Written Protocol · NP
Georgia Nurse Protocol Agreement for Nurse Practitioners
Required. The Nurse Protocol Agreement is the written instrument Georgia 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.
No experience- or hours-based independent-practice pathway exists for NPs in Georgia — searched for affirmatively, not merely unfound. Even the narrower 'non-prescriptive' delegation track (§43-34-23) requires a signed physician protocol. The 2023-2024 reform, and H.B. 54 (eff. 5/25/2026, home-health ordering + death-certificate signing), expanded delegable authority but created no route to autonomy.
What a Georgia Nurse Protocol Agreement must contain
Governed by the Georgia Board of Nursing and the Georgia State Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Nurse Practitioner shall practice pursuant to a written Nurse Protocol Agreement with the Physician, as delegating physician, filed with the Georgia Composite Medical Board as required by O.C.G.A. § 43-34-25 and Ga. Comp. R. & Regs. Chapter 360-32. The protocol shall identify each practice location, the specialty congruence between the Physician and the Nurse Practitioner, the drugs, devices, treatments, and diagnostic studies the Nurse Practitioner may order, and the parameters for delegated acts, including refill authority and conditions requiring the Physician's evaluation. The Nurse Practitioner may not prescribe Schedule I or Schedule II controlled substances except as permitted under the limited emergency hydrocodone or oxycodone authority set forth in O.C.G.A. § 43-34-25(d.1).
The Physician shall review one hundred percent (100%) of patient records involving controlled substances at least quarterly and one hundred percent (100%) of records reflecting an adverse outcome within thirty (30) days, and shall review at least ten percent (10%) of all other patient records annually, consistent with Rule 360-32. The Physician shall conduct a direct, on-site observation of the Nurse Practitioner at least annually. A delegating physician's principal practice location must be in Georgia or within fifty (50) miles of the location where the protocol is used.
- The Nurse Protocol Agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- Ga. Comp. R. & Regs. r. 480-35-.04board rule
Requirements for a pharmacist drug therapy modification (DTM) protocol, including required protocol contents, physician diagnosis/initiation, monitoring, and termination.
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
Within 50 miles
O.C.G.A. § 43-34-25: the delegating physician must hold an active Georgia medical license, practice medicine in Georgia, and have a principal place of practice either within Georgia or, if outside, within 50 miles of the location where the protocol is utilized (defined as the patient's physical location at time of service — applies even to telehealth encounters per GCMB guidance). This rule was NOT removed by the 2023-2024 reform, contrary to a common assumption; it is a deficiency that cannot be cured on an incomplete protocol submission.
Supervision ratio
Up to 8 at a time (combined across provider types)
O.C.G.A. § 43-34-25(g)/(g.1)/(g.2), as amended by H.B. 1046 (eff. 7/1/2024): a delegating physician is capped at a flat 'combined equivalent of eight' APRN nurse protocol agreements and PA job descriptions together — for BOTH entering agreements and actively supervising, confirmed directly against GCMB's current guidance — raised from a prior 4-APRN cap, with exceptions for hospitals, colleges/universities, public health departments, county boards of health, free clinics, and birthing centers. A Cornell LII mirror still showing 'enter 8/actively supervise 4' language reflects the pre-2024 (2019-vintage) rule, not a surviving distinction.
Chart review
standard (non-accredited-facility) nurse protocol agreement: 10% of charts · Annually · countersignature required
Ga. Comp. R. & Regs. 360-32-.02: delegating physician must review and sign 100% of records for patients who received a controlled-substance prescription — confirmed QUARTERLY, not a one-time pass at prescription — and 100% of records where an adverse outcome occurred (within 30 days of discovery); 10% of all OTHER patient records, reviewed at least annually (coded here as the general 10%/annual figure — the three distinct review tracks aren't separately representable in this schema's single-percentage/frequency field).
accredited-facility nurse protocol agreement (reduced track): 10% of charts · Quarterly
Facilities meeting accreditation/evidence-based-guideline standards may use a flat 10%-of-all-records review, but must hold and document quarterly clinical collaboration meetings (telephone, in-person, or on-site — modality flexible) in exchange.
Meeting cadence
accredited-facility nurse protocol agreement (reduced chart-review track): Quarterly, in person or via telehealth
See chartReview above — this is the trade-off for the reduced 10% review standard. No universal meeting-frequency requirement was found for the standard (non-accredited) track beyond the annual protocol review/renewal itself.
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
Requires a protocol addendum and a DEA registration change — APRN DEA registrations otherwise only permit Schedule III-V.
Written agreement
Required
Unconditional — Georgia's term is a 'nurse protocol agreement' (O.C.G.A. § 43-34-25), a written document mutually signed by the APRN and a physician, filed with GCMB within 30 days of execution, reviewed/renewed at least annually. A separate, narrower track (§ 43-34-23) permits non-prescriptive delegation without Board filing, but still requires a signed physician protocol — there is no branch of NP practice free of a written physician agreement.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same framework as `pa` — O.C.G.A. § 14-7-5 requires PC shareholders to be licensed in, and actively practicing, the profession the entity is organized to deliver. Confirmed directly: § 14-7-5's eligible-profession list explicitly names 'registered professional nursing' as its own listed profession, separate from medicine — an NP may own an entity organized to deliver nursing-scope services, but not a medicine-practicing PC/PLLC.
Legal sources for these rules (6)
- O.C.G.A. § 43-34-25 — Delegation of certain medical acts to APRNs (nurse protocol agreement, 50-mile rule, ratio, prescriptive limits)
- O.C.G.A. § 43-34-23 — Non-prescriptive delegation track (no Board filing required)
- Ga. Comp. R. & Regs. R. 360-32-.02, -.04 — Nurse Protocol Agreements (via Cornell LII mirror)secondary
- Georgia Composite Medical Board — 'Important Information Regarding APRN Protocol Agreements' (June 24, 2024)
- Georgia Composite Medical Board — '2026 Legislative Session – Rule & Law Updates' (confirms the flat combined-8 ratio, both entering and supervising)
- H.B. 54 (2025-26 session) — home-health-ordering and death-certificate-signing authority for APRNs/PAs, eff. 5/25/2026secondary
About Georgia's rules
Georgia remains one of the more restrictive states in this dataset — no independent-practice pathway exists for NP/PMHNP/CRNA/CNM/CNS, and a 50-mile APRN physician-proximity rule was NOT removed by 2023-2024 reform (a common misconception). That reform raised the ratio cap (4→a combined 8 APRNs+PAs) and added a narrow hydrocodone/oxycodone-only Schedule II exception — APRNs/PAs are otherwise barred from Schedule II. Georgia's primary-source sites were unusually inaccessible this pass; treat citations with extra caution pending follow-up.
Other clinicians in Georgia: see the state overview.