Georgia NP Collaboration Requirements Summary

Georgia nurse practitioners must practice under a written nurse protocol agreement with a delegating (collaborating) physician. Georgia is a collaborative-practice state with a high level of physician involvement and no independent-practice pathway; the physician delegates specific medical acts to the NP and is responsible for those acts. The agreement is filed with the Georgia Composite Medical Board only when the NP is authorized to prescribe.

Source: O.C.G.A. § 43-34-25

Type of Collaborative Relationship

Georgia NPs work under a nurse protocol agreement in which a delegating physician authorizes specific medical acts, and the physician stays closely involved. There is no independent-practice or reduced-supervision pathway in Georgia. One physician may collaborate with up to the combined equivalent of eight NPs and PAs at a time, with exceptions for certain practice settings and no ratio limit for NPs who do not prescribe. The physician must be in a comparable specialty area or field, must practice in Georgia (or within 50 miles of the patient), and must observe the NP on site at least once a year. Georgia law also makes the delegating physician responsible for the medical acts the NP performs under the agreement.

Source: O.C.G.A. § 43-34-25(c), (g)

What is an NP’s scope of practice in Georgia?

Georgia NPs (APRNs) may perform the medical acts a delegating physician authorizes in a nurse protocol agreement — including assessing, diagnosing, treating, and ordering drugs, devices, and diagnostic studies — so long as those acts fall within the NP’s own scope, specialty, and certification. Practice is always tied to the delegated authority set out in the agreement.

Do NPs need a collaborating physician in Georgia?

Yes. Georgia NPs must practice under a nurse protocol agreement with a delegating physician; the agreement must be filed with the board only when the NP is authorized to prescribe.

Can NPs practice independently in Georgia?

No. Georgia has no independent-practice pathway and no transition to reduced supervision; NPs always work under a nurse protocol agreement with a delegating physician.

How many NPs can a physician supervise in Georgia?

Up to the combined equivalent of eight NPs and PAs at one time. Certain practice settings — such as hospitals, public health, and free clinics — are exempt from this limit, and there is no ratio cap for NPs who do not prescribe.

Who can be a collaborating physician in Georgia?

A physician licensed to practice medicine in Georgia — or whose principal place of practice is within 50 miles of where the patient receives services — who is in a comparable specialty area or field to the NP.

Are there proximity or in-person requirements in Georgia?

Yes. The physician’s principal place of practice must be in Georgia or within 50 miles of where the patient receives services, and the physician must conduct an on-site observation of the NP at least once a year. These requirements apply regardless of practice model, including telehealth.

Collaboration Agreement Requirements

Georgia’s written agreement is called a nurse protocol agreement. It must identify all parties and their license and DEA numbers, describe the practice and its locations, state the NP’s specialty, set the standard of care for the patient population, and spell out the parameters of the delegated acts — the drugs, devices, treatments, and diagnostic studies the NP may order, along with refill limits and a plan for immediate physician consultation. Both the NP and the delegating physician must sign it, a copy must be kept at each practice site, and it must be reviewed, revised, or updated at least once a year.

Source: Rule 360-32-.02; O.C.G.A. § 43-34-25(c)

What must be included in an NP collaborative agreement in Georgia?

The agreement must identify all parties (with license and DEA numbers), describe the practice and its locations, state the NP’s specialty, set the applicable standard of care, provide for immediate physician consultation, and define the delegated acts. That includes the drugs, devices, treatments, diagnostic studies, and refill limits the NP is authorized to use.

What is the collaborative agreement called in Georgia?

It is called a nurse protocol agreement.

Who has to sign the collaborative agreement in Georgia?

Both the NP and the delegating physician must sign it. If a designated back-up physician is used, that physician must also concur in writing.

How often must the agreement be reviewed or renewed in Georgia?

At least once a year. The delegating physician and NP must review, revise, or update the agreement annually, and any amendments must be filed with the board within 30 days.

Is a back-up physician required in Georgia?

No. A back-up physician is not required, but if one is used they must practice medicine in Georgia, have the same scope of practice as the collaborating physician, and agree in writing to the terms of the agreement and to provide consultation in the physician’s absence.

Board Filing Requirements

Georgia requires the nurse protocol agreement to be filed with the Georgia Composite Medical Board only when the NP is authorized to prescribe — no filing is required for a non-prescribing NP. When prescribing is involved, the agreement is submitted through the board’s portal, and amendments must be filed within 30 days of execution. No additional documents are required.

Source: Rule 360-32-.03(4)

Do you have to file the collaborative agreement with the board in Georgia?

Only if the NP will prescribe. A nurse protocol agreement must be submitted to the Georgia Composite Medical Board only when the NP is authorized to write prescriptions; a non-prescribing NP does not file one.

