Collaborating Physician Requirements in Texas: What NPs Need to Know

Reviewed by the CollabDocs Compliance Team | Last Reviewed October 2026

In Texas, finding a collaborating physician is an important step for nurse practitioners (NPs) who want to prescribe medications and build or grow their practice. Texas law requires NPs to have physician-delegated prescriptive authority, generally established through a written Prescriptive Authority Agreement (PAA). Understanding what this agreement must include, how often you and your physician need to meet, and what prescribing restrictions apply can help you stay compliant while focusing on what matters most: caring for your patients and running your practice.

As a team of NPs and PAs, we know that navigating collaboration requirements can feel overwhelming, especially when you’re also managing the many responsibilities of practice ownership. This guide breaks down the Texas requirements in practical terms, including how to structure your agreement, what to look for in a collaborating physician, and how to maintain a compliant arrangement as your practice evolves.

Key Texas Collaborating Physician Requirements 

• Texas NPs can’t prescribe independently. A physician delegates prescriptive authority through a written Prescriptive Authority Agreement (PAA).
• The PAA must be reviewed, signed and dated at least once a year.
• For agreements signed on or after Sept. 1, 2019, the NP and physician meet at least monthly, and meetings can be remote.
• A physician can delegate to no more than 7 APRNs and PAs combined (FTE), with exceptions for hospital and medically underserved settings.
• There’s no geographic proximity requirement.
• Schedule II prescribing is limited to hospital facility-based and hospice settings.

What Is a Collaborating Physician Called in Texas?

The physician who delegates prescriptive authority to an NP goes by a few names. The Texas Medical Board typically uses “delegating physician” or “supervising physician,” while many NPs use “collaborating physician.” Whatever you call the role, finding a collaborating physician in Texas means finding one who will sign a Prescriptive Authority Agreement (PAA), the formal agreement that governs that delegation.

Texas law distinguishes between an NP’s professional nursing scope of practice and the medical authority delegated by a physician. An NP’s license and advanced practice authorization establish the nursing services they may provide, while delegated prescriptive authority allows them to prescribe or order medications and devices within the terms of the agreement and applicable law.

A PAA is a working document. It establishes how the NP and physician will communicate, coordinate patient care, handle emergencies, and conduct quality assurance activities.

The key distinction is that a PAA governs delegated prescriptive authority. It does not independently authorize an NP to perform every medical act or expand the NP’s scope beyond what Texas law permits. Depending on the practice setting and delegated activities, additional protocols or written authorizations may apply.

The primary legal framework is found in Chapter 157 of the Texas Occupations Code. The Texas Medical Board (TMB) and Texas Board of Nursing (BON) provide additional regulatory guidance.

Is a Prescriptive Authority Agreement the Same as a Collaborative Practice Agreement?

Not exactly. In many states, NPs and physicians sign a collaborative practice agreement that outlines how they’ll work together. Texas instead uses a Prescriptive Authority Agreement (PAA), which is narrower. A PAA is the written agreement through which a physician delegated prescriptive authority to an NP, so it applies when the NP will prescribe under that delegation. It does not define the NP’s full scope of practice, which comes from their nursing license, APRN authorization, and BON rules for their role and population focus.

A PAA still carries real oversight requirements. Under Texas Occupations Code §157.0512, the agreement must be in writing, signed and dated by both parties, and must describe a quality assurance and improvement plan that includes chart review and periodic meetings.

If you’re moving to Texas from another state, expect the paperwork and terminology to look different. The role of a collaborative practice agreement varies by state, so review Texas requirements rather than reusing an agreement from a previous state.

What Must a Texas NP’s Prescriptive Authority Agreement Include?

Texas Occupations Code § 157.0512 establishes the minimum requirements for a PAA. The agreement must be written, signed, and dated by both parties, and it should accurately reflect the actual practice arrangement.

Before signing a PAA, the NP must hold an active Texas license in good standing, and both the NP and physician must disclose to each other any prior disciplinary action by the Texas Medical Board, Texas Board of Nursing, or Texas Physician Assistant Board.

At a minimum, a Texas PAA must include:

•     The names, addresses, and professional license numbers of the physician and NP.
•     The nature of the practice, including practice locations or settings.
•     The types or categories of drugs and devices the NP may or may not prescribe.
•     A general plan for consultation and referral.
•     A plan for addressing patient emergencies.
•     The process for communication and sharing patient-care information.
•     Any alternate physicians who will provide temporary supervision, if applicable.
•     A prescriptive authority quality assurance and improvement plan that includes chart reviews, periodic meetings, and documentation methods.

The agreement does not have to spell out step-by-step instructions for every disease, symptom, or clinical condition. Instead, it should establish a workable framework for delegated prescribing and meaningful physician collaboration.

How Often Must a Texas PAA Be Reviewed?

