Hawaii PA Collaboration Requirements Summary

Hawaii requires every PA to have a supervising physician who accepts responsibility for the PA’s medical services and must direct and exercise supervision at all times. Physician involvement is high, driven mainly by Hawaii’s chart review rule: the physician must personally review the records of every patient the PA sees within seven working days. Hawaii does not require a written collaborative agreement, but the PA’s practice-related activities must be established in writing by the employer, and the physician must submit a statement to the board accepting the supervisory relationship. A PA’s certification is automatically inactivated if they are no longer supervised, and there is no experience threshold that reduces oversight over time. This page covers Hawaii’s rules on the supervising relationship, written practice documentation, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: Haw. Admin. Rules 16-85-44.5

Type of Collaborative Relationship

Hawaii requires a supervising physician who accepts responsibility for the PA’s medical services and must direct and exercise supervision at all times. Physician involvement is high — the physician must review every patient record, provide a means of direct communication, and designate an alternate physician when absent. There is no path to reduced supervision or independent practice for PAs in Hawaii, and a PA’s certification is automatically inactivated if the supervising relationship ends.

Source: Haw. Admin. Rules 16-85-49(a)

What is a PA’s scope of practice in Hawaii?

A PA in Hawaii acts as the agent of their supervising physician in all practice-related activities, and those activities must be established in writing by the employer. Where the supervising physician is an osteopathic physician, the PA’s services must be those commonly furnished in an osteopathic physician and surgeon’s office.

Do PAs need a collaborating physician in Hawaii?

Yes. A PA must have a supervising physician, group of physicians, or osteopathic physician and surgeon who accepts responsibility for the PA’s services, and certification is automatically inactivated if the PA is no longer supervised.

Can PAs practice independently in Hawaii?

No. The supervising physician must direct and exercise supervision at all times, and Hawaii sets no hour count or experience threshold that leads to reduced supervision or independent practice.

How many PAs can a physician collaborate with in Hawaii?

Four at any one time.

Who can be a collaborating physician in Hawaii?

A physician, group of physicians, or osteopathic physician and surgeon licensed to practice medicine and surgery in Hawaii who accepts responsibility for the PA’s services. Hawaii sets no additional experience or specialty requirement, though supervision by an osteopathic physician limits the PA to services commonly furnished in that physician’s office.

Are there proximity or in-person requirements in Hawaii?

No, Hawaii sets no general distance or on-site presence requirement. The supervising physician must provide adequate means for direct communication with the PA, and where physical presence is not required that communication may happen by telephone, two-way radio, or other technology. The exception is a PA working with an osteopathic physician: care should be given in that physician’s presence unless the physician judges that the patient is not endangered and unforeseen complications could not arise.

Collaboration Agreement Requirements

Hawaii does not require a written collaborative agreement. Instead, the PA’s practice-related activities must be established in writing by the employer, and the PA is treated as the physician’s agent in carrying them out. There is no state template, no signature requirement, no on-site storage rule for that documentation, and no review or renewal schedule. Separately, the PA and the physician must establish written guidelines for medical record review and keep them at the practice setting.

Source: Haw. Admin. Rules 16-85-49.1(a)

What must be included in a PA collaborative agreement in Hawaii?

Hawaii requires no collaborative agreement and sets no required content for one. The PA’s practice-related activities must be established in writing by the employer, and the PA and supervising physician must separately establish written guidelines for reviewing medical records that fit the specific practice.

What is the collaborative agreement called in Hawaii?

Hawaii has no named collaborative agreement for PAs. The written documents that do exist are the employer’s written statement of the PA’s practice-related activities and the written medical record review guidelines.

Who has to sign the collaborative agreement in Hawaii?

Hawaii sets no signature requirement, since no collaborative agreement is required. The supervising physician does have to sign a statement submitted to the board accepting responsibility for directing and supervising the PA.

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

Hawaii sets no review or renewal schedule.

Is a backup physician required in Hawaii?

Yes, in practice — the supervising physician must designate an alternate supervising physician for their absence. Because Hawaii requires no collaborative agreement, there is no document the alternate must be named in.

Board Filing Requirements

Hawaii requires the supervising physician to submit a signed statement to the board confirming they will direct and supervise the PA and retain full professional and legal responsibility for the PA’s performance and for patient care. That statement is filed as part of the PA’s certification application, so a PA cannot practice while certification is pending. When the relationship ends, both the PA and the physician must notify the board within 10 days.

Source: Haw. Admin. Rules 16-85-49(a)(2)

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

No, because Hawaii requires no collaborative agreement. What must be filed is the supervising physician’s signed statement accepting responsibility for directing and supervising the PA, which is submitted with the certification application. There is no recurring filing requirement after that.

