Written Protocol · PA
South Carolina Scope of Practice Guidelines for Physician Assistants
Required. The Scope of Practice Guidelines is the written instrument South Carolina 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 SC. The 2019 reform (Act No. 32) removed a prior 3-PA-per-physician cap specific to PAs, but folded PAs into the combined 6-provider cap shared with NP/CNM/CNS (§40-47-195(D)(1)(c)) — not a net loosening for a physician juggling multiple provider types.
What a South Carolina Scope of Practice Guidelines must contain
Governed by the South Carolina Board of Medical Examiners and the South Carolina Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Physician Assistant ("PA") shall practice pursuant to scope of practice guidelines signed by the Physician and the Physician Assistant, as required by S.C. Code § 40-47-960. The Physician shall notify the South Carolina Board of Medical Examiners in writing of the proposed supervisory relationship and the proposed scope of practice guidelines before the relationship takes effect. A copy of the guidelines shall be kept on file at every practice site.
A supervising physician may not supervise more than three (3) Physician Assistants providing clinical service at one time, as provided under S.C. Code § 40-47-955. The scope of practice guidelines shall specify the medical acts, tasks, and functions the Physician Assistant is authorized to perform, including any Schedule II controlled substance authority under S.C. Code § 40-47-965, and the situations requiring the Physician's direct evaluation or immediate referral. The Board may conduct random audits of the guidelines and the underlying supervisory relationship.
- The Scope of Practice Guidelines on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- 2026 S.C. Act No. 166 (S.449), codified at S.C. Code §§ 40-43-245 and 40-47-205statute
Authorizes collaborative practice agreements between a South Carolina pharmacist and physician, effective May 18, 2026, but provides that such agreements may not be implemented until the South Carolina Board of Pharmacy and Board of Medical Examiners adopt implementing regulations.
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
No proximity requirement
§40-47-955(A): supervision 'must be continuous but must not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where the services are rendered.' When the supervising physician is not co-located with the PA, the board must give 'special consideration' to the monitoring plan and grant prior approval (§40-47-195(C)(3)) — not a fixed mile/minute radius.
PA with <2 years continuous practice, or changing specialties: On-site presence required
§40-47-955(C): may not practice at a location off-site from the supervising physician until completing 60 days of on-site clinical experience with that physician — waivable in writing by the supervising physician on a board-approved form.
Supervision ratio
Up to 6 at a time (combined across provider types)
§40-47-195(D)(1)(c): a physician may not enter scope-of-practice guidelines/practice agreements with more than the equivalent of 6 full-time PAs, NPs, CNMs, or CNSs COMBINED — e.g. a physician already supervising 4 NPs may take on at most 2 PAs. The board may approve an exception on application.
Chart review
Percentage set by agreement · As needed · countersignature required
§40-47-955(C): the supervising physician or alternate must 'review, initial, and date' an offsite PA's charts periodically 'as specified in the written scope of practice guidelines' — required, but no statutory percentage or fixed cadence; the practice's own guidelines set the schedule.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
§40-47-965: drugs/devices must be authorized in the written scope of practice guidelines. Oral Schedule II narcotics require express supervising-physician authorization, a direct patient evaluation, an initial supply capped at 5 days, and physician consultation/approval (documented in the chart) for any subsequent prescription. Parenteral Schedule II in a hospital setting requires a prior physician examination. Requires individual DEA registration and, every 2 years, 4 CE hours on prescribing/monitoring Schedule II–IV substances.
Written agreement
Required
SC's statute calls this a 'written scope of practice guidelines' document (§40-47-960), not a 'practice agreement' — functionally the same gating document required before a PA may practice, signed by all supervising physicians and the PA and kept on file at every practice site.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation under Title 33, Chapter 19 (Professional Corporation Supplement) — medical practices must be wholly owned by physicians licensed to practice medicine in SC.
Legal sources for these rules (5)
- S.C. Code § 40-47-955 — Scope of PA's Practice; Physical Presence Requirements of Supervising Physician
- S.C. Code § 40-47-960 — Scope of Practice Guidelines
- S.C. Code § 40-47-965 — Requirements for Writing Prescriptions for Drugs, Controlled Substances, and Medical Devices
- S.C. Code § 40-47-195 — Supervising Physicians; Scope of Practice Guidelines (combined 6-provider cap)
- S.C. Board of Medical Examiners Advisory Opinion on Corporate Practice of Medicine (Nov. 21, 2022)
About South Carolina's rules
A physician may not hold practice agreements/scope-of-practice guidelines with more than a COMBINED 6 full-time-equivalent PA+NP+CNM+CNS at once (§40-47-195(D)(1)(c)) — a single shared cap, not four separate ones. A widely-repeated '3 PA' cap was repealed in 2019 (Act 32). SC remains restricted-practice for APRNs; a 2,000-hour full-practice-authority bill (S.45/H.3580) is pending, not yet law.
Other clinicians in South Carolina: see the state overview.