How to open a med spa: what the rules actually require

⚠️ Alabama regulates the professional entity by registering it and by naming which entities may employ a delegate. The Board of Medical Examiners records and maintains a permanent file on all professional corporations incorporated by physicians and osteopaths. And to qualify for registration a physician assistant must be employed by a qualified physician, or by a partnership, medical professional corporation, medical professional association or physician practice foundation that also employs a qualified supervising physician, or by an entity the Board has approved. Ownership restrictions elsewhere in Alabama law were not surveyed here.

• (k) Record and maintain a permanent file on all professional corporations incorporated by physicians and osteopaths.

  Ala. Admin. Code r. 540-X-1 (Board duties — professional corporations) · verified Sep 4, 2026

• (1) Be employed by: (a) A physician qualified under these rules or by a partnership, medical professional corporation, medical professional association or physician practice foundation that also employs a supervising physician qualified under these rules; or (b) An entity approved by the Board under Rule 540-X-7-. 22;

  Ala. Admin. Code r. 540-X-7 (Registration as a physician assistant — employment) · verified Sep 4, 2026

No corporate-practice doctrine, but a real ownership restriction. Alaska’s professions statutes and the Medical Board’s regulations state no corporate-practice-of-medicine doctrine — see the claim below for the chapters read. The restriction Alaska does impose sits in Title 10: a professional corporation may be incorporated only by persons licensed to render the professional service, and a certificate from the profession’s regulatory board that every incorporator, director and shareholder is licensed must be filed with the articles.

• ⚠️ Alaska states no corporate-practice-of-medicine doctrine in its professions statutes or the medical board’s regulations. A survey of the Medical Board chapter (AS 08.64), the Nursing chapter (AS 08.68), the Barbers and Hairdressers chapter (AS 08.13), the centralized licensing chapter (AS 08.01) and the corresponding regulations (12 AAC 40, 12 AAC 02, 12 AAC 09) returns no provision on corporate practice, business-entity ownership of a practice, fee-splitting, dividing a fee, or rebates. Alaska regulates WHO may perform an act and under whose supervision, not who may own the business that employs them. Anyone citing you an Alaska corporate-practice rule is describing a document these chapters do not contain.

  AS 08.64 (surveyed), AS 08.68 (surveyed), AS 08.13 (surveyed), AS 08.01 (surveyed); 12 AAC 40, 12 AAC 02 and 12 AAC 09 (surveyed) · verified Sep 5, 2026

• One or more persons, each of whom is licensed to render a professional service in the state, may incorporate a professional corporation by filing articles of incorporation that include the name of the profession to be practiced, the names and addresses of all original shareholders, directors, and officers, and the office address; and a certificate from the regulatory board of the profession certifying that each of the incorporators, directors, and shareholders is licensed to practice the profession shall be filed with the articles.

  AS 10.45.010 · verified Sep 8, 2026

Arizona’s grounds for discipline were surveyed and forbid no non-physician ownership, and a professional corporation may issue up to 49% of its voting shares to non-licensees unless its licensing authority sets a different percentage. The money is reached where the ownership is not: dividing a professional fee for patient referrals is unprofessional conduct, and that ground closes on “a contractual arrangement that has the same effect” — so a management or marketing fee is judged by what it does, not what it is called.

• ⚠️ Arizona catches the arrangement by its effect, not its label. Unprofessional conduct includes “charging a fee for services not rendered or dividing a professional fee for patient referrals among health care providers or health care institutions or between these providers and institutions or a contractual arrangement that has the same effect.” That closing clause is the point — a management or marketing contract structured to do what a fee split does is inside the ground.

  Ariz. Rev. Stat. § 32-1401(27)(v) · verified Sep 2, 2026

• And its only carve-out is research, not marketing. “this subdivision does not apply to payments from a medical researcher to a physician in connection with identifying and monitoring patients for a clinical trial regulated by the united states food and drug administration.” Nothing in the exception describes a lead-generation or per-patient marketing arrangement.

  Ariz. Rev. Stat. § 32-1401(27)(v) · verified Sep 2, 2026

⚠️ Arkansas regulates the ownership interest through disclosure. The board treats it as an ethical violation for a physician to fail to disclose to a patient that the physician holds an ownership interest in a facility or service, outside the physician’s own practice, to which the physician refers that patient. Delegation is separately bounded by who the employee is: a medical assistant is defined as an employee who has been delegated tasks and who has NOT been licensed or specifically authorized to perform them. And the medical corporation act is as absolute as this corpus gets. All of the officers, directors and shareholders of a corporation subject to that subchapter must at all times be licensed under the Arkansas Medical Practices Act, and “No person who is not so licensed shall have any part in the ownership, management, or control of the corporation, nor may any proxy to vote any shares of the corporation be given to a person who is not so licensed.” Ownership, management and control are named separately, so leaving the shares in licensed hands while moving control elsewhere is reached by the same sentence. Licensed people form the entity under the ordinary Business Corporation Act, only licensed employees may treat, and the corporation needs a certificate of registration from the Arkansas State Medical Board. These claims survey §§ 4-29-305 to 4-29-309 and two board rules; they do not survey the rest of Arkansas’s entity law.

• (3) A licensed physician fails to disclose to a patient that the physician has an ownership interest in a facility or service to which the physician refers the patient that is outside of the physician’s own practice;

  17 CAR § 140-2601(3) (Ethical violations for physicians) · verified Sep 4, 2026

• (2) "Medical assistant" means an employee of a physician who has been delegated medical practices or tasks and who has not been licensed by or specifically authorized to perform the practice or task pursuant to other provisions of Arkansas law;

  17 CAR § 140-2502(2) (definition of “Medical assistant”) · verified Sep 4, 2026

California strongly bars the corporate practice of medicine. This is the opposite of a permissive-ownership state.

• ⚠️ California’s ban is broad and expressly survives co-ownership. The offer, delivery, receipt or acceptance by a licensee of “any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers” is unlawful — “irrespective of any membership, proprietary interest, or coownership in or with any person to whom these patients … are referred”. Shared ownership is not a defense.

  Cal. Bus. & Prof. Code § 650(a) · verified Sep 2, 2026 · read at Public.Law — California Codes

• ⚠️ AND THIS IS THE MSO percentage-fee question answered in a sentence. “The payment or receipt of consideration for services other than the referral of patients that is based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished or with the fair rental value of any premises or equipment leased or provided” by the recipient to the payer. A percentage-of-revenue management fee is lawful in California where it is commensurate with value — and unlawful where it is not.

  Cal. Bus. & Prof. Code § 650(b) · verified Sep 2, 2026 · read at Public.Law — California Codes

⚠️ Colorado names the corporate practice of medicine doctrine in its statute and expressly refuses to let its own professional-corporation provisions be read as an exception to it. Ownership sits with licensed physicians; a PA may hold shares only while physicians keep MAJORITY ownership; and lay directors are barred from touching medical judgment.

• It is unprofessional conduct to practice medicine “as the partner, agent, or employee of, or in joint venture with, any person who does not hold a license to practice medicine within this state”, or as an employee of or in joint venture with “any corporation other than a professional service corporation for the practice of medicine as described in section 12-240-138.” The general-business-corporation med spa employing its own physician is the arrangement this forecloses.

  Colo. Rev. Stat. § 12-240-121(1)(g)(I) · verified Sep 2, 2026

• ⚠️ and the statute names the doctrine, which almost no other state does. “nothing in this subsection (1)(g) shall be construed to otherwise create an exception to the corporate practice of medicine doctrine.” In most states the doctrine is inferred from the licensure requirement and argued about; in Colorado it is written down, and the professional-corporation route is expressly not a way around it.

  Colo. Rev. Stat. § 12-240-121(1)(g)(II)(B) · verified Sep 2, 2026

Connecticut confines a professional service corporation to rendering the professional service it was incorporated for, permits it to render that service only through licensed officers, employees and agents, and restricts who may hold its stock or its voting power. It also reaches control, though narrowly: persons licensed in another jurisdiction may not be shareholders, directors or officers if they unlawfully practice here or direct or control a Connecticut licensee’s delivery of professional services or exercise of professional judgment.

• Any person or group of persons licensed or otherwise legally authorized to render the same professional services may organize and become a shareholder or shareholders of a professional corporation for profit under the provisions of chapter 601, for the sole and specific purpose of rendering the same professional service.

  Conn. Gen. Stat. §33-182c(a) (Organization) · verified Sep 3, 2026

• No corporation organized and incorporated under this chapter may render professional services except through its officers, employees and agents who are licensed or otherwise legally authorized to render such professional services within this state; provided this provision shall not be interpreted to include in the term employee clerks, secretaries, bookkeepers, technicians and other assistants who are not usually and ordinarily considered by custom and practice to be rendering professional services to the public for which a license or other legal authorization is required.

  Conn. Gen. Stat. §33-182d (Services to be rendered by licensed persons only) · verified Sep 3, 2026

Delaware’s cited restriction runs through the Professional Corporation form. A corporation organized under Chapter 6 of Title 8 exists for the sole and specific purpose of rendering a single professional service, and its shareholders may be only individuals who are themselves licensed or otherwise legally authorized to render that same service. The chapter permits exactly one combination — medicine and podiatry — and expressly leaves untouched the professional relationship, the contract and tort liabilities, and the standards for professional conduct of the person rendering the service. These claims survey Chapter 6 alone and do not report on requirements elsewhere in Delaware law. The Board of Medical Licensure and Discipline’s regulation then names the arrangement among its enumerated unprofessional conduct: Payment of a fee by a physician to another physician who referred the patient, unless the fee is in proportion to work actually performed by the referring physician, and willful failure to disclose to a patient that a referring physician holds a financial interest in an outside ancillary testing or treatment facility.

• The term "professional corporation" means a corporation which is organized and incorporated, under this chapter, for the sole and specific purpose of rendering a single professional service or qualified related professional services, and which has as its shareholders only individuals who themselves are duly licensed or otherwise legally authorized within this State to render the same professional service, or those component qualified related professional services, as the corporation.

  8 Del. C. §603(2) · verified Sep 3, 2026

• The term "qualified related professional services" means, and is limited to, any combination of the practice of medicine by doctors of medicine or doctors of osteopathy or both, and the practice of podiatry by doctors of podiatric medicine.

  8 Del. C. §603(3) · verified Sep 3, 2026

The district requires every shareholder, director and officer to be licensed — and then expressly declines to require them to work there. a professional corporation may be organized solely to render professional services through its shareholders, directors, officers, employees or agents who are themselves licensed, and a person may not be a shareholder, director or officer, or render professional services on its behalf, unless they are an individual licensed to render a professional service for which the corporation is organized — with one narrow exception, that a single-shareholder corporation’s secretary need not be licensed, and must not perform professional services if they are not. The definition says the same from the other direction: shareholders may be only individuals duly licensed to render THE SAME professional service as the corporation. But §29-508(c) is the provision to read before structuring anything: nothing in the chapter requires a shareholder or incorporator to have a present or future EMPLOYMENT relationship with the corporation, or actively to participate in any capacity in the production of its income or the performance of its professional services. Licensure is required; labor is not. The Health Occupations Revision Act then reaches the arrangement from the disciplinary side: paying or agreeing to pay anything of value to, or splitting or dividing fees for professional services with, any person for bringing or referring a patient is a ground for disciplinary action.

• A professional corporation may be organized solely to render professional services through its shareholders, directors, officers, employees, or agents who are themselves licensed to render the particular service, and to render service ancillary thereto. A professional corporation may employ individuals who are not licensed, but they shall not perform professional services.

  D.C. Code §29-505(a) (Purpose for organization; powers authorized) · verified Sep 3, 2026

• A disciplinary action may be taken against a person who submits false statements to collect fees for which services are not provided or submits statements to collect fees for services which are not medically necessary.

  D.C. Code §3-1205.14(a)(13) · verified Sep 3, 2026

Florida has no strict corporate-practice-of-medicine ban. Non-physician ownership is instead gated by the Health Care Clinic Act.

• ⚠️ Florida’s kickback ban is broad and it is criminal in form. “It is UNLAWFUL for any health care provider or any provider of health care services to offer, pay, solicit, or receive a kickback, directly or indirectly, overtly or covertly, in cash or in kind, for referring or soliciting patients.” Four verbs and four adverbial pairs — the drafting is designed to catch arrangements dressed up as something else.

  Fla. Stat. § 456.054(2) · verified Sep 2, 2026

• And the definition turns on a tax test, which is unusual. “Kickback” means “a remuneration or payment, by or on behalf of a provider of health care services or items, to any person as an incentive or inducement to refer patients for past or future services or items, when the payment is not tax deductible as an ordinary and necessary expense.” a marketing payment that is a genuine ordinary and necessary business expense sits outside the definition; one that is not, does not.

  Fla. Stat. § 456.054(1) · verified Sep 2, 2026

Georgia reaches the ownership question through its Professional Corporation Act. The Act limits who may hold shares, requires the professional service to be delivered by licensed people, and fixes who must sit on the board.

• The Georgia Professional Corporation Act expressly counts medicine and surgery as a “profession” for its purposes, alongside dentistry, pharmacy, psychology, registered professional nursing and others — so a medical practice organized as a professional corporation falls inside the Act.

  O.C.G.A. §14-7-2 · verified Aug 17, 2026 · read at FindLaw Codes

• Shares in a professional corporation may only be issued to, held by, or transferred to a person licensed to practice the profession the corporation was organized for who — unless disabled — is actively engaged in that practice as an active practicing member of the corporation. Each stock certificate must be endorsed disclosing that restriction, and shares standing in the name of a disqualified or retired person are void outside the holding periods the Code section allows.

  O.C.G.A. §14-7-5(a) · verified Aug 17, 2026 · read at FindLaw Codes

Hawaii’s line on who may own a medical practice is drawn by the professional corporation act and the licensing statutes’ unlicensed-practice grounds. The Act defines a professional service as one that may lawfully be rendered only by persons licensed under the named chapters, medicine, nursing, and pharmacy among them, restricts share ownership to qualified persons, organizes professional corporations for a single profession, allows services to be rendered only through licensed individuals, requires not less than one-half of the directors and all officers other than the secretary and treasurer to be qualified persons, and confines the corporation to the profession in its articles. The medical practice act makes employing any person to solicit patients, and knowingly permitting an unlicensed person to perform activities requiring a license, grounds for discipline; the uniform licensing statute reaches aiding an unlicensed person and employing any unlicensed person where licensure is required, and fines a licensee who acts as the agent, partner, or associate of an unlicensed person with intent to evade the licensing laws. None of the sections cited here addresses the division of fees or a percentage arrangement with a non-clinical owner.

• "Professional service" means any service that lawfully may be rendered only by persons licensed under chapters 442, 448, 453, 455, 457, 459, 461, 463E, 465, 466, 471, and 605. "Qualified person" means an individual who is eligible under this chapter to own shares issued by a professional corporation.

  Haw. Rev. Stat. § 415A-2 ("Professional service"; "Qualified person") · verified Sep 8, 2026

• Except as provided in this section, professional corporations may be organized under this chapter only for the purpose of rendering professional services and services ancillary thereto within a single profession.

  Haw. Rev. Stat. § 415A-3(a) · verified Sep 8, 2026

Idaho’s professional service corporations chapter is repealed. The official Title 30 chapter index — the document surveyed for this claim — lists Chapter 13, professional service corporations, as REPEALED. That is a statement about that one chapter, not about the whole of Idaho law. The Business Corporation Act now applies to domestic corporations incorporated under any general for-profit statute of the state where the power to amend or repeal was reserved. these claims do not survey the Medical Practice Act, board rules or Idaho case law for a corporate-practice doctrine, and do not establish that no professional-corporation provision exists elsewhere — so a repealed chapter should not be read as permission to have a non-physician own a medical practice. What IS on record from the medical side is economic: dividing fees or gifts, or agreeing to split or divide fees or gifts received for professional services with any person, institution or corporation in exchange for referral, is a ground for discipline, as is giving or receiving, or aiding or abetting the giving or receiving of, rebates, directly or indirectly.