A PAA and any amendments must be reviewed, dated, and signed by both parties at least once a year. The agreement must also be made available to the appropriate licensing board no later than the third business day after a request.

Both the NP and physician should retain a copy of the signed agreement and any amendments. Texas law requires retention until at least two years after the agreement terminates.

Annual review is the minimum, not a reason to leave an outdated agreement in place. If your practice adds a location, changes its prescribing services, or modifies its physician coverage, review whether the PAA and related registrations need to be updated.

Does Texas Require a Separate Protocol in Addition to the PAA?

Not always. The Texas Medical Board explains that delegation protocols may be incorporated into the PAA rather than maintained as a separate document. However, the appropriate documentation depends on the type of delegated activity and the practice setting. Hospital-based practices, for example, may use protocols under applicable facility-based rules.

For NPs, the practical takeaway is to confirm that the written documents governing your clinical and prescribing activities cover the services you actually provide.

How Often Must a Texas NP Meet With a Collaborating Physician?

For PAAs executed on or after September 1, 2019, Texas requires the NP and physician to meet at least once a month. These meetings may take place in a manner agreed upon by the parties, including remotely.

PAAs signed before September 1, 2019 may be subject to different meeting frequency and format requirements. If your agreement predates that date, review it with counsel or consider executing a new agreement.

Monthly meetings must be documented and include discussion of:

•     Patient treatment and care.
•     Changes needed in patient care plans.
•     Referral-related issues.
•     Opportunities to improve patient care.

The monthly meeting requirement applies even when the NP and physician work in the same location. Physical proximity does not eliminate the obligation to meet.

For NPs working with a physician remotely, this means a collaboration arrangement can be structured without routine in-person meetings, provided the agreement and applicable requirements are followed.

How Many NP Charts Must a Collaborating Physician Review in Texas?

Texas law does not establish a universal minimum number or percentage of NP charts that a physician must review. Instead, the physician and NP determine the chart-review volume as part of the PAA’s quality assurance and improvement plan.

The Texas Medical Board identifies several factors to consider when setting chart-review expectations, including:

•     The NP’s experience and time in practice.
•     How long the NP and physician have worked together.
•     Whether they practice in the same setting.
•     The complexity of patient care.

The agreement should clearly state how many charts will be reviewed, how reviews will be documented, and how the parties will use the findings to support quality improvement.

Practical tip: Avoid vague language such as “periodic chart review.” Establish a realistic review schedule, assign responsibility for tracking completion, and document any follow-up actions.

How Many Nurse Practitioners Can a Physician Supervise in Texas?

Generally, a Texas physician may enter into prescriptive authority agreements with no more than seven advanced practice registered nurses (APRNs) and PAs combined, or the full-time equivalent of seven.

Exceptions apply to prescriptive authority exercised in:

• A facility-based hospital practice.
• A practice serving a medically underserved population.

These exceptions are established in Texas Occupations Code § 157.0512(d). The medically underserved category is defined in § 157.051 and includes qualifying settings such as federally qualified health centers, rural health clinics, certain public health clinics, and designated shortage areas.

The limit applies to the combined number of APRNs and PAs, not seven of each profession. Before entering into an agreement, confirm the physician’s existing delegation commitments and whether a statutory exception applies to your practice.

Does a Texas NP Need an In-Person or Nearby Collaborating Physician?

Texas does not generally require a collaborating physician to be physically present at the NP’s practice location at all times, nor does it establish a universal geographic-proximity requirement for a PAA.

However, the physician must provide adequate supervision of delegated prescriptive authority. The agreement must establish how the parties will communicate, share patient-care information, address emergencies, and conduct required quality assurance activities.

For PAAs subject to the monthly meeting requirement, the parties determine the manner of those meetings. Remote meetings may be used under agreements executed on or after September 1, 2019.

For NPs considering a remote collaborating physician, the more important question is whether the arrangement supports timely consultation, meaningful oversight, and compliance with the written agreement.

Can a Texas NP Prescribe Medication Independently?

No. Texas NPs do not have independent prescriptive authority. They may prescribe or order medications and devices under physician-delegated authority, subject to their credentials, the PAA or other applicable delegation mechanism, and state and federal law.

The agreement should clearly identify the categories of drugs and devices the NP is authorized to prescribe, as well as any restrictions imposed by the physician. Prescriptive authority looks very different from state to state. For a broader look at whether nurse practitioners can prescribe medications and how that authority is granted, see our national guide.

An NP’s authority to prescribe a particular medication should never be assumed solely because the medication falls within the NP’s specialty or clinical expertise. Prescriptive authority depends on the applicable legal requirements and the scope of delegation.

What Controlled Substances Can a Texas NP Prescribe?

Texas permits physician-delegated prescribing of certain controlled substances, but the rules differ by schedule.

