Carolyn Buppert, NP, JD


December 20, 2005


Does my supervising MD need to review and sign off on every one of my charts? My nurse practice act in Georgia is vague with regard to supervision/collaboration issues.

Response from Carolyn Buppert, NP, JD

There is no state where the law requires physicians to sign every one of a nurse practitioner's (NP's) charts. In Tennessee, a physician must sign 20% of an NP's charts every 30 days. In Arkansas, there is a requirement for physician cosignature of NP orders. Practice protocols or facility requirements must specify when NP's orders must be cosigned. In Georgia, a physician must sign any prescription an NP writes. Georgia is the only state with this requirement.

Fifteen states have some form of requirement that a physician oversee -- collaborate, delegate, or supervise -- an NP's practice, and signing of charts is one way to document that oversight. The specificity of the chart review requirements vary greatly from state to state. In Alabama, Georgia, Maryland, Mississippi, Nevada, New York, Pennsylvania, Vermont, and Virginia, NPs work under collaborative agreements, delegation agreements, or protocols, and state law requires that these documents include a schedule for review of charts by a physician. In Illinois, a physician must be on site once a month for consultation with an NP. In Louisiana, a physician must visit, once a week, the site where an NP practices. In Missouri, a physician must be involved within a specified time frame with patients who have new or significant conditions other than acute self-limited or well-defined problems. In South Dakota, a physician must have personal contact with an NP no less than one half day a week or a minimum of 1 hour per 10 hours of practice.

In 35 states, there are no requirements for physician review of patient charts.

For the exact legal language of a state's requirements, visit the "laws" section of your state Board of Nursing Web site. For a summary of each state's laws, see The Pearson Report .

Even though there may be no legal requirement that a physician sign NPs' documentation, some physician employers want to do so, to assure themselves that they are overseeing the work of their employees. Some physicians believe that they must sign the chart if they are billing for the services. However, Medicare, Medicaid, and most commercial payers have no requirement for physician cosignature of NPs' records.


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