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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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

Worth knowing

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.

The watch

Pending in Guam

Statutes move, boards write rules, sunsets arrive. This watch is checked against primary sources on a standing cadence — last verified 11 August 2026 — and every item links the source it was read from.

Rulemaking in progress

Guam's rewritten nursing rules, APRN chapter complete, await legislative adoption; existing full-practice rules still govern.

Guam Legislature, Doc. No. 38GL-25-0906 (GBNE board packet, July 2025)

Every jurisdiction, every item — The Watch →.

What Gale runs

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

In the product today

  • Chat runs the practice — say what you need in your own words, and Gale books it, finds the guide, or opens the screen already filled in.
  • 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.
  • Your credentials in one place — every license, DEA registration, board certification and plan enrollment you already hold, with reminders at 90, 60 and 30 days before one expires. Gale checks your NPI against the national registry and marks what it checked. It does not file applications; a credentialing service can.
  • Referrals from colleagues through your own link, acknowledged and booked in one place, and a view of which referral sources send you patients and which have gone quiet.
  • Practice notes on your public page, and your own notes on Gale’s health articles in the content library — credited to you, and nothing is public until you publish it.
  • An activity and access log that records who opened, changed or exported a patient’s chart, and when.
  • Connect Claude to set up your services, rates and hours by talking to it. It cannot open a patient record, move money or sign anything.

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.
  • Currents — the regulatory watch for your state and the latest evidence for your specialty, dated, sourced, and re-verified on a standing cadence. Quiet weeks say so.

Built, on sample data for now

  • Insurance billing — a billing console, coding you review and attest, and every claim followed from draft to paid. Today a claim is checked by Gale’s own test system: nothing reaches a payer and no money moves.
  • Outreach — check-ins for patients who have drifted, drafted overnight for you to approve. Approving sends nothing yet; patient contact stays off until it opens.
  • Your panel, sorted so the patients who are due or slipping out of care come first — a sort order, not a prediction — with show rates and between-visit activity counted beside it.
  • Practice health — whether notes get signed and Good Faith Estimates go out on time.
  • Guidance monitoring — the between-visit guidance a patient chooses to share with you, with anything off track listed first. It fills as patients share.
  • Workbooks — your charts, claims, referral pipeline, compliance records and clinician roster as tables you can edit. New accounts start on a sample practice.
  • A desktop bridge and scheduled agents, for work that runs while you are away. A scheduled agent can never send a message, move money or sign anything.
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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