• The Idaho Code Title 30 chapter index lists Chapter 13, Professional Service Corporations, as repealed.

  Idaho Code tit. 30, ch. 13 (chapter index — REPEALED) · verified Sep 3, 2026

• Dividing fees or gifts or agreeing to split or divide fees or gifts received for professional services with any person, institution or corporation in exchange for referral is a ground for medical discipline.

  Idaho Code §54-1814(8) · verified Sep 3, 2026

Illinois is among the strictest corporate-practice states, and its regulators say so in a document written for med spas specifically: a med spa is a medical practice, so it must be owned by physicians — or, for the services within their scope, by APRNs. There is no room for a non-clinical shareholder in the entity that delivers care.

• ⚠️ Illinois has a dedicated fee-splitting section and its ban is not limited to referrals. “a licensee under this Act may not directly or indirectly divide, share or split any professional fee or other form of compensation for professional services with anyone in exchange for a referral or otherwise, other than as provided in this Section 22.2.” The words “or otherwise” do the work — an arrangement with no referral in it is still inside the section unless an exception applies.

  225 ILCS 60/22.2(a) · verified Sep 2, 2026

• The first exception is for genuine shared work, on three conditions. Two or more licensed health care workers may “each receive adequate compensation for concurrently rendering services to a patient and … divide the fee” — provided “the patient has full knowledge of the division” and the division “is made in proportion to the actual services personally performed and responsibility assumed by each licensee consistent with his or her license”. Concurrent work, proportionate split, patient knowledge.

  225 ILCS 60/22.2(b) · verified Sep 2, 2026

This section said Indiana was “comparatively permissive” with no strict corporate-practice ban. the claims beneath it say the opposite, and they are what the statute says. The employment safe harbor in the medical practice act is not general: it reaches only “an entity described in subsection (a)(21) through (a)(22)” — a hospital licensed under IC 16-21 or IC 12-25, or a health care organization whose members, shareholders or partners are themselves licensed providers — and even for those the entity must not direct or control the physician’s independent medical acts, decisions or judgment. Separately, a professional corporation may issue shares only to licensed individuals, to general partnerships whose partners are all licensed, to other professional corporations, or to the trustee of a qualified trust. A lay-owned company is outside both lists. These claims survey IC 25-22.5-1-2, IC 23-1.5-3-1 and chapter 25-1-9; they do not survey the whole of Indiana’s entity law.

• Indiana’s employment safe harbor is not general — it names the entities it covers, and a lay-owned company is not one of them. “An employment or other contractual relationship between an entity described in subsection (a)(21) through (a)(22) and a licensed physician does not constitute the unlawful practice of medicine or osteopathic medicine under this article if the entity does not direct or control independent medical acts, decisions, or judgment of the licensed physician.” Subsection (a)(21) is “A hospital licensed under IC 16-21 or IC 12-25”, and (a)(22) is “A health care organization whose members, shareholders, or partners are individuals, partnerships, corporations, facilities, or institutions licensed or legally authorized by this state to provide health care or professional services as” a physician, a psychiatric hospital, a hospital, a health maintenance organization, a health facility, a dentist, a registered or licensed practical nurse, a midwife, an optometrist, a podiatrist, a chiropractor, a physical therapist or a psychologist. The no-control condition is a SECOND requirement on those entities, not a route for any other kind of owner.

  Ind. Code §25-22.5-1-2(c) · verified Jul 26, 2026

• Indiana’s standards-of-practice chapter was surveyed and contains no fee-division ground. ic 25-1-9 is the chapter that supplies the grounds for disciplining a health practitioner, and it contains no prohibition on dividing or sharing a professional fee, and no use of “rebate”, “kickback” or “remuneration”. An absence in this chapter, not in Indiana law as a whole.

  Ind. Code ch. 25-1-9 (Health Professions Standards of Practice), read in full · verified Sep 2, 2026

⚠️ Iowa defines the medical spa by what it holds itself out as, not by who owns it — and then carves one ownership structure back out. a medical spa is any entity, however organized, that is advertised, announced, established or maintained for the purpose of providing medical aesthetic services; the definition expressly excludes a dermatology practice wholly owned and controlled by one or more Iowa-licensed physicians where at least one owner is actively practicing at each location. On the conduct side, knowingly aiding, assisting, procuring or advising a person in the unlawful practice of medicine is a ground for discipline, as is accepting remuneration for referring a patient in violation of law or medical ethics. The entity law answers the structure question separately: a professional corporation may be organized only to practice one specific profession, or professions that could lawfully be combined by a licensed individual — medicine and surgery, osteopathic medicine and surgery, and practice as a physician assistant are deemed such a combination, without expanding the physician assistant’s scope — and no shareholder may voluntarily transfer shares except to the corporation or to an individual licensed to practice a profession the corporation is authorized to practice. These claims survey chapter 496C and the two rules cited; they do not survey the rest of Iowa’s entity law.

• “Medical spa” means any entity, however organized, that is advertised, announced, established, or maintained for the purpose of providing medical aesthetic services. Medical spa shall not include a dermatology practice that is wholly owned and controlled by one or more Iowa-licensed physicians if at least one of the owners is actively practicing at each location.

  Iowa Admin. Code r. 481—655.6(1) (definition of “Medical spa”) · verified Sep 4, 2026

• Knowingly aiding, assisting, procuring, or advising a person in the unlawful practice of acupuncture, medicine and surgery, or osteopathic medicine and surgery.

  Iowa Admin. Code r. 481—661.1(21) (Grounds for discipline) · verified Sep 4, 2026

Kansas confines a professional corporation to one type of professional service. a professional corporation may be organized ONLY for the purpose of rendering one type of professional service and service ancillary to it, and shall not engage in any other business — except that the statute permits certain named combinations of the professional types it lists, identified by their item numbers in the definitions section. That definitions section enumerates the professions, including an osteopathic physician or surgeon, a physician, surgeon or doctor of medicine, and a registered professional nurse, each paragraph constituting one type. Separately, directly or indirectly giving or receiving any fee, commission, rebate or other compensation for professional services not actually and personally rendered — other than through the legal functioning of lawful professional partnerships, corporations, limited liability companies or associations — is unprofessional conduct.

• A professional corporation may be organized only for the purpose of rendering one type of professional service and service ancillary thereto and shall not engage in any other business, except that a single professional corporation may be organized to and render professional services under any two or more of the types set forth in items (2), (6), (13) and (17) of subsection (b) of K.S.A. 17-2707, and amendments thereto.

  Kan. Stat. Ann. §17-2710 · verified Sep 3, 2026

• "Professional service" means the type of personal service rendered by a person duly licensed, registered or certified by this state as a member of any of the following professions, each paragraph constituting one type: a certified public accountant; an architect; an attorney-at-law; a chiropractor; a dentist; an engineer; an optometrist; an osteopathic physician or surgeon; a physician, surgeon or doctor of medicine; a veterinarian; a podiatrist; a pharmacist; a land surveyor; a licensed psychologist; a specialist in clinical social work; a licensed physical therapist; a landscape architect; a registered professional nurse.

  Kan. Stat. Ann. §17-2707(b) · verified Sep 3, 2026

Kentucky's licensing prohibition reaches the premises and the holding out, not only the treatment. No person shall engage or attempt to engage in the practice of medicine or osteopathy within the state, or open, maintain, or occupy an office or place of business within the state for engaging in practice, or in any manner announce or express a readiness to engage in practice, unless the person holds a valid and effective license or permit issued by the board. Violating or attempting to violate, directly or indirectly, or assisting in, abetting or conspiring to violate any provision of the medical practice act — including the code of conduct promulgated by the board — is itself a ground for discipline. These claims survey the Medical Practice Act; Kentucky's business-entity and professional-service-corporation statutes are NOT surveyed here, so confirm the entity form with counsel.

• No person shall engage or attempt to engage in the practice of medicine or osteopathy within this state, or open, maintain, or occupy an office or place of business within this state for engaging in practice, or in any manner announce or express a readiness to engage in practice within this state, unless the person holds a valid and effective license or permit issued by the board as hereinafter provided.

  Ky. Rev. Stat. §311.560(1) · verified Sep 3, 2026

• The board may deny, probate, suspend or revoke a license where the licensee has violated or attempted to violate, directly or indirectly, or assisted in or abetted the violation of, or conspired to violate any provision or term of any medical practice act, including but not limited to the code of conduct promulgated by the board under KRS 311.601.

  Ky. Rev. Stat. §311.595(12) · verified Sep 3, 2026

Louisiana defines a physician as a natural person, and that is where the ownership analysis starts. “Physician” means a natural person holding an allopathic or osteopathic degree who holds a license, permit, certification or registration issued by the board to engage in the practice of medicine in Louisiana — a corporation cannot itself be one. The economic rule is stated as a cause for discipline and it names entities directly: Soliciting, accepting or receiving anything of economic value in return for and based on the referral of patients to another Person, Firm, Or Corporation, or in return for the prescription of medications or medical devices. Knowingly employing a physician's assistant whose conduct includes any of the enumerated causes is a further ground. On the cosmetology side, the statute states that the Board of Cosmetology shall constitute a Professional Association within the meaning of Article VII, Section 9 of the Louisiana Constitution. These claims survey the Medical Practice Act and that one cosmetology definition; Louisiana's professional corporation and business-entity statutes are NOT surveyed here, so confirm the entity form with counsel.

• "Physician" means a natural person who is the holder of an allopathic (M.D.) degree or an osteopathic (D.O.) degree from a medical college in good standing with the board who holds a license, permit, certification, or registration issued by the board to engage in the practice of medicine in the state of Louisiana.

  La. Rev. Stat. §37:1262(2) · verified Sep 3, 2026

• Soliciting, accepting, or receiving anything of economic value in return for and based on the referral of patients to another person, firm, or corporation or in return for the prescription of medications or medical devices is a cause for which the board may refuse to issue, or may suspend or revoke any license or permit.

  La. Rev. Stat. §37:1285(A)(19) · verified Sep 3, 2026

Maine’s professional corporation rule is narrower than it first reads. A professional corporation may render professional services in Maine only THROUGH individuals licensed or otherwise authorized to render them — but the same section says this does not require an individual employed by the corporation to be licensed to perform services for it where a license is not otherwise required. The corporation is confined to the professional service authorized by its articles and services or businesses reasonably related to it, while its funds may be invested in real estate, mortgages, securities or any other type of investment. These claims survey chapter 22-A of Title 13 and do not report on restrictions elsewhere in Maine law.

• A domestic professional corporation or foreign professional corporation may render professional services in this State only through individuals licensed or otherwise authorized in this State to render the services.

  13 M.R.S. §734(1) · verified Sep 3, 2026

• Nothing in subsection 1 may be construed to require an individual employed by a professional corporation to be licensed to perform services for the corporation if a license is not otherwise required.

  13 M.R.S. §734(2)(A) · verified Sep 3, 2026

Maryland confines a professional corporation to a single profession and to the professional service named in its articles, and its Medical Practice Act contemplates a physician practicing within or as a professional corporation — so the corporate form is available, but it is not a route to mixing a medical practice with an unrelated business. Maryland’s self-referral law is the financial-arrangement rule on record: except as the section itself provides, a health care practitioner may not refer a patient, or direct an employee or contractor to refer a patient, to a health care entity in which the practitioner or the practitioner with immediate family owns a beneficial interest, in which immediate family owns 3 percent or more, or with which any of them has a compensation arrangement — defined as any agreement or system involving any remuneration between the practitioner or an immediate family member and a health care entity. Whether a particular med spa owner is a “health care entity” under that law, and whether any of its exceptions apply, is not surveyed by these claims.

• Except as permitted under subsection (b) of this section, a corporation may be a professional corporation solely for the purpose of rendering professional services within a single profession.

  Md. Code, Corps. & Ass’ns §5-102(a)(1) · verified Sep 3, 2026

• A professional corporation may not render a professional service or engage in an activity other than the professional service authorized by its articles of incorporation.

  Md. Code, Corps. & Ass’ns §5-104(a) · verified Sep 3, 2026

Massachusetts’ professional corporation chapter decides who may own the practice: shares may issue only to licensed natural persons, to partnerships every partner of which is one, or to entities themselves authorized to render the service — and a MAJORITY of the directors must be licensed, as must all officers except the treasurer, clerk, secretary and their assistants.

• A professional corporation may issue shares, fractional shares, and rights or options to purchase shares ONLY to natural persons licensed — in Massachusetts or another state, territory or the District of Columbia — to render a professional service permitted by the corporation’s articles of organization; to partnerships in which every partner is such a person; or to professional corporations, business corporations or limited liability companies themselves authorized to render that service. A lay individual is not in the list.

  Mass. Gen. Laws ch. 156A, § 10(a) · verified Sep 1, 2026

• The board and the officers are licensed too, with a named exception: a MAJORITY of the directors of a professional corporation, and ALL of its officers except the treasurer, clerk, secretary and their assistants, shall be licensed in the commonwealth to render a professional service permitted by the articles of organization. The exception is precisely the administrative offices — the clinical direction is not among them.

  Mass. Gen. Laws ch. 156A, § 9 · verified Sep 1, 2026

Michigan runs professional corporations through the Business Corporation Act, and its shareholder rule reaches through holding companies rather than stopping at the first entity.

• ⚠️ Michigan files fee-splitting under “unethical business practices”, and names the drug mark-up. The department shall investigate and the board may sanction “unethical business practices, consisting of 1 or more of the following: (i) false or misleading advertising. (ii) dividing fees for referral of patients or accepting kickbacks on medical or surgical services, appliances, or medications purchased by or in behalf of patients.” a rebate on medications bought for patients sits in the same clause as paying for referrals.

  Mich. Comp. Laws § 333.16221(d)(i)–(ii) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

• One or more licensed persons may form a professional corporation, and each shareholder must be either a licensed person in one or more of the professional services the corporation provides, or an entity that is directly or beneficially owned only by such licensed persons. The rule follows ownership through an intermediate entity rather than stopping at it.

  Mich. Comp. Laws § 450.1283(1) and (2) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

⚠️ chapter 319b is opt-in. It restricts ownership of a professional firm to licensed professionals — but a Minnesota firm may furnish professional services WITHOUT electing into the chapter, so long as no other Minnesota statute, rule or Tenet Of Common Law requires the election. That common-law question is not answered here.

• ⚠️ Minnesota names the med spa business model as fee splitting. “fee splitting” is unprofessional conduct “including without limitation … (4) dispensing for profit any drug or device, unless the physician has disclosed the physician’s own profit interest.” Selling a drug or a device at a mark-up is inside the fee-splitting ground unless the profit interest is disclosed — which is a different and larger duty than the § 151.37 filing.

  Minn. Stat. § 147.091, subd. 1(p)(4) · verified Sep 2, 2026

• ⚠️ and the disclosure has a form, a time and a sentence it must contain. “The physician must make the disclosures required in this clause in advance and in writing to the patient and must include in the disclosure a statement that the patient is free to choose a different health care provider.” In advance, in writing, and carrying that sentence — three requirements a verbal mention at the point of sale does not meet.

