Nurse Practitioner Collaboration Requirements in Ohio

A summary of Ohio’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for NPs and the physicians who collaborate with them.

01 State Overview

Ohio NP Collaboration Laws Overview

Collaborating Physician Required? Yes

Physician Involvement: Standard

Agreement Name: Standard Care Arrangement

On-Site Requirements: None.

Chart Review: Required at least annually as part of a quality assurance process; no fixed number of charts.

Controlled Substances: Yes, with a federal DEA registration. Schedule II is limited to narrow circumstances.

Reduced Supervision / Transition Requirements: None.

02 State Requirements Summary

Ohio NP Collaboration Requirements Summary
Ohio requires an NP to practice under a written standard care arrangement with at least one collaborating physician (or podiatrist) whose practice is the same as or similar to the NP’s. The collaborating physician does not have to be on-site, but must be continuously available to communicate in person or electronically. Ohio does not offer a path to fully independent practice; the collaborative relationship is required throughout an NP’s career.

Source: ORC 4723.431(A)(1)

03 Collaboration Type

Type of Collaborative Relationship
Ohio requires every practicing NP to have a collaborating physician through a written standard care arrangement, with no option for independent practice. The physician does not need to be physically present but must be continuously available for communication, and a single physician may collaborate with a limited number of NPs. There is no transition period or hours requirement that leads to reduced supervision.

Source: ORC 4723.431(A)

04 Agreements

Collaboration Agreement Requirements
Ohio calls the written agreement a standard care arrangement, and it must contain a defined set of items covering referral, consultation, coverage during absences, dispute resolution, prescribing quality assurance, and signatures. Both the NP and the collaborating physician (or the physician’s designated representative) must sign it. Ohio does not provide a template.

Source: ORC 4723.431(B); OAC 4723-8-04(D)

05 Board Filing

Board Filing Requirements
The standard care arrangement itself does not have to be filed with or pre-approved by the Board of Nursing, but the NP must submit the collaborating physician’s name and business address to the board within 30 days of first practicing. The NP may begin practicing without waiting for board approval. Changes and terminations carry their own notice deadlines.

Source: ORC 4723.431(A)(1)

06 Compliance

Collaboration Compliance
Once a standard care arrangement is active, Ohio requires participation in a quality assurance process that includes periodic chart review, an opportunity to discuss feedback, and a patient-evaluation process. Chart review must occur at least annually, and the NP must be able to discuss the results with the collaborating physician. Past agreements must be retained for three years.

Source: OAC 4723-8-05(C)

07 Prescribing

Prescribing Rules
Ohio NPs may prescribe within a prescriptive authority that cannot exceed that of their collaborating physician, and controlled-substance prescribing requires a federal DEA registration. Schedule II prescribing is sharply limited: it is generally allowed only for terminal patients as a continuation of a physician-initiated prescription and for amounts not exceeding a single 72-hour supply. NPs must also review OARRS (the state prescription-monitoring database) reports.

Source: ORC 4723.481; OAC 4723-9-10

08 Specialty & Telehealth

Specialty & Telehealth Requirements
Ohio’s main specialty-related rule is that psychiatric-mental health NPs may collaborate with a physician in psychiatry, pediatrics, or primary care/family practice. Ohio is silent on whether the collaborating physician is legally responsible for the NP’s care.

Source: ORC 4723.431(A)(2); OAC 4723-8-04(C)