Maryland PA Collaboration Requirements Summary

Maryland requires every PA to work under a collaboration agreement with one or more Maryland-licensed physicians, called patient care team physicians. Physician involvement is low: no on-site presence, no required meetings, and no chart review, as long as the physician is accessible electronically. The agreement is not filed with the Board, but the PA cannot begin practicing until the Board has been notified that an agreement is executed and told which physicians are on it. A PA’s scope is bounded by what is customary to the practice of a listed patient care team physician, and certain advanced duties need Board approval unless the PA has 7,000 hours of experience. This page covers Maryland’s rules on the collaborative relationship, the collaboration agreement, board notice, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: Md. Code Health Occ. 15-302(a)

Type of Collaborative Relationship

Maryland requires a collaboration agreement with at least one Maryland-licensed physician, but keeps ongoing physician involvement low. There is no on-site presence requirement, no meeting cadence, and no chart review, provided the collaborating physician is accessible by electronic means. What does bound a PA’s practice is specialty: a PA may not perform a medical act that is not customary to the practice of a patient care team physician listed on the agreement, except in a medical emergency. Maryland offers no path to fully independent practice.

Source: Md. Code Health Occ. 15-301(d)(3)(iv)

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

A PA’s scope in Maryland is limited to what is customary to the practice specialty of a patient care team physician listed on the collaboration agreement. Outside a medical emergency, a PA may not perform a medical act that falls outside that customary practice. The agreement may further limit scope or specify office procedures if the parties choose.

Do PAs need a collaborating physician in Maryland?

Yes. A PA must have an executed collaboration agreement listing one or more Maryland-licensed physicians, and a physician may not collaborate with a PA without notifying the Board that an agreement is complete.

Can PAs practice independently in Maryland?

No. A collaboration agreement with at least one patient care team physician is required, and if no listed physician remains on the agreement the PA may not practice until a new agreement is executed.

How many PAs can a physician collaborate with in Maryland?

Eight at any one time. That cap does not apply in a hospital, a correctional facility, a detention center, or a public health facility.

Who can be a collaborating physician in Maryland?

A physician licensed in Maryland whose customary practice specialty covers what the PA will be doing. A collaboration agreement may list only a Maryland-licensed PA and one or more Maryland-licensed physicians.

Are there proximity or in-person requirements in Maryland?

No, Maryland sets no distance, travel, or on-site presence requirement. Collaboration expressly does not require a collaborating physician’s constant physical presence in the practice setting, provided the physician is accessible by electronic means.

Collaboration Agreement Requirements

Maryland’s written agreement is called a collaboration agreement, and the state provides a sample template. At minimum it must describe the qualifications of the PA and of the physician or group of physicians, state any practice specialty of those physicians, and describe the settings where the PA will practice. If the PA will prescribe, the agreement must also carry a set of prescribing provisions and attestations, including attestations about the PA’s certification or recent pharmacology education and about the PA’s degree or work experience. The PA and all listed patient care team physicians sign it, and it must be maintained at the practice setting and produced to the Board on request.

Source: Md. Code Health Occ. 15-302(b)

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

Three things at minimum: a description of the qualifications of the PA and the physician or group of physicians who developed the agreement, any practice specialty of those physicians, and a description of the settings in which the PA will practice. To allow prescribing, the agreement must additionally state the PA’s authority to prescribe and, if applicable, dispense, and include attestations that prescribing will comply with federal and state law, that charts will note any prescription the PA writes or dispenses, that written and dispensed prescriptions will carry the required PA and physician identifying information, that the PA passed the national certification exam within the previous two years or completed eight category 1 pharmacology education hours in that period, and that the PA holds a bachelor’s degree or its equivalent or has two years of work experience as a PA. The agreement may also limit the PA’s scope or specify office procedures.

What is the collaborative agreement called in Maryland?

It is called a collaboration agreement. Maryland refers to the physicians listed on it as patient care team physicians, and the Board provides a sample template.

Who has to sign the collaborative agreement in Maryland?

The PA and all listed patient care team physicians. The signed agreement must be kept at the primary place of practice.

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

Maryland sets no review or renewal schedule for the collaboration agreement.

Is a backup physician required in Maryland?

No, Maryland does not require a designated backup physician. Listing more than one patient care team physician does matter in practice, though: if a listed physician suddenly departs, becomes incapacitated, dies, or can no longer legally practice, the agreement stays active under the remaining listed physicians. If none remain, the PA must stop practicing until a new agreement is executed.

