South Carolina PA Collaboration Requirements Summary

South Carolina requires every PA to practice with a named supervising physician, and that physician must notify the Board of the proposed relationship and file the PA’s scope of practice guidelines before the PA starts. Involvement is standard once a PA is established, but it starts higher: a PA with less than two years of continuous practice, or one changing specialties, must spend 60 days working on-site with the supervising physician before practicing at a separate location. That 60-day period can be waived in writing by the physician. Filing is unusually forgiving in one respect — the PA may begin practicing 10 business days after the guidelines are submitted and continue until the Board makes a final decision. This page covers South Carolina’s rules on collaboration, the scope of practice guidelines, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: S.C. Code § 40-47-938(A)

Type of Collaborative Relationship

South Carolina requires PAs to practice under a supervising physician at all times, with no route to independent practice. Involvement is standard day to day, with a front-loaded on-site period for PAs who are new to practice or new to a specialty. A PA’s authority comes from the written scope of practice guidelines filed with the Board, and a physician may work with no more than the equivalent of six full-time advanced practice providers at a time.

Source: S.C. Code § 40-47-195(D)(1)

What is a PA’s scope of practice in South Carolina?

A PA’s scope of practice is what the written scope of practice guidelines set out. Those guidelines specify the medical conditions for which therapies may be initiated, continued, or modified, the treatments the PA may provide, and any drug therapy by drug-specific classification. They must also identify the situations that require direct evaluation by, or immediate referral to, the supervising physician.

Do PAs need a collaborating physician in South Carolina?

Yes. Every PA must have a named supervising physician, and that physician must notify the Board in writing of the proposed supervisory relationship and submit the PA’s proposed scope of practice guidelines.

Can PAs practice independently in South Carolina?

No. South Carolina has no independent or autonomous practice option for PAs. Reaching two years of continuous practice lifts the 60-day on-site requirement, but it does not remove the need for a supervising physician, who maintains responsibility for the health care delivery team.

How many PAs can a physician collaborate with in South Carolina?

A physician may not hold scope of practice guidelines or practice agreements with more than the equivalent of six full-time advanced practice providers. That limit counts PAs, nurse practitioners, certified nurse midwives, and clinical nurse specialists together, and the physician also may not work with more than six such individuals providing clinical services at any one time. The Board may approve an exception on application by the physician.

Who can be a collaborating physician in South Carolina?

The supervising physician must hold permanent, active, and unrestricted authorization to practice medicine in South Carolina and be actively practicing medicine within the state. The physician cannot agree to oversee a medical act, task, or function that falls outside their own usual practice, training, or experience, though the Board may approve an exception where it finds quality of care and patient safety will be maintained.

Are there proximity or in-person requirements in South Carolina?

Yes, for newer PAs. A PA with less than two years of continuous practice, or one who is changing specialties, may not practice at a location off-site from the supervising physician until completing 60 days of on-site clinical experience with that physician. The supervising physician may waive that requirement, in whole or in part, in writing on a board-approved form submitted to the Board.

Collaboration Agreement Requirements

South Carolina’s written agreement is called the scope of practice guidelines, and the state provides both a template and a guidelines addendum. The PA and the supervising physician sign it. Copies must be on file at all practice sites, and while South Carolina sets no fixed review schedule, any change to the PA’s scope must be submitted to the Board.

Source: S.C. Code § 40-47-960(A)

What must be included in a PA collaborative agreement in South Carolina?

The guidelines must include the name, license number, and practice addresses of all supervising physicians, the name and practice address of the PA, and the date the guidelines were developed along with every date they were reviewed or amended. They must also set out the medical conditions for which therapies may be initiated, continued, or modified, the treatments allowed, and any drug therapy by drug-specific classification. Finally, they must name the situations requiring direct evaluation by or immediate referral to the physician, including authorization for Schedule II controlled substance prescriptions.

What is the collaborative agreement called in South Carolina?

It is called the scope of practice guidelines. South Carolina provides a template and an accompanying guidelines addendum.

Who has to sign the collaborative agreement in South Carolina?

The PA and the supervising physician must both sign.

How often must the agreement be reviewed or renewed in South Carolina?

South Carolina sets no specific review or renewal requirement. The guidelines must record the date they were developed and each date they were reviewed or amended. Any requested change to the PA’s scope must be submitted to the Board in writing, with documentation of the PA’s competence to perform the added acts.

Is a backup physician required in South Carolina?

No — South Carolina sets no specific backup physician requirement. Naming alternate supervising physicians carries a practical benefit, though: if the supervisory relationship ends, a current alternate may serve as supervising physician under the existing guidelines for up to 90 days after the Board is notified, while a new physician is designated and new guidelines are approved.

Board Filing Requirements

South Carolina requires the scope of practice guidelines to be filed — the supervising physician notifies the Board in writing of the proposed relationship and submits the proposed guidelines. The PA cannot start immediately, but does not have to wait for a decision either: practice may begin 10 business days after submission and continue until the Board rules. Termination must be reported to the Board immediately by both parties.