Can a PA start practicing as soon as they file in Hawaii?

No, not for initial certification — a PA cannot practice while their certification application is pending. The supervising physician’s statement is part of that application, so board action on the certification is what allows practice to begin.

What are the termination and notice requirements in Hawaii?

Both the supervising physician and the PA must notify the board within 10 days when supervision or employment ends. A PA’s certification is automatically inactivated once they are no longer supervised, and Hawaii allows no grace period for an unexpected termination.

Collaboration Compliance

Hawaii’s central ongoing obligation is chart review, and it is one of the most demanding in the country: the supervising physician must personally review the records of each patient the PA sees within seven working days. The physician must also keep adequate means of direct communication available and designate an alternate when absent. Hawaii sets no meeting cadence, no chart co-signature requirement, and no records retention period.

Source: Haw. Admin. Rules 16-85-49(a)(5)

How many charts must a collaborating physician review in Hawaii?

All of them — the supervising physician must personally review the records of each patient seen by the PA within seven working days. Hawaii’s statute sets lower, tiered review percentages for newer PAs, but the Board of Medicine’s rules impose the higher standard and control. The PA and physician must also establish written record-review guidelines appropriate to the practice and keep them at the practice setting, available to the Hawaii medical board and the regulated industries complaints office on request.

How often must a PA and collaborating physician meet in Hawaii?

Hawaii sets no required meeting cadence. The supervising physician must provide adequate means for direct communication with the PA and must designate an alternate supervising physician during any absence.

How long must collaboration records be kept in Hawaii?

Hawaii sets no retention period for supervision records. The written medical record review guidelines must be kept in the office of the practice setting where the PA or supervising physician practices.

Prescribing Rules

PAs in Hawaii may prescribe, dispense, and administer controlled substances in Schedules II through V when the supervising physician delegates that authority. To delegate it, the physician must hold Hawaii controlled-substance registration, and the PA must register with the federal DEA. Hawaii also has specific requirements for what appears on a PA’s prescriptions, including the supervising physician’s DEA number for controlled substances.

Source: Haw. Admin. Rules 16-85-49(a)(8),(9)

Can a PA prescribe controlled substances in Hawaii?

Yes, when the supervising physician delegates that authority. The supervising physician must hold Hawaii controlled-substance registration in order to delegate authority to prescribe, dispense, and administer Schedule II through V medications, and a PA delegated controlled-substance authority must register with the federal DEA. Hawaii adds no heightened supervision requirement specific to controlled substances beyond its general chart review rule.

Can a PA prescribe Schedule II drugs in Hawaii?

Yes, Hawaii’s rules contemplate PAs prescribing Schedule II medications when the supervising physician delegates that authority. Any Schedule II through V prescription a PA writes must carry the supervising physician’s DEA registration number.

What schedule drugs can a PA prescribe in Hawaii?

Schedules II through V, as delegated by the supervising physician. The physician’s authority to delegate depends on holding Hawaii controlled-substance registration, and the PA’s own DEA registration is required for controlled-substance prescribing.

Does a PA need a DEA license in Hawaii?

Yes, a PA delegated controlled-substance authority must register with the federal DEA. Hawaii does not require a separate state registration for the PA, but it does require the supervising physician to hold Hawaii controlled-substance registration to delegate that authority. Every prescription a PA writes must include the printed name, address, and phone number of both the supervising physician and the PA, with the PA’s signature next to their printed name.

Can a PA prescribe independently (without physician sign-off) in Hawaii?

No. Prescribing authority exists only through delegation from the supervising physician, controlled-substance prescriptions must carry that physician’s DEA number, and the physician reviews every patient record within seven working days.

Specialty & Telehealth Requirements

Hawaii sets no telehealth-specific requirements for PAs but does impose additional requirements on PAs supervised by an osteopathic physician. Those PAs are limited to services commonly furnished in an osteopathic physician and surgeon’s office, and their care should generally be given in that physician’s presence.

Source: Haw. Admin. Rules 16-93-45(2)

Are there telehealth or telemedicine requirements for PAs in Hawaii?

Hawaii sets no telehealth-specific requirement for PAs in the master regulatory data. Technology including telephone and two-way radio is how the supervising physician satisfies the requirement to provide adequate means for direct communication where physical presence is not required.

Are there specialty-specific requirements for PAs in Hawaii?

Yes, PAs supervised by an osteopathic physician face additional requirements. Their services are limited to those commonly furnished in an osteopathic physician and surgeon’s office, and care should be given in that physician’s presence unless the physician judges the patient is not endangered and unforeseen complications could not arise.