CRNA · Puerto Rico
Collaborative Practice Agreement for Certified Registered Nurse Anesthetists in Puerto Rico
Yes, a written physician agreement is required. Puerto Rico does not name a specific instrument.
Ley 254-2015 Art. 2(e)(2)(c) authorizes the 'Enfermera/o Anestesista' to select, administer, and monitor anesthesia and perform advanced airway/resuscitation measures, but only 'en colaboración con los médicos' and per protocols agreed with the patient's physician for each procedure — no independent-practice pathway is codified.
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
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
No PR statute was found addressing individual DEA registration for CRNAs; treat as unconfirmed rather than assuming a mainland-style registration requirement.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 — no PR statute found barring CRNA ownership of a nursing-services professional corporation.
Legal sources for these rules (1)
What a collaborating physician costs here
Typical monthly cost in Puerto Rico
$500 – $600
Estimate for one Certified Registered Nurse Anesthetist. Standard-tier state.
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.