Collaborative Agreement
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NP · Alabama

Collaborative Practice Agreement for Nurse Practitioners in Alabama

Yes, a written physician agreement is required. Alabama calls it a Standard Protocol (within a Written Collaborative Agreement).

Practice authoritySupervision required
Written agreementAgreement required
What Alabama calls itStandard Protocol (within a Written Collaborative Agreement)
Governing boardAlabama Board of Nursing and the Alabama State Board of Pharmacy
Agreement familyCollaborative Practice
Research date2026-09-03 · clauses 2026-09-03

A collaborative practice agreement is required at all times with no experience-based sunset — Alabama's 4,000-hour/2-year threshold (below) reduces the INTENSITY of collaboration (on-site to telecommunication), it does not end the agreement requirement itself, unlike states with a true independence pathway.

What the collaboration must look like

The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.

Proximity

CRNP with <2 years (4,000 hours) of collaborative-practice experience: On-site presence required

Collaborating physician must be physically present at the approved practice site for not less than 10% of the CRNP's scheduled hours (Ala. Admin. Code r. 540-X-8-.08 / mirrored 610-X-5-.09).

CRNP with ≥2 years (4,000 hours) of collaborative-practice experience: Available remotely (no on-site requirement)

On-site presence requirement drops away, replaced by a minimum quarterly meeting; remote/satellite sites still require a physician visit no less than twice annually regardless of experience tier. No mileage/radius figure could be confirmed in the rule text retrieved.

Supervision ratio

Up to 9 at a time (combined across provider types)

Same combined 360 hours/week (9 FTE) cap shared across CRNP, CNM, and PA per collaborating physician (Ala. Admin. Code r. 540-X-8-.08).

Chart review

Percentage set by agreement · Quarterly

Collaborating physician must complete quarterly quality assurance with each CRNP, reviewing 'a meaningful sample of medical records plus all adverse outcomes' — no fixed percentage codified. Records retained for duration of collaboration plus 3 years after termination.

Meeting cadence

Quarterly

Minimum quarterly meeting cadence once the 4,000-hour/2-year threshold is met and on-site presence is no longer required.

Prescriptive authority

Separate prescribing terms required · controlled substances permitted

A Qualified Alabama Controlled Substances Certificate (QACSC) is required for any controlled-substance prescribing, renewed annually (due Dec. 31). Eligibility requires active collaborative practice with a physician holding an unrestricted Alabama Controlled Substances Certificate, 8 hrs CME on controlled-substance prescribing plus 4 hrs advanced pharmacology within the preceding year, ≥12 months active AL clinical practice, and separate DEA registration after QACSC issuance (Ala. Admin. Code r. 540-X-18).

Written agreement

Required

Practice ownership (corporate practice of medicine)

Licensee-only ownership required — Same Title 10A same-profession-ownership framework as `pa` — a CRNP cannot independently own a clinic without a collaborating-physician relationship (secondary-sourced characterization; not independently confirmed against primary statutory text).

Legal sources for these rules (5)
The document: Standard Protocol (within a Written Collaborative Agreement)
What a Alabama Standard Protocol (within a Written Collaborative Agreement) must contain, who governs it and who signs: read the Standard Protocol (within a Written Collaborative Agreement) page on practiceagreement.com.

What a collaborating physician costs here

Typical monthly cost in Alabama

$500 – $700

Estimate for one Nurse Practitioner. This state's rules add a restrictive-tier premium.

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.