Virginia PA Collaboration Requirements Summary

Virginia requires PAs to practice as part of a patient care team with a patient care team physician or podiatrist, though several settings are exempt from needing a separate written agreement. Involvement is standard: the physician must be available at all times to collaborate and consult, and must periodically review the PA’s charts on a schedule the practice agreement itself sets, scaled to how sick the patients are and where the care happens. Nothing is filed — Virginia stopped requiring practice agreements to be submitted for approval, so there is no waiting period and no termination notice. The agreement is unusually flexible in form: Virginia requires no signatures, permits electronic storage, and allows it to live inside credentialing documents or practice protocols. This page covers Virginia’s rules on collaboration, the practice agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: Va. Code Ann. § 54.1-2952(B)

Type of Collaborative Relationship

Virginia requires PAs to practice as part of a patient care team led by a patient care team physician or podiatrist, with no route to independent practice. Involvement is standard rather than heavy: the physician must be reachable at all times to collaborate and consult, but Virginia sets no on-site requirement and no meeting cadence. A PA’s scope of practice is identified by the team and written into the practice agreement, and one physician may work with no more than six PAs at a time. Virginia also states directly that serving on a patient care team does not, by itself, make one team member legally responsible for another member’s actions or inactions.

Source: Va. Code Ann. § 54.1-2952(A)

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

A PA’s scope of practice is identified by the patient care team and set out in the practice agreement. The agreement must take into account the PA’s level of competence, the number of patients, the types of illness the physicians or podiatrists treat, the nature of the treatment, any special procedures, and the physician’s availability — so that physician involvement starts early and continues regularly.

Do PAs need a collaborating physician in Virginia?

Yes in most settings, though not every setting requires a separate written agreement. Every PA practices as part of a patient care team with a patient care team physician or podiatrist. PAs employed by a hospital, a state behavioral health facility, or a federally qualified health center may practice without a separate practice agreement where the facility’s credentialing and privileging requirements incorporate the same components, and PAs appointed as medical examiners need no practice agreement at all.

Can PAs practice independently in Virginia?

No. Virginia has no independent or autonomous practice option for PAs and no transition pathway that reduces oversight over time. Even in the facility settings where a separate practice agreement is not required, the PA continues to practice as part of a patient care team, in collaboration and consultation with a patient care team physician or podiatrist.

How many PAs can a physician collaborate with in Virginia?

No more than six at any one time. A patient care team physician or patient care team podiatrist may not collaborate or consult with more than six PAs on a patient care team at any one time.

Who can be a collaborating physician in Virginia?

Virginia sets no specific qualification requirements for a patient care team physician. Podiatrists may serve in the same role as patient care team members. One practical limit does apply where the PA prescribes: the schedules and categories of drugs and devices in the agreement must fall within the patient care team physicians’ or podiatrists’ own scope of practice and proficiency.

Are there proximity or in-person requirements in Virginia?

No — Virginia sets no geographic, travel, or on-site presence requirement. What Virginia does require is availability: the patient care team physician or podiatrist must be available at all times to collaborate and consult with the PA. A practice agreement may optionally provide for periodic site visits at a location where the physician does not regularly practice, in the manner and at the frequency that physician determines.

Collaboration Agreement Requirements

Virginia’s written agreement is called a practice agreement, and the state provides a template. It is unusually flexible in form — Virginia requires no signatures, no backup physician, and no set review schedule, and the agreement may be kept in writing or electronically and may be folded into credentialing documents, practice protocols, or procedures. What Virginia does require is that the PA maintain evidence of the agreement and produce it to the Board on request.

Source: Va. Code Ann. § 54.1-2951.1(C)

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

The practice agreement must provide for periodic review of patient charts or electronic health records, set guidelines for how collaboration and consultation will happen among the parties and the patient, provide for periodic joint evaluation of the services delivered, and cover appropriate physician input in complex clinical cases, patient emergencies, and referrals. It must also include an evaluation process for the PA’s performance that specifies the time period — proportionate to the acuity of care and the practice setting — within which the physician reviews the record of services the PA rendered. If the PA prescribes, the agreement must list the schedules and categories of drugs and devices that fall within the patient care team physicians’ or podiatrists’ scope of practice and proficiency.

What is the collaborative agreement called in Virginia?

It is called a practice agreement. Virginia provides a template.

Who has to sign the collaborative agreement in Virginia?

Virginia sets no signature requirement for the practice agreement. The PA must be able to produce evidence of the agreement to the Board on request, whether it is kept in writing or electronically.

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

Virginia sets no specific review or renewal requirement. The agreement itself must, however, build in periodic joint evaluation of the services delivered and an evaluation process for the PA’s performance.

Is a backup physician required in Virginia?

No — Virginia sets no specific backup or alternate physician requirement. Virginia also provides no grace period if the patient care team physician unexpectedly becomes unavailable.

Board Filing Requirements

Virginia requires no board filing for PAs. The Board no longer requires practice agreements to be submitted for approval before a PA begins practicing, no supplemental documents are required, there is no recurring filing, and no notice is owed when a collaboration ends. The one standing obligation is that the PA must maintain evidence of the practice agreement and provide it to the Board on request.

