The collaborating physician shall:
Provide professional medical oversight and direction to the certified nurse
(b) Be readily available
for direct communication or by radio, telephone or
(c) Be readily
available for consultation or referrals of patients from the certified nurse
(d) Be readily available
during labor management to provide direct medical intervention and to attend
deliveries if needed.
readily available at each remote practice site.
(2) In the event the collaborating physician
is not readily available, provisions shall be made for professional medical
oversight and direction by a covering physician who is readily available, who
is pre-approved by the Board of Medical Examiners, and who is familiar with
these rules. The collaborating physician shall certify to the Board of Medical
Examiners at least annually that any approved covering physician continues to
agree to serve in that capacity and shall inform the Board of Medical Examiners
of the termination of a covering physician within ten (10) days of the
(3) In the event of an
unanticipated, permanent absence of a collaborating physician, a previously
approved covering physician may be designated as a temporary collaborating
physician for a period of up to sixty (60) days. During the sixty (60) day time
period, a new "Notice of Commencement" designating a new collaborating
physician should be submitted for approval.
(4) The certified nurse midwife's scheduled
hours in patient homes, and/or facilities licensed by the Alabama Department of
Public Health and facilities certified by the Alabama Department of Public
Health are not subject to the required minimum hours for physician
(a) Have no additional
requirement for documentation of on-site collaboration when working in the same
facility with the Certified Nurse Midwife (CNM).
Be present for not less than ten percent
(10%) of the CNM's scheduled hours in an approved practice site with a CNM who
has less than two (2) years (4,000 hours) of collaborative practice experience:
1. Since initial certification; or
2. In the collaborating physician's practice
documentation of the CNM's two (2) years (4,000 hours) of collaborative
practice experience for the duration of the collaborative practice and for
three (3) years following the termination of the collaborative practice
(d) Visit remote
practice sites no less than twice annually.
(e) Meet no less than quarterly with the CNM
who has more than two (2) years (4,000 hours) of collaborative practice
(f) Complete quarterly
quality assurance with each CNM. Documentation of any quality assurance review
required by this chapter shall be maintained by the collaborating physician for
the duration of the collaborative practice and for three years following the
termination of the collaborative practice agreement.
(g) Allow a pre-approved covering physician
to be present in lieu of the collaborating physician.
The collaborating physician shall provide
notice in writing to the State Board of Medical Examiners of the commencement
or termination of a collaborative practice agreement as required by Rule
(7) The Joint Committee may, at its
discretion, waive the requirement of written verification of physician
availability upon documentation of exceptional circumstances. Employees of
state and county health departments are exempt from the requirement of written
verification of physician availability.
A written standard protocol specific to
the specialty practice area of the certified nurse midwife and the specialty
practice area of the collaborating physician, approved and signed by both the
collaborating physician and the certified nurse midwife shall:
(a) Identify all sites where the certified
nurse midwife will practice within the collaboration protocol.
(b) Identify the physician's principal
(c) Be maintained at
each practice site and on file with the Board of Nursing and Board of Medical
(d) Include a formulary
of drugs, devices, medical treatments, tests and procedures that may be
prescribed, ordered, and implemented by the certified nurse midwife consistent
with these rules, and which are appropriate for the collaborative practice
(e) Include a
pre-determined plan for emergency services.
(f) Specify the process by which the
certified nurse midwife shall refer a patient to a physician other than the
Specify a plan for quality assurance management with defined quality outcome
measures for evaluation of the clinical practice of the certified nurse midwife
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.
Quality assurance monitoring may be performed by designated personnel, with
final results presented to the physician and certified nurse midwife for
review. The certified nurse midwife shall maintain a copy of the plan for
quality assurance, in a form prescribed by the Board of Nursing, on file with
the Board of Nursing. The collaborating physician shall maintain an updated
copy of the plan for quality assurance on file with the Board of Medical
physician shall maintain independent medical judgment related to the practice
of medicine at all times, irrespective of employment structure or business
(10) Irrespective of the
location of the principle practice site and any remote site(s) of the
collaboration, all services provided to patients and actions incident to
services provided to patients of the collaborative 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 collaborating physician, covering
physician, and certified nurse midwife shall comply with all applicable Alabama
laws, rules, and regulations pertaining to services and actions incident to
services provided to Alabama patients of the collaborative practice. Actions
incident to services include, but are not limited to, professional medical
oversight and direction to the certified nurse midwife regarding Alabama
patients, consultation or referral of Alabama patients from the certified nurse
midwife, quality assurance review of the medical records of Alabama patients,
and maintenance of documentation pursuant to this chapter. The collaborating
physician shall maintain all documentation required pursuant to this chapter
for the duration of the collaborative practice and for three years following
the termination of the collaborative practice agreement.
Ala. Admin. Code r.
New Rule: Filed June 20,
1996; effective July 26, 1996. Repealed and New Rule: Filed August 25, 2003;
effective September 29, 2003. Amended: Filed July 22, 2005; effective August
26, 2005. Amended: Filed October 6, 2006; effective November 10, 2006. Amended:
Filed February 21, 2008; effective March 27, 2008. Amended: Filed September 24,
2012; effective October 29, 2012.
Administrative Monthly Volume XXXIII, Issue No. 10, July 31,
2015, eff. 8/6/2015.
Administrative Monthly Volume XXXVI, Issue No. 04, January 31,
2018, eff. 3/8/2018.
Administrative Monthly Volume XXXVII, Issue No. 09, June 28,
2019, eff. 8/3/2019.
Administrative Monthly Volume XXXIX, Issue No. 07, April 30,
2021, eff. 6/14/2021.
Was previously Rule
renumbered as per certification filed April 23, 2004; effective May 28,
Author: Alabama Board of Medical
Statutory Authority: Code of Ala.