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Written Protocol · NP

Alabama Standard Protocol for Nurse Practitioners

Required. The Standard Protocol 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.

Practice authoritySupervision required
Written agreementAgreement required
What Alabama calls itStandard Protocol
Agreement familyCollaborative Practice
Research date2026-09-03 · clauses 2026-09-03

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 an Alabama Standard Protocol must contain

Each numbered item is a statutory requirement the Standard Protocol must satisfy.

  1. 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.

  2. 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.

  3. The Standard Protocol 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 Standard Protocol has to carry, from Alabama'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).

Sources for the supervision rules (5)
How the relationship works day to day
Who has to be where, how often you meet, and what the physician costs: Nurse Practitioner in Alabama on collaborativeagreement.com.

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.