Current through Register Vol. 40, No. 6, March 31, 2022
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.
shall be no independent, unsupervised practice by physician
(3) The supervising
physician shall be readily available for direct communication or by telephone
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
(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
If the physician
assistant is to perform duties at a remote site physician supervision requires
(a) The supervising physician
receives a daily status report to be made in person, by telephone, or by
telecommunications from the assistant on any complications or unusual problems
physician will be present ten percent (10%) of the P. A.'s scheduled work hours
in an approved remote practice site if:
P.A. has less than two (2) years (4,000 hours) in a registration agreement.
2. The P.A. has entered into a new
registration agreement and the new supervising physician has a dissimilar
primary specialty than the previous supervising physician.
If the P.A. has at least two
(2) years (4,000 hours) in a registration agreement, the supervising physician
1. Visit the remote site no less than
twice a year.
2. Meet with the P.A.
no less than quarterly.
(d) A pre-approved covering physician is
allowed to be present in lieu of the supervising physician.
(e) The supervising physician, during office
visits, if applicable, reviews with the assistant case histories of patients
with unusual problems or complications.
(f) An appropriate physician personally
diagnoses or treats patients requiring physician follow-up.
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
The mechanism for
quarterly quality assurance shall be as follows:
1. Specify a plan for quarterly quality
assurance management with defined quality outcome measures for evaluation of
the clinical practice of the physician assistant and include review of a
meaningful sample of medical records plus all adverse outcomes. The term
"medical records" includes, but is not limited to, electronic medical records.
Documentation of quality assurance review shall be readily retrievable,
identify records that were selected for review, include a summary of findings
conclusions, and, if indicated, recommendations for change.
2. Countersignature by supervising physician
must be pursuant to established policy and/or applicable legal regulations and
(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
(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
Ala. Admin. Code r.
Repealed and Replaced:
Filed September 21, 1998; effective October 26, 1998. Repealed and New Rule:
Filed August 22, 2002; effective September 26, 2002. Repealed and New Rule:
Filed September 19, 2002; effective October 24, 2002. Amended: Filed October
21, 2010; effective November 25, 2010.
Administrative Monthly Volume XXXIII, Issue No. 03, December 31,
2014, eff. 1/15/2015.
Administrative Monthly Volume XXXIV, Issue No. 03, December 31,
2015, eff. 1/30/2016.
Administrative Monthly Volume XXXVI, Issue No. 01, October 31,
2017, eff. 12/3/2017.
Administrative Monthly Volume XXXIX, Issue No. 02, November 30,
2020, eff. 1/14/2021.
Administrative Monthly Volume XL, Issue No. 01, October 29, 2021,
Author: Alabama Board of Medical
Code of Ala.