For nurse practitioners · Guam

Full practice from the first license.

Guam licenses APRNs to practice with independent judgment and primary responsibility for patients from initial licensure — no physician supervision, collaboration agreement, or transition period is required for practice authority, and AANP rates Guam Full Practice.

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Every state with a pathway

The moment

Independence attaches at licensure

Guam licenses APRNs to practice with independent judgment and primary responsibility for patients from initial licensure — no supervision, no collaboration agreement, no transition period — and AANP rates the territory Full Practice.

One honest asterisk: prescribing is a separate board grant, with pharmacology coursework, 1,000 hours of APRN practice, and board-reviewable protocols behind it. Practice authority is day one; prescriptive independence is not literally day one.

The requirement

RN license, graduate degree in an NP role, and national certification; no supervised-practice period for practice authority (separate prescriptive-authority application requires pharmacology coursework and 1,000 hours of APRN practice)

The moment it attaches

Initial APRN licensure by the Guam Board of Nurse Examiners

The timeline

APRN regulation authorized by P.L. 24-206 (May 1998); current APRN rules per official compilation of January 4, 2022

The statute

10 GCA ch. 12, art. 3 (Nurse Practice Act; APRN regulation authorized by P.L. 24-206 (1998)); 25 GAR ch. 6, §§6501-6507

The receipt

Other platforms would show a testimonial here. Gale has no Guam NPs to quote, and we do not invent people — so here is the dated, sourced fact instead.

Guam's rules give APRNs 'global signature authority': wherever a Guam law or rule demands a physician's signature, certification, or endorsement, an APRN's signature counts (25 GAR 6504(g), official compilation of Jan. 4, 2022).

10 GCA ch. 12, art. 3 (Nurse Practice Act; APRN regulation authorized by P.L. 24-206 (1998)); 25 GAR ch. 6, §§6501-6507

Scope and carve-outs

The grant and the strings, at equal weight

APRNs assume primary responsibility for patient care using independent judgment: examine and diagnose, admit/manage/discharge from facilities, order and interpret diagnostics, prescribe therapies and devices, and refer (25 GAR 6504). Carve-out: prescribing medications requires a separate board grant of prescriptive authority (pharmacology coursework, 1,000 APRN practice hours, board-reviewable protocols); with it, APRNs may prescribe legend drugs and Schedule II-V controlled substances with a DEA number; drugs outside the APRN's protocols require a collaborating physician's order.

What Gale runs

The inventory, split honestly. Nothing dark is dressed as live.

In the product today

  • Scheduling and the calendar.
  • Notes, with a scribe that drafts during the visit — you stay the final editor of every note.
  • Telehealth where the chart lives.
  • The patient record — see a sample chart, no signup.
  • Superbills for the patient who wants to claim out-of-network benefits.
  • The Fee Schedule — the one Gale document that states the fee.
  • Your practice page, in the public directory compiled from the NPPES registry.

Opening with the founding cohort

  • Concierge memberships — a monthly plan your practice sells on its own terms. Not sellable yet: enrollment fails closed behind a legal switch until counsel clears it. No countdown — when it clears, it clears.
  • The loop tracker — every referral, lab, and question a visible loop with an owner, a state, and a promised window. Closing one requires an outcome note; nothing silently expires.
  • The guided founding sequence — practice setup walked step by step with the first cohort: entity, posted prices, the practice page, the first visit.
The economics

No physician attached means no standing invoice between you and your own practice — the economics of independence here are unusually legible. What Gale adds is built to read the same way.

Gale’s side of the ledger is deliberately short. The software is free, and Gale earns one flat all-in fee on a transaction — charged only when your practice is actually paid, never as a subscription, never with per-feature line items, never a spread on your rate. The number itself lives in exactly one document, on purpose, so it can never quietly say two different things in two places: the Fee Schedule states it.
The playbook

The deepest state cluster we have built is California’s — eight guides on the 103/104 ladder, cited to the statute and the board’s own filings. They are California’s rules, not Guam’s; the same treatment is coming state by state. Until then, they show the depth of homework to expect from us.

The California playbook →
Questions with citable answers
Not literally. Practice authority — examining, diagnosing, admitting and discharging, ordering and interpreting diagnostics — attaches at initial APRN licensure. Prescribing requires a separate grant of prescriptive authority from the board: pharmacology coursework, 1,000 hours of APRN practice, and board-reviewable protocols. With it, APRNs may prescribe legend drugs and Schedule II–V controlled substances with a DEA number.
Prescribing runs within your protocols: a drug outside them requires a collaborating physician’s order. Within them, legend drugs and Schedule II–V controlled substances are covered.
Where to start

Your page may already exist

Gale publishes a public directory compiled from the NPPES registry. Find your listing, claim it, and see how you rank for your own name — that page is the front door your independent practice will be found through.

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