  Minn. Stat. § 147.091, subd. 1(p) · verified Sep 2, 2026

Mississippi’s line on who may own a medical practice is drawn by the professional corporation act, and the licensing statutes cited here reach the use of unlicensed people. a professional corporation may issue shares only to individuals authorized to render the professional service in its articles, to professional corporations and partnerships so authorized, or to others the licensing authority expressly permits; it exists solely to render professional services within a single profession, renders them only through licensed individuals, and may not render any service outside its articles. The medical practice act makes knowingly assisting an unlicensed person to practice medicine unprofessional conduct. None of the sections cited here addresses the division of fees or a percentage arrangement with a non-clinical owner.

• The Professional Corporation Act defines a qualified person as an individual, general partnership, professional corporation, or other entity that is eligible under Sections 79-10-1 through 79-10-117 to be issued shares by a professional corporation.

  Miss. Code Ann. § 79-10-5(h) · verified Sep 8, 2026

• A professional corporation may issue shares only to individuals authorized by law in this or another state to render a professional service described in the corporation's articles of incorporation, to professional corporations and general partnerships so authorized, or to any other individual or entity if expressly authorized by the licensing authority having jurisdiction over the professional services described in its articles.

  Miss. Code Ann. § 79-10-31(1) · verified Sep 8, 2026

Missouri’s Professional Corporation Law restricts who may hold shares. a professional corporation may issue shares, fractional shares, rights or options to purchase shares, and other securities only to natural persons authorized by law — in Missouri or another US jurisdiction — to render a professional service permitted by the corporation’s articles of incorporation, and to trustees of revocable trusts on the conditions the section sets out. The Law defines a “disqualified person” to reach not only individuals but corporations, partnerships, limited liability companies, fiduciaries, trusts, associations, governmental agencies and other entities that are or become ineligible to own shares. These claims survey sections 356.011 to 356.261 and do not report on restrictions elsewhere in Missouri law.

• A professional corporation may issue shares, fractional shares, rights or options to purchase shares, and other securities only to natural persons who are authorized by law in this state, or in any other state or territory of the United States or the District of Columbia, to render a professional service permitted by the articles of incorporation of the corporation, and trustees, in trust, of revocable trust agreements, of which the trustee is a natural person who is authorized by the law of this state, or any other state or territory of the United States or the District of Columbia, to render a professional service permitted by the articles of incorporation of the corporation.

  Mo. Rev. Stat. §356.111.1(1) · verified Sep 3, 2026

• "Disqualified person", any natural person, corporation, partnership, limited liability company, fiduciary, trust, association, governmental agency or other entity that for any reason is or becomes ineligible under sections 356.011 to 356.261 to own shares issued by a professional corporation.

  Mo. Rev. Stat. §356.021(1) · verified Sep 3, 2026

Montana’s line on who may own a medical practice is drawn by the professional corporation act and one rule of the board of medical examiners. The Act defines a professional service as one that may lawfully be rendered only by licensed persons and may not lawfully be rendered by an ordinary business corporation, restricts share ownership in a professional corporation to qualified persons, requires at least one-half of the combined directors and officers to be qualified persons, and allows a professional corporation to render professional services only through natural persons permitted to render them. The Board’s unprofessional-conduct rule then reaches the employment relationship directly: it is unprofessional conduct for a physician or physician assistant to practice as the partner, agent, or employee of, or in joint venture with, a person who does not hold an equivalent license, unless the licensee is incorporated as a professional entity or is practicing with a licensed health care facility or provider under a written agreement that the relationship may not affect the licensee’s independent judgment. The uniform licensing statute makes aiding a person to circumvent a licensure law, assisting unlicensed practice, and allowing another person or organization to practice by use of the licensee’s license unprofessional conduct. None of these sections addresses the division of fees; the Board’s rule speaks to the employment relationship and the independence of judgment, not to how revenue is shared.

• "Professional service" means any service that may lawfully be rendered only by persons licensed under a licensing law of this state and that may not lawfully be rendered by a corporation organized under the Montana Business Corporation Act. (6) "Qualified person" means a natural person, general partnership, or professional corporation eligible under this chapter to own shares issued by a professional corporation.

  Mont. Code Ann. § 35-4-109(5)-(6) · verified Sep 8, 2026

• Professional corporations may be organized under this chapter only for the purpose of rendering professional services and services ancillary thereto within a single profession, except that a professional corporation may be incorporated for the purpose of rendering professional services within two or more professions and for any purpose or purposes for which corporations may be organized under the Montana Business Corporation Act to the extent that such combination of professional purposes or professional and business purposes is permitted by the licensing laws and rules of this state applicable to such professions.

  Mont. Code Ann. § 35-4-205 · verified Sep 8, 2026

Nebraska verifies that every director, officer, shareholder and professional employee of a professional corporation (bar the secretary and assistant secretary) is duly licensed or otherwise legally authorized to render the professional service the corporation is organized for, or a service ancillary to it, and it forces a disqualified holder OUT: on becoming legally disqualified, that person must sever all employment with and financial interests in the corporation forthwith, and the corporation’s failure to require this is a ground for forfeiting its articles of incorporation and dissolution.

• If any officer, shareholder, agent, or employee of a corporation organized under sections 21-2201 to 21-2222 who has been rendering professional service to the public becomes legally disqualified to render such professional service within this state, or accepts employment that places restrictions or limitations upon his continued rendering of such professional services, he shall sever all employment with, and financial interests in, such corporation forthwith. A corporation’s failure to require compliance with this provision shall constitute a ground for the forfeiture of its articles of incorporation and its dissolution.

  Neb. Rev. Stat. §21-2213 · verified Sep 3, 2026

• Certificate of registration from the regulating board means verification that all of those directors, officers, shareholders, and professional employees listed on the application filed with the Secretary of State, except for the secretary and assistant secretary, are duly licensed or otherwise legally authorized to render the professional service for which the professional corporation is organized or a service ancillary to those which the professional corporation renders.

  Neb. Rev. Stat. §21-2202(1) · verified Sep 3, 2026

Nevada restricts ownership of a professional entity to natural persons licensed to render the very services the entity was formed to provide, and extends the restriction to voting agreements and transfers so that control cannot be separated from licensure. It reaches CONTROL as well as ownership: an officer, director or manager must themselves be licensed to render those services, and a professional entity that fails to require compliance with those officer, director and manager duties is subject to forfeiture of its charter. The Medical Practice Act adds the money rules: directly or indirectly receiving from any person, corporation or other business organization any fee, commission, rebate or other form of compensation intended or tending to influence the physician’s objective evaluation or treatment of a patient is a ground for discipline or denial of licensure, and so is dividing a fee between licensees except where the patient is informed of the division and it is made in proportion to the services personally performed and the responsibility assumed by each licensee.

• No professional entity may issue any of its owner’s interest to anyone other than a natural person who is licensed to render the same specific professional services as those for which the professional entity was formed.

  Nev. Rev. Stat. §89.070(1)(a) · verified Sep 3, 2026

• No owner may enter into a voting trust agreement or any other type of agreement vesting another person with the authority to exercise the voting power of any or all of his or her owner’s interest, unless the other person is licensed to render the same specific professional services as those for which the professional entity was formed.

  Nev. Rev. Stat. §89.070(1)(b) · verified Sep 3, 2026

A New Hampshire professional corporation may be organized only to render professional services within a single profession — subject to the carve-out the statute itself makes at RSA 294-A:2, II, which these claims do not reach. The chapter defines a professional service by reference to what may lawfully be rendered only by named licensed professionals — physicians and surgeons, physician associates and registered professional nurses among them — and which may not lawfully be rendered by an ordinary business corporation, and it defines a qualified person as one eligible under the chapter to own shares issued by a professional corporation.

• Except as provided in RSA 294-A:2, II, professional corporations may be organized under this chapter only for the purpose of rendering professional services, including necessary related services, within a single profession.

  N.H. Rev. Stat. §294-A:2, I (Permissible Purposes of Professional Corporations) · verified Sep 3, 2026

• Professional service means any service which may lawfully be rendered only by certified public accountants, public accountants, architects, attorneys, podiatrists, chiropractors, dentists, pharmacists, professional engineers, land surveyors, registered professional nurses, optometrists, physicians and surgeons, physician associates, psychologists, veterinarians, and all other professionals licensed, registered, certified, or otherwise authorized and permitted to practice independently under the provisions of RSA 309-B, 310-A, 311, 315, 316-A, 317-A, 318, 326-B, 327, 328-D, 329, 329-B, 330-A, or 332-B, and which may not lawfully be rendered by a corporation organized under the law of this state applicable to business corporations.

  N.H. Rev. Stat. §294-A:1, VI (“Professional service” defined) · verified Sep 3, 2026

New Jersey restricts practice entities to licensed professionals, and then spells out exactly how an outside business may take part — by two routes and no others. It may hold a limited partner interest while supplying back-office services only, with every clinical and pricing decision left with the licensee; or it may directly employ a licensee, but only in five enumerated settings.

• ⚠️ New Jersey’s rule is a self-referral ban with a 1991 cut-off. “a practitioner shall not refer a patient or direct an employee of the practitioner to refer a patient to a health care service in which the practitioner or the practitioner’s immediate family, or the practitioner in combination with the practitioner’s immediate family, has a significant beneficial interest, unless the practitioner held the interest prior to july 31, 1991” and discloses it. Interests taken after that date are not curable by disclosure — they bar the referral.

  N.J.A.C. 13:35-6.17 · verified Sep 2, 2026 · read at Cornell Legal Information Institute

• ⚠️ and “health care service” is defined to include dispensing drugs and devices. It means “a business entity which provides on an in-patient or out-patient basis: Testing for or diagnosis or treatment of human disease or dysfunction or dispensing of drugs or medical devices for the treatment of human disease or dysfunction”, including but not limited to a bioanalytical laboratory, pharmacy, home health care agency or home infusion therapy company. An entity that dispenses drugs or devices is inside the referral rule.

  N.J.A.C. 13:35-6.17 (“health care service”) · verified Sep 2, 2026 · read at Cornell Legal Information Institute

⚠️ the medical practice act was read end to end and it regulates the practice, not the company. Sections 61-6-1 through 61-6-35 contain no professional-corporation requirement and no restriction on who may hold an ownership interest in a medical practice — the words "corporation", "shareholder", "partnership" and "limited liability" do not appear in the Act at all. What the Act does control is licensee conduct: procuring, aiding or abetting an illegal procedure is unprofessional conduct, and so is fee splitting. So what this Act constrains is who performs and directs the medicine, not how the business holding it is owned. Ownership rules elsewhere in New Mexico law were not surveyed and are not answered here.

• The Medical Practice Act, Sections 61-6-1 through 61-6-35 NMSA 1978, was surveyed in full as published by the New Mexico Medical Board. It contains no corporate-practice-of-medicine provision: no requirement that a practice be organized as a professional corporation, and no restriction on who may own an interest in one. The terms "corporation", "shareholder", "partnership" and "limited liability" do not occur in the Act. Its restrictions attach to the practice of medicine and to licensee conduct rather than to business ownership.

  N.M. Stat. Ann. §§ 61-6-1 to 61-6-35 (Medical Practice Act), read in full — absence claim · verified Sep 4, 2026

• “Unprofessional or dishonorable conduct”, as used in this section, means, but is not limited to because of enumeration, conduct of a licensee that includes the following: (1) procuring, aiding or abetting an illegal procedure;

  N.M. Stat. Ann. § 61-6-15(D)(1) (License may be refused, revoked or suspended) · verified Sep 4, 2026

New York is a strict corporate-practice state. Only a licensed person may practice medicine or use the title “physician”, and a Professional Service Corporation may be organized only by individuals authorized to render that same service. ⚠️ The separate EMPLOYMENT offense has a count in it — knowingly aiding or abetting THREE OR MORE unlicensed persons, or employing them. Fee-sharing is separately misconduct, subject to named exceptions including an authorized professional subcontractor or consultant and a supervised trainee.

• Only a person licensed or otherwise authorized under the Education Law’s medicine article may practice medicine or use the title “physician.”

  N.Y. Educ. Law §6522 · verified Aug 17, 2026

• A professional service corporation may be organized only by one or more individuals duly authorized to render the same professional service, and for the purpose of rendering that same service. Its certificate of incorporation must name the original shareholders, directors and officers and carry certificates from the licensing authority that each of them is authorized to practice the profession.

  N.Y. Bus. Corp. Law §1503 · verified Aug 17, 2026

North Carolina is a strict corporate-practice state and says so in plain terms: the Medical Board’s position is that a business practicing medicine must be owned in its entirety by people holding active North Carolina licenses. The Professional Corporation Act carries that into company law — a professional corporation’s articles of incorporation must carry its licensing board’s certification that the shareholding requirements are met.

• The Medical Board’s position is that businesses practicing medicine in North Carolina must be owned in their entirety by persons holding active North Carolina licenses, and that the owners must be licensees of the Board or one of the combinations the Professional Corporation Act permits. This is a board position statement, not a statute — it states how the Board reads the law it enforces.

  NCMB Position Statement 10.1.2 (adopted March 2016, amended September 2025) · verified Aug 17, 2026

• All of the shares of stock of a professional corporation must be owned and held by a licensee or licensees, at least one incorporator must be a licensee, and at least one director and one officer must be a licensee. The articles of incorporation must designate the professional services to be rendered and carry a certification from the appropriate licensing board that the shareholding requirements are met.

  N.C. Gen. Stat. §55B-4 · verified Aug 17, 2026

The chapter read does not state a corporate-practice doctrine, but it does regulate the money directly, in the disciplinary grounds. Paying or receiving any fee, commission, rebate or other compensation — directly or indirectly — for medical services not actually or personally rendered, or for patient referrals, is a ground for discipline. And the same paragraph expressly preserves what it does not reach: the prohibition does not affect the lawful distributions of professional partnerships, corporations, limited liability companies or associations. These claims establish the fee-splitting and referral limits and that professional entities may lawfully distribute. Who may own the entity is answered in a different chapter, which is also cited here: a professional corporation may have as shareholders only individuals licensed or otherwise legally authorized to render the same professional service, together with the nonlicensed employees and minority owners that chapter allows, and may be created only to render one specific type of professional service and services ancillary to it, or two or more kinds of professional service that the licensing laws specifically authorize to be practiced in combination.

• The payment or receipt, directly or indirectly, of any fee, commission, rebate, or other compensation for medical services not actually or personally rendered, or for patient referrals;

  N.D.C.C. § 43-17-31(1)(r) (Fee-splitting, rebates and payment for referrals) · verified Sep 5, 2026

• this prohibition does not affect the lawful distributions of professional partnerships, corporations, limited liability companies, or associations.

  N.D.C.C. § 43-17-31(1)(r) (Professional entities are expressly preserved) · verified Sep 5, 2026

Ohio answers the ownership question the other way round from most of this corpus. The statute expressly authorizes a physician to practice through a corporation, an LLC, a partnership or a professional association — and then says that list is not exhaustive.

• ⚠️ Ohio makes the division of fees for referral a disciplinary ground, and reaches beyond money. It is grounds for discipline to engage in “the division of fees for referral of patients, or the receiving of a thing of value in return for a specific referral of a patient to utilize a particular service or business”. “a thing of value” and “a particular service or business” together catch reciprocal arrangements that never involve a fee at all.

  Ohio Rev. Code § 4731.22(B)(17) · verified Sep 2, 2026

• ⚠️ and its one named exception helps nobody in this market. The ground applies “except as authorized in section 4731.31” — which permits “a rural hospital or a health care facility that is owned or operated by a rural hospital” to employ a physician, a rural hospital being one in a county “that has a population of less than one hundred twenty-five thousand”. A cosmetic practice is not inside that door.