Source: S.C. Code § 40-47-938(B)

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

Yes. The supervising physician must notify the Board in writing of the proposed supervisory relationship and include the proposed scope of practice guidelines. No additional documents are required at filing.

Can a PA start practicing as soon as they file in South Carolina?

Not immediately — but the PA does not have to wait for Board approval. The PA may begin clinical practice with the named supervising physician and alternate physicians ten business days after the scope of practice guidelines are submitted, and may continue until the Board makes a final determination. The same ten-business-day rule applies to amendments adding new acts, tasks, or functions.

What are the termination and notice requirements in South Carolina?

If the supervisory relationship ends for any reason, both the PA and the supervising physician must inform the Board immediately in writing, including the reasons for the termination. After that notification, a current alternate supervising physician may serve under the existing scope of practice guidelines for up to 90 days, until a new supervising physician is designated and new guidelines are approved.

Collaboration Compliance

South Carolina’s ongoing obligations center on chart review for PAs practicing off-site from their supervising physician. There is no meeting cadence, no availability standard, and no separate documentation or retention rule. The heightened piece is prescribing: consultation with and approval by the physician must be documented in the patient’s chart for Schedule II prescriptions after the first one and for any continuing drug therapy.

Source: S.C. Code § 40-47-955(C)

How many charts must a collaborating physician review in South Carolina?

There is no fixed chart count. When a PA practices off-site from the supervising physician, that physician or an alternate must review, initial, and date the PA’s charts periodically, at the frequency written into the scope of practice guidelines, to ensure quality of care and patient safety. South Carolina’s chart review rule addresses off-site practice specifically and sets no percentage or numeric target.

How often must a PA and collaborating physician meet in South Carolina?

South Carolina sets no specific meeting requirement. There is also no availability standard dictating how reachable the supervising physician must be during practice hours.

How long must collaboration records be kept in South Carolina?

South Carolina sets no specific retention period and no separate supervision documentation requirement. Copies of the scope of practice guidelines must be on file at all practice sites. Physician consultation and approval must be documented in the patient’s chart for any Schedule II prescription after the initial one and for any prescription continuing drug therapy.

Prescribing Rules

PAs in South Carolina may prescribe the drug therapy written into their scope of practice guidelines by drug-specific classification, and must hold a valid federal DEA registration and prescribe in accordance with DEA rules. South Carolina adds no other requirements for prescriptive authority. Schedule II is the tightly controlled piece: only orally administered drugs qualify, the physician must have expressly approved that authority in the guidelines, and the PA must have directly evaluated the patient.

Source: S.C. Code § 40-47-965(A)(6)

Can a PA prescribe controlled substances in South Carolina?

Yes, with a valid federal DEA registration and prescribing in accordance with DEA rules. What a PA may prescribe is bounded by the drug-specific classifications written into their scope of practice guidelines.

Can a PA prescribe Schedule II drugs in South Carolina?

Yes, but only orally administered Schedule II drugs, and only where the supervising physician expressly approved that authority in the written scope of practice guidelines. The PA must have directly evaluated the patient, unless the PA is taking calls for the supervising or alternate physician treating that patient. An initial Schedule II narcotic prescription is capped at a five-day supply, and any authorization after that must be in consultation with and approved by the supervising physician, documented in the patient’s chart.

What schedule drugs can a PA prescribe in South Carolina?

A PA may prescribe the drug therapy set out in their scope of practice guidelines by drug-specific classification. Schedule II is limited to orally administered drugs under the conditions above; South Carolina sets no separate schedule-by-schedule list beyond that. Prescriptions must be written on a preprinted form carrying both the PA’s and the supervising physician’s name, address, and phone number.

Does a PA need a DEA license in South Carolina?

Yes — a PA must have a valid DEA registration and prescribe in accordance with DEA rules. South Carolina does not add a separate state controlled substances registration for PAs.

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

No. Prescribing is limited to the drug classifications the supervising physician approved in the scope of practice guidelines. Routine prescriptions do not require individual sign-off, but any Schedule II prescription after the initial one, and any prescription continuing drug therapy, requires consultation with and approval by the supervising physician documented in the patient’s chart.

Specialty & Telehealth Requirements

South Carolina sets no telehealth-specific or specialty-specific requirements for PAs. The standard collaboration, agreement, filing, compliance, and prescribing rules apply the same way regardless of specialty or how care is delivered.

Source: S.C. Code Title 40, Ch. 47 (Physician Assistants Practice Act; South Carolina sets no specialty- or telehealth-specific provision for PAs)

Are there telehealth or telemedicine requirements for PAs in South Carolina?

No — South Carolina sets no specific telehealth or telemedicine requirement for PAs. Note that the 60-day on-site requirement for PAs with less than two years of practice carries no telehealth exemption, so remote-only work does not remove it.

Are there specialty-specific requirements for PAs in South Carolina?

No — South Carolina sets no specialty-specific requirement for PAs. Specialty still shapes the arrangement in two ways: a physician cannot oversee acts outside their own usual practice, training, or experience, and a PA changing specialties must complete the 60-day on-site period again regardless of how long they have practiced.