Collaborative Agreement or Protocol: Which One Your State Requires

Does your state require a collaborative agreement or a protocol?

It depends on the state, and the answer sits in two documents you can read this afternoon: the nurse practice act in your state code, and the board rule chapter it points to. Between them they say whether a nurse practitioner needs a written instrument with a physician at all, what that instrument is called, who has to sign it, and whether it is filed with a board or kept in your office.

The map most nurse practitioners start from is the American Association of Nurse Practitioners' practice-environment classification, which sorts states into full, reduced and restricted practice. A reduced-practice state is one where state law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or limits the setting; a restricted-practice state requires career-long supervision, delegation or team management 1Ref 1American Association of Nurse Practitioners (2026).State Practice Environment.AANP's own definitions of full, reduced and restricted practice: that a reduced-practice state requires a career-long regulated collaborative agreement or limits the setting, and a restricted-practice state requires career-long supervision, delegation or team management. Used for the classification only, never for any state's instrument.. The page is stamped updated May 2026, and it is a trade association's classification rather than law: it can tell you your state probably wants a document, and nothing about what the document is or where it goes.

The names diverge more than three labels can hold. Ohio calls its instrument a standard care arrangement, Georgia a nurse protocol agreement, California a standardized procedure; New York wants written practice protocols and a written practice agreement until an hours threshold; Texas splits by setting. Each name carries a different idea about who holds the authority, and that idea decides who signs.

But the label does tell you which question to carry to the board page. In a full-practice state the question is whether anything has to be filed before you open. Everywhere else it is what the document is called, who has to sign it, and whether the board wants a copy.

Collaboration, delegation or an institutional procedure: what the name means

The noun on the document names the legal relationship behind it. A collaborative agreement or standard care arrangement is a two-party document between you and a physician who collaborates. A protocol agreement, in Georgia's usage, is a delegation: the physician hands you authority for named medical acts. A standardized procedure, in California's usage, is a document of the institution, written by nursing, medicine and administration together. Reading which one your state uses tells you who owns the document.

Georgia's rule chapter defines a nurse protocol agreement as a written document, mutually agreed upon and signed by an APRN and a physician, by which the physician delegates to that APRN the authority to perform certain medical acts 2Ref 2Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's regulatory definition of a nurse protocol agreement as a signed delegation document between an APRN and a physician; the minimum-accepted-standards record-review schedule (100 percent of controlled-substance records at least quarterly, 100 percent of adverse-outcome records within 30 days, 10 percent of other records at least annually); the alternate accredited-location rule with its combined equivalent of eight APRNs or PAs; the definition of immediate consultation and the designated-physician absence coverage.. Delegation is the operative word: the authority is the physician's, and the chapter builds a record-review schedule on that premise. Under what the Composite Medical Board calls minimum accepted standards, the delegating physician reviews 100 percent of patient records involving controlled substances at least quarterly, 100 percent of records with an adverse outcome within 30 days, and 10 percent of all other records at least annually 2Ref 2Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's regulatory definition of a nurse protocol agreement as a signed delegation document between an APRN and a physician; the minimum-accepted-standards record-review schedule (100 percent of controlled-substance records at least quarterly, 100 percent of adverse-outcome records within 30 days, 10 percent of other records at least annually); the alternate accredited-location rule with its combined equivalent of eight APRNs or PAs; the definition of immediate consultation and the designated-physician absence coverage..

