Protocol · PA · Ohio
Practice Protocol for Physician Assistants in Ohio
Required. Ohio law names the instrument a Supervision Agreement, 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.
No independent-practice pathway exists for PAs in Ohio at any tenure. A pending bill (H.B. 963) would remove the geographic-proximity requirement and other administrative burdens, but per the sponsoring association's own tracker, it 'remains pending' with no hearing yet — not enacted.
What an Ohio Supervision Agreement must contain
Governed by the State Medical Board of Ohio and the State Board of Pharmacy of Ohio. Each numbered item is a statutory requirement the Supervision Agreement must satisfy.
The Physician Assistant ("PA") shall practice pursuant to a written Supervision Agreement with the Physician, as required by Ohio Rev. Code § 4730.19. The Supervision Agreement shall state that the Physician agrees to supervise the Physician Assistant, that the Physician Assistant agrees to practice under that supervision, that the Physician is legally responsible for the services the Physician Assistant provides under it, and the respective responsibilities, limitations, and referral circumstances that apply.
A supervising physician may not supervise more than five (5) Physician Assistants at any one time, as provided under Ohio Rev. Code § 4730.21. The Parties shall retain the Supervision Agreement and any amendments and shall produce them to the State Medical Board of Ohio upon request.
- The Supervision Agreement 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 Supervision Agreement has to carry, from Ohio's supervision rules.
Proximity
after the first 500 hours of delegated prescriptive authority: Available remotely (no on-site requirement)
Ohio Rev. Code §4730.21: the supervising physician must be 'continuously available for direct communication,' either physically present or 'readily available through telecommunication' — no mileage/radius standard is codified.
first 500 hours of exercising delegated prescriptive authority: On-site presence required
Ohio Rev. Code § 4730.44 (also OAC 4730-1-06): 'During the first five hundred hours of a physician assistant's exercise of physician-delegated prescriptive authority, the physician assistant shall exercise that authority only under the on-site supervision of a supervising physician.' Only after this threshold does the general telecommunication-availability standard apply. Section 4730.44 also exempts PAs with 1,000 or more hours of prior prescriptive-authority experience from another state, or from military, VA or U.S. Public Health Service practice, from the 500-hour on-site startup period.
Supervision ratio
Up to 5 at a time
A physician may not supervise more than 5 PAs at any one time (Ohio Rev. Code § 4730.21). The cap is on concurrent active supervision, not total signed supervision agreements.
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
OARRS consultation required before prescribing opioids/benzodiazepines (narrow exceptions for hospice/terminal, institutional administration, ≤7-day scripts, and cancer treatment absent red flags), then at least every 90 days during ongoing opioid/benzodiazepine treatment, or at least annually for other reportable drugs prescribed 90+ days (OAC 4730-2-10).
Written agreement
Required
Unconditional — Ohio's term is a 'supervision agreement' (Ohio Rev. Code §4730.19), which may not cover more than one supervising physician per PA-side agreement, though one physician may hold agreements with multiple PAs up to the ratio cap.
Practice ownership (corporate practice of medicine)
Non-licensee ownership permitted — Ohio has NO corporate-practice-of-medicine doctrine — the State Medical Board formally declared (3/15/2012) that Ohio law does not prohibit a physician from rendering services as a corporate employee, grounded in Ohio Rev. Code §4731.226 (authorized business-entity forms: corporations, LLCs, partnerships, professional associations). Physicians may form multidisciplinary entities combining with other licensed professionals under §4731.226(C), which expressly overrides professional codes of ethics that would otherwise bar combination practice.
Sources for the supervision rules (9)
- Ohio Rev. Code §4730.19 — Supervision agreement
- Ohio Rev. Code §4730.21 — Proximity/telecommunication standard, 5-PA ratio cap
- Ohio Rev. Code §4730.41, §4730.411 — PA prescriptive authority, Schedule II restrictions
- Ohio Rev. Code §4730.44 — 500-hour on-site prescriptive-authority startup period
- OAC 4730-1-06 — 500-hour on-site period implementation (via Cornell LII mirror, read directly)secondary
- OAC 4730-2-04 — PA supervision/prescribing competence standards (via Cornell LII mirror, read directly)secondary
- OAC 4730-2-10 — OARRS consultation requirements (via Cornell LII mirror, read directly)secondary
- Ohio Rev. Code §4731.226 — Authorized business-entity forms (CPOM)
- H.B. 963 (current General Assembly) — pending PA-practice modernization, not enacted
About Ohio's rules
Ohio recently relaxed CRNA supervision from 'immediate presence' to facility-wide 'collaboration' (H.B. 52, eff. 6/8/2026, now current law), and will loosen RN laser-delegation rules similarly (H.B. 377, eff. 8/25/2026 — NOT yet law as of this file's date). No independent-practice pathway exists for NP/PMHNP/PA despite active pending reform bills (a 2,000-hour NP threshold, PA proximity removal) — none enacted. Ohio has no corporate-practice-of-medicine doctrine (State Medical Board, 2012). Non-nurse midwifery has no current licensure pathway.
Other clinicians in Ohio: see the state overview.