Alabama Administrative Code
Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS
Chapter 540-X-7 - ASSISTANTS TO PHYSICIANS
Section 540-X-7-.23 - Requirements For Supervised Practice - Physician Assistants (P.A.)

(1) Physician supervision requires, at all times, a direct, continuing and close supervisory relationship between a physician assistant and the physician to whom the assistant is registered.

(2) There shall be no independent, unsupervised practice by physician assistants.

(3) The supervising physician shall be readily available for direct communication or by telephone or telecommunication.

(4) The supervising physician shall be available for consultation or referrals of patients from the physician assistant.

(5) In the event the physician to whom the physician assistant is registered is not readily available, provisions must be made for professional medical oversight and direction by a covering physician who is readily available, who is preapproved by the Board of Medical Examiners, and who is familiar with these rules.

(6) In the event of an unanticipated, permanent absence of a supervising physician, a previously approved covering physician may be designated as a temporary supervising physician for a period of up to sixty (60) days. During the sixty (60) day time period, a new registration agreement designating a new supervising physician should be submitted for approval.

(7) If the physician assistant is to perform duties at a remote site, the application for registration must clearly specify the circumstances and provide written verification of physician availability for consultation and/or referral, and direct medical intervention in emergencies and after hours, if indicated. The Board, at its discretion, may waive the requirement of written verification upon documentation of exceptional circumstances. Employees of state and county health departments and facilities certified by the Alabama Department of Mental Health are exempt from the requirement of written verification of physician availability.

(8) The supervising physician and the physician assistant shall adhere to any written guidelines established by the Board to govern the prescription practices of physician assistants.

(9) If the physician assistant is to perform duties at a remote site physician supervision requires the following:

(10) The supervising physician must complete quarterly quality assurance with each physician assistant. Documentation of any quality assurance review required by this chapter shall be maintained by the supervising physician for the duration of the registration agreement and for three years following the termination of the supervised practice agreement.

(11) The supervising physician must maintain documentation of the physician assistant's two (2) years (4,000 hours) of supervised practice experience for the duration of the supervised practice and for three (3) years following the termination of the registration agreement.

(12) The physician shall at all times maintain independent medical judgment related to the practice of medicine, irrespective of employment structure or business model.

(13) Irrespective of the location of the principal practice site and any remote site(s) of the supervised practice, all services provided to patients and actions incident to services provided to patients of the supervised practice shall be deemed to have occurred in the state where the patient is located at the time of service or action incident to the service. The supervising physician, covering physician, and physician assistant shall comply with all applicable Alabama laws, rules, and regulations pertaining to services and actions incident to services provided to Alabama patients of the supervised practice. Actions incident to services include, but are not limited to, professional medical oversight and direction to the physician assistant regarding Alabama patients, consultation, or referral of Alabama patients from the physician assistant, quality assurance review of the medical records of Alabama patients, and maintenance of documentation pursuant to this chapter. The supervising physician shall maintain all documentation required pursuant to this chapter for the duration of the supervised practice and for three years following the termination of the supervised practice agreement.