A summary of Ohio’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for NPs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: Standard
Agreement Name: Standard Care Arrangement
On-Site Requirements: None.
Chart Review: Required at least annually as part of a quality assurance process; no fixed number of charts.
Controlled Substances: Yes, with a federal DEA registration. Schedule II is limited to narrow circumstances.
Reduced Supervision / Transition Requirements: None.
Ohio NP Collaboration Requirements Summary
Ohio requires an NP to practice under a written standard care arrangement with at least one collaborating physician (or podiatrist) whose practice is the same as or similar to the NP’s. The collaborating physician does not have to be on-site, but must be continuously available to communicate in person or electronically. Ohio does not offer a path to fully independent practice; the collaborative relationship is required throughout an NP’s career.
Source: ORC 4723.431(A)(1)
Type of Collaborative Relationship
Ohio requires every practicing NP to have a collaborating physician through a written standard care arrangement, with no option for independent practice. The physician does not need to be physically present but must be continuously available for communication, and a single physician may collaborate with a limited number of NPs. There is no transition period or hours requirement that leads to reduced supervision.
Source: ORC 4723.431(A)
What is an NP’s scope of practice in Ohio?
An Ohio NP provides nursing care within their certified specialty and may diagnose, treat, and prescribe as authorized under a standard care arrangement with a collaborating physician. The specific services offered must be described in that arrangement, consistent with the NP’s certification.
Do NPs need a collaborating physician in Ohio?
Yes. Ohio NPs must practice under a written standard care arrangement with one or more collaborating physicians (or podiatrists) whose practice is the same as or similar to the NP’s.
Can NPs practice independently in Ohio?
No. Ohio has no path to independent practice; a standard care arrangement with a collaborating physician is required throughout an NP’s career.
How many NPs can a physician supervise in Ohio?
A physician may collaborate with no more than five NPs at the same time in the prescribing component of their practices. Ohio sets no cap on collaboration outside the prescribing component.
Who can be a collaborating physician in Ohio?
The collaborating physician must be licensed in Ohio and practicing in a specialty that is the same as or similar to the NP’s. Psychiatric-mental health NPs may instead collaborate with a physician in psychiatry, pediatrics, or primary care/family practice.
Are there proximity or in-person requirements in Ohio?
No. The collaborating physician must be continuously available to communicate with the NP in person or by electronic communication, but Ohio sets no on-site or geographic proximity requirement.
Collaboration Agreement Requirements
Ohio calls the written agreement a standard care arrangement, and it must contain a defined set of items covering referral, consultation, coverage during absences, dispute resolution, prescribing quality assurance, and signatures. Both the NP and the collaborating physician (or the physician’s designated representative) must sign it. Ohio does not provide a template.
Source: ORC 4723.431(B); OAC 4723-8-04(D)
What must be included in an NP collaborative agreement in Ohio?
The standard care arrangement must include criteria for patient referral, a consultation process, a coverage plan for absences, a dispute-resolution process, the collaborating physician’s agreement to sign death certificates, a statement of the NP’s services and prescriptive scope, quality assurance provisions (including chart review and controlled-substance provisions), and the signatures and dates of the parties.
What is the collaborative agreement called in Ohio?
It is called a standard care arrangement.
Who has to sign the collaborative agreement in Ohio?
Both the NP and each collaborating physician must sign, indicating review of and agreement to the terms. A physician’s designated representative (a department or unit director/chair in the same specialty, with legal authorization) may sign on the physician’s behalf.
How often must the agreement be reviewed or renewed in Ohio?
Ohio sets no fixed review or renewal interval, but the standard care arrangement must include the date of its most recent review.
Is a backup physician required in Ohio?
No specific backup physician is required, but the arrangement must include a coverage plan ensuring a physician (or podiatrist) is available for emergency care during planned or emergency absences of either party.
Board Filing Requirements
The standard care arrangement itself does not have to be filed with or pre-approved by the Board of Nursing, but the NP must submit the collaborating physician’s name and business address to the board within 30 days of first practicing. The NP may begin practicing without waiting for board approval. Changes and terminations carry their own notice deadlines.
Source: ORC 4723.431(A)(1)
Do you have to file the collaborative agreement with the board in Ohio?