Ohio's statute is built on collaboration. An advanced practice registered nurse may practice only under a standard care arrangement entered into with each collaborating physician or podiatrist 3Ref 3Ohio General Assembly (2026).Section 4723.431 | Standard care arrangements..Ohio's statutory requirement that an APRN practice only under a standard care arrangement entered into with each collaborating physician or podiatrist, and the cap barring a physician or podiatrist from collaborating at the same time with more than five nurses in the prescribing component of their practices., and the board's rule fixes the timing: prior to engaging in practice, an arrangement is entered into with each physician or podiatrist with whom the nurse practitioner collaborates 4Ref 4Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's rule that a standard care arrangement is entered into prior to practice with each physician or podiatrist with whom the nurse practitioner collaborates, that a new one is required when the nurse practices at a different or additional organization with a collaborator outside the primary employer, the mandatory contents (signatures, quality assurance and chart review, referral criteria, consultation process, absence and emergency coverage plan, dispute resolution, OARRS provisions), three-year retention of superseded arrangements, and the rule's 2026-03-26 effective date.. Note the plural. One arrangement per collaborator, and a new one when the nurse works at a different or additional organization and collaborates with a physician outside the primary employer 4Ref 4Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's rule that a standard care arrangement is entered into prior to practice with each physician or podiatrist with whom the nurse practitioner collaborates, that a new one is required when the nurse practices at a different or additional organization with a collaborator outside the primary employer, the mandatory contents (signatures, quality assurance and chart review, referral criteria, consultation process, absence and emergency coverage plan, dispute resolution, OARRS provisions), three-year retention of superseded arrangements, and the rule's 2026-03-26 effective date..

California's standardized procedure belongs to the organized health care system where it will be used. The Board of Registered Nursing's explanation says standardized procedures must be developed collaboratively by nursing, medicine and administration in that system, in writing, dated and signed by the authorized personnel, with eleven required elements set out in Title 16 CCR section 1474 5Ref 5California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's instrument being a standardized procedure developed collaboratively by nursing, medicine and administration in the organized health care system where it is used, in writing, dated and signed by the authorized personnel, with eleven required elements under Title 16 CCR section 1474, as the legal mechanism for functions otherwise the practice of medicine; the document's December 1998 date and 2019 PDF reissue and that it does not cover the AB 890 pathways.. The statute names three approvers: the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee 6Ref 6California Legislature (2018).California Business and Professions Code Section 2836.1.California statute's three approvers of a standardized procedure or protocol (the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee) and what a furnishing standardized procedure specifies: the drugs or devices furnished, the extent of physician supervision, and periodic review of the nurse practitioner's competence.. For a solo NP that third signature is the practical problem.

Read your own state's definition the same way. The verb in it, collaborates, delegates or develops, tells you who is responsible for what you do.

Is the document filed with a board or kept in your office?

Some states register the document and some only require that it exist and be produced on request. Georgia is a filing state, and the filing belongs to the physician. Texas keeps neither of its instruments on file with the board, while New York and Florida keep the document at the practice location. Ohio requires you to hold superseded arrangements for three years. The answer sets your timeline: a registered document has a processing time.

Georgia's process runs through the Composite Medical Board, and the board points the application at the delegating physician. The board's protocol registration page says applications are accessible and submittable online only by delegating physicians, with access since extended to APRNs holding an active protocol number, that the APRN protocol agreement costs $150 to file, that all fees are non-refundable, and that processing times are currently averaging 30 business days depending on the complexity of the agreement 7Ref 7Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's $150 non-refundable filing fee for an APRN protocol agreement, that the application is accessible and submittable online by the delegating physician with access since extended to APRNs holding an active protocol number, that filing moved online only in July 2025, and the board's stated processing average of 30 business days depending on complexity, all as read 2026-09-01.. Filing has been online only since July 2025, and all of this is as the page read on September 1, 2026 7Ref 7Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's $150 non-refundable filing fee for an APRN protocol agreement, that the application is accessible and submittable online by the delegating physician with access since extended to APRNs holding an active protocol number, that filing moved online only in July 2025, and the board's stated processing average of 30 business days depending on complexity, all as read 2026-09-01.. The 30 days is the board's own average with no promise attached. Build it into the opening date, along with the physician's calendar.

Texas goes the other way. The Board of Nursing's APRN FAQ says a prescriptive authority agreement under Board Rule 222.5 or a facility-based protocol under Board Rule 222.6 has to be in place before the practice it authorizes, and that neither is submitted to the Board when signed unless the Board asks. A copy of the prescriptive authority agreement is produced within three business days of the request, and the FAQ adds that Texas law does not specifically say the same of a facility-based protocol, while each licensing board may still ask for one 10Ref 10Texas Board of Nursing (2026).Frequently Asked Questions - Advanced Practice Registered Nurse.Texas's two instruments, a prescriptive authority agreement under Board Rule 222.5 or a facility-based protocol under Board Rule 222.6, required in place before the practice they authorize, that neither is submitted to the Board on signing unless requested, and the three-business-day production requirement for the prescriptive authority agreement with the Board's own note that Texas law does not specifically extend it to a facility-based protocol; Board FAQ as read 2026-09-01.. The signed copy, the dates on it and where you keep it are the whole of your compliance record.