Board Filing Requirements

Maryland does not require the collaboration agreement itself to be filed, but it does require notice to the Board before practice begins. The PA must notify the Board of the executed collaboration agreement and of each patient care team physician listed on it, and a physician may not collaborate with a PA without that notice on file. Once the Board has been notified, the PA may begin practicing. There is no recurring filing, but termination and changes to prescribing authority carry short notice deadlines.

Source: Md. Code Health Occ. 15-301(d)(2)

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

No, but you must notify the Board that it exists. The PA gives notice of the executed collaboration agreement and of each patient care team physician listed on it, in a manner the Board approves. The agreement itself stays at the practice setting and is produced only on request.

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

Yes, once the Board has been notified of an executed collaboration agreement. A PA may not begin practicing before that notice is given.

What are the termination and notice requirements in Maryland?

Either the physician or the PA must notify the Board within 10 days of the relationship under a collaboration agreement ending. Separately, if a patient care team physician restricts or removes a PA’s delegated prescribing authority, that physician must notify the Board within 5 business days. Maryland allows no grace period for an unexpected departure — practice continues only if another listed physician remains on the agreement.

Collaboration Compliance

Maryland sets no fixed ongoing compliance obligations. There is no required chart review, no chart co-signature, no meeting cadence, no supervision documentation, and no records retention period. The one continuing standard is availability: the collaborating physician must be accessible by electronic means, which is what allows the physician to be off site.

Source: Md. Code Health Occ. 15-101(d)(2)

How many charts must a collaborating physician review in Maryland?

None — Maryland requires no chart review. There is no chart co-signature requirement either. Where the PA has prescribing authority, the collaboration agreement must attest that medical charts will contain a notation of any prescription the PA writes or dispenses.

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

Maryland sets no required meeting cadence. The collaborating physician must be accessible by electronic means, and the PA’s practice must stay within what is customary to a listed physician’s specialty.

How long must collaboration records be kept in Maryland?

Maryland sets no retention period for collaboration records. The collaboration agreement must be maintained at the practice setting and made available to the Board on request.

Prescribing Rules

PAs in Maryland may prescribe when a patient care team physician delegates that authority through the collaboration agreement. For controlled dangerous substances, the physician cannot delegate at all unless the PA holds both a valid Maryland controlled dangerous substance registration and a valid federal DEA registration. Prescribing is also bounded by specialty — a PA may not perform a medical act that is not customary to the practice of a listed patient care team physician, outside a medical emergency.

Source: Md. Code Health Occ. 15-302.2(b)(3)

Can a PA prescribe controlled substances in Maryland?

Yes, but only if the PA holds both a Maryland controlled dangerous substance registration and a federal DEA registration. The delegation must also be written into the collaboration agreement along with the required prescribing attestations. Maryland adds no heightened supervision requirement specific to controlled substances.

Can a PA prescribe Schedule II drugs in Maryland?

Maryland’s master regulatory data does not address drug schedules individually. It treats controlled dangerous substances as a category, requiring both state and federal registration plus delegation through the collaboration agreement.

What schedule drugs can a PA prescribe in Maryland?

Maryland’s master regulatory data sets no schedule-by-schedule limits on PA prescribing. What a PA may prescribe is what the patient care team physician delegates in the collaboration agreement, limited to what is customary to that physician’s practice, with both registrations in place for controlled dangerous substances.

Does a PA need a DEA license in Maryland?

Yes, a valid federal DEA registration is required to prescribe or dispense controlled dangerous substances, along with a Maryland controlled dangerous substance registration. Maryland sets no separate prescription pad rule, but the collaboration agreement must attest that written prescriptions carry the PA’s name, business address, and business telephone number, and that dispensed prescriptions carry the PA’s name plus the patient care team physician’s name, business address, and business telephone number.

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

No. Prescribing exists only through delegation from a patient care team physician written into the collaboration agreement, and that physician can restrict or remove the delegation at any time by notifying the Board within 5 business days.

Specialty & Telehealth Requirements

Maryland sets no telehealth-specific requirements for PAs, but it does gate certain advanced duties behind Board approval. A PA may perform an advanced duty without prior Board approval only if the Board has already approved that PA for it, or if the PA has at least 7,000 hours of clinical practice experience.

Source: Md. Code Health Occ. 15-302.1(e)

Are there telehealth or telemedicine requirements for PAs in Maryland?

Maryland sets no telehealth-specific requirement for PAs in the master regulatory data. Electronic accessibility is how the collaborating physician satisfies the availability standard while off site.

Are there specialty-specific requirements for PAs in Maryland?

Yes, advanced duties require prior Board approval unless the PA has at least 7,000 hours of clinical practice experience or the Board has already approved that PA to perform the duty. Separately, a PA’s practice is limited to what is customary to the specialty of a patient care team physician listed on the collaboration agreement.