  Ohio Rev. Code § 4731.31(A)(1), (B) · verified Sep 2, 2026

Oklahoma writes an express employment carve-out. An entity whose principal purpose or function is providing hospital or medical care may employ one or more persons duly licensed to practice medicine without itself being regarded as practicing medicine, and the employment does not, in and of itself, count as unprofessional conduct by the physician employed. Separately, obtaining or offering to accept any fee or other remuneration on the assurance that a manifestly incurable disease can or will be cured is unprofessional conduct. And the professional entity act answers ownership in the other direction. No person may be a MANAGER of a professional entity who is not duly licensed for the same or a related profession, and “No person may be a shareholder of a professional corporation who is not an INDIVIDUAL duly licensed” for it — a natural person, not another entity. The entity may render professional services only through owners, managers, employees and agents who are licensed, with clerks, secretaries, bookkeepers, technicians and other assistants expressly outside the term “employee” for that purpose. So the employment carve-out governs who may EMPLOY a physician; the Professional Entity Act governs who may OWN and MANAGE the entity, and the two answers differ.

• may employ one or more persons who are duly licensed to practice medicine in this state without being regarded as itself practicing medicine within the meaning and provisions of this section.

  Okla. Stat. tit. 59, § 492 (An entity providing medical care may employ physicians) · verified Sep 5, 2026

• shall not, in and of itself, be considered as an act of unprofessional conduct by the person so employed

  Okla. Stat. tit. 59, § 492 (Being employed is not itself unprofessional conduct) · verified Sep 5, 2026

An Oregon professional corporation may render its professional services ONLY through persons licensed or otherwise authorized in this state to render them. The chapter also says expressly that it does not affect the professional relationship with the patient or the standards of professional conduct, and it keeps a shareholder personally liable for their own negligent or wrongful acts and for those of anyone under their direct supervision and control.

• A domestic professional corporation or a foreign professional corporation may render professional service or services in this state only through a person or persons who are licensed or otherwise authorized in this state to render such professional service or services.

  Or. Rev. Stat. §58.156(1) (Method by which professional corporation to render services) · verified Sep 3, 2026

• This chapter does not affect the law applicable to the professional relationship between a person rendering professional service or services and a person receiving the service or services, and it does not affect the standards of professional conduct of a profession.

  Or. Rev. Stat. §58.185(2) · verified Sep 3, 2026

For a professional corporation formed by medical doctors, the State Board of Medicine’s test for a co-owner has two parts: the co-owner must be a health care practitioner who treats human ailments and is licensed in Pennsylvania to provide health care WITHOUT receiving a referral or supervision from another practitioner, AND the boards regulating those practitioners must themselves permit the corporation to be formed. On the money rather than the ownership, the Medical Practice Act of 1985 was read in full and prohibits no fee splitting — an absence in that Act, not in Pennsylvania law as a whole.

• A medical doctor may form a professional corporation with other medical doctors, or with health care practitioners who treat human ailments and are licensed in Pennsylvania to provide health care services without receiving a referral or supervision from another practitioner — and then only if the boards regulating those practitioners also permit the formation.

  49 Pa. Code §16.21 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• The osteopathic board’s parallel rule names the professions directly: a licensee may form partnerships or professional corporations for the practice of medicine with other licensed physicians (allopathic or osteopathic), optometrists, dentists, psychologists, podiatrists and chiropractors, where the incorporation is also authorized by the relevant chapter.

  49 Pa. Code §25.214(b) (State Board of Osteopathic Medicine) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

In a Rhode Island professional service corporation, every officer, director and shareholder must be a licensed practitioner — and must be employed by the corporation in that practice. a corporation organized under that chapter may render the professional services of NOT MORE THAN ONE of the enumerated professions, provided that every officer, director and shareholder is an individual authorized to practice that profession and is employed by the corporation in it; and no individual may be an officer, shareholder, director or employee of any other corporation practicing the same profession without the prior written approval of the applicable regulatory agency. The chapter then names the combinations it permits, the first of which groups physicians, dentists, registered nurses, podiatrists, optometrists, physician assistants, chiropractic physicians, physical therapists, psychologists, midwives and nurse-midwives. Investment is left open — the chapter does not prohibit such a corporation from investing its funds in real estate, mortgages, stocks, bonds or any investment not otherwise prohibited. And the eligibility rule has teeth: if a shareholder BECOMES ineligible they must transfer their shares to an eligible person or offer them to the corporation for redemption at fair-market value, and where transfer is blocked by the articles or bylaws the corporation SHALL redeem them and compensate the holder in full. Dividing fees, or agreeing to split or divide fees received for professional services with any person for bringing to or referring a patient, is unprofessional conduct.

• Any corporation organized under this chapter may engage in rendering professional services of not more than one of the professions enumerated in §7-5.1-2, provided that every officer, director, and shareholder of the corporation is an individual authorized to practice the profession and is employed by the corporation in that practice. No individual may be an officer, shareholder, director, or employee of any other corporation engaged in the practice of the same profession without the prior written approval of the applicable regulatory agency or agencies.

  R.I. Gen. Laws §7-5.1-3(a) · verified Sep 3, 2026

• Nothing in these provisions is to be construed to prohibit a corporation organized under this chapter from engaging in the practice of the following combination of professions: Physicians, dentists, registered nurses, podiatrists, optometrists, physician assistants, chiropractic physicians, physical therapists, psychologists, midwives, or nurse-midwives.

  R.I. Gen. Laws §7-5.1-3(b)(1) · verified Sep 3, 2026

South Carolina limits who may hold shares in a professional corporation to individuals authorized to render the professional service the corporation was formed for, together with qualifying partnerships and professional corporations, and lets the licensing authority for a profession restrict that further where it considers this necessary to prevent violation of the profession’s ethical standards.

• A professional corporation may issue shares, fractional shares, and rights or options to purchase shares only to individuals who are authorized by law in this or another state to render a professional service described in the corporation’s articles of incorporation; general partnerships in which all the partners are qualified persons with respect to the professional corporation and in which at least one partner is authorized by law in this state to render such a professional service; and professional corporations, domestic or foreign, authorized by law in this State to render such a professional service.

  S.C. Code §33-19-200(a) · verified Sep 3, 2026

• If a licensing authority with jurisdiction over a profession considers it necessary to prevent violation of the ethical standards of the profession, the authority by rule may restrict or condition, or revoke in part, the authority of professional corporations to issue shares.

  S.C. Code §33-19-200(b) · verified Sep 3, 2026

SDCL §47-11-3 closes the obvious workaround, and it is the sentence to read first. All of the officers, directors, and shareholders of a medical corporation shall AT ALL TIMES be persons licensed pursuant to the Medical Practice Act. No person who is not so licensed shall have any part in the ownership or control of such corporation — and no proxy to vote any shares may be given to a person who is not so licensed, which closes the route of leaving title with a physician while moving the votes elsewhere. In a corporation formed under the chapter, one or more persons may act as the SOLE stockholders, directors or officers. And persons licensed under the Medical Practice Act, corporations formed under chapter 47-11, or any combination of them, may form a limited liability company to own, operate and maintain an establishment for the study, diagnosis and treatment of human ailments and injuries. Chapter 36-4 then names the arrangement itself among the acts that are unprofessional or dishonorable conduct: Splitting fees, or giving to any person furnishing a patient any portion of the fees received from the patient, or paying or giving any person consideration of any kind for furnishing a patient — and, separately, employing what is known as cappers or steerers.

• All of the officers, directors, and shareholders of a corporation subject to this chapter shall at all times be persons licensed pursuant to the Medical Practice Act. No person who is not so licensed shall have any part in the ownership or control of such corporation, nor may any proxy to vote any shares of such corporation be given to a person who is not so licensed.

  S.D. Codified Laws §47-11-3 · verified Sep 3, 2026

• In any corporation formed under this chapter one or more persons may act as the sole stockholders, directors, or officers of such corporation. Persons licensed pursuant to the Medical Practice Act and corporations formed under chapter 47-11, or any combination thereof, may form a limited liability company to own, operate, and maintain an establishment for the study, diagnosis, and treatment of human ailments and injuries, whether physical or mental.

  S.D. Codified Laws §47-11-1 · verified Sep 3, 2026

Tennessee runs medical practices through Medical Professional Corporations, and its share-ownership rule follows ownership through intermediate entities rather than stopping at the first one.

• Only two categories may form and own shares in a Medical Professional Corporation doing business in Tennessee: PHYSICIANS licensed under Title 63 chapter 6 or 9, or licensed in another state; and partnerships, MPCs or MPLLCs in which ALL partners, shareholders, members or holders of financial rights are themselves such physicians — or entities directly or indirectly owned by them. The rule follows ownership through the stack.

  Tenn. Comp. R. & Regs. 0880-02-.20(1)(b) · verified Sep 2, 2026

• The exception is a closed statutory list: the health care professional combinations specifically enumerated in T.C.A. § 48-101-610, and professionals authorized by §§ 48-101-610 or 48-248-401 to own shares or hold financial rights. A profession not on that list does not qualify, and a lay investor is on no list.

  Tenn. Comp. R. & Regs. 0880-02-.20(1)(b)2.(ii) · verified Sep 2, 2026

Texas follows the corporate-practice-of-medicine doctrine, derived from the Medical Practice Act’s licensure requirement rather than a single titled statute.

• ⚠️ in Texas paying for patients is a crime, not a board matter. “a person commits an offense if the person knowingly offers to pay or agrees to accept, directly or indirectly, overtly or covertly any remuneration in cash or in kind or any benefit or commission to or from another for securing or soliciting a patient or patronage” for or from a person licensed by a state health care regulatory agency. “PATRONAGE” is wider than patients, and “any benefit” is wider than money.

  Tex. Occ. Code § 102.001(a) · verified Sep 2, 2026

• And the penalty escalates. The offense is a class a misdemeanor, rising to a felony of the third degree where the person “has previously been convicted of an offense under this section” or “was employed by a federal, state, or local government at the time of the offense”. ⚠️ this section was amended effective 1 SEPTEMBER 2025 by H.B. 4454 — recent enough that older guidance may not reflect it.

  Tex. Occ. Code § 102.001(b)–(c) · verified Sep 2, 2026

Utah reaches the outside owner through interference. Section 58-67-501 puts within “unlawful conduct” the act of substantially interfering with a licensee’s lawful and competent practice of medicine by any person or entity that manages, owns, operates, or conducts a business having a direct or indirect financial interest in that practice. It reaches contracts too: entering a contract that limits a licensee’s ability to advise patients fully about treatment options is itself unlawful conduct. And the fee rule carves out the legitimate structures by name — nothing in it precludes the legal relationships within lawful professional partnerships, corporations or associations. And the professional corporation act restricts ownership directly, not only through interference. a person may not be an officer, director or shareholder of a professional corporation unless licensed to render the same specific professional services — medicine and osteopathic medicine count as the same service, so an M.D. and a D.O. may hold shares in one entity — and the single exception is that a nonlicensed person may serve as secretary or treasurer. Shares may be issued or voluntarily transferred only to those licensed persons, or to others to the extent the applicable licensing act allows, and “Any shares issued in violation of this section are void.” The corporation may render professional services only through licensed officers, employees and agents. These claims survey Title 58 chapter 67, one division rule and §§ 16-11-7 to 16-11-9; they do not survey the rest of Utah’s entity law.

• substantially interfering with a licensee’s lawful and competent practice of medicine in accordance with this chapter by: (i) any person or entity that manages, owns, operates, or conducts a business having a direct or indirect financial interest in the licensee’s professional practice; or (ii) anyone other than another physician licensed under this title, who is engaged in direct clinical care or consultation with the licensee in accordance with the standards and ethics of the profession of medicine;

  Utah Code § 58-67-501(1)(c) (Unlawful conduct) · verified Sep 4, 2026

• directly or indirectly giving or receiving any fee, commission, rebate, or other compensation for professional services not actually and personally provided or supervised; however, nothing in this section shall preclude the legal relationships within lawful professional partnerships, corporations, or associations or the relationship between an approved supervising physician and physician assistants or advanced practice nurses supervised by them;

  Utah Admin. Code R156-67-502(4) (Unprofessional conduct — fees and professional entities) · verified Sep 4, 2026

Vermont defines a professional service as one that may lawfully be rendered only by a licensed person and MAY NOT lawfully be rendered by an ordinary business corporation. It separately defines a qualified person — an individual or general partnership eligible under the chapter to be issued shares by a professional corporation — and a licensing authority as the body empowered to authorize the rendition of a professional service. These are the chapter’s definitions; the operative share-issue restriction sits elsewhere in the chapter and is not quoted here. The Medical Practice Act also names the arrangement itself: division of fees, or agreeing to split or divide the fees received for professional services with any person for bringing or referring a patient, is unprofessional conduct.

• Professional service means a service that may be lawfully rendered only by a person licensed or otherwise authorized by a licensing authority in this State to render the service, and may not be lawfully rendered by a corporation under Title 11A.

  Vt. Stat. tit. 11, §817(6) · verified Sep 3, 2026

• Qualified person means an individual or general partnership that is eligible under this chapter to be issued shares by a professional corporation.

  Vt. Stat. tit. 11, §817(7) · verified Sep 3, 2026

Virginia’s professional corporation must state a sole and specific purpose in its articles.

• ⚠️ Virginia’s remuneration ban is real but narrowly targeted — read the object of the referral. “No practitioner of the healing arts shall knowingly and willfully solicit or receive any remuneration directly or indirectly, in cash or in kind, in return for referring an individual or individuals to a facility or institution as defined in § 37.2-100 or a hospital as defined in § 32.1-123.” It reaches referrals to those defined places, not every payment between a practice and a marketer.

  Va. Code § 54.1-2962.1 · verified Sep 2, 2026

• And Virginia pins its definition to the federal one. The Board’s regulations “shall exclude from the definition of ‘remuneration’ any payments, business arrangements, or payment practices not prohibited by title 42, SECTION 1320a-7b (b) Of The United States Code, as amended, or any regulations promulgated pursuant thereto.” The federal anti-kickback safe harbors are therefore load-bearing in Virginia by statute.

  Va. Code § 54.1-2962.1 · verified Sep 2, 2026

Washington channels ownership through the Professional Service Corporation Act: shares may be held by the people licensed to render the service the corporation was organized to render.

• ⚠️ Washington’s rebate ban reaches the sale of the drug itself, not just referrals. It is unlawful to pay or allow, or for a licensee to request or receive, “directly or indirectly, a rebate, refund, commission, unearned discount or profit by means of a credit or other valuable consideration in connection with the referral of patients … OR … on the sale, rental, furnishing or supplying of … drugs, medication, or medical supplies, or any other goods, services or supplies prescribed for medical diagnosis, care or treatment.”

  Wash. Rev. Code § 19.68.010(1) · verified Sep 2, 2026

• ⚠️ owning an interest is permitted, but the disclosure has three parts and one of them is a promise. a financial interest is not prohibited where the referring practitioner “affirmatively discloses to the patient in writing” that interest, and “provides the patient with a list of effective alternative facilities, informs the patient that he or she has the option to use one of the alternative facilities, and assures the patient that he or she will not be treated differently by the referring practitioner if the patient chooses one”. a list, an option, and an assurance — not a line in a consent form.

  Wash. Rev. Code § 19.68.010(2) · verified Sep 2, 2026

West Virginia does not leave the corporate practice question to a general corporations statute — the Medical Practice Act itself makes it UNLAWFUL for any corporation to practice or offer to practice medicine, surgery or podiatric medicine, or to perform medical acts through one or more physician assistants, without a certificate of authorization issued by the Board of Medicine designating it an authorized medical corporation. To obtain one, an in-state applicant must furnish satisfactory proof that each shareholder is a licensed physician under the Medical Practice Act article or under the two other articles the provision cross-references by citation. For a corporation formed outside the state, the claim on record here is the shareholder test: it may be designated a foreign medical corporation on furnishing proof that ALL its shareholders are licensed physicians, podiatric physicians or physician assistants in one or more states, with a complete list submitted. The section’s other conditions for foreign corporations are not surveyed by these claims.