Can an NP start practicing as soon as they file in Georgia?

Yes, but with a prescribing limit. An NP may begin practicing, but cannot prescribe controlled substances until the board has approved the protocol and the NP has been issued a DEA number; before then, only non-scheduled medications may be prescribed.

What are the termination and notice requirements in Georgia?

The delegating physician must notify the board within 10 working days of terminating an agreement. If the physician dies or leaves, the NP must notify the board within 7 days; a designated physician may then serve for up to 60 days until a new agreement is approved.

Collaboration Compliance

Georgia’s ongoing obligations center on physician chart review, an annual on-site observation, and immediate availability for consultation. For prescribing NPs, the physician must review and sign 100% of records for patients receiving controlled substances at least quarterly, 10% of all other records annually, and 100% of any records involving an adverse outcome within 30 days. The physician must also observe the NP on site at least once a year and be available for immediate consultation by phone or other telecommunication.

Source: Rule 360-32-.02(7); Rule 360-32-.05(2)

How many charts must a collaborating physician review in Georgia?

For prescribing NPs, the physician must review and sign 100% of controlled-substance patient records at least quarterly, 10% of all other records annually, and 100% of adverse-outcome records within 30 days. For non-prescribing NPs, periodic review is required but no fixed count is set.

How often must an NP and collaborating physician meet in Georgia?

Georgia does not set a routine meeting cadence; instead, the physician must conduct an on-site observation of the NP at least once a year and remain available for immediate consultation.

How long must collaboration records be kept in Georgia?

Georgia sets no fixed retention period for collaboration records generally. The physician must document and keep a record of the annual on-site observation and of the NP’s annual pharmacology training, and provide them to the board on request.

Prescribing Rules

Georgia NPs may prescribe as delegated in the nurse protocol agreement, but controlled-substance authority is limited and requires board approval plus a DEA number. NPs may prescribe non-scheduled drugs and, once the protocol is approved and a DEA number issued, Schedule III–V controlled substances. Schedule I and II substances generally may not be prescribed by an NP — the only exception is hydrocodone, oxycodone, or compounds thereof in emergency situations, under strict conditions. Refills are limited to a 12-month supply, except oral contraceptives, hormone replacement therapy, and prenatal vitamins, which may be refilled for up to 24 months.

Source: O.C.G.A. § 43-34-25(d.1), (k)

Can an NP prescribe controlled substances in Georgia?

Yes, but with limits. After the board approves the protocol and the NP obtains a DEA number, an NP may prescribe Schedule III–V controlled substances; Schedule I and II are generally off-limits except a narrow emergency exception.

Can an NP prescribe Schedule II drugs in Georgia?

Generally no. The only exception is hydrocodone, oxycodone, or compounds thereof in an emergency, and only if the NP has at least one year of post-licensure experience, the authority is written into the agreement, the order is a one-time supply of five days or less, the patient is 18 or older, and the NP completes one hour of relevant continuing education every two years.

What schedule drugs can an NP prescribe in Georgia?

Non-scheduled (legend) drugs, plus Schedule III–V controlled substances once the protocol is approved and a DEA number is issued. Schedule I cannot be prescribed, and Schedule II only under the narrow hydrocodone/oxycodone emergency exception.

Does an NP need a DEA license in Georgia?

Yes. An NP must obtain a federal DEA number to prescribe scheduled controlled substances. Georgia references the DEA number generally and does not impose a separate state controlled-substance registration.

Can an NP prescribe independently (without physician sign-off) in Georgia?

No. Prescribing authority is delegated through the nurse protocol agreement, and patients receiving controlled substances must be evaluated by the delegating (or designated) physician at least quarterly.

Specialty & Telehealth Requirements

Georgia sets no telehealth-specific or specialty-specific collaboration requirements, but its standard rules apply in full to telehealth practice. Whether care is delivered in person or by telehealth, the physician must still practice in Georgia or within 50 miles of the patient and observe the NP at least once a year; the board has indicated these requirements do not change based on business model. The collaborating physician must be in a comparable specialty area or field to the NP, and Georgia law makes the physician responsible for the NP’s delegated medical acts.

Source: Rule 360-32-.01(11); O.C.G.A. § 43-34-25(a)(12)

Are there telehealth or telemedicine requirements for NPs in Georgia?

No specific telehealth rule, but the standard requirements still apply. The physician’s location and annual on-site observation requirements apply regardless of business model; for telehealth practices, the physician may be able to meet the observation requirement by observing the NP at the virtual telehealth site, though the rules do not specify how.

Are there specialty-specific requirements for NPs in Georgia?

No. Georgia sets no specialty-specific collaboration requirements, other than the general rule that the collaborating physician must be in a comparable specialty area or field to the NP.