No. Prior board approval of the standard care arrangement is not required, though the board may periodically review it for compliance. The NP must, however, submit each collaborating physician’s name and business address to the board within 30 days of first engaging in practice.
Can an NP start practicing as soon as they file in Ohio?
Yes. The NP may begin practicing and then submit the collaborating physician’s name and business address to the board within 30 days of starting.
What are the termination and notice requirements in Ohio?
The NP must notify the board of any additions or deletions of collaborating physicians within 30 days of the change. If a physician terminates the collaboration, the physician must give the NP written or electronic notice, and the NP must then notify the board as soon as practicable by submitting a copy of that notice. If a collaboration ends due to the physician’s termination notice or death, the NP may continue practicing under the existing arrangement without a collaborating physician for up to 120 days.
Collaboration Compliance
Once a standard care arrangement is active, Ohio requires participation in a quality assurance process that includes periodic chart review, an opportunity to discuss feedback, and a patient-evaluation process. Chart review must occur at least annually, and the NP must be able to discuss the results with the collaborating physician. Past agreements must be retained for three years.
Source: OAC 4723-8-05(C)
How many charts must a collaborating physician review in Ohio?
Ohio does not set a fixed number of charts. It requires periodic random chart review — including prescribing patterns and any Schedule II prescribing — at least annually by the collaborating physician or a designated quality-assurance committee member.
How often must an NP and collaborating physician meet in Ohio?
Ohio does not set a fixed meeting cadence, but the quality assurance process must give the NP and collaborating physician an opportunity to discuss feedback or issues following chart review.
How long must collaboration records be kept in Ohio?
Copies of previously effective standard care arrangements must be kept by the NP for three years and provided to the board on request. The employer must keep the most current arrangement on file.
Prescribing Rules
Ohio NPs may prescribe within a prescriptive authority that cannot exceed that of their collaborating physician, and controlled-substance prescribing requires a federal DEA registration. Schedule II prescribing is sharply limited: it is generally allowed only for terminal patients as a continuation of a physician-initiated prescription and for amounts not exceeding a single 72-hour supply. NPs must also review OARRS (the state prescription-monitoring database) reports for reported drugs.
Source: ORC 4723.481; OAC 4723-9-10
Can an NP prescribe controlled substances in Ohio?
Yes, with a federal DEA registration, and the NP’s prescriptive authority cannot exceed that of the collaborating physician. Ohio also requires OARRS (prescription-monitoring) review for reported drugs.
Can an NP prescribe Schedule II drugs in Ohio?
Yes, but only in narrow circumstances. Generally, an NP may prescribe a Schedule II controlled substance only when the patient has a terminal condition, a physician initially prescribed the substance, and the prescription does not exceed the amount needed for a single 72-hour period.
What schedule drugs can an NP prescribe in Ohio?
An Ohio NP may prescribe drugs within a prescriptive authority that does not exceed the collaborating physician’s, including controlled substances with a DEA registration. Schedule II is restricted to the limited terminal-patient continuation circumstances described above.
Does an NP need a DEA license in Ohio?
Yes. To prescribe controlled substances, an Ohio NP must obtain a federal DEA registration and include the number on the prescription (except where DEA registration is not required under Board of Pharmacy rules).
Can an NP prescribe independently in Ohio?
No. Prescribing occurs under the standard care arrangement, and the NP’s prescriptive authority cannot exceed that of the collaborating physician. Narrow situations also require prior physician consultation, such as certain pain treatments.
Specialty & Telehealth Requirements
Ohio’s main specialty-related rule is that psychiatric-mental health NPs may collaborate with a physician in psychiatry, pediatrics, or primary care/family practice. Ohio is silent on whether the collaborating physician is legally responsible for the NP’s care.
Source: ORC 4723.431(A)(2); OAC 4723-8-04(C)
Are there telehealth or telemedicine requirements for NPs in Ohio?
No. Ohio sets no telehealth-specific collaboration requirement for NPs.
Are there specialty-specific requirements for NPs in Ohio?
Ohio sets no general specialty-specific requirement, but psychiatric-mental health NPs may collaborate only with a physician (not a podiatrist) practicing in psychiatry, pediatrics, or primary care/family practice.
How do you verify a collaborating physician’s license in Ohio?
The collaborating physician must be authorized to practice in Ohio, and their license can be verified through the State Medical Board of Ohio’s public license lookup.
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