New York keeps its paperwork at the practice location. Until a nurse practitioner has completed more than 3,600 hours of qualifying experience, the State Education Department requires practice in accordance with written practice protocols and a written practice agreement with a collaborating physician 8Ref 8New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York's requirement that a nurse practitioner practice in accordance with written practice protocols and a written practice agreement with a collaborating physician unless or until the NP has completed more than 3,600 hours of qualifying experience, and that the page addresses the death of the collaborating physician while saying nothing about retirement or voluntary termination.. Past the threshold, under Education Law 6902(3)(b), the NP attests to collaborative relationships on Form NP-CR, and the form says it is kept at the practice location and is not filed with the Department 9Ref 9New York State Education Department, Office of the Professions (2017).Nurse Practitioner Form NP-CR, Collaborative Relationships Attestation Form.New York's Form NP-CR: the more-than-3,600-hour threshold under Education Law 6902(3)(b), that the form is kept at the practice location rather than filed with the Department, that collaborative relationships replace the written practice agreement without eliminating physician collaboration, the dispute clause under which the physician's recommendation prevails, and the form's May 2017 revision date.. The Department's practice-information page also addresses what happens to the written practice agreement when the collaborating physician dies, and says nothing about retirement or voluntary termination, so ask the Office of the Professions, in writing, about any other departure 8Ref 8New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York's requirement that a nurse practitioner practice in accordance with written practice protocols and a written practice agreement with a collaborating physician unless or until the NP has completed more than 3,600 hours of qualifying experience, and that the page addresses the death of the collaborating physician while saying nothing about retirement or voluntary termination..

Florida's board page tells an APRN who is not registered for autonomous practice to file the protocol at the APRN's practice location 11Ref 11Florida Board of Nursing (2026).Advanced Practice Registered Nurse.That a Florida APRN who is not registered for autonomous practice files the protocol at the APRN's practice location, as stated on the board's APRN page checked 2026-09-01.. Pennsylvania's State Board of Nursing lists three filings around the CRNP prescriptive-authority collaborative agreement, the application, a change application and a termination filing, so ending one is a filing of its own 13Ref 13Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2026).Application Information (State Board of Nursing).The existence and names of Pennsylvania's CRNP prescriptive-authority collaborative agreement application, its change application, and the termination filing, as listed on the State Board of Nursing's application-information page read 2026-09-01. Not used for fees or deadlines.. Ohio's rule says what to do with old ones: a superseded standard care arrangement is retained for three years 4Ref 4Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's rule that a standard care arrangement is entered into prior to practice with each physician or podiatrist with whom the nurse practitioner collaborates, that a new one is required when the nurse practices at a different or additional organization with a collaborator outside the primary employer, the mandatory contents (signatures, quality assurance and chart review, referral criteria, consultation process, absence and emergency coverage plan, dispute resolution, OARRS provisions), three-year retention of superseded arrangements, and the rule's 2026-03-26 effective date..

What has to be inside it

The contents are set by rule, and the lists are longer than a template borrowed from a colleague would suggest. Ohio enumerates the sections of a standard care arrangement in rule 4723-8-04. Georgia's chapter 360-32 sets the record-review schedule and defines immediate consultation and absence coverage. California's Title 16 CCR section 1474 lists eleven required elements, and Business and Professions Code 2836.1 adds what a furnishing procedure has to specify. Read your state's list before drafting.

