Collaborative Practice Agreement · NP
Alabama Standard Protocol (within a Written Collaborative Agreement) for Nurse Practitioners
Required. The Standard Protocol (within a Written Collaborative Agreement) is the written instrument Alabama law names for a Nurse Practitioner working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
A collaborative practice agreement is required at all times with no experience-based sunset — Alabama's 4,000-hour/2-year threshold (below) reduces the INTENSITY of collaboration (on-site to telecommunication), it does not end the agreement requirement itself, unlike states with a true independence pathway.
What a Alabama Standard Protocol (within a Written Collaborative Agreement) must contain
Governed by the Alabama Board of Nursing and the Alabama State Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Nurse Practitioner ("CRNP") shall practice pursuant to a written collaborative agreement (a "Standard Protocol") with the Physician, as required by Ala. Code § 34-21-81 et seq. and Ala. Admin. Code r. 610-X-5 and r. 540-X-8. Collaboration under the Standard Protocol does not require the Physician's on-site presence, but does require the oversight described below.
Until the Nurse Practitioner has accumulated two (2) years or four thousand (4,000) hours of experience, whichever occurs first, the Physician shall be present at least ten percent (10%) of the Nurse Practitioner's scheduled practice hours. Thereafter, the Physician and the Nurse Practitioner shall meet at least quarterly, and the Physician shall visit any remote practice site at least twice per year. The Physician shall conduct a quarterly quality assurance review of a meaningful sample of the Nurse Practitioner's patient records and of all adverse outcomes. A physician may not collaborate with Certified Registered Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants whose combined scheduled hours exceed three hundred sixty (360) full-time- equivalent hours per week.
- The Standard Protocol (within a Written Collaborative Agreement) on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- Ala. Code § 34-23-77statute
Authorizes a Collaborative Practice Agreement between an Alabama-licensed pharmacist and physician; requires the agreement to be submitted to and approved by both the Board of Pharmacy and the Board of Medical Examiners before it is effective.
- Ala. Admin. Code r. 680-X-2-.44board rule
Alabama Board of Pharmacy rule implementing Collaborative Drug Therapy Management Agreements: required terms, eligibility, quality assurance, renewal, and limitations.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
CRNP with <2 years (4,000 hours) of collaborative-practice experience: On-site presence required
Collaborating physician must be physically present at the approved practice site for not less than 10% of the CRNP's scheduled hours (Ala. Admin. Code r. 540-X-8-.08 / mirrored 610-X-5-.09).
CRNP with ≥2 years (4,000 hours) of collaborative-practice experience: Available remotely (no on-site requirement)
On-site presence requirement drops away, replaced by a minimum quarterly meeting; remote/satellite sites still require a physician visit no less than twice annually regardless of experience tier. No mileage/radius figure could be confirmed in the rule text retrieved.
Supervision ratio
Up to 9 at a time (combined across provider types)
Same combined 360 hours/week (9 FTE) cap shared across CRNP, CNM, and PA per collaborating physician (Ala. Admin. Code r. 540-X-8-.08).
Chart review
Percentage set by agreement · Quarterly
Collaborating physician must complete quarterly quality assurance with each CRNP, reviewing 'a meaningful sample of medical records plus all adverse outcomes' — no fixed percentage codified. Records retained for duration of collaboration plus 3 years after termination.
Meeting cadence
Quarterly
Minimum quarterly meeting cadence once the 4,000-hour/2-year threshold is met and on-site presence is no longer required.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
A Qualified Alabama Controlled Substances Certificate (QACSC) is required for any controlled-substance prescribing, renewed annually (due Dec. 31). Eligibility requires active collaborative practice with a physician holding an unrestricted Alabama Controlled Substances Certificate, 8 hrs CME on controlled-substance prescribing plus 4 hrs advanced pharmacology within the preceding year, ≥12 months active AL clinical practice, and separate DEA registration after QACSC issuance (Ala. Admin. Code r. 540-X-18).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same Title 10A same-profession-ownership framework as `pa` — a CRNP cannot independently own a clinic without a collaborating-physician relationship (secondary-sourced characterization; not independently confirmed against primary statutory text).
Legal sources for these rules (5)
- Ala. Code § 34-21-81 — Advanced Practice Nursing Definitionssecondary
- Ala. Admin. Code r. 540-X-8-.08 — Collaborative Practice Requirements (Physicians and CRNPs)
- Ala. Admin. Code r. 610-X-5-.09 — Collaborative Practice (Board of Nursing mirror)
- Ala. Admin. Code Ch. 540-X-18 — Qualified Alabama Controlled Substances Certificate (QACSC)
- Alabama Board of Medical Examiners — CRNP/CNM Collaboration guidance
About Alabama's rules
Alabama is a restrictive state: PA/CRNP/CNM all require an indefinite collaborative agreement with no independence pathway, and share a combined 360 hours/week (9 FTE) supervision cap per physician. CRNA's status is a genuine ambiguity — statute requires an 'immediately available' physician/dentist/podiatrist, but no filed agreement or ratio regime exists like CRNP/CNM's; flagged for legal review.
Other clinicians in Alabama: see the state overview.