Source: Va. Code Ann. § 54.1-2951.1(D)

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

No. The Board no longer requires practice agreements to be submitted for approval prior to practicing. The PA must maintain evidence of the agreement — in writing or electronically — and provide it to the Board on request.

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

There is no filing step in Virginia, so there is no waiting period tied to one. A licensed PA may practice once a practice agreement is in place, or, in a qualifying facility, once the credentialing arrangement covers the required components.

What are the termination and notice requirements in Virginia?

Virginia sets no termination or notice requirement. There is no obligation to notify the Board when a practice agreement ends, and Virginia provides no grace period allowing a PA to keep practicing if the patient care team physician becomes unavailable.

Collaboration Compliance

Virginia’s ongoing obligations come down to two things: the patient care team physician must be available at all times to collaborate and consult, and must periodically review the PA’s charts on a timeline the practice agreement sets. Beyond that, Virginia requires no meeting cadence, no chart co-signature, and no separate documentation or retention rule. The agreement must also build in a joint evaluation of the services delivered and an evaluation process for the PA’s performance.

Source: 18VAC85-50-101(A)

How many charts must a collaborating physician review in Virginia?

There is no fixed chart count, but review is required. The practice agreement must provide for periodic review of patient charts or electronic health records, and must specify the time period within which the physician reviews the record of services the PA rendered — a period that has to be proportionate to the acuity of care and the practice setting. Chart co-signature is not required.

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

Virginia sets no specific meeting requirement. The patient care team physician or podiatrist must be available at all times to collaborate and consult with the PA. The practice agreement must also provide for periodic joint evaluation of the services delivered and an evaluation process for the PA’s performance.

How long must collaboration records be kept in Virginia?

Virginia sets no specific retention period and no separate supervision documentation requirement. The PA must maintain evidence of the practice agreement and provide it to the Board on request. Where a PA performs invasive procedures, the physician’s attestation form for each procedure is kept by the parties and made available to the Board on request rather than filed.

Prescribing Rules

PAs in Virginia may prescribe drugs and devices, including controlled substances, as provided in the practice agreement. The agreement must list the schedules and categories the PA may prescribe, and all of them must fall within the scope of practice and proficiency of the patient care team physicians or podiatrists. Virginia’s PA rules add no separate state prescribing credential, no controlled-substance-specific requirements, and no prescription pad rules.

Source: Va. Code Ann. § 54.1-2952.1(A)

Can a PA prescribe controlled substances in Virginia?

Yes, as provided in the practice agreement. A licensed PA has authority to prescribe controlled substances and devices as set forth in Virginia’s drug control provisions and as the practice agreement allows. Virginia’s PA rules add no further requirements specific to controlled substance prescribing.

Can a PA prescribe Schedule II drugs in Virginia?

Yes — Virginia’s PA rules set no schedule-based restriction on PAs. What a PA may prescribe is determined by the schedules and categories written into the practice agreement, which must fall within the patient care team physicians’ or podiatrists’ own scope of practice and proficiency.

What schedule drugs can a PA prescribe in Virginia?

Whichever schedules and categories of drugs and devices the practice agreement lists. Those are bounded by the scope of practice and proficiency of the patient care team physicians or podiatrists, rather than by a PA-specific schedule list in Virginia’s rules. Virginia sets no special prescription pad requirements.

Does a PA need a DEA license in Virginia?

Virginia’s PA rules do not state a DEA registration requirement for PAs. Prescriptive authority in Virginia runs through the practice agreement rather than through a separate state credential, and Virginia’s PA provisions name no additional requirement for controlled substance prescriptive authority. Confirm federal registration requirements directly before prescribing controlled substances.

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

No. Prescribing authority comes from the practice agreement and is capped by the patient care team physicians’ or podiatrists’ own scope of practice and proficiency. Individual prescriptions do not require sign-off or co-signature, and Virginia sets no heightened requirement for controlled substances.

Specialty & Telehealth Requirements

Virginia has several setting- and procedure-specific rules for PAs but no telehealth-specific requirements. Certain facilities may employ PAs without a separate practice agreement, PAs serving as medical examiners need none at all, and invasive procedures require the physician to attest to the PA’s competence.

Source: Va. Code Ann. § 54.1-2952(C)

Are there telehealth or telemedicine requirements for PAs in Virginia?

No — Virginia sets no telehealth-specific requirement for PAs. Because there is no on-site or proximity rule to begin with, no telehealth exemption is needed. The availability standard runs to the physician, who must be reachable to collaborate and consult at all times.

Are there specialty-specific requirements for PAs in Virginia?

Yes — three, and they mostly loosen requirements rather than add them. PAs employed by a hospital, a state behavioral health facility, or a federally qualified health center may practice without a separate practice agreement if the facility’s credentialing and privileging requirements build in the same components, including designating a patient care team physician or podiatrist; PAs appointed as medical examiners may practice without a written or electronic practice agreement. For invasive procedures, the physician must attest that the PA can safely and competently perform the procedure, and a completed form for each procedure is kept by the parties and made available to the Board on request rather than filed in advance.