Supervision Agreement · PA
Hawaii Supervisory Practice Agreement for Physician Assistants
Required. The Supervisory Practice Agreement is the written instrument Hawaii law names for a Physician Assistant working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
No independent-practice pathway exists for PAs in Hawaii — physician supervision is required for as long as the PA practices (HRS § 453-5.3).
What a Hawaii Supervisory Practice Agreement must contain
Each numbered item is a statutory requirement the Supervisory Practice Agreement must satisfy.
The Physician Assistant ("PA") shall practice under the supervision of the Physician, as required by Haw. Rev. Stat. § 453-5.3. The Physician shall submit a Verification of Supervising Physician form to the Hawaii Board of Medical Examiners before the Physician Assistant begins practice; the Physician Assistant's license becomes inactive if no supervising physician is on file with the Board.
The Physician shall establish written guidelines for reviewing the Physician Assistant's medical records, and, if the Physician Assistant has fewer than one (1) year of experience, shall review at least fifty percent (50%) of the Physician Assistant's records within thirty (30) days of the encounter for the first six (6) months of supervision. A physician may not supervise more than two (2) Physician Assistants at one time, as provided under Haw. Admin. R. § 16-85-49, subject to any subsequent amendment of that rule.
- The Supervisory Practice Agreement also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Supervisory Practice Agreement has to carry, from Hawaii's supervision rules.
Proximity
Available remotely (no on-site requirement)
No codified mile/minute radius or on-site requirement; the board sets the 'degree of supervision' by rule (HRS § 453-5.3(a)) and the physician/PA jointly maintain written guidelines for chart review.
Supervision ratio
Not codified — no cap on file
Chart review
first 6 months of supervision: 50% of charts · Monthly (within 30 days of the patient visit)
Haw. Code R. § 17-1737 / HRS § 453-5.3 — supervising physician must review 50% of medical records within 30 days of the visit during the PA's first 6 months of supervision.
6 months to 1 year of supervision: 25% of charts (within 30 days of the patient visit)
Reduced from 50% following Hawaii S.B. 1406 (eff. July 1, 2019), which also repealed a prior 100%-review requirement.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Prescriptive scope is set out in the written supervision guidelines required by HRS § 453-5.3; the statute does not itself state a controlled-substance schedule limit.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation under HRS § 415A-9; shareholders licensed in the profession the corporation practices
Ownership is legally distinct from the clinical supervisory relationship above.
Sources for the supervision rules (3)
About Hawaii's rules
Hawaii grants APRNs (NP/CRNA/CNM/CNS) full independent practice with no collaborative-agreement requirement (HRS § 457-8.5); prescriptive authority is a separate application, not automatic. Hawaii has no general corporate-practice-of-medicine statute — HRS § 415A-9 requires professional-corporation shareholders to be licensed, but doesn't clearly resolve multi-discipline (e.g. physician+APRN) ownership.
Other clinicians in Hawaii: see the state overview.