For Schedules III–V, the total prescription period, including refills, generally cannot exceed 90 days. Before authorizing a refill beyond the initial 90-day period, the NP must consult the delegating physician and document the consultation in the patient’s chart. Physician consultation and documentation are also required before prescribing these controlled substances to a child under two years of age.

Schedule II prescribing is much more limited. In a hospital facility-based practice, it may be authorized under policies approved by the hospital’s medical staff, for patients admitted with an intended stay of 24 hours or more or receiving care in the hospital’s emergency department. Freestanding emergency medical care facilities, which are separate from a hospital, do not qualify. Schedule II prescribing may also be authorized as part of a qualifying hospice plan of care for a terminally ill patient.

An NP must also meet applicable Texas prescriptive authority and DEA registration requirements. Texas no longer requires a separate state controlled substances registration through DPS for APRNs.

Because controlled-substance rules are highly specific, NPs should confirm that the medication, care setting, patient circumstances, delegation terms, and required registrations all align before prescribing.

What Are the Texas Medical Board Registration Requirements?

A signed PAA is only one part of establishing a compliant delegation arrangement. The physician must also complete the applicable registration requirements with the Texas Medical Board.

For physician-delegated prescriptive authority, the TMB requires registration before the NP begins working under that delegation. Changes to supervision or delegation information must generally be updated within 30 days. The TMB’s online registration system provides instructions and eligibility requirements for physicians and delegates.

Before starting a new collaboration, confirm that:

•     The PAA is signed and dated.
•     The physician has completed the required registration.
•     The practice locations and delegation information are accurate.
•     The NP’s Texas license and prescriptive authority are active.
•     Any applicable controlled-substance registrations are in place.

What Happens When a Texas PAA Is Terminated?

Ending a collaboration requires more than notifying the physician or removing their name from practice documents.

The physician must update the TMB’s delegation records within 30 days of a termination or other applicable change. The parties should also document the termination date, retain the agreement and amendments, notify relevant parties, and confirm how the NP’s prescribing and delegated activities will be handled during the transition.

An NP should not assume that a replacement physician’s agreement can be finalized retroactively. Plan for the transition before the existing arrangement ends, and verify that all required delegation and registration steps are complete before continuing activities that depend on physician authority.

What Should NPs Look for in a Texas Collaborating Physician Agreement?

A compliant PAA establishes the regulatory framework, but the broader collaboration contract should also address how the relationship will work in practice.

How Much Does a Collaborating Physician Cost in Texas?

 Collaborating physician fees in Texas vary based on your specialty, practice model, number of locations, prescribing needs (especially controlled substances), and how much support is included. Some physicians charge a flat monthly fee, while others charge per chart review or by the hour, and some arrangements add onboarding or administrative fees.

When comparing quotes, look at what’s included along with the monthly number. Physician malpractice coverage, agreement drafting, and help with TMB registration can add up if they’re billed separately.

At CollabDocs, there’s a one-time initial fee, then a flat monthly rate that varies by state and practice needs. That rate includes your physician match, a compliant Prescriptive Authority Agreement, physician malpractice coverage, and ongoing support. See what’s included on our collaboration pricing page, or request a free quote before you commit.

Questions to Ask About Collaborating Physician Fees

•     Whether the fee is flat-rate, per-review, or based on another arrangement.
•     Which services are included in the fee.
•     Whether additional practice locations or prescribing needs change the cost.
•     How and when payments are due.
•     Whether there are separate onboarding or administrative fees.

The goal is to understand the full cost of collaboration and avoid unexpected charges as your practice grows.

Term, Termination, and Physician Replacement

Your agreement should specify its duration, renewal process, termination notice requirements, and procedures for replacing a physician.

This is particularly important for independent practices. If a physician relationship ends unexpectedly, the NP may need to pause prescribing or other delegated activities until a compliant replacement arrangement is established.

Discuss contingency plans before signing. A clear transition process can help protect continuity of patient care and reduce avoidable interruptions to practice operations.

Confidentiality, Documentation, and Liability

The contract should address the handling of patient information, secure communication, record retention, and professional liability coverage.

Both parties should understand their responsibilities for maintaining appropriate insurance and notifying insurers when the collaboration arrangement changes. Coverage should reflect the actual services and professional roles involved.

How Do Collaboration Requirements Differ by Practice Setting?

The core requirements for delegated prescriptive authority remain important across practice models, but the operational details can vary.

NP-Owned Clinics and Private Practices

If you’re starting your own practice in Texas, plan the collaboration arrangement and the business structure together. Texas law governing the corporate practice of medicine and professional ownership can affect how clinical services are organized, so entity decisions matter early. Our guide on how to start a health care business covers legal structure and ownership in more detail.

A PAA does not resolve every ownership or practice-structure issue. NPs should seek qualified legal guidance to confirm that the business entity, clinical decision-making, and delegation arrangements comply with applicable law.

