Tennessee PA Collaboration Requirements Summary

Tennessee requires every PA to practice in collaboration with a licensed physician who has control of and responsibility for the services the PA provides. Involvement is among the highest of any state: the physician must be reachable for consultation at all times, personally review at least a fifth of the PA’s charts every month, review certain charts in full within 10 business days, and physically visit any remote practice site every 30 days. Some of those site visits can be handled by secure video — up to 10 a year in most settings, and all of them for PAs working solely via telehealth or in certain clinic types. The written protocol that defines the PA’s services is not filed with the Board, but the PA must report their collaborating physician, and cannot begin practicing until that physician validates the relationship online. This page covers Tennessee’s rules on collaboration, the protocol, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: Tenn. Code Ann. § 63-19-106(b)

Type of Collaborative Relationship

Tennessee requires PAs to practice in collaboration with a licensed physician at all times, with no route to independent practice. Involvement is high and hands-on: the physician must be available for consultation at all times, review charts on a fixed schedule, and travel to any remote site the PA works from at least monthly. A PA’s authority is the range of services written into a jointly developed protocol, and Tennessee sets no numerical cap on how many PAs one physician may collaborate with.

Source: Tenn. Code Ann. § 63-19-106(a)(4)

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

A PA’s scope of practice is the range of services set out in the written protocol jointly developed by the PA and the collaborating physician. A PA may perform only tasks that fall within their own range of skills and competence, that are within the collaborating physician’s usual scope of practice, and that are consistent with protecting patients’ health and wellbeing.

Do PAs need a collaborating physician in Tennessee?

Yes. A PA must at all times practice in collaboration with a licensed physician who has control of and responsibility for the services the PA provides.

Can PAs practice independently in Tennessee?

No. Tennessee has no independent or autonomous practice option for PAs, and no hours- or years-based pathway that reduces oversight over time.

How many PAs can a physician collaborate with in Tennessee?

Tennessee sets no numerical limit. The number is determined by the physician at the practice level, consistent with good medical practice.

Who can be a collaborating physician in Tennessee?

The collaborating physician must be licensed in Tennessee to practice medicine and surgery, osteopathic medicine, or podiatry. That physician — and any substitute physician — must have experience or expertise in the same area of medicine as the PA. The PA’s tasks must also fall within the collaborating physician’s usual scope of practice.

Are there proximity or in-person requirements in Tennessee?

Yes — the collaborating physician must visit any remote site at least once every 30 days. Up to 10 of those required visits in a rolling 12-month period may be conducted by secure, HIPAA-compliant electronic means; the remainder must take place in person at the clinic. PAs practicing solely via telehealth, or in a community mental health center, federally qualified health center, or free or reduced-fee clinic, may have all required visits and chart reviews handled electronically.

Collaboration Agreement Requirements

Tennessee’s written agreement is called a protocol, and it must be jointly developed and approved by the PA and the collaborating physician. There is no state template. Both sign and date it, it must be reviewed at least every two years, and it must be maintained at the PA’s practice location and made available for board inspection on request.

Source: Tenn. R. & Regs. 0880-02-.18(5)

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

The protocol must set out the range of services the PA may provide, discuss the problems and conditions the PA is likely to encounter along with the appropriate treatment for them, and outline the applicable standard of care. It must also account for all protocol drugs through an appropriate formulary, be specific to the patient population seen, and be dated and signed by both clinicians. Tennessee provides no sample form or template.

What is the collaborative agreement called in Tennessee?

It is called a protocol, or written protocol. Tennessee does not use the term collaborative agreement in its PA rules.

Who has to sign the collaborative agreement in Tennessee?

The PA and the collaborating physician must both sign, and the protocol must be dated.

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

At least every two years. The protocol must be reviewed and updated biennially by both the PA and the collaborating physician.

Is a backup physician required in Tennessee?

Yes. The collaborating physician must designate one or more alternate physicians who have agreed in advance to take on responsibility for collaborating with the PA during the collaborating physician’s absence. Tennessee does not require those alternates to be named in the protocol itself, but any substitute must have experience or expertise in the same area of medicine as the PA.

Board Filing Requirements

Tennessee does not require the protocol to be filed, but the PA does have to report their collaborating physician to the Board of Physician Assistants. A PA cannot begin practicing on the strength of that notice alone — the collaborating physician must validate the relationship in the Board’s online portal first. Changes in the primary collaborating physician carry a 15-day reporting deadline.

Source: Tenn. Code Ann. § 63-19-107(1)

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

No — the protocol itself is not filed. It is maintained at the PA’s practice location and made available on request. What the PA must file is notice of the primary collaborating physician’s name, address, and license number, plus a Notice of Authorization for Prescribing where prescriptive authority has been delegated.

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

No. The collaborating relationship is not validated until the collaborating physician validates it in the Board’s online portal, so filing alone is not enough to begin practice.

What are the termination and notice requirements in Tennessee?