Ohio's rule requires a standard care arrangement to carry the signatures, a reference to quality assurance and chart review, criteria for referral, a process for consultation, a plan for coverage in the physician's absence and in an emergency, a process for resolving disputes, and provisions on OARRS, the state's prescription monitoring system, with the rule text effective March 26, 2026 4Ref 4Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's rule that a standard care arrangement is entered into prior to practice with each physician or podiatrist with whom the nurse practitioner collaborates, that a new one is required when the nurse practices at a different or additional organization with a collaborator outside the primary employer, the mandatory contents (signatures, quality assurance and chart review, referral criteria, consultation process, absence and emergency coverage plan, dispute resolution, OARRS provisions), three-year retention of superseded arrangements, and the rule's 2026-03-26 effective date.. The statute adds the cap that shapes who can sign. A collaborating physician or podiatrist who has arrangements with more than five nurses may not collaborate at the same time with more than five nurses in the prescribing component of their practices 3Ref 3Ohio General Assembly (2026).Section 4723.431 | Standard care arrangements..Ohio's statutory requirement that an APRN practice only under a standard care arrangement entered into with each collaborating physician or podiatrist, and the cap barring a physician or podiatrist from collaborating at the same time with more than five nurses in the prescribing component of their practices..

Georgia's chapter defines immediate consultation, assigns a designated physician to cover the delegating physician's absences, and sets the review schedule above, with an alternate rule at accredited locations where the review is 10 percent of records and a delegating physician may carry up to a combined equivalent of eight APRNs or PAs 2Ref 2Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's regulatory definition of a nurse protocol agreement as a signed delegation document between an APRN and a physician; the minimum-accepted-standards record-review schedule (100 percent of controlled-substance records at least quarterly, 100 percent of adverse-outcome records within 30 days, 10 percent of other records at least annually); the alternate accredited-location rule with its combined equivalent of eight APRNs or PAs; the definition of immediate consultation and the designated-physician absence coverage.. The cap has exemptions in the statute, so read O.C.G.A. 43-34-25 alongside the chapter.

California's standardized procedure is the legal mechanism for functions that would otherwise be the practice of medicine, on top of the eleven elements in section 1474 5Ref 5California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's instrument being a standardized procedure developed collaboratively by nursing, medicine and administration in the organized health care system where it is used, in writing, dated and signed by the authorized personnel, with eleven required elements under Title 16 CCR section 1474, as the legal mechanism for functions otherwise the practice of medicine; the document's December 1998 date and 2019 PDF reissue and that it does not cover the AB 890 pathways.. A furnishing procedure under Business and Professions Code 2836.1 specifies which drugs or devices may be furnished, the extent of physician supervision, and a periodic review of the nurse practitioner's competence 6Ref 6California Legislature (2018).California Business and Professions Code Section 2836.1.California statute's three approvers of a standardized procedure or protocol (the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee) and what a furnishing standardized procedure specifies: the drugs or devices furnished, the extent of physician supervision, and periodic review of the nurse practitioner's competence..

Whichever state you are in, the required clauses in a collaborative agreement are a separate lookup from whether you need one at all. The physician's liability carrier may have a list of its own; ask for it before the first draft.

Your state went full practice. Do you still need a document?

Often yes, at least once, and sometimes for years. Full practice authority in the AANP sense means no career-long agreement, and the route to that status still runs through paper: Illinois requires a notarized attestation filed with IDFPR, and New York requires more than 3,600 hours under a written practice agreement before a form replaces it. Whether you need an agreement after full practice authority is a question about your first years, and about Schedule II.

Illinois is the clearest example. Section 65-43 of the Nurse Practice Act, as it read after Public Act 103-60 took effect on January 1, 2024, lets an APRN practice without a written collaborative agreement after filing a notarized attestation with IDFPR, and it sets thresholds of at least 250 hours of continuing education or training and at least 4,000 clinical hours 12Ref 12Illinois General Assembly (2024).225 ILCS 65/65-43, Nurse Practice Act, Sec. 65-43. Full practice authority..Illinois's full practice authority section as current at P.A. 103-60, effective 2024-01-01: the notarized attestation filed with IDFPR to practice without a written collaborative agreement, the at-least-250 continuing-education-hour and at-least-4,000 clinical-hour thresholds, the Schedule II narcotic consultation-relationship carve-out that survives full practice authority, and that the section carries a scheduled repeal date.. The same section keeps a consultation relationship for Schedule II narcotics in place after full practice authority is granted, and it carries its own scheduled repeal date, so re-read the text before relying on it 12Ref 12Illinois General Assembly (2024).225 ILCS 65/65-43, Nurse Practice Act, Sec. 65-43. Full practice authority..Illinois's full practice authority section as current at P.A. 103-60, effective 2024-01-01: the notarized attestation filed with IDFPR to practice without a written collaborative agreement, the at-least-250 continuing-education-hour and at-least-4,000 clinical-hour thresholds, the Schedule II narcotic consultation-relationship carve-out that survives full practice authority, and that the section carries a scheduled repeal date.. If your state went full practice, its statute may still hold state caps on schedule ii authority that survive the same way.

