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(B)           the written or verbal order as described in Part (b)(3)(A) of this Rule shall be entered into the patient record with a notation that it is issued on the specific order of a primary or back-up supervising physician and signed by the nurse practitioner and the physician.

(4)           Refills may be issued for a period not to exceed one year except for schedules II, IIN, III, and IIIN, which may not be refilled.

(5)           Each prescription shall be noted on the patient's chart and include the following information:

(A)          medication and dosage;

(B)           amount prescribed;

(C)           directions for use;

(D)          number of refills; and

(E)           signature of nurse practitioner.

(6)           Prescription Format:

(A)          all prescriptions issued by the nurse practitioner shall contain the supervising physician(s) name, the name of the patient, and the nurse practitioner's name, telephone number, and approval number;

(B)           the nurse practitioner's assigned DEA number shall be written on the prescription form when a controlled substance is prescribed as defined in Subparagraph (b)(2) of this Rule.

(c)  The nurse practitioner may obtain approval to dispense the drugs and devices other than samples included in the collaborative practice agreement for each practice site from the Board of Pharmacy, and dispense in accordance with 21 NCAC 36 .1700, that is hereby incorporated by reference including subsequent amendments of the referenced materials.

History Note:        Authority G.S. 90-6; 90-18(14); 90-18.2; 90-171.23(b)(14);

Recodified from 21 NCAC 36 .0227(h) Eff. August 1, 2004;

Amended Eff. November 1, 2008; August 1, 2004.


(a)  Availability: The primary or back-up supervising physician(s) and the nurse practitioner shall be continuously available to each other for consultation by direct communication or telecommunication.

(b)  Collaborative Practice Agreement:

(1)           shall be agreed upon and signed by both the primary supervising physician and the nurse practitioner, and maintained in each practice site;

(2)           shall be reviewed at least yearly. This review shall be acknowledged by a dated signature sheet, signed by both the primary supervising physician and the nurse practitioner, appended to the collaborative practice agreement and available for inspection by members or agents of either Board;

(3)           shall include the drugs, devices, medical treatments, tests and procedures that may be prescribed, ordered and performed by the nurse practitioner consistent with Rule .0809 of this Section; and

(4)           shall include a pre-determined plan for emergency services.

(c)  The nurse practitioner shall demonstrate the ability to perform medical acts as outlined in the collaborative practice agreement upon request by members or agents of either Board.

(d)  Quality Improvement Process.

(1)           The primary supervising physician and the nurse practitioner shall develop a process for the ongoing review of the care provided in each practice site including a written plan for evaluating the quality of care provided for one or more frequently encountered clinical problems.

(2)           This plan shall include a description of the clinical problem(s), an evaluation of the current treatment interventions, and if needed, a plan for improving outcomes within an identified time-frame.

(3)           The quality improvement process shall include scheduled meetings between the primary supervising physician and the nurse practitioner at least every six months.  Documentation for each meeting shall:

(A)          identify clinical problems discussed, including progress toward improving outcomes as stated in Subparagraph (d)(2) of this Rule, and recommendations, if any, for changes in treatment plan(s);

(B)           be signed and dated by those who attended; and

(C)           be available for review by members or agents of either Board for the previous five calendar years and be retained by both the nurse practitioner and primary supervising physician.

(e)  Nurse Practitioner-Physician Consultation.  The following requirements establish the minimum standards for consultation between the nurse practitioner/primary or back-up supervising physician(s):

(1)           During the first six months of the initial collaborative practice agreement, there shall be:

(A)          review and countersigning of notations of medical acts by a primary or back-up supervising physician within seven days of nurse practitioner- patient contact.

(B)           meetings with the primary supervising physician on a weekly basis for one month after approval to practice is received and at least monthly for a total of six months.

(2)           During the first six months of a subsequent collaborative practice agreement between a nurse practitioner previously approved to practice and a different primary supervising physician, there shall be meetings with the new primary supervising physician monthly for the first six months.

(3)           Documentation of the meetings shall:

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