The PA must notify the Board of Physician Assistants of a change in primary collaborating physician within 15 days of the change. Tennessee provides no grace period allowing a PA to keep practicing if the collaborating physician unexpectedly becomes unavailable — though the required alternate physician arrangement is designed to cover absences.

Collaboration Compliance

Chart review is the center of Tennessee’s ongoing obligations: at least 20% of the PA’s charts every 30 days, plus complete review of certain charts within 10 business days. Alongside that, the collaborating physician must be available for consultation at all times or arrange for a substitute physician, and must visit any remote practice site at least monthly. Tennessee requires no separate chart co-signature and sets no documentation or retention rule.

Source: Tenn. R. & Regs. 0880-02-.18(7),(8)

How many charts must a collaborating physician review in Tennessee?

At least 20% of the charts monitored or written by the PA every 30 days. On top of that baseline, the physician must personally review the full record within 10 business days — and certify that review in the patient’s chart within 30 days — whenever review is medically indicated, the patient requests it, a prescription falls outside the protocol, the prescriber is a PA holding a temporary license, or a controlled drug has been prescribed. Separate chart co-signature is not required.

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

Tennessee sets no separate meeting cadence, but it does require monthly site visits. The collaborating physician must visit any remote site at least once every 30 days, with up to 10 of those annual visits permitted by secure electronic means and the rest in person. The physician must also be available for consultation at all times, or arrange for a substitute physician to be available.

How long must collaboration records be kept in Tennessee?

Tennessee sets no specific retention period and no separate supervision documentation requirement. The protocol must be maintained at the PA’s practice location and made available on request to the Board of Medical Examiners, the Board of Physician Assistants, or their authorized agents.

Prescribing Rules

PAs in Tennessee may prescribe legend drugs and controlled substances where the collaborating physician has delegated that authority, and must file notice of the delegation with the Board. Controlled substance prescribing requires DEA registration and compliance with all applicable DEA requirements. Schedules II through IV carry a significant condition: the PA cannot prescribe them unless the drug is specifically authorized by the formulary in the protocol, or the physician expressly approves after consultation before the first prescription.

Source: Tenn. Code Ann. § 63-19-107(2)(B)

Can a PA prescribe controlled substances in Tennessee?

Yes, where the collaborating physician has delegated that authority. The PA must register with and comply with all applicable DEA requirements, and must file a notice with the Board of Physician Assistants identifying the PA and the delegating physician.

Can a PA prescribe Schedule II drugs in Tennessee?

Yes, but only under a condition. A PA may not prescribe Schedule II, III, or IV controlled substances unless the prescription is specifically authorized by the formulary in the protocol, or expressly approved by the collaborating physician after consultation before the first prescription or dispensing. Schedule II and III opioids on the formulary are further limited to a nonrefillable 30-day course of treatment unless specifically approved after consultation — a limit that does not apply to prescriptions issued in a hospital, a licensed nursing home, or certain licensed inpatient facilities.

What schedule drugs can a PA prescribe in Tennessee?

Legend drugs and controlled substances, to the extent the collaborating physician delegates that authority. Schedules II through IV carry the formulary-or-consultation condition described above, and Schedule II and III opioids carry the 30-day course limit. Prescriptions must be written on a preprinted prescription pad bearing the collaborating physician’s name, address, and telephone number.

Does a PA need a DEA license in Tennessee?

Yes — a PA delegated authority to prescribe or issue controlled substances must register with and comply with all applicable DEA requirements. Tennessee refers to the DEA’s requirements rather than setting up a separate state controlled substances registration for PAs.

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

No. A PA prescribes only what the collaborating physician has delegated, and Schedules II through IV require either formulary authorization or the physician’s express approval after consultation before the first prescription. Individual prescriptions do not need co-signature, but any chart in which a controlled drug was prescribed must be personally reviewed by the physician within 10 business days.

Specialty & Telehealth Requirements

Tennessee has one specialty-specific rule for PAs, covering invasive spinal procedures, and no telehealth-specific practice requirements. Telehealth does change how oversight can be delivered, though — a PA practicing solely via telehealth may have all required site visits and chart reviews handled electronically.

Source: Tenn. Code Ann. § 63-19-107(5)

Are there telehealth or telemedicine requirements for PAs in Tennessee?

No — Tennessee sets no telehealth-specific practice requirement for PAs. Telehealth does affect oversight logistics: a PA practicing solely via telehealth may have all required remote-site visits and chart reviews conducted by secure, HIPAA-compliant electronic means rather than in person.

Are there specialty-specific requirements for PAs in Tennessee?

Yes — invasive spinal procedures carry an on-site requirement. In settings not licensed as health care facilities, a PA may perform invasive procedures involving the spine, spinal cord, sympathetic nerves of the spine, or a block of major peripheral nerves of the spine only when a qualifying Tennessee physician is physically present in the same building; that physician must be actively practicing spinal injections and hold current privileges to do so at a licensed facility. The rule does not apply to major joint injections other than sacroiliac injections, or to soft tissue injections or epidurals for surgical anesthesia or labor analgesia in unlicensed settings.