A summary of North Carolina’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: Supervisory Arrangement
On-Site Requirements: None
Chart Review: No fixed count
Controlled Substances: Allowed. Requires a valid federal DEA registration; the collaborating physician must hold at least the same schedules as the PA.
Reduced Supervision / Transition Requirements: None
North Carolina PA Collaboration Requirements Summary
North Carolina requires every PA to practice with a primary collaborating (supervising) physician, and a PA cannot begin practice until the Board acknowledges the filing that names that physician. Physician involvement is high at the start of each collaboration — monthly meetings for the first six months — then eases to twice-yearly meetings, though involvement stays high for opioid prescribing. Day-to-day practice is flexible: North Carolina sets no on-site, proximity, or travel requirements, and no limit on how many PAs one physician may collaborate with. PAs cannot practice independently, and the primary collaborating physician remains accountable to the Board for the PA’s medical activities and professional conduct. This page covers North Carolina’s rules on collaboration, the collaborative agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.
Source: N.C. Gen. Stat. § 90-9.3(b)
Type of Collaborative Relationship
North Carolina requires PAs to practice under a primary collaborating physician who is accountable to the Board for the PA’s medical activities and professional conduct. Physician involvement is high during the first six months of each new arrangement and then steps down, but there is no route to independent practice. The PA’s authority comes from what the physician delegates in the written Supervisory Arrangement, and North Carolina sets no limits on physician-to-PA ratios or physical proximity.
Source: 21 NCAC 32S .0213(c)
What is a PA’s scope of practice in North Carolina?
A PA’s scope of practice is the set of medical acts, tasks, and functions the primary collaborating physician delegates in the written Supervisory Arrangement. Delegation must fit the PA’s education, qualification, training, skills, and competence, and must also be appropriate to the collaborating physician’s own skills. The team must identify the PA’s scope of practice in writing.
Do PAs need a collaborating physician in North Carolina?
Yes. Every PA must have a primary collaborating physician, and before starting practice the PA must give the Board that physician’s name, address, and telephone number.
Can PAs practice independently in North Carolina?
No. North Carolina offers no independent or autonomous practice option for PAs, and no transition pathway based on hours or years. The primary collaborating physician stays accountable to the Board at all times, including when a back-up physician is covering.
How many PAs can a physician collaborate with in North Carolina?
There is no specific limit. North Carolina sets no numerical cap; the collaborating physician is expected to provide adequate supervision and comply with all applicable laws and rules.
Who can be a collaborating physician in North Carolina?
North Carolina sets no specific qualification requirements for a primary collaborating physician. A back-up physician, if one is used, must be licensed to practice medicine by the Board, not barred by the Board from supervising a PA, and approved by the primary collaborating physician as willing and qualified to oversee the PA’s medical acts.
Are there proximity or in-person requirements in North Carolina?
No, North Carolina sets no specific requirement. There are no geographic, travel, or on-site presence rules, so remote collaboration is permitted. The team must still define in writing the PA’s relationship with and access to each collaborating physician.
Collaboration Agreement Requirements
North Carolina’s written agreement is called a Supervisory Arrangement, and it is the written statement describing what the physician delegates to the PA. The PA and the collaborating physician both sign it, and any approved back-up physicians sign the back-up list kept with it. North Carolina provides no template and sets no review or renewal schedule, but a copy must be kept on file at every practice site.
Source: 21 NCAC 32S .0201(9)
What must be included in a PA collaborative agreement in North Carolina?
The Supervisory Arrangement must be a written statement describing the medical acts, tasks, and functions the physician delegates to the PA, plus a current signed list of any approved back-up physicians. Separately, the team must document in writing the PA’s scope of practice, the relationship with and access to each collaborating physician, and a process for evaluating the PA’s performance. North Carolina does not provide a state template.
What is the collaborative agreement called in North Carolina?
It is called a Supervisory Arrangement.
Who has to sign the collaborative agreement in North Carolina?
The PA and the collaborating physician must both sign the statement describing the supervisory arrangements. Any approved back-up physician must also sign and date the back-up physician list retained as part of the Supervisory Arrangement.
How often must the agreement be reviewed or renewed in North Carolina?
North Carolina sets no specific review or renewal requirement. The signed statement must be kept on file at all practice sites and made available to the Board on request.
Is a backup physician required in North Carolina?
No, a back-up physician is not required — but if one will be used, they must be identified in advance. All potential back-up physicians must appear on the current, signed back-up list retained as part of the Supervisory Arrangement.
Board Filing Requirements
North Carolina does not require the Supervisory Arrangement itself to be filed, but the PA must submit an Intent to Practice filing naming the collaborating physician before practicing. The PA cannot start on filing alone — the Board must acknowledge that it has received and processed the filing. Changes must be reported within 15 days, and unexpected loss of the collaborating physician has its own short-fuse notice rule.
