Practice Agreement · NP
Nurse Practitioner Practice Agreement in Maryland
Maryland law does not require a Nurse Practitioner to hold a named agreement with a physician. Practices still use one to define the working relationship; here is what it covers and what the state does require.
The 2015 Nurse Practitioner Full Practice Authority Act eliminated the prior mandatory physician-attestation/collaboration requirement. The mentorship is informal (no written agreement filed) and time-bound, not indefinite — after 18 months (or immediately, if already certified elsewhere) the NP practices fully independently.
Independent practice requires: 18 months of mentorship (available consultation/collaboration) from a Maryland-licensed physician or NP with ≥3 years' clinical experience — ONLY required for an NP never previously certified in Maryland or any other state; an NP already certified elsewhere is exempt from this mentorship entirely and practices independently from initial MD certification.
What a Nurse Practitioner practice agreement covers in Maryland
Governed by the Maryland Board of Nursing and the Maryland Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
Maryland does not require the Nurse Practitioner to enter into a collaborating-physician agreement or attestation; the Nurse Practitioner practices, diagnoses, and prescribes, including Schedule II through V controlled substances, under the Nurse Practitioner's own license, consistent with Health Occupations Article, Title 8, and shall separately hold a Maryland Controlled Dangerous Substances (CDS) registration if prescribing controlled substances.
If this is the Nurse Practitioner's first certification as a Certified Registered Nurse Practitioner in any state, the Nurse Practitioner shall identify a mentor — a Certified Registered Nurse Practitioner or physician with at least three (3) years of clinical experience — for eighteen (18) months of consultation and collaboration from the date the Nurse Practitioner's certification application is received by the Maryland Board of Nursing.
- The agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- COMAR 10.34.29 (Drug Therapy Management)regulation
Maryland Board of Pharmacy regulation implementing Health Occupations Article §§ 12-6A-01 to 12-6A-10, governing prescriber-pharmacist agreements, protocols, and therapy management contracts.
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
first-time NP (never certified in any state) during the 18-month mentorship: Available remotely (no on-site requirement)
The mentor need only be 'available for advice, consultation, and collaboration, as needed' — no on-site or fixed-radius standard.
after the 18-month mentorship, or any NP already certified in another state: No proximity requirement
No physician availability/proximity standard applies once independent.
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
Covered by the practice agreement · controlled substances permitted
Schedule II-V. Schedule II-III prescriptions are capped at a 30-day supply per single filling under Maryland's general controlled-substance dispensing limits. Requires Maryland CDS registration and federal DEA registration.
Written agreement
Not required
No written collaborative practice agreement is required at any point — even the 18-month first-time-NP mentorship is an informal consultation relationship, not a filed agreement.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Maryland does not recognize PLLCs, and medical-services Professional Corporations are limited to physician shareholders — no independent NP practice-entity ownership pathway was confirmed in this pass. Treat as an open item rather than a settled fact given NPs' full clinical independence.
This ownership question is legally distinct from the clinical independence granted by the 2015 Act above.
About Maryland's rules
Maryland's APRN categories are NOT uniform: CRNPs/CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), but CRNAs remain fully supervised with NO prescriptive authority at all (Maryland is one of ~11 states granting CRNAs none), and only the psychiatric-mental-health population focus of CNS practice is independent. Maryland does not recognize PLLCs — professional entities use physician-only Professional Corporations, so multi-disciplinary PC ownership questions are open items below.
Other clinicians in Maryland: see the state overview.