formularies. See Board Rules, Chapter 540-X-17 for more information regarding prescribing for obesity/weight loss.
      • What are the requirements for controlled substance prescribing?
        • To prescribe controlled substances, nurse practitioners must apply and be approved for a Qualified Alabama Controlled Substances Certificate (QACSC). https://www.albme.gov/licensing/crnp-cnm/qacsc/. The medicines the APRN can prescribe must be listed in the collaboration agreement.
        • To prescribe Schedule II controlled substances, a nurse practitioner must also apply and be approved for a Limited Purpose Schedule II Permit (LPSP). https://www.albme.gov/licensing/crnp-cnm/lpsp/. The Schedule II controlled substances must also be within the practice of the collaborating physician.

      For more detailed information and official forms, please refer to the Alabama State Board of Nursing and Board of Medical Examiners websites.


      Sources for Reference