Source: 21 NCAC 32S .0203(b)
Do you have to file the collaborative agreement with the board in North Carolina?
No, the Supervisory Arrangement itself is not filed with the Board. Before beginning practice, though, the PA must provide the Board with the name, address, and telephone number of the physician who will collaborate with them in that setting, using the Board’s Intent to Practice filing.
Can a PA start practicing as soon as they file in North Carolina?
No. The PA may not commence practice until the Board acknowledges that it has received and processed the Intent to Practice filing.
What are the termination and notice requirements in North Carolina?
The PA must notify the Board of any change to the filed information within 15 days. If the collaborating physician becomes unavailable unexpectedly — injury, sudden illness, death, or similar — the PA must notify the Board within two business days and may be granted up to 30 days to file for a new primary collaborating physician; without that filing, the PA can no longer practice at the affected site.
Collaboration Compliance
Once the collaboration is active, the main ongoing obligation is a required meeting cadence: monthly for the first six months, then at least every six months. Each meeting must be documented in a written record signed by both clinicians. North Carolina does not require chart review or chart co-signature, but the team must have an evaluation process and the physician must periodically review the drugs the PA prescribes.
Source: 21 NCAC 32S .0213(e)
How many charts must a collaborating physician review in North Carolina?
There is no fixed chart count — North Carolina does not require routine chart review. The team must establish a process for evaluating the PA’s performance, and the physician must maintain a written policy for periodically reviewing the drugs the PA prescribes. Chart co-signature is not required.
How often must a PA and collaborating physician meet in North Carolina?
Monthly for the first six months of a new practice arrangement, then at least once every six months. Meetings must cover practice-relevant clinical issues and quality improvement measures.
How long must collaboration records be kept in North Carolina?
North Carolina sets no specific retention period. A written record of each required meeting — signed and dated by both clinicians and describing the clinical issues discussed and the quality improvement measures taken — must be kept and made available to the Board on request, and the signed Supervisory Arrangement must stay on file at all practice sites.
Prescribing Rules
PAs in North Carolina may prescribe, including controlled substances, once the collaborating physician has provided written instructions on indications and contraindications and a written policy for periodic review of the drugs prescribed. Controlled-substance prescribing requires a valid federal DEA registration, and the collaborating physician must hold at least the same schedules as the PA. Targeted controlled substances — Schedule II and III opioids — carry extra consultation requirements.
Source: N.C. Gen. Stat. § 90-18.1(b)
Can a PA prescribe controlled substances in North Carolina?
Yes, with a valid federal DEA registration and in accordance with DEA rules. The collaborating physician must possess at least the same schedules of controlled substances as the PA’s DEA registration.
Can a PA prescribe Schedule II drugs in North Carolina?
Yes — North Carolina’s PA rules do not restrict PAs to particular schedules. A PA’s authority is bounded by their own DEA registration and by the schedules the collaborating physician holds. Additional consultation rules apply to targeted controlled substances, which include Schedule II and III opioids.
What schedule drugs can a PA prescribe in North Carolina?
PAs may prescribe drugs generally, including controlled substances in whichever schedules their own DEA registration covers. The collaborating physician must hold at least those same schedules. North Carolina adds no separate schedule-based limit and no special prescription-pad requirement.
Does a PA need a DEA license in North Carolina?
Yes, a valid federal DEA registration is required to prescribe controlled substances. North Carolina defers to DEA rules and does not add a separate state controlled-substances registration for PAs.
Can a PA prescribe independently (without physician sign-off) in North Carolina?
No. A PA may prescribe only after the collaborating physician has provided written instructions on indications and contraindications and a written policy for periodic review of the drugs prescribed, and the physician’s own controlled-substance schedules cap the PA’s. Individual prescriptions do not need physician sign-off, but the PA must personally consult the physician before prescribing a targeted controlled substance at a facility that primarily treats pain with narcotics when use is expected to exceed 30 days, and at least every 90 days when such a prescription continues.
Specialty & Telehealth Requirements
North Carolina sets no telehealth-specific or specialty-specific requirements for PAs. Standard collaboration, agreement, filing, compliance, and prescribing rules apply the same way whether care is delivered in person or remotely, and regardless of specialty.
Source: 21 NCAC 32S .0213 (general collaboration requirements; North Carolina’s PA rules contain no specialty- or telehealth-specific provision)
Are there telehealth or telemedicine requirements for PAs in North Carolina?
No, North Carolina sets no specific telehealth or telemedicine requirement for PAs. The state’s general collaboration rules apply, and because there are no on-site or proximity requirements, no telehealth exemption is needed.
Are there specialty-specific requirements for PAs in North Carolina?
No, North Carolina sets no specialty-specific requirement for PAs. The added consultation rules for targeted controlled substances at pain-management facilities are the closest thing, and they attach to the prescription rather than to a specialty.
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