Protocol · PA · Missouri
Practice Protocol for Physician Assistants in Missouri
Required. Missouri law names the instrument a Collaborative Practice Arrangement, and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it must contain, and the terms it has to carry.
Missouri has no independent-practice pathway for PAs — a written collaborative practice arrangement with a physician is mandatory for as long as the PA practices, regardless of experience (§ 334.735).
What a Missouri Collaborative Practice Arrangement must contain
Governed by the Missouri State Board of Registration for the Healing Arts and the Missouri Board of Pharmacy. Each numbered item is a statutory requirement the Collaborative Practice Arrangement must satisfy.
The Physician Assistant ("PA") shall practice pursuant to a written Collaborative Practice Arrangement with the Physician, as required by Mo. Rev. Stat. § 334.735, on substantially the same terms as apply to Nurse Practitioners under this Agreement: geographic proximity sufficient for effective collaboration, on-site presence of the Physician at least once every two (2) weeks (except as documented exceptions provide), and chart review of at least ten percent (10%) of records every fourteen (14) days, or twenty percent (20%) of controlled-substance-prescribing records every fourteen (14) days.
Source: Mo. Rev. Stat. § 334.735
A physician may not have Collaborative Practice Arrangements in effect with more than six (6) full-time-equivalent Nurse Practitioners, Physician Assistants, and assistant physicians combined, as provided under § 334.735.16. The Physician shall file the collaborating physician form for the Physician Assistant with the Missouri State Board of Registration for the Healing Arts, as required by § 334.735.15.
Source: Mo. Rev. Stat. § 334.735
- The Collaborative Practice Arrangement also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
- Mo. Rev. Stat. § 334.735statute
Physician Assistant Collaborative Practice Arrangement requirements, filing of the collaborating-physician form, and the 6-FTE collaboration cap.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Collaborative Practice Arrangement has to carry, from Missouri's supervision rules.
Proximity
Available remotely (no on-site requirement)
§ 334.735 requires the collaborating physician and PA to 'maintain geographic proximity,' with no numeric mileage in the current statutory text. A pre-2024 75-mile rule was reportedly rescinded by board action (secondary-sourced — not independently confirmed against current rule text; verify before relying on this for compliance decisions). PAs also generally practice 'within the same office facility' as the supervising physician per the statutory definition of supervision, with exceptions for hospital/nursing-home/correctional-facility follow-up exams if reviewed and countersigned.
Supervision ratio
Up to 6 at a time (combined across provider types)
No physician may hold collaborative practice arrangements/supervision agreements with more than 6 full-time-equivalent APRNs, PAs, and/or assistant physicians in any combination concurrently (§§ 334.104, 334.735). Exceptions exist for hospital inpatient care and population-based public health services.
Chart review
10% of charts · As needed (every 14 days)
10% of all charts documenting the PA's care, reviewed at least every 14 days (§ 334.735). Rises to 20% for charts in which the PA prescribed a controlled substance — see prescriptiveAuthority notes.
Meeting cadence
As needed
The collaborating physician (or another physician named in the arrangement) must be present for sufficient periods of time at least once every 2 weeks to conduct chart review and provide medical direction, except in documented extraordinary circumstances (§ 334.735). No MEETING_FREQUENCIES value maps exactly to 'biweekly' — treat this as the closest available approximation, not a monthly cadence.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Controlled-substance delegation requires the collaborating physician hold an unrestricted federal DEA registration; separate written delegation within the collaborative practice arrangement (§ 334.735).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Traditional corporate-practice-of-medicine doctrine; professional corporations under RSMo Chapter 356 generally require shareholders licensed in the relevant profession
Sources for the supervision rules (2)
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.