Collaborative Practice Agreement · NP
Puerto Rico Written Collaborative Agreement for Nurse Practitioners
Required. The Written Collaborative Agreement is the written instrument Puerto Rico 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.
Ley 254-2015 Art. 2(b)/(e)(2) says advanced practice nurses 'puede[n] funcionar de manera independiente' and may hold private practice, but every NP task involving diagnosis, orders, or prescribing must be 'previamente discutid[o]' or run through 'protocolos y acuerdos colaborativos con el médico' — no experience-based exit exists. AANP classifies PR 'Reduced Practice.'
What a Puerto Rico Written Collaborative Agreement must contain
Governed by the Puerto Rico Board of Nurse Examiners and the Puerto Rico Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Nurse Practitioner shall practice pursuant to a written collaborative agreement with the Physician, describing the Nurse Practitioner's specific functions and scope of practice, as required by Law 254-2015 ("Ley para Regular la Práctica de la Enfermería en Puerto Rico"). Puerto Rico law does not provide an independent-practice pathway that removes this requirement.
The Nurse Practitioner may prescribe medications and order diagnostic studies under the collaborative agreement, but may never prescribe Schedule I or Schedule II controlled substances under Puerto Rico's Controlled Substances Act, regardless of experience or certification. The Nurse Practitioner shall submit the collaborative agreement, and documentation of the Nurse Practitioner's prescriptive privileges, to the Puerto Rico Board of Nurse Examiners at each license renewal and whenever the Nurse Practitioner's employment conditions change.
- The Written Collaborative Agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- Ley Núm. 247 de 3 de septiembre de 2004, según enmendada ("Ley de Farmacia de Puerto Rico")statute
Puerto Rico Pharmacy Act, published by the Puerto Rico Department of Health, providing for a Board-defined "Protocol" under which a pharmacist and a physician (or group of physicians) may agree that the pharmacist will manage a patient's pharmacotherapy on a collaborative basis.
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
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
No PR statute was found expressly requiring individual DEA registration for NPs, unlike NC/VA — this may be addressed only in Board of Nursing regulations not reviewed in this pass.
Written agreement
Required
Unconditional for the diagnostic/treatment/prescribing functions that define NP practice — Ley 254-2015 gates every one of them on a collaborative protocol/agreement with the patient's physician, even though the same statute recognizes NPs' right to own an independent nursing-practice business.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 (14 L.P.R.A. §§3921–3938) — stockholders/incorporators must be licensed to provide the professional service named in the certificate of incorporation. Ley 254-2015 Art. 2(b) separately recognizes an APRN's right to establish independent private practice, unlike the PA entry above.
Unlike PAs, nothing in Ley 254-2015 or Ley 164-2009 was found barring an APRN from independently owning a nursing-services professional corporation.
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.