A summary of Alabama’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for PAs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: High
Agreement Name: Registration agreement
On-Site Requirements: None routinely
Chart Review: No fixed count
Controlled Substances: Allowed, Schedules III–V only.
Reduced Supervision / Transition Requirements: 2 years / 4,000 hours in a registration agreement eases remote-site on-site rules.
Alabama PA Collaboration Requirements Summary
Alabama requires every PA to work under a collaborating (supervising) physician, and a PA cannot begin practice until the Board of Medical Examiners approves the registration. Physician involvement is high: the physician must keep a direct, continuing, and close working relationship with the PA, though day-to-day on-site presence generally is not required. PAs cannot practice independently in Alabama; after 4,000 hours (about two years) the remote-site on-site rules ease, but supervision continues. This page covers Alabama’s rules on supervision, the collaborative agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.
Source: Ala. Code § 34-24-303(a)
Type of Collaborative Relationship
Alabama requires PAs to practice under a collaborating physician with a direct, continuing, and close supervisory relationship at all times. Physician involvement is high, and there is no route to fully independent practice — the only easing comes after 4,000 hours, when remote-site on-site rules relax. A PA’s authority is defined by a written job description approved by the Board.
Source: Ala. Admin. Code § 540-X-7-.01(10)
What is a PA’s scope of practice in Alabama?
A PA’s scope of practice is set by a written job description approved by the Board of Medical Examiners. The PA performs medical services under physician supervision as spelled out in that Board-approved job description.
Do PAs need a collaborating physician in Alabama?
Yes. A PA must be registered with the Board to practice under a physician the Board has approved to supervise them before offering any care.
Can PAs practice independently in Alabama?
No. Alabama requires a direct, continuing, and close supervisory relationship with a physician at all times; there is no independent or autonomous practice option for PAs.
How many PAs can a physician collaborate with in Alabama?
A physician may collaborate with up to nine full-time-equivalent (FTE) advanced practice providers — a combined cap of 360 hours per week across all PAs, nurse practitioners, and nurse midwives, counting agreements in other states. Once a physician supervises more than four FTEs, they must complete documented monthly quality-assurance review with each new provider for the first six months.
Who can be a collaborating physician in Alabama?
A collaborating physician must hold a current, unrestricted Alabama medical license and meet an experience requirement. The physician must have practiced at least three years, or at least one year with a recognized specialty board certification (or one year if the site is limited to a hospital), and must have completed the Board’s required continuing education on supervising PAs.
Are there proximity or in-person requirements in Alabama?
Generally no, on-site supervision is not routinely required. At an approved remote practice site, though, the physician must be present for 10% of the PA’s scheduled hours during the PA’s first two years/4,000 hours; after that, the physician must visit the remote site at least twice a year.
Collaboration Agreement Requirements
Alabama’s written agreement is a registration agreement, and the state provides the required forms rather than leaving the content open. Both the physician and the PA sign it. Alabama does not require the agreement to be stored on-site and sets no fixed review or renewal schedule for it.
What must be included in a PA collaborative agreement in Alabama?
The required content is supplied through the state’s registration forms. Alabama uses standardized documents — including an application for registration, a core duties and scope-of-practice document, and, where applicable, a non-controlled prescribing formulary — rather than a free-form written agreement.
What is the collaborative agreement called in Alabama?
It is called a registration agreement. Alabama also refers to the physician’s disclosure as a collaborative and supervisory agreement.
Who has to sign the collaborative agreement in Alabama?
Both the collaborating physician and the PA must sign.
How often must the agreement be reviewed or renewed in Alabama?
Alabama sets no fixed review or renewal requirement for the agreement itself.
Is a backup physician required in Alabama?
No, a backup physician is not required, but any backup physician must be pre-approved by the Board. The collaborating physician must certify at least annually that the covering physician remains available and must notify the Board within 10 days if that arrangement ends. Alabama provides a covering physician agreement for this purpose.
