Protocol · PA · Alabama
Practice Protocol for Physician Assistants in Alabama
Alabama does not define a named protocol for Physician Assistants. Here is what the state does require and what a written protocol usually covers.
Ala. Admin. Code r. 540-X-7-.23: 'There shall be no independent, unsupervised practice by physician assistants.' No experience threshold ever removes the supervision requirement.
What a Physician Assistant protocol must contain in Alabama
Alabama requires a written protocol but gives it no statutory name. Governed by the Alabama Board of Medical Examiners and the Alabama State Board of Pharmacy. Each numbered item is a requirement the protocol must satisfy.
The Physician Assistant ("PA") shall practice under a direct, continuing, and close supervisory relationship with the Physician, as required by Ala. Admin. Code ch. 540-X-7, which does not require the Physician's on-site presence. The Physician shall maintain a quality assurance plan providing for review of a meaningful sample of the Physician Assistant's patient records and of all adverse outcomes.
A physician may not supervise or collaborate with Physician Assistants, Certified Registered Nurse Practitioners, and Certified Nurse Midwives whose combined scheduled hours exceed three hundred sixty (360) full-time-equivalent hours per week. The Physician Assistant's registration to the Physician shall be approved and filed with the Alabama Board of Medical Examiners, and any change in supervising physician shall be reported to the Board.
- The protocol also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the protocol has to carry, from Alabama's supervision rules.
Proximity
PA with <2 years (4,000 hours) of experience, remote/satellite site: On-site presence required
Supervising physician must be physically present at the approved practice site for not less than 10% of the PA's scheduled hours (Ala. Admin. Code r. 540-X-7-.23).
PA with ≥2 years (4,000 hours) of experience, remote/satellite site: Available remotely (no on-site requirement)
The on-site presence requirement does not apply; instead the physician must visit the remote site at least twice a year and meet with the PA at least quarterly. No mileage or radius figure appears in the rule text.
Supervision ratio
Up to 9 at a time (combined across provider types)
A physician may not collaborate with/supervise any combination of CRNPs, CNMs, and PAs exceeding 360 hours/week (i.e., 9 FTE positions total, combined across all three provider types) — a shared cap, not a per-type cap (Ala. Admin. Code r. 540-X-8-.08, cross-referenced for PAs).
Chart review
Percentage set by agreement · Quarterly · countersignature required
Quarterly quality-assurance review of 'a meaningful sample of medical records plus all adverse outcomes' — no specific percentage codified. Countersignature required 'pursuant to established policy and/or applicable legal regulations and accreditation standards,' also with no fixed percentage (Ala. Admin. Code r. 540-X-7-.23, -.24). Records retained for duration of practice plus 3 years after termination.
Meeting cadence
Quarterly
Minimum quarterly meeting cadence; modality not specified as exclusively in-person or telehealth.
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
PAs prescribe legend drugs under the supervising physician's authority. Controlled-substance prescribing appears to run through the supervising physician's own DEA and Alabama Controlled Substances Certificate rather than a PA-specific certificate (the QACSC chapter covers only CRNPs and CNMs); confirm against the controlled-substances section of Ala. Admin. Code 540-X-7.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — PC or PLLC with licensed shareholders (Title 10A)
Alabama has no strict corporate-practice-of-medicine doctrine barring corporate ownership generally, but PAs cannot own/operate an independent practice outside a registered supervising-physician relationship.
Sources for the supervision rules (3)
- Ala. Code § 34-24-290 et seq. — Assistants to Physicians
- Ala. Admin. Code r. 540-X-7-.23, -.24 — Physician Assistant Supervision Requirements
- Ala. Admin. Code r. 540-X-8-.08 — Combined CRNP/CNM/PA Supervision Ratio (cross-referenced)
About Alabama's rules
Alabama is a restrictive state: PA/CRNP/CNM all require an indefinite collaborative agreement with no independence pathway, and share a combined 360 hours/week (9 FTE) supervision cap per physician. CRNA's status is a genuine ambiguity — statute requires an 'immediately available' physician/dentist/podiatrist, but no filed agreement or ratio regime exists like CRNP/CNM's; flagged for legal review.
Other clinicians in Alabama: see the state overview.