• It is unlawful for any corporation to practice or offer to practice medicine, surgery, podiatric medicine, or to perform medical acts through one or more physician assistants in this state without a certificate of authorization issued by the board designating the corporation as an authorized medical corporation.

  W. Va. Code §30-3-15(a) · verified Sep 3, 2026

• Eligible licensees may apply for a certificate of authorization by furnishing satisfactory proof to the board that each shareholder of the proposed medical or podiatry corporation is a licensed physician pursuant to this article, §30-3E-1 et seq., or §30-14-1 et seq. of this code.

  W. Va. Code §30-3-15(b)(2) · verified Sep 3, 2026

Wisconsin’s constraint on who may own a practice runs through the LICENSE: the entity may not do what only a licensed person may do.

• ⚠️ Wisconsin’s fee-splitting ban has two limbs and the second is the one a med spa trips over. No licensee “may give or receive, directly or indirectly, to or from any person, firm or corporation any fee, commission, rebate or other form of compensation or anything of value for sending, referring or otherwise inducing a person to communicate with a licensee in a professional capacity, or for any professional services not actually rendered personally or at his or her direction.” Paying anyone out of professional fees for work the licensee neither performed nor directed is fee splitting, referral or no referral.

  Wis. Stat. § 448.08(1m) · verified Sep 2, 2026

• The section is titled for what it requires as much as what it forbids — “fee splitting; separate billing required, partnerships and corporations; contract exceptions” — and subsection (2) imposes separate billing on any licensee who renders medical or surgical service or assistance to a patient, physician, corporation, institution or organization.

  Wis. Stat. § 448.08 (title); § 448.08(2) · verified Sep 2, 2026

Wyoming puts the ownership rule into language the articles of incorporation must actually contain. a professional practice corporation incorporated after the act must carry this sentence in its articles, immediately after the provision on authorized shares: “All shareholders of the corporation are, and will continually be, licensed in the profession for which the corporation is formed, and no professional service will be offered by the corporation except by or under the supervision of licensed stockholders or licensed employees.” Two things follow that a med spa should read carefully — the shareholder requirement is CONTINUING (“and will continually be”), not merely a condition at formation; and services may be offered by or under the supervision of licensed stockholders or licensed employees. The corporate name must end with “A Professional Corporation” or the initials “P.C.”. These claims survey the professional corporation provisions of Title 17 and do not report on restrictions elsewhere in Wyoming law.

• The articles of incorporation of a professional practice corporation incorporated after the date of this act shall contain the following language: "All shareholders of the corporation are, and will continually be, licensed in the profession for which the corporation is formed, and no professional service will be offered by the corporation except by or under the supervision of licensed stockholders or licensed employees." This language shall be inserted in the articles immediately after the provisions pertaining to the aggregate number of shares which the corporation is authorized to issue.

  Wyo. Stat. Ann. §17-3-104 · verified Sep 3, 2026

• The name of a professional corporation shall contain either the words "A Professional Corporation" or the capital initials "P.C.". These words or initials shall be the last word of the name of the professional corporation.

  Wyo. Stat. Ann. §17-3-103 · verified Sep 3, 2026

Alabama has a chapter for this and it tiers the delegate. 540-x-11 governs lasers and light/energy-based devices — any energy source, chemical or modality affecting living tissue below the stratum corneum, for surgical, therapeutic or cosmetic purposes — and says outright that using them is the practice of medicine. A physician may delegate only NON-ABLATIVE treatments, only through written protocols, and only to a properly trained LEVEL 1 OR LEVEL 2 DELEGATE — and Alabama counts the training in hours: THIRTY for a physician, FORTY for a delegate, before either may use a device. The written protocol is a physician’s order kept ON SITE and producible to the Board on request. The delegating physician must formulate or approve the protocol, review and authorize it at least ANNUALLY, and provide on-site or locally remote supervision.

• (1) A physician must complete thirty (30) hours of training. A Level 1 or 2 Delegate must complete forty (40) hours of training.

  Ala. Admin. Code r. 540-X-11-.06(1) (Initial training requirements for physicians and delegates) · verified Sep 4, 2026

• Written protocols for the purpose of this section shall mean physician’s order, standing delegation order, standing medical order, or other written order that is maintained on site. A written protocol must be provided to the Board upon request and must provide, at a minimum, the following: (1) A statement identifying the individual physician authorized to utilize the specified device and responsible for the delegation of the performance of the specified procedure, including proof of the physician’s training in accordance with these rules; (2) A statement of the activities, decision criteria, and plan the Level 1 or 2 Delegate shall follow when performing delegated procedures;

  Ala. Admin. Code r. 540-X-11-.05 (Written protocols) · verified Sep 4, 2026

Alaska’s Medical Board sets the delegation standard in regulation, and it is unusually specific about the paperwork. Under 12 AAC 40.920 a physician, podiatrist, osteopath or physician assistant may delegate a routine medical duty only if it is within the delegator’s own scope, a licensee has assessed the patient, the patient’s condition is stable and predictable, the delegate’s training is DOCUMENTED, and the duty would not require the delegate to exercise professional medical judgment. The delegator must give written instructions covering the procedure, the predicted outcomes, how to respond to complications, and how to document the task. Delegation is specific to that person AND that patient — it authorizes nobody else — the delegator must remain readily available in person or by telecommunication, and remains responsible for the quality of care. AS 08.64.106 supplies the statutory basis, and among the requirements it sets for those regulations is an absolute bar: duties related to pain management and opioid use and addiction may not be delegated at all. The Board of Barbers and Hairdressers’ regulations answer the microneedling question through the definition of the esthetician’s tools: for the statutory definition of esthetics, an “appliance” means only a device used to stimulate natural physiological processes to improve the health and appearance of the skin, which operates within the manufacturer’s guidelines, does NOT directly ablate or destroy live tissue, does NOT involve an incision into skin beyond the epidermis, and is not a Class III or Class IV laser.

• the duty to be delegated must be within the scope of practice of the delegating physician, podiatrist, osteopath, or physician assistant; (2) a licensed physician, podiatrist, osteopath, or physician assistant must assess the patient's medical condition and needs to determine if a duty for that patient may be safely delegated; (3) the patient's medical condition must be stable and predictable;

  12 AAC 40.920(a)(1)-(3) (Standards for delegation of routine duties) · verified Sep 5, 2026

• the person to whom the duty is to be delegated has received the training needed to safely perform the delegated duty, and this training has been documented;

  12 AAC 40.920(a)(4)-(6) (Standards for delegation of routine duties) · verified Sep 5, 2026

Arizona’s delegation rules here are about the unlicensed medical assistant: what one may do, that injections require DIRECT supervision, and what direct supervision physically means.

• A medical assistant is an unlicensed person who may perform delegated tasks commensurate with their training but may not diagnose or design/modify a treatment program. Failing to adequately supervise medical assistants or other personnel is itself unprofessional conduct.

  A.R.S. §32-1401 · verified Jul 26, 2026

• A medical assistant may take body fluid specimens and administer injections only under the direct supervision of a doctor of medicine, physician assistant or nurse practitioner. Arizona lists separately the tasks a medical assistant may do WITHOUT direct supervision — billing, coding, insurance, scheduling, charting, visual acuity screening — and injections are not among them.

  A.R.S. §32-1456(A) and (D) · verified Sep 1, 2026

Arkansas says the cosmetic laser is the practice of medicine, and writes the delegation protocol around it. 17 CAR § 140-1601 finds that using medical lasers on human beings, for therapeutic or cosmetic purposes, constitutes the practice of medicine, and lets a physician delegate a minor procedure only on a protocol. The delegation rule adds a factor test before any task reaches an unlicensed employee, two of which are that the practice can be performed without requiring the exercise of judgment based on medical knowledge and that its results are reasonably predictable. The delegating physician remains responsible for the employee’s acts throughout, and may not hand that supervisory responsibility to anyone but another physician who knowingly accepts it, nor delegate anesthesia to an unlicensed person at all. The Department of Health’s cosmetology rules define the aesthetician by EXTERNAL work: any person who engages in the practice of beautifying the body by cleaning, waxing, externally manipulating or stimulating the body by means of the hands, devices, apparatus or appliances, with or without cosmetic preparations, antiseptics, tonics, lotions and creams — a definition that stops at the surface and names no procedure that penetrates it.

• (2) The physician, when delegating these minor procedures, must comply with the following protocol:

  17 CAR § 140-1601(b)(2) (Laser surgery guidelines — protocol) · verified Sep 4, 2026

• A physician shall not: (1) Transfer his or her responsibility for supervising an unlicensed person in the performance of a delegated medical practice except to another physician who has knowingly accepted that responsibility; (2) Authorize or permit an unlicensed person to whom a medical practice is delegated to delegate the performance of that practice to another person; (3) Delegate to an unlicensed person the administration of anesthesia;

  17 CAR § 140-2506(1)-(3) (Physician delegation — prohibitions) · verified Sep 4, 2026

In California, using prescriptive drugs (Botox, fillers) and prescriptive/energy devices (lasers, IPL) for cosmetic reasons IS the practice of medicine.

• A physician may delegate injectable and laser procedures only to appropriately licensed personnel — registered nurses, nurse practitioners, or physician assistants — under genuine supervision. Unlicensed staff (including medical assistants) and improperly licensed staff (estheticians, cosmetologists, LVNs) may not perform them, regardless of training. A “paper” medical-director arrangement is aiding and abetting the unlicensed practice of medicine.

  Cal. Bus. & Prof. Code §2052; Medical Board of California — Medical Spas guidance · verified Jul 26, 2026

• Whenever an elective cosmetic procedure involving a laser or intense pulse light device is performed by a licensed health care provider acting within the scope of their license, a physician with relevant training and expertise shall be immediately available — defined in the rule as contactable by electronic or telephonic means without delay, interruptible, and able to furnish assistance and direction throughout the procedure and to inform the patient of post-procedure care provisions. Those provisions must sit in the provider’s standardized procedures or protocols.

  Cal. Code Regs. tit. 16, §1364.50 · verified Sep 1, 2026 · read at Cornell Legal Information Institute

Colorado permits delegation to UNLICENSED people who are “qualified by experience, education, or training” under a physician’s personal and responsible direction — but carves prescribing out of it entirely, and shuts the door on an unlicensed physician using the exemption as a side entrance.

• The “practice of medicine” reaches energy devices without naming them: it means holding out as able to diagnose, treat, prescribe for, palliate, or prevent any human disease, ailment, pain, injury, deformity or physical condition — “whether by the use of drugs, surgery, manipulation, electricity, telemedicine, the interpretation of tests … or any physical, mechanical, or other means whatsoever.” Colorado wrote a catch-all rather than a device list, so a modality invented after 2019 is inside it by construction.

  Colo. Rev. Stat. § 12-240-107(1)(a) · verified Sep 2, 2026

• ⚠️ the delegation exemption, and its three limits. No license is required for “the rendering of services, other than the prescribing of drugs, by persons qualified by experience, education, or training, under the personal and responsible direction and supervision of a person licensed … to practice medicine.” Colorado will let an unlicensed person perform a medical service — but never prescribe, never without demonstrable qualification, and never at arm’s length.

  Colo. Rev. Stat. § 12-240-107(3)(l) · verified Sep 2, 2026

Connecticut names, by statute, exactly who may perform a cosmetic medical procedure in a medical spa: the physician, physician assistant or advanced practice registered nurse the spa employs or contracts with, or a registered nurse. The active-practice and training-plus-experience requirements attach to the physician, physician assistant and advanced practice registered nurse the spa engages — the statute adds the registered nurse separately, without restating those conditions. Failing to supervise a physician assistant adequately is a separate ground for restricting a physician’s license. The cosmetology chapter then says what an ESTHETICIAN may not do: esthetics means skin-care services — cleansing, toning, stimulating, exfoliating or similar procedures using cosmetic preparations, hands, devices, apparatus or appliances to enhance or improve the appearance of the skin, makeup application, lash and brow work, and manual or mechanical hair removal — and EXCLUDES the use of a prescriptive laser device, the performance of a cosmetic medical procedure as defined in the medical spa statute, and any practice, activity or treatment that constitutes the practice of medicine. The medical spa statute’s non-exhaustive list of cosmetic medical procedures names dermaplaning, dermastamping, dermarolling and dermabrasion that removes cells beyond the stratum corneum, as well as class II devices designed to induce deep skin tissue alteration.

• Each medical spa shall employ or contract for the services of a physician licensed pursuant to chapter 370, a physician assistant licensed pursuant to chapter 370, or an advanced practice registered nurse licensed pursuant to chapter 378. Each such physician, physician assistant or advanced practice registered nurse shall be actively practicing in the state and have received education or training from an institution of higher education or professional organization to perform cosmetic medical procedures and have experience performing such procedures.

  Conn. Gen. Stat. §19a-903c(b) (Medical spas) · verified Sep 3, 2026

• Any cosmetic medical procedure performed at a medical spa shall be performed in accordance with the provisions of this title and title 20, and shall only be performed by such physician, physician assistant or advanced practice registered nurse, or a registered nurse licensed pursuant to chapter 378.

  Conn. Gen. Stat. §19a-903c(b) · verified Sep 3, 2026

Delaware writes two supervision regimes and a med spa can sit under either. The one that reaches a non-physician directly is 24 DAC 1700 § 11: the delegating physician is responsible for that individual’s medical activities, may not delegate a function the delegate is barred from performing, and may not be involved in patient care in name only — with direct supervision meaning physically on the premises, and indirect supervision meaning present or reachable electronically and able to be physically present within 30 minutes. The regime Delaware writes for physician associates is the more detailed of the two: the collaborating physician may not be involved in patient care in name only, must be involved in active patient care on a regular basis, and may not assign medical acts exceeding the physician’s own license. Unless a Board regulation changes the number — and except where both work in the same physical office or facility building — that physician may collaborate with no more than 4 physician associates at a time, with the PA’s scope identified in a written collaborative agreement kept on file where care is given; a physician associate above 6,000 postgraduate clinical practice hours may be released from the regime on application. Two disciplinary grounds reach supervision directly: failing to supervise a person working under a physician’s supervision, and knowingly assisting unauthorized practice. A physician practice with multiple offices must have a physician member visit each at least monthly. The Act’s own exceptions section states that its practice-of-medicine provisions do not apply to the business of cosmetology, and the cosmetology chapter states that an aesthetician is not authorized to prescribe medication or provide medical treatment in the same manner as a dermatologist.

• An aesthetician is not authorized to prescribe medication or provide medical treatment in the same manner as a dermatologist.

  24 Del. C. §5124(1) · verified Sep 3, 2026

• A collaborating physician may not be involved in patient care in name only and must be involved in active patient care on a regular basis.

  24 Del. C. §1771(d) · verified Sep 3, 2026

The District draws its line at the stratum corneum and does it inside the definition of practicing medicine: offering or performing any invasive procedure of the body, or otherwise affecting the layer of skin below the stratum corneum for surgical, therapeutic or COSMETIC purposes, is the practice of medicine — excluding, by the statute’s own terms, procedures known as body tattooing or body piercing. Other health professionals may still perform such a procedure, but only if a licensed physician has authorized it or the performer is one of the named clinicians who has the necessary training and experience. The Barber and Cosmetology Board’s rules then say the same from the esthetician’s side: esthetics is the application of creams, lotions, scrubs, polishes, waxes, cosmetics, eyelashes and other beauty treatments directly onto the skin for a TEMPORARY improvement in appearance, EXCLUDING peels and microdermabrasion, plus facial and neck hair removal by depilatories, waxing or tweezers; master esthetics adds microdermabrasion, resurfacing and chemical peel. Licensees are prohibited from procedures using cosmetic exfoliating substances or devices that affect more than the top layer of the epidermis — a device is not intended to remove viable skin below the stratum corneum, and such use is beyond the scope of every person and establishment the Board licenses — while FDA-registered devices intended for cosmetic skin care remain permitted.