Board Filing Requirements
A PA must register with the Board of Medical Examiners before practicing. The PA cannot practice on filing alone; Board approval is required first. When the arrangement ends, both the PA and the physician must notify the Board.
Source: Ala. Code § 34-24-303(a)
Do you have to file the collaborative agreement with the board in Alabama?
Yes. The PA must be registered with the Board of Medical Examiners, which provides the forms for submission, before practicing.
Can a PA start practicing as soon as they file in Alabama?
No. Board approval is required before a PA may practice — filing alone is not enough.
What are the termination and notice requirements in Alabama?
Both the PA and the physician must notify the Board of the termination. Notice must be in writing (using the state’s termination form) and state the effective date and the reasons; failing to notify the Board may be treated as a rule violation affecting future applications.
Collaboration Compliance
Once the collaboration is active, the physician must run quarterly quality-assurance chart review, meet with certain remote-site PAs at least quarterly, and keep the required records. On-site supervision is not required, but the physician must maintain a direct, continuing, and close supervisory relationship throughout.
Source: Ala. Admin. Code § 540-X-7-.23
How many charts must a collaborating physician review in Alabama?
There is no fixed chart count. The physician must complete quarterly quality-assurance review covering a meaningful sample of medical records plus all adverse outcomes. A PA at a remote site must also send the physician a daily status report of any complications or unusual problems.
How often must a PA and collaborating physician meet in Alabama?
At least quarterly for a PA at a remote site who has more than 4,000 practice hours. Alabama does not otherwise set a fixed meeting cadence, but the physician must maintain a continuing, close supervisory relationship and quarterly quality-assurance review.
How long must collaboration records be kept in Alabama?
Records must be kept for the duration of the registration agreement plus three years after it ends. This applies to quality-assurance documentation and to the physician’s records of the PA’s 4,000 hours of supervised practice.
Prescribing Rules
PAs in Alabama may prescribe, but controlled-substance authority is limited to Schedules III–V and requires a Qualified Alabama Controlled Substances Certificate (QACSC) plus a valid DEA number. Prescribing operates within the physician-approved formulary and any Board protocols — it is not independent.
Source: Ala. Code § 20-2-63(a)
Can a PA prescribe controlled substances in Alabama?
Yes, for Schedules III, IV, and V only. The PA must hold a Qualified Alabama Controlled Substances Certificate (QACSC) and a valid DEA registration number, and prescribe within the physician’s approved formulary and any Board protocols.
Can a PA prescribe Schedule II drugs in Alabama?
No. PAs in Alabama cannot prescribe Schedule II medications.
What schedule drugs can a PA prescribe in Alabama?
PAs may prescribe controlled substances in Schedules III, IV, and V, along with non-controlled (legend) drugs. Controlled-substance prescribing requires the QACSC and a valid DEA number and must follow the approved formulary.
Does a PA need a DEA license in Alabama?
Yes, a valid federal DEA registration number is required to prescribe controlled substances, together with the state QACSC. Alabama’s rules reference state controlled-substance registration (the QACSC) and a valid DEA number; they do not add a separate state DEA registration.
Can a PA prescribe independently (without physician sign-off) in Alabama?
No. A PA’s prescribing is bounded by the supervising physician’s approved formulary and Board protocols, so it is not independent of the physician.
Specialty & Telehealth Requirements
Alabama sets no specific telehealth or telemedicine requirement for PAs in its master rules, but it does have separate specialty rules for anesthesiologist assistants. Standard supervision, agreement, and prescribing rules otherwise apply.
Source: Ala. Admin. Code § 540-X-7-.37
Are there telehealth or telemedicine requirements for PAs in Alabama?
No, Alabama sets no specific telehealth or telemedicine requirement for PAs.
Are there specialty-specific requirements for PAs in Alabama?
Yes, anesthesiologist assistants are governed by a separate set of rules. General PA supervision, agreement, and prescribing rules apply otherwise.
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