New York's version is an hours clock. Past 3,600 hours of qualifying experience, the written practice agreement and protocols fall away and the NP attests on Form NP-CR to collaborative relationships instead. The form is explicit that those relationships replace the written practice agreement without eliminating physician collaboration, and it carries a dispute clause: when the NP and the physician disagree, the physician's recommendation prevails 9Ref 9New York State Education Department, Office of the Professions (2017).Nurse Practitioner Form NP-CR, Collaborative Relationships Attestation Form.New York's Form NP-CR: the more-than-3,600-hour threshold under Education Law 6902(3)(b), that the form is kept at the practice location rather than filed with the Department, that collaborative relationships replace the written practice agreement without eliminating physician collaboration, the dispute clause under which the physician's recommendation prevails, and the form's May 2017 revision date.. The form is marked revised May 2017; check for a newer one before printing it.

California's newer pathways under AB 890 sit outside everything cited here. The Board of Registered Nursing's explanation of standardized procedures is stamped December 1998, reissued as a PDF in 2019, and does not cover them 5Ref 5California Board of Registered Nursing (1998).An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice.California's instrument being a standardized procedure developed collaboratively by nursing, medicine and administration in the organized health care system where it is used, in writing, dated and signed by the authorized personnel, with eleven required elements under Title 16 CCR section 1474, as the legal mechanism for functions otherwise the practice of medicine; the document's December 1998 date and 2019 PDF reissue and that it does not cover the AB 890 pathways.. The board's own AB 890 pages are the source for them.

How to run the lookup in an hour

Start at your board's APRN page, then read the statute section and the rule chapter it cites, then open the form. That order takes under an hour in most states and it produces the four answers you need: whether a document is required, what it is called, who signs it, and whether it is filed. Write down the section numbers as you go; the physician you approach will ask for them.

1. Start on the board's APRN page, where every board cited here names its instrument: Georgia's protocol registration page, the Texas Board of Nursing's APRN FAQ, New York's practice-information page, Florida's APRN page, Pennsylvania's application-information page. 2. Read the statute it cites: Ohio Revised Code 4723.431, New York Education Law 6902(3)(b), Illinois 225 ILCS 65/65-43, California Business and Professions Code 2836.1, Georgia O.C.G.A. 43-34-25. 3. Read the rule chapter under it: Ohio Administrative Code 4723-8-04, Georgia chapter 360-32, California Title 16 CCR 1474, Texas Board Rules 222.5 and 222.6. The contents, the review schedule, the retention period and the caps live here. 4. Open the form, if there is one: Georgia's online protocol application, New York's Form NP-CR, Illinois's notarized attestation, Pennsylvania's application, change and termination filings. Where there is no form, as in Texas, the signed document is the form. 5. Ask how many APRNs and PAs a prospective collaborator already carries, before negotiating anything else: Ohio's five in the prescribing component and Georgia's eight combined equivalents mean a willing physician may have no room.

While you are on the board page, two adjacent lookups usually sit a click away: whether the state layers anything on buprenorphine prescribing with required physician involvement, and what required not-a-physician signage the board expects in a practice a nurse practitioner runs.

None of the statutes or rules above names a fee for a physician's signature; what a collaborator charges is a private term between the two of you. And nothing in these instruments turns on whether you practice as a nursing corporation, pllc or pc; the entity is a separate lookup, worth its own hour.

What is left after the lookup is a decision: whose signature to seek, on what terms, and at what price. That one is yours to make with the physician, and, where money changes hands, with your CPA and counsel.