Practice Agreement · PA
Physician Assistant Practice Agreement in Puerto Rico
Puerto Rico law does not require a Physician Assistant 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.
No independent-practice pathway exists or could exist under this credential — Art. 12 (20 L.P.R.A. §141j) requires supervision to be 'continua' and expressly not 'incidental' for as long as the Médico Asistente practices. This role is structurally a supervised bridge credential, chiefly for physicians who have not yet passed PR medical licensure, not an independent midlevel profession.
What a Physician Assistant practice agreement covers in Puerto Rico
Governed by the Puerto Rico Medical Licensing and Discipline Board. Each numbered item is a statutory requirement the agreement must satisfy.
The Physician Assistant ("Médico Asistente") shall practice under the continuous supervision of the Physician, as required by Law 71-2017 ("Ley para Regular la Profesión de Médicos Asistentes de Puerto Rico"). The Parties shall identify the Physician Assistant's field of practice, ensure that delegated medical tasks are appropriate to the Physician Assistant's level of competence, define the supervision and access the Physician Assistant has to the Physician, and establish a process to evaluate the Physician Assistant's performance.
A supervising physician may not have more than two (2) Physician Assistants under supervision at one time, except that the Physician Assistant may have a separate supervising physician for each medical discipline in which the Physician Assistant practices. The Physician Assistant does not have authority to prescribe medications in Puerto Rico; the Physician Assistant may write medical orders and progress notes only when co-signed by the Physician, except in an emergency when another physician may co-sign if the Physician is unavailable.
- The 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
Available remotely (no on-site requirement)
Art. 12 requires supervision to be continuous and not incidental, but does not specify physical presence, a mile/minute radius, or a telecommunication standard. Whether the Junta de Licenciamiento y Disciplina Médica expects on-site presence in practice is an open question not resolved by the statute's text — verify before relying on this for compliance.
Supervision ratio
Up to 2 at a time
Art. 12 (20 L.P.R.A. §141j): 'Ningún Médico Supervisor podrá tener bajo su cargo y supervisión más de dos (2) Médicos Asistentes' — no supervising physician may have more than 2 PAs at once. A PA who practices in multiple medical disciplines may have one supervisor per discipline (not a combined multi-discipline cap).
Chart review
Percentage set by agreement · As needed · countersignature required
Not a periodic sampled review — Art. 11 (20 L.P.R.A. §141i) requires EVERY progress note the PA writes to be signed by both the PA and the Médico Supervisor, with the Junta empowered to set a maximum time between drafting and countersignature. Medical orders likewise require the supervisor's signature except in defined emergencies.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · no controlled-substance authority
Art. 11 (20 L.P.R.A. §141i): 'Los Médicos Asistentes no tendrán autoridad para recetar medicamentos en Puerto Rico' — PAs have NO prescriptive authority of any kind, controlled or otherwise. They may write medical orders, but only when countersigned by the supervising physician (or, in an emergency where life/health is at risk and the supervisor is unavailable, by another physician).
Written agreement
Required
Not a written 'practice agreement' in the NC/VA sense — Ley 71-2017 conditions practice on an ongoing supervisory relationship with a specific licensed M.D./D.O. ('Médico Supervisor'), reported to the Junta, rather than a negotiated contract document.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Art. 7 (20 L.P.R.A. §141e) affirmatively bars a Médico Asistente from associating with any other person or entity to form a 'corporación profesional' under Ley 164-2009 (Cap. 238) for the purpose of grouping licensed PAs — unlike the other provider types in this dataset, PAs have NO independent-ownership pathway of any kind and must practice as employees/contractors of a physician-owned entity.
Stricter than every other provider type here: this is a categorical prohibition on PA-only or PA-inclusive professional corporations, not merely a non-licensee-ownership restriction.
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.