Hospitals and Health Systems

Hospital-based practices may operate under facility-based delegation rules and approved protocols. The Texas Medical Board recognizes that a PAA is not always required in hospital or long-term care facility-based settings when another authorized delegation mechanism applies.

NPs should work with medical staff leadership and compliance teams to confirm which delegation documents, privileging requirements, and internal policies govern their roles.

Telemedicine Practices

Telemedicine does not eliminate the need for appropriate physician delegation or compliance with prescribing requirements. Remote practices should establish reliable consultation procedures, secure communication, appropriate documentation, and a workable process for required quality assurance meetings. If you’re building a virtual practice from the ground up, here’s what to expect when starting your own telemedicine practice.

NPs prescribing controlled substances through telemedicine must also follow applicable federal and Texas requirements. Because these rules can change, verify current requirements before implementing or expanding a telehealth prescribing model.

What Are the Most Common Physician Collaboration Issues in Texas?

Compliance problems often come from day-to-day administration rather than the agreement itself. Common issues include:

• Missed or undocumented monthly meetings. A meeting that happened but wasn’t documented can be hard to prove during a board review.
• Vague chart review terms. Language like “periodic review” makes it unclear whether the quality assurance plan is being followed.
• Outdated TMB registration. Changes to supervision or delegation generally must be updated within 30 days.
• Prescribing outside the agreement. This includes drugs not covered in the PAA, controlled substance refills beyond 90 days without documented physician consultation, or Schedule II prescribing outside qualifying settings.
• Missing the annual review. The PAA must be reviewed, signed, and dated at least once a year.
• Exceeding the delegation limit. A physician may be over the seven-APRN/PA limit without the NP knowing.
• Gaps when a physician leaves. Continuing delegated activities before a replacement agreement and registration are in place.

How Can NPs Maintain Ongoing Compliance in Texas?

Compliance continues well after the PAA is signed. It requires ongoing attention to documentation, communication, prescribing practices, and changes in the practice.

We recommend building a simple compliance process around the following recurring responsibilities:

Texas NP Collaboration Checklist

•     Keep the signed PAA and amendments accessible to both parties.
•     Review, date, and sign the PAA at least annually.
•     Schedule and document monthly quality assurance meetings.
•     Track chart reviews according to the written quality assurance plan.
•     Verify that practice locations and delegation registrations are current.
•     Confirm that prescribing remains within delegated authority.
•     Review controlled-substance requirements and applicable registrations.
•     Maintain a transition plan if the physician relationship changes.

A designated staff member can help track administrative deadlines, but the NP and physician should both understand their responsibilities. Regularly reviewing the agreement against actual practice operations can help identify gaps before they disrupt patient care or become regulatory concerns.

For current requirements, refer directly to the Texas Medical Board’s Prescribing and Supervision guidance and the Texas Board of Nursing’s APRN Practice FAQs.

How CollabDocs Helps Texas NPs Find a Collaborating Physician

At CollabDocs, we’re a team of NPs and PAs who understand that finding a collaborating physician in Texas is about more than meeting a regulatory requirement. It’s about building a professional relationship that fits your specialty, practice model, and patient-care needs.

Since 2020, we’ve helped facilitate more than 4,000 successful NP and PA connections. Our physician network and dedicated team help clinicians navigate the matching process, with most clients being matched within 48 hours, and every match is guaranteed within 14 days.

We help make the process more straightforward by connecting you with physicians whose experience and availability align with your practice needs. From understanding collaboration requirements to establishing a relationship that supports your work, we’re here to help you move forward with greater clarity and confidence.

Ready to get matched with a Texas collaborating physician? Learn more about how CollabDocs can support your practice and help you take the next step toward a compliant collaboration arrangement. Book a demo today to get started. 

Disclaimer: This article is for educational purposes only and is not legal advice. Texas laws and regulations may change, and requirements can vary based on your credentials, practice setting, and delegated activities. Consult the relevant licensing boards and qualified healthcare legal counsel regarding your specific circumstances.

References

• Texas Legislature. Texas Occupations Code, Chapter 157: Authority of Physician to Delegate Certain Medical Acts, Sections 157.051, 157.0511, 157.0512, and 157.054
• Texas Medical Board. Prescribing and Supervision
• Texas Board of Nursing. APRN Practice FAQs
• Texas Board of Nursing. Rules and Regulations: 22 Texas Administrative Code Chapters 221 and 222, including Rule 222.5, Prescriptive Authority Agreement, and Rule 222.8, Authority to Order and Prescribe Controlled Substances
  
• Texas Medical Board. FAQ 239: How Many Charts Must Be Reviewed?
• Texas Medical Board. FAQ 237: How Often Are Meetings Required?
• U.S. Drug Enforcement Administration, Diversion Control Division. Telemedicine