• The practice of medicine includes offering or performing any type of invasive procedure of the body, whether through a body opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum, for surgical, therapeutic, or cosmetic purposes, excluding procedures known as body tattooing or body piercing.

  D.C. Code §3-1201.02(7)(A)(iv) · verified Sep 3, 2026

• Nothing in this paragraph shall be construed as preventing or restricting other health professionals from offering or undertaking any type of invasive procedure of the body, whether through a body opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum, for surgical, therapeutic, or cosmetic purposes, if the procedure has been authorized by a licensed physician; or is performed by an advanced practice registered nurse, an anesthesiologist assistant, a dentist, a physician assistant, a podiatrist, a practical nurse, a registered nurse, or a surgical assistant who has received the necessary training and experience to perform the procedure in a safe and effective manner.

  D.C. Code §3-1201.02(7)(B) · verified Sep 3, 2026

Florida regulates cosmetic procedures through the physician’s duty to supervise and to delegate only to qualified people.

• Delegating professional responsibilities to a person the physician knows (or should know) is not qualified by training, experience, or licensure is a disciplinable offense.

  Fla. Stat. §458.331(1)(w) · verified Jul 26, 2026

• Aiding, assisting, procuring, or advising an unlicensed person to practice medicine is a ground for discipline against the physician.

  Fla. Stat. §458.331(1)(f) · verified Jul 26, 2026

Georgia licenses the people who operate cosmetic lasers, in two tiers, and requires the facility to have a consulting physician behind them. Separately, a physician delegates medical acts to a nurse by written protocol or to a physician assistant by a board-approved job description.

• An assistant laser practitioner may perform cosmetic laser services under the supervision of a Board-licensed physician or a licensed senior laser practitioner. A senior laser practitioner may perform cosmetic laser services and may supervise assistant laser practitioners performing them.

  Ga. Comp. R. & Regs. 360-35-.05 · verified Aug 17, 2026

• A consulting physician must be licensed in Georgia, have a principal place of business in Georgia or practice within 50 miles of the facility supervised, be trained in laser modalities (physics, safety, technique, indications, pre- and post-operative care, and treating complications), and be available for emergency consultation. The consulting physician establishes the protocols for the cosmetic laser services provided at a facility and files those protocols with the Board.

  Ga. Comp. R. & Regs. 360-35-.06 · verified Aug 17, 2026

Hawaii defines the practice of medicine by any means, method, or agent, and the sections cited here put the supervision line in the statute rather than in a rule about medical assistants. The practice of medicine includes the use of drugs, surgery, electricity, telehealth, and any means to diagnose, treat, prescribe for, or correct any human condition, and no person may practice or offer to practice medicine without a license from the Hawaii medical board. A physician assistant or emergency medical services licensee may render services under the direction and control of a licensed physician, that direction and control does not in every case require the physician’s personal presence, and the employing physician retains full professional and personal responsibility for any act that constitutes the practice of medicine. Anyone practicing medicine under a physician’s supervision must be licensed as a physician assistant, except a person trained to do only a very limited number of diagnostic or therapeutic procedures under a physician’s direction, who is not deemed a practitioner of medicine; the board sets the degree of supervision, and a physician who supervises below it commits professional misconduct. The Board’s rule makes the physician assistant the supervising physician’s agent. A registered nurse may delegate nursing tasks to unlicensed assistive personnel but never assessment, evaluation, or nursing judgment. On the cosmetology side, an esthetician is defined by the work of massaging, cleansing, stimulating, manipulating, exercising, or beautifying the skin with hands or nonmedically prescribed apparatus, cosmetic preparations, and hair removal by means other than electrolysis; the practice of cosmetology is beauty care of the skin, hair, scalp, and nails for cosmetic purposes; and the chapter does not restrict licensed professionals acting within their own scope. None of the sections cited here names microneedling, lasers, or a medical director.

• the practice of medicine by a physician or an osteopathic physician includes the use of drugs and medicines; surgery; manual medicine; water; electricity; hypnotism; telehealth; the interpretation of tests, including primary diagnosis of pathology specimens, medical imaging, or any physical; osteopathic medicine; any means, method, or agent, either tangible or intangible, to diagnose, treat, prescribe for, palliate, or correct disease, or prevent any human disease, condition, ailment, pain, injury, deformity, illness, infirmity, defect, physical or mental condition in the human subject.

  Haw. Rev. Stat. § 453-1 · verified Sep 8, 2026

• Except as otherwise provided by law, no person shall practice medicine or surgery in the State, either gratuitously or for pay, or offer to practice medicine or surgery in the State, or advertise or announce one's self, either publicly or privately, as prepared or qualified to practice medicine or surgery in the State, or append the letters "Dr.", "M.D.", or "D.O." to one's name with the intent to imply that the person is a practitioner of medicine or surgery, without having a valid unrevoked license or a limited and temporary license obtained from the Hawaii medical board.

  Haw. Rev. Stat. § 453-2(a) · verified Sep 8, 2026

Idaho defines the supervising physician as reaching unlicensed personnel, and that is the provision a med spa turns on. a “supervising physician” is a physician responsible for the direction and supervision of the activities of, and patient services provided by, licensed or unlicensed medical personnel — so the statute contemplates unlicensed staff working under a physician and puts the physician on the hook for what they do. Failing to supervise the activities of interns, residents, nurse practitioners, certified nurse-midwives, clinical nurse specialists or physician assistants is a ground for medical discipline, and so is knowingly aiding or abetting any person to practice medicine who is not authorized to. The practice of medicine itself is defined broadly, reaching investigation, diagnosis, treatment, correction, prevention of, or prescription for any human condition by any means or instrumentality involving the application of principles or techniques of medical science — and, separately, offering or holding oneself out as able to do those acts.

• "Supervising physician" means a physician who is responsible for the direction and supervision of the activities of and patient services provided by licensed or unlicensed medical personnel.

  Idaho Code §54-1803(4) · verified Sep 3, 2026

• Failing to supervise the activities of interns, residents, nurse practitioners, certified nurse-midwives, clinical nurse specialists, or physician assistants is a ground for medical discipline.

  Idaho Code §54-1814(17) · verified Sep 3, 2026

Illinois treats energy devices that disrupt the skin as the practice of medicine, then grades the supervision by whether the procedure is ablative. Ablative means the physician is on site. Non-ablative means the physician can be at the end of a phone. That distinction is the one an Illinois operator has to get right.

• The use of a Class 3b or Class 4 laser, an intense pulsed-light device, a radiofrequency device or a medical microwave device for dermatologic conditions or cosmetic procedures that disrupt the epidermal surface of the skin — ablative or non-ablative — is the practice of medicine, and may be performed only by a licensed physician or under delegation as the Section provides.

  68 Ill. Adm. Code 1285.336 (as stated in the IDFPR/IDPH med spa memo) · verified Aug 17, 2026

• A physician may delegate ABLATIVE procedures to a licensed practical nurse, a registered professional nurse, a full practice authority APRN or another person only with on-site supervision by the physician. For NON-ABLATIVE procedures the physician may instead be available by telephone or other electronic means to respond promptly to any question or complication.

  68 Ill. Adm. Code 1285.336 · verified Aug 17, 2026

Indiana defines the practice of medicine broadly enough to reach injectables and energy procedures: prescribing or administering treatment, and procedures that cut, burn or vaporize tissue, are the practice of medicine.

• The “practice of medicine” includes prescribing or administering any form of treatment and procedures that cut, burn, or vaporize tissue by mechanical means, laser, or penetration of the skin — the statutory basis for treating cosmetic injectables and energy-device procedures as medicine.

  Ind. Code §25-22.5-1-1.1 · verified Jul 26, 2026

• Indiana’s esthetician definition was read in full and is a closed list with a medical carve-out. An esthetician is “a person who engages solely in one (1) or more of the following practices”: “giving facials, applying makeup, and giving skin care”; “beautifying, massaging, or cleaning the body with the use of cosmetic preparations, antiseptics, tonics, lotions, or creams”; and removing superfluous hair “by the use of depilatories, waxing, or tweezers”. The term expressly “does not include performing any of the acts described in subsection (a)… in treating an illness or a disease” No act of puncturing appears — an absence in this definition.

  Ind. Code § 25-8-2-9.5 · verified Sep 2, 2026

Iowa wrote a rule for the medical director at a medical spa, and it counts in hours, miles and percentages. 481—655.6 requires the medical director to hold an active unrestricted Iowa license to supervise EACH delegated service, to ENSURE that the people performing delegated services receive direct, in-person, ON-SITE supervision AT LEAST FOUR HOURS EACH WEEK — from the director or another qualified licensed physician or qualified supervising nonphysician professional — and that it is documented, to review on site each week and read AT LEAST 10 percent of patient charts, and to be physically located WITHIN 60 MILES of where the delegated services are performed AT ALL TIMES. A medical aesthetic service may only be performed by a qualified licensed or certified nonphysician person or a qualified laser technician where the medical director has delegated it, and the director remains ultimately responsible for all of it.

• A medical aesthetic service shall only be performed by qualified licensed or certified nonphysician persons or qualified laser technicians if the service has been delegated by a medical director who is responsible for supervision of the services performed at a medical spa in Iowa.

  Iowa Admin. Code r. 481—655.6(2) (Delegation by a medical director) · verified Sep 4, 2026

• A medical director at a medical spa shall: a. Hold an active unrestricted Iowa medical license to supervise each delegated medical aesthetic service; b. Possess the appropriate education, training, experience and competence to safely supervise each delegated medical aesthetic service; c. Retain responsibility for the supervision of each medical aesthetic service performed by qualified licensed or certified nonphysician persons or qualified laser technicians;

  Iowa Admin. Code r. 481—655.6(3) (Medical director) · verified Sep 4, 2026

Kansas bounds the cosmetology license twice over, and both limits matter to a med spa. An esthetician practices the profession of cosmetology ONLY to the listed extent, and the skin work on that list must be both NONINVASIVE and “provided for esthetic rather than medical purposes” — two independent conditions, either of which a cosmetic medical procedure can fail. On the medical side the Act sweeps in by function rather than title: persons who prescribe, recommend or furnish medicine or drugs, or perform any surgical operation of whatever nature by the use of any surgical instrument, procedure, equipment or mechanical device for the diagnosis, cure or relief of any wound, injury, infirmity or disease, are DEEMED to be engaged in the practice of medicine and surgery. Delegating professional responsibilities to a person the licensee knows or has reason to know is not qualified by training, experience or licensure is unprofessional conduct.

• "Esthetician" means any person who, for compensation practices the profession of cosmetology only to the following extent: Eyebrow and eyelash services, cleansing, stimulating or performing any other noninvasive beautifying process on any skin surface by means of hands or mechanical or electrical appliances, other than electric needles, provided for esthetic rather than medical purposes; temporary hair removal from the face or any part of the body by use of the hands or mechanical or electrical appliances other than electric needles; or using cosmetic preparations, antiseptics, lotions, creams or other preparations in performing any of the practices described in this subsection.

  Kan. Stat. Ann. §65-1901(f) · verified Sep 3, 2026

• For the purpose of this act the following persons shall be deemed to be engaged in the practice of medicine and surgery: persons who prescribe, recommend or furnish medicine or drugs, or perform any surgical operation of whatever nature by the use of any surgical instrument, procedure, equipment or mechanical device for the diagnosis, cure or relief of any wounds, fractures, bodily injury, infirmity, disease, physical or mental illness or psychological disorder, of human beings.

  Kan. Stat. Ann. §65-2869(b) · verified Sep 3, 2026

Kentucky's cosmetology chapter draws the med spa line itself, in one sentence. No person shall engage in the practice of cosmetology, esthetic practices or nail technology for other than cosmetic purposes, nor engage in them for the treatment of physical or mental ailments — and the chapter does not apply to persons authorized by Kentucky law to practice medicine, nursing and the other named professions who perform incidental practices of cosmetology in the normal course of their own profession. The esthetic-practices definition then contemplates the medical setting expressly: it includes providing preoperative and postoperative esthetic skin care, either referred by or supervised by a medical professional, unless the acts are performed incident to treatment of an illness or a disease. On the medical side the practice of medicine is defined as the diagnosis, treatment or correction of any and all human conditions, ailments, diseases, injuries or infirmities by any and all means, methods, devices, or instrumentalities; and employing an unlicensed person as a practitioner of medicine, or otherwise aiding, assisting or abetting the unlawful practice of medicine or any other healing art, is a ground for discipline.

• No person shall engage in the practice of cosmetology, esthetic practices, or nail technology for other than cosmetic purposes nor shall any person engage in the practice of cosmetology, esthetic practices, or nail technology for the treatment of physical or mental ailments. This chapter does not apply to persons authorized by the law of this state to practice medicine, podiatry, optometry, dentistry, chiropractic, nursing, or embalming who perform incidental practices of cosmetology, esthetic practices, and nail technology in the normal course of the practice of their profession.

  Ky. Rev. Stat. §317A.020(1) · verified Sep 3, 2026

• "Esthetic practices" means one or more of the following acts: providing preoperative and postoperative esthetic skin care, either referred by or supervised by a medical professional, unless these acts are performed incident to treatment of an illness or a disease; work as a student in a board-approved school; or work performed by a licensed massage therapist.

  Ky. Rev. Stat. §317A.010(7)(e) · verified Sep 3, 2026

Louisiana names the med spa failure modes inside one definition of unprofessional conduct. r.s. 37:1285(a)(13) makes unprofessional conduct a cause for refusing, suspending or revoking a license, and its enumerated examples read like a list of how a cosmetic practice goes wrong: Failing to maintain independent medical judgment, improperly delegating or supervising, exercising undue influence, enabling the unauthorized practice of medicine, practicing or enabling practice by an impaired provider, and failing to practice within the scope of education, training and experience. A separate cause reaches the arrangement rather than the act: knowingly performing any act which in any way assists an unlicensed person to practice medicine, or having professional connection with or lending one's name to an illegal practitioner. Physician assistants have their own cause — utilizing one without approval and recordation as required by law, or permitting one within the physician's employment to conduct activities outside the designated scope of the assistant's approval and registration. The practice of medicine is defined broadly enough to catch cosmetic work: holding oneself out as engaged in, or actually engaging in, the diagnosing, treating, curing or relieving of any bodily condition, defect or injury in another person, by any drug, instrument or force, or any other agency or means. The cosmetology board’s rules then name the procedures a salon license does not reach. No license or permit issued by the Board of Cosmetology authorizes, in a salon it licenses, the use of lasers, MICRO-NEEDLING, micro-blading, any service or procedure which penetrates or invades the live tissue or dermis by any means — instruments, product insertion, puncturing, cutting, needling or chemical exfoliation — or the use of any mechanical or electrical apparatus classified as a medical device by the FDA. Estheticians shall not perform any procedure which will affect the dermis or skin below the epidermis; esthetic services are the work performed on the epidermis, and the board’s definition of nano-needling is a non-invasive technique that does not penetrate beyond the epidermis by more than .25 mm.

• Unprofessional conduct, including but not limited to, conduct manifested as sexual misconduct, disruptive behavior, failing to cooperate with the board, failing to maintain independent medical judgment, improperly delegating or supervising, exercising undue influence, enabling the unauthorized practice of medicine, practicing or enabling practice by an impaired provider, failing to practice within the scope of education, training, and experience, intentionally falsifying or fraudulently altering records, or failing to create or maintain medical records, is a cause for which the board may refuse to issue, or may suspend or revoke any license or permit, or impose probationary or other restrictions.

  La. Rev. Stat. §37:1285(A)(13) · verified Sep 3, 2026

• Knowingly performing any act which, in any way, assists an unlicensed person to practice medicine, or having professional connection with or lending one's name to an illegal practitioner, is a cause for which the board may refuse to issue, or may suspend or revoke any license or permit.

  La. Rev. Stat. §37:1285(A)(18) · verified Sep 3, 2026

Maine writes the delegation rule a med spa actually operates under, and it is CONDITIONAL rather than open: a physician may delegate activities relating to medical care to employees or support staff only where the activities are carried out by custom and usage under the physician’s control, do not themselves require a license, and the physician has ensured the staff have the appropriate training, education and experience AND that they perform the activities competently and safely. The physician remains legally liable and the delegate is treated as the physician’s agent. The section expressly does not reach registered nurses or licensed physician associates, who are governed by their own chapters — and for physician associates the dividing line is 4,000 documented hours of clinical practice, below which a filed collaborative agreement is required and above which a physician associate may be the principal clinical provider in a practice with no physician partner, under a practice agreement. The practice of aesthetics defined by the barbering and cosmetology chapter does not include the diagnosis, treatment or therapy of any dermatological condition.

• The practice of aesthetics under this subsection does not include the diagnosis, treatment or therapy of any dermatological condition.

  32 M.R.S. §14202(7) · verified Sep 3, 2026

• This chapter may not be construed as prohibiting a physician or surgeon from delegating to the physician’s or surgeon’s employees or support staff certain activities relating to medical care and treatment carried out by custom and usage when the activities are under the control of the physician or surgeon; the activities being delegated do not, unless otherwise provided by law, require a license, registration or certification to perform; the physician or surgeon ensures that the employees or support staff have the appropriate training, education and experience to perform these delegated activities; and the physician or surgeon ensures that the employees or support staff perform these delegated activities competently and safely.

  32 M.R.S. §3270-A · verified Sep 3, 2026

Maryland attaches its delegation duties to the licensed physician who actually delegates. That physician must evaluate the risk to the patient, delegate only technical acts customary to their own practice and for which the assistant has been trained, remain responsible for the act, and supervise it — and responsibility cannot be handed to another physician without that physician’s express consent. Maryland sets the required presence by tier rather than by one nonsurgical rule: patient preparation, history interviews, specimen collection, tuberculin skin tests, electrocardiography, prescription transmittal, oral drugs and microdermabrasion may be delegated without on-site supervision; injections and peripheral intravenous lines require on-site supervision; and a surgical technical act requires the delegating physician present, scrubbed and personally performing the surgery in the same surgical field. An act that is exclusively limited to a licensed, certified or registered occupation may not be delegated to an assistant — a limit on who may receive the act, not a bar on delegating it to someone whose own license covers it. The cosmetology statute answers the microneedling question in its own definition: “provide esthetic services” means cleansing, exercising, exfoliating, massaging, cosmetic microneedling, stimulating, toning or any similar procedure on the skin or scalp by electrical, mechanical or any other means, and includes superficial exfoliation of the epidermis and nonablative skin rejuvenation — but it does not include the diagnosis of illness, disease or injury, or performing ablation of the dermis or hypodermis; hair removal under that definition is by any means other than a laser light-based device.

• A licensed physician who delegates shall: (1) Evaluate the risk to the patient and the outcome of the delegated acts; (2) Delegate only those technical acts that are customary to the practice of the licensed physician; (3) Delegate only those technical acts for which the assistant has been trained; (4) Be responsible for the acts of the assistant; and (5) Supervise the assistant.

  Md. Code Regs. 10.32.12.03(A) (Standards for the Licensed Physician Delegating to an Assistant) · verified Sep 3, 2026

• With on-site supervision a licensed physician may delegate to an assistant the preparing and administering of injections limited to intradermal, subcutaneous, and intramuscular (deltoid, gluteal, vastus lateralis), to include small amounts of local anesthetics, and the establishing of a peripheral intravenous line. Microdermabrasion may be delegated without on-site supervision.

  Md. Code Regs. 10.32.12.04(D)(1)(j), (D)(2)(a)–(b) · verified Sep 8, 2026

What chapter 112 creates behind a physician assistant is a supervising physician, in one unusually direct sentence: supervision must be CONTINUOUS, and it expressly does not require the physician to be present. The absence of a presence requirement is paid for in liability — and what the assistant may do is set by their own training rather than by a list.

• A physician assistant may perform medical services when those services are rendered under the supervision of a registered physician. That supervision shall be CONTINUOUS but shall NOT require the personal presence of the supervising physician or physicians. Massachusetts settles the on-site question in the statute itself rather than leaving it to a board rule.

  Mass. Gen. Laws ch. 112, § 9E · verified Sep 1, 2026

• What a physician assistant may do is set by their own training rather than by a list: depending upon their level of professional training and experience as determined by a supervising physician, they may perform medical services of a general nature and may order tests and therapeutics in private practice, group practice or a health care facility, consistent with that facility’s bylaws and policies.

  Mass. Gen. Laws ch. 112, § 9E · verified Sep 1, 2026

Michigan is a delegation-permissive state with real limits inside it. A licensee may delegate to a licensed or unlicensed individual qualified by education, training or experience — but only where the act is within the scope of the licensee’s own profession and is performed under the licensee’s supervision — and may not delegate at all where the act requires the education, skill and judgment of the licensee. Separately, the esthetics license is capped by statute at the stratum corneum, so what may be delegated to a licensee is not the same question as what that license itself reaches.

• A licensee may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions — provided they fall within the scope of practice of the licensee’s own profession and are performed under the licensee’s supervision. Michigan does not restrict delegation to licensed people the way several states in this corpus do. (Michigan Compiled Laws complete through PA 12 of 2025.)

  Mich. Comp. Laws § 333.16215(1) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

• ⚠️ AND HERE IS THE LIMIT THAT DOES THE WORK. A licensee SHALL NOT delegate an act, task, or function if, under standards of acceptable and prevailing practice, it requires the level of education, skill, and judgment required of the licensee. The test is the act’s difficulty, not the delegate’s job title — so a well-trained unlicensed person is eligible for some things and no amount of training makes them eligible for others.

  Mich. Comp. Laws § 333.16215(1) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

Minnesota puts laser use inside the statutory definition of practicing medicine — invasive and NONINVASIVE alike — and makes unlicensed practice a gross misdemeanor. Delegation is permitted but bounded twice over: the delegate must be qualified, and must stay inside the expressed legal scope of their own license.

• A person is “practicing medicine” if the person offers or undertakes to perform any surgical operation including any invasive or noninvasive procedures involving the use of a laser or laser assisted device, upon any person. Minnesota is one of the few states to put lasers in the STATUTE rather than a board rule, and the word “noninvasive” closes the usual argument that a surface treatment is not a medical act.

  Minn. Stat. § 147.081, subd. 3(4) · verified Sep 2, 2026

• ⚠️ and unlicensed practice is a crime, not a license matter. Any person violating the prohibition on practicing medicine without a license is guilty of a gross misdemeanor. For a Minnesota med spa this is the practical difference: an unlicensed operator running a laser is not facing a board complaint, they are facing a criminal charge.

  Minn. Stat. § 147.081, subd. 2 · verified Sep 2, 2026

Mississippi puts its supervision lines in the medical board’s rules, and the one that reaches a med spa most directly is the laser rule. The statute defines the practice of medicine as suggesting, recommending, prescribing, or directing any drug, medicine, appliance, or other agency for the cure, relief, or palliation of any ailment for compensation, and requires a license from the State Board of Medical Licensure before practicing. The Board’s laser rule declares the use of laser, pulsed light, or similar devices for invasive or cosmetic procedures to be the practice of medicine, limited to physicians and those directly supervised by physicians, with a physician on the premises and directly involved in the treatment if required. Physician assistants practice with physician supervision, may perform any delegated medical service within their training that forms part of the physician’s scope, are the agents of their supervising physicians, and supervision means overseeing and accepting responsibility for the services rendered. The Board of Nursing lets a registered nurse assign the administration of patient medications to other licensed nurses only, except as its Part 2860 sets out. On the cosmetology side, esthetics is defined as massaging the face or neck, brow work, lash and brow tinting, waxing, and stimulating, cleaning, or beautifying the face, neck, arms, or legs by hand, apparatus, or cosmetic preparation, and excludes the diagnosis, treatment, or therapy of any dermatological condition; the cosmetology board’s rules forbid any service or tool that penetrates the skin below the epidermis, forbid practicing medicine or surgery and excising moles or skin tags, and allow dermaplaning only with a disposable, non-surgical 10R rounded edge butterblade. None of the sections cited here names microneedling or a medical director.

• The practice of medicine shall mean to suggest, recommend, prescribe, or direct for the use of any person, any drug, medicine, appliance, or other agency, whether material or not material, for the cure, relief, or palliation of any ailment or disease of the mind or body, or for the cure or relief of any wound or fracture or other bodily injury or deformity, or the practice of obstetrics or midwifery, after having received, or with the intent of receiving therefor, either directly or indirectly, any bonus, gift, profit or compensation;

  Miss. Code Ann. § 73-25-33(1) · verified Sep 8, 2026

• Every person who desires to practice medicine must first obtain a license to do so from the state board of medical licensure, but this section shall not apply to physicians now holding permanent license, the same having been recorded as required by law.

  Miss. Code Ann. § 73-25-1 · verified Sep 8, 2026

Missouri fixes the supervision burden in numbers, and it counts charts. a physician may enter collaborative practice arrangements with registered professional nurses, in the form of written agreements, jointly agreed-upon protocols or standing orders, and those arrangements may delegate authority to administer or dispense drugs and provide treatment — but only within the nurse’s scope of practice and consistent with that nurse’s skill, training and competence. The statute then fixes the review burden in numbers: the APRN must submit at least ten percent of the charts documenting their delivery of health care services for physician review every fourteen days, and the collaborating physician must review every fourteen days at least twenty percent of the charts in which the APRN prescribes controlled substances. Where the arrangement covers diagnosis and initiation of treatment for acutely or chronically ill or injured persons, the collaborating physician must be present for sufficient periods of time at least once every two weeks. Geographic proximity is required, subject to the exceptions the section itself sets out. Separately, delegating professional responsibilities to a person not qualified by training, skill, competency, age, experience or licensure is a ground for discipline. On the cosmetology side the licensed practice is enumerated: the Class E esthetician occupation is defined by a list of manual and apparatus-based skin practices, with cosmetic preparations not to exceed ten percent phenol.

• "Class E - estheticians" includes the use of mechanical, electrical apparatuses or appliances, or by the use of cosmetic preparations, antiseptics, tonics, lotions or creams, not to exceed ten percent phenol, engages for compensation, either directly or indirectly, in any one, or any combination, of the following practices: massaging, cleansing, stimulating, manipulating, exercising, beautifying or similar work upon the scalp, face, neck, ears, arms, hands, bust, torso, legs or feet and removing superfluous hair by means other than electric needle or any other means of arching or tinting eyebrows or tinting eyelashes, of any person.

  Mo. Rev. Stat. §329.010(5)(d) · verified Sep 3, 2026

• A physician may enter into collaborative practice arrangements with registered professional nurses. Collaborative practice arrangements shall be in the form of written agreements, jointly agreed-upon protocols, or standing orders for the delivery of health care services. Collaborative practice arrangements, which shall be in writing, may delegate to a registered professional nurse the authority to administer or dispense drugs and provide treatment as long as the delivery of such health care services is within the scope of practice of the registered professional nurse and is consistent with that nurse's skill, training and competence.

  Mo. Rev. Stat. §334.104.1 · verified Sep 3, 2026

Montana defines the practice of medicine by the act, not the setting, and its medical board sets the supervision line for unlicensed staff in a rule. The statute makes the diagnosis, treatment, or correction of human conditions by any means the practice of medicine, telemedicine included, and a medical assistant is exempt only when rendering services under the appropriate amount and type of supervision of a licensee. The Legislature directed the Board of Medical Examiners to require onsite supervision of a medical assistant for invasive procedures, administration of medication, or allergy testing, and the Board’s rule does so: a delegating provider must personally provide onsite or direct supervision for injections other than immunizations, invasive procedures, and intravenous administration of medication, and may not delegate surgery, which the Board defines to include any procedure in which tissue is cut or altered by mechanical or energy forms including laser energy. No provision in the medical practice act or the Board’s rules requires a medical spa to designate a medical director. On the cosmetology side, the statute defines esthetics as skin care of the body including safety-approved electrical appliances, chemical compounds formulated for professional application, and temporary hair removal; the chapter does not prohibit services by persons licensed to practice the healing arts; and the Board of Barbers and Cosmetologists defines noninvasive as superficial procedures confined to the stratum corneum through which living cells are never altered, cut, or scarred, and makes performing services or using devices outside the licensee’s scope unprofessional conduct. The Board’s own Med Spa FAQ then names the procedure: asked about microdermabrasion, microneedling and chemical peels, it answers that a licensee with the proper training may perform microdermabrasion and chemical peels, and that any procedure compromising the germinative or basal layers of the skin is prohibited for its licensees.

• "Practice of medicine" means the diagnosis, treatment, or correction of or the attempt to or the holding of oneself out as being able to diagnose, treat, or correct human conditions, ailments, diseases, injuries, or infirmities, whether physical or mental, by any means, methods, devices, or instrumentalities, including electronic and technological means such as telemedicine. If a person who does not possess a license to practice medicine in this state under this chapter and who is not exempt from the licensing requirements of this chapter performs acts constituting the practice of medicine, the person is practicing medicine in violation of this chapter.

  Mont. Code Ann. § 37-3-102(11) · verified Sep 8, 2026

• The board shall adopt guidelines by administrative rule for: (a) the performance of administrative and clinical tasks by a medical assistant that are allowed to be delegated by a physician, physician assistant, or podiatrist, including the administration of medications; and (b) the level of physician, physician assistant, or podiatrist supervision required for a medical assistant when performing specified administrative and clinical tasks delegated by a physician, physician assistant, or podiatrist. However, the board shall adopt a rule requiring onsite supervision of a medical assistant by a physician, physician assistant, or podiatrist for invasive procedures, administration of medication, or allergy testing.

  Mont. Code Ann. § 37-3-104(1) · verified Sep 8, 2026

Nebraska defines delegation in nursing terms — transferring the authority, responsibility AND accountability to perform nursing interventions — and places delegating, directing and assigning within the registered nurse’s own practice, bounded by the Nurse Practice Act. It also puts an affirmative duty on every credential holder to report anyone they have reason to believe is practicing without a credential. Separately, the Board’s own rules bound the cosmetology licenses: the practice of esthetics is upon the skin or epidermis, and neither esthetics nor cosmetology includes using injectables and lasers. That rule names those two modalities and does not name microneedling.

• Delegating means transferring to another individual the authority, responsibility, and accountability to perform nursing interventions.

  Neb. Rev. Stat. §38-2205 (“Delegating” defined) · verified Sep 3, 2026

• Nursing actions by a registered nurse include delegating, directing, or assigning nursing interventions that may be performed by others and that do not conflict with the Nurse Practice Act.

  Neb. Rev. Stat. §38-2212(2)(h) · verified Sep 3, 2026

Nevada’s Medical Practice Act contains no med-spa “medical director” designation — the phrase does not appear anywhere in NRS chapter 630, which was surveyed in full. Supervision is regulated instead through the named supervising-physician relationship that defines a physician assistant, and through a disciplinary ground for failing to supervise a medical assistant adequately. For dermal fillers Nevada goes further: the statutory list of who may inject is exhaustive, a medical assistant is not on it, and the injection may not be delegated to anyone off that list. The cosmetology board’s rules answer the microneedling question by needle depth. A licensee shall not perform an invasive procedure — which includes the penetration of the skin by needles, the abrasion of the skin below the stratum corneum, the application of substances affecting anything below the stratum corneum, and the injection or administration of any substance — but the needle prohibition does not apply to a licensed advanced esthetician performing microneedling, microchanneling or dermarolling if the gauge and penetration of the needles do not exceed 1.5 mm (unless directly supervised by a health care professional) and the needles are not used for an ablative esthetic medical procedure, to remove blood or to inject any substance. The statutory bar on an advanced esthetician performing any ablative esthetic medical procedure applies regardless of supervision and regardless of the device, laser and ablative microneedling included. A cosmetologist or esthetician may remove skin at or above the stratum corneum for beautification, and “invasive procedure” is defined as an act below the stratum corneum that is outside the licensee’s scope, is not solely for beautification, and excises, vaporizes, disintegrates or removes living tissue.

• Nevada’s Medical Practice Act contains no med-spa “medical director” designation. The full text of NRS chapter 630 was surveyed and the phrase “medical director” does not appear in it, nor do “medical spa” or “med spa”; the chapter regulates supervision through the named supervising-physician relationship and the medical-assistant supervision ground instead.

  Nev. Rev. Stat. ch. 630 (Physicians and Physician Assistants — full chapter surveyed) · verified Sep 3, 2026

• A physician assistant is a person qualified to perform medical services under the supervision of a supervising physician and who has been issued a license by the Board.

  Nev. Rev. Stat. §630.015 (“Physician assistant” defined) · verified Sep 3, 2026

New Hampshire makes the licensee answerable for who works in their office: employing or ALLOWING an unlicensed person to practice there is itself a disciplinary ground. It also treats regular or frequent consultation by an unlicensed person as the practice of medicine without a license, so a consultation exception cannot be used as a standing arrangement. The cosmetology chapter defines esthetics by an enumerated list of surface treatments — giving facials, applying makeup, giving therapeutic skin care treatments, removing superfluous hair, applying eyelashes, beautifying, massaging, cleansing or stimulating the face, neck, arms and shoulders with cosmetic preparations, devices or appliances, and providing pedicure and manicure services — a list on which no procedure that punctures the skin appears.

• The board may take disciplinary action against a licensee who has employed or allowed an unlicensed person to practice in the licensee’s office.

  N.H. Rev. Stat. §329:17, VI(e) · verified Sep 3, 2026

• Regular or frequent consultation by an unlicensed person, as determined by the licensing board, shall constitute the practice of medicine without a license.

  N.H. Rev. Stat. §329:21, II (consultation exception) · verified Sep 3, 2026

Two rules meet here and they must not be confused. Lasers are swept into the definition of SURGERY for the office-surgery rules. The separate delegation rule addresses physical modalities, and it gives an unlicensed aide a list of exactly five — hot packs, cold packs, paraffin baths, contrast baths and whirlpool baths. Nothing on that list is a cosmetic device.

• For the purposes of the office-surgery rules, surgery means a manual or operative procedure, including the use of lasers, performed upon the body to preserve health, diagnose or treat disease, repair injury, correct deformity or defect, prolong life or relieve suffering.

  N.J.A.C. 13:35-4A.3 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• An unlicensed aide may administer exactly five physical modalities: hot packs, cold packs, paraffin baths, contrast baths and whirlpool baths. No other modality — including TENS or traction — may be delegated to an unlicensed aide, and an aide may not carry out a rehabilitative exercise program.

  N.J.A.C. 13:35-6.14(d) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

New Mexico wrote a rule for this exact business, and it is recent. 16.12.14 NMAC — "Nursing Practice in Aesthetic Healthcare Facilities", effective 2024-05-21 — defines an aesthetic healthcare facility and requires it to employ a clinical supervisor who is an APRN or other licensed independent practitioner with the training to perform every procedure the facility offers. That supervisor must develop or approve written protocols for all procedures, detailed enough that making independent healthcare decisions never falls to someone without the scope to make them. On the physician side, the medical board treats the use of medical therapeutic and cosmetic devices as the practice of medicine, and a medical assistant may use one only if certified on that device, only if it is non-incisive and non-ablative, and only when the supervising physician is immediately available on the premises.

• Licensees may work in an aesthetic healthcare facility only if the facility employs a clinical supervisor who is an APRN or other licensed independent healthcare practitioner reasonably known to possess the appropriate education, training, and skills to safely perform all aesthetic healthcare procedures offered in the facility.

  16.12.14.8(B) NMAC (Nursing Practice in Aesthetic Healthcare Facilities, eff. 2024-05-21) · verified Sep 4, 2026

• develops or approves and implements written protocols for all aesthetic healthcare procedures performed at the aesthetic healthcare facility. The protocols must provide sufficient and specific details, including guidance on identifying and responding to adverse events, to assure that making independent healthcare decisions does not become the responsibility of individuals without the appropriate scope of practice to make such decisions.

  16.12.14.9(B)(5) NMAC (Clinical supervisor) · verified Sep 4, 2026

New York reaches cosmetic procedures through the definition of the practice of medicine, plus the physician’s own duties not to delegate to the unqualified and not to permit unlicensed practice. On 7 March 2025 the State Board for Medicine determined that using an energy device which affects the basement membrane or deeper tissue is the practice of medicine — grading devices by depth. The Education Department adopted that determination for every physical condition except laser hair removal, on which it has not acted. Inside it, only a licensed practitioner or a registered professional nurse under a physician’s general supervision may carry out the treatment.

• New York defines the practice of medicine as diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition. Administering a prescription drug such as a neuromodulator or dermal filler, and prescribing it, fall inside that definition.

  N.Y. Educ. Law §6521 · verified Aug 17, 2026

• Delegating professional responsibilities to a person when the licensee knows or has reason to know that the person is not qualified — by training, by experience, or by licensure — to perform them is professional misconduct.

  N.Y. Educ. Law §6530(25) · verified Aug 17, 2026

The Medical Board treats an aesthetic laser as a surgical instrument: altering human tissue with one is surgery, and therefore the practice of medicine. Everything about who may hold the handpiece follows from that.

• The Medical Board’s position is that the revision, destruction, incision or other structural alteration of human tissue using laser technology is surgery. It may be performed by a physician, or by a licensed health care professional acting within their own scope with appropriate medical training and under the supervision — preferably on-site — of a physician.

  NCMB Position Statement 5.1.2 (adopted July 1999, amended May 2021) · verified Aug 17, 2026

• The supervising physician is expected to provide oversight of both licensed and non-licensed personnel before and after the procedure, and to remain available for emergencies.

  NCMB Position Statement 5.1.2 · verified Aug 17, 2026

The Medical Practice Act itself sets the terms on which a physician assistant may practice. A PA serving a patient located in the state must hold an active North Dakota PA license or be privileged under chapter 43-17.5, and the Board of Medicine sets the rules governing a PA’s conduct, licensure, qualifications and discipline. The hard limit is negative rather than positive: a PA is NOT authorized to perform any service that must be performed by someone licensed under chapters 43-12.1, 43-13, 43-15 and 43-28. On the nursing side, a nurse may supervise and delegate nursing interventions, to an individual the nursing chapter exempts under a named subsection. The cosmetology chapter answers the microneedling question in its definitions: esthetics excludes any procedure invading living tissue below the stratum corneum and excludes advanced esthetic procedures; advanced esthetics includes microneedling, nonablative procedures, advanced chemical peels and lancet extractions but not treatment of a medical ailment or ablative procedures; and an advanced esthetician must file proof of board-approved additional training before using microneedling pens, rollers or devices.

• An individual providing the services of a physician assistant under this chapter to a patient located in this state shall possess an active North Dakota license for physician assistant practice or be privileged to practice in this state under chapter 43 - 17.5.

  N.D.C.C. § 43-17-02.1(1) (Physician assistant — scope of practice) · verified Sep 5, 2026

• The board shall adopt rules governing the conduct, licensure, fees for licensure and privilege, qualifications, and discipline of physician assistants.

  N.D.C.C. § 43-17-02.1(1) (Board rules govern PA conduct and discipline) · verified Sep 5, 2026

Across the acts these chapters cover — light-based devices and the administration of drugs — Ohio puts a delegating physician behind the act, answerable to the Board for it, and the esthetics license itself authorizes nothing that breaks the skin. Which rules that physician is held to turns on the act, not the job title: an injection delegated to an unlicensed person runs through chapter 4731-23, and light-based devices split into four separate lanes that disagree with each other. Ablative may never be delegated at all; a vascular laser may go to a nurse under an on-site physician watching at most two people; hair removal may go to a certified non-licensee under a physician watching up to five, who need not always be in the building.

• Applying a light-based medical device to the human body is itself the practice of medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery. Everything a non-physician does with one of these devices in Ohio is therefore a delegation from a physician, and is lawful only to the extent a specific rule permits it.

  Ohio Admin. Code 4731-18-02(A) · verified Sep 1, 2026

• A physician shall not delegate the application of light based medical devices for ablative procedures. This is the one absolute in the chapter: there is no training, certification or supervision arrangement that makes an ablative treatment delegable to anyone, and none of the carve-outs for vascular lasers, hair removal or phototherapy reaches ablative work.

  Ohio Admin. Code 4731-18-02(B) · verified Sep 1, 2026

Oklahoma writes the supervision duty as a list the supervising physician must satisfy, and it is unusually concrete about orders. In all patient care settings that physician must provide appropriate methods of supervising the physician assistant’s services, and § 519.6 names them: being responsible for the formulation or approval of all orders and protocols — standing, direct or otherwise — and periodically reviewing them; regularly reviewing the services provided and any problems or complications; being available physically or by telemedicine or direct telecommunication for consultation, emergencies or referral; and reviewing a sample of outpatient medical records. The Cosmetology and Barbering Board’s scope rule then draws the esthetician’s line by DEPTH: cosmetology expressly does not include services that puncture the skin or that fall within the healing arts, and “puncturing the skin” is defined to include microneedling — a multi-needled device creating microchannels at a depth greater than 0.25 mm — as well as laser, ultrasound and HIFU, plasma pen, injections including needle-free devices, FDA Class 3 devices and dermabrasion.

• In all patient care settings, the supervising physician shall provide appropriate methods of supervising the health care services provided by the physician assistant including:

  Okla. Stat. tit. 59, § 519.6 (Supervision in all patient care settings) · verified Sep 5, 2026

• being responsible for the formulation or approval of all orders and protocols, whether standing orders, direct orders or any other orders or protocols, which direct the delivery of health care services provided by a physician assistant, and periodically reviewing such orders and protocols

  Okla. Stat. tit. 59, § 519.6(a) (Responsibility for all orders and protocols) · verified Sep 5, 2026

Oregon does not let a physician associate practice on an informal understanding: a written collaboration agreement signed by a physician, podiatric physician or employer is a precondition of practicing at all, and the degree of collaboration is set at the associate’s primary location of practice by reference to the patient’s condition, the standard of care and the associate’s own education, experience and competence. The cosmetology chapter draws its own line inside the definition of esthetics: the listed skin and facial care practices — cleansing, stimulating, manipulating, exfoliating and applying lotions or creams with the hands or apparatuses, temporary hair removal including dermaplaning, makeup artistry, eyebrow and eyelash services, and facial and body treatments — count as esthetics only when performed to keep the skin healthy and attractive and NOT for medical diagnosis or treatment of disease or physical or mental ailments. The Board’s device rules then answer the microneedling question by DEPTH rather than by name: an esthetician is limited to mechanical or electric apparatuses, appliances or devices that do not penetrate beyond the epidermis except through natural physiological effects, and the devices an esthetician may use expressly include those used for nanoneedling, microneedling and similar procedures — within that limit. The epidermis is the outermost layer only; an esthetician is presumed to be working below it on exfoliating or removing skin below the epidermal layer or destroying or damaging the dermis or muscle; an esthetic device is not a laser, intense pulsed light or a needle-free filler injector; and an esthetician may not use any device for medical diagnosis or treatment of disease or physical or mental ailments.

• A physician associate may not practice medicine unless the physician associate has entered into a collaboration agreement signed by a physician, podiatric physician or employer.

  Or. Rev. Stat. §677.510(2)(a) · verified Sep 3, 2026

• A physician associate shall engage in collaboration with the appropriate health care provider as indicated by the condition of the patient, the standard of care and the physician associate’s education, experience and competence. The degree of collaboration must be determined at the physician associate’s primary location of practice.

  Or. Rev. Stat. §677.510(1) · verified Sep 3, 2026

On the medical side Pennsylvania delegates by TEST rather than by list: seven conditions, all of which must hold before a physician delegates a medical service to a health care practitioner or a technician — with a separate standing-protocol route for emergencies. The cosmetology side is the opposite shape, and it is a list: the board’s definition of esthetics names massaging, applying preparations, hair removal by tweezers or wax, and eyelash work, with no depth or penetration language anywhere in it.

• A medical doctor may delegate the performance of a medical service to a health care practitioner or a technician only where the delegation is consistent with the standards of acceptable medical practice embraced by the medical doctor community in Pennsylvania, and where it does not violate any other statute or regulation governing the person receiving it.

  49 Pa. Code §18.402(a) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• The delegating physician must confirm the person receiving the delegation has the education, training, experience and continued competency to perform it safely, must determine there is no undue risk to that particular patient, and assumes responsibility for the delegated service.

  49 Pa. Code §18.402(a) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

Rhode Island’s practice-of-medicine definition reaches holding out as well as doing: a person is regarded as practicing medicine who holds themself out as able to diagnose, treat, operate or prescribe for anyone ill or alleged to be ill, or who professes to heal or undertakes by any means or method to do those things — and attaching M.D., D.O. or a similar abbreviation indicating engagement in treatment or diagnosis is itself practicing medicine. The delegation ground is stated as unprofessional conduct: practicing medicine with an unlicensed physician, except in an accredited preceptorship or residency training program, or aiding or abetting unlicensed persons in the practice of medicine. On the cosmetology side, esthetics is defined as cleansing, stimulating, manipulating and beautifying skin, including the treatment of skin problems such as dehydration, temporary capillary dilation, excessive oiliness and clogged pores.

• “Practice of medicine” includes the practice of allopathic and osteopathic medicine. Any person is regarded as practicing medicine within the meaning of this chapter who holds themself out as being able to diagnose, treat, operate, or prescribe for any person ill or alleged to be ill with disease, pain, injury, deformity, or abnormal physical or mental condition, or who either professes to heal, offer, or undertake, by any means or method, to diagnose, treat, operate, or prescribe for any person for disease, pain, injury, deformity, or physical or mental condition.

  R.I. Gen. Laws §5-37-1(a)(22) · verified Sep 3, 2026

• Unprofessional conduct includes practicing medicine with an unlicensed physician except in an accredited preceptorship or residency training program, or aiding or abetting unlicensed persons in the practice of medicine.

  R.I. Gen. Laws §5-37-5.1(15) · verified Sep 3, 2026

South Carolina reaches supervision and delegation failures through the Board of Medical Examiners’ misconduct grounds: knowingly performing an act that in any way assists an UNLICENSED person to practice is itself misconduct, as is being convicted of or sanctioned for illegal or unauthorized practice, and so is assisting or abetting a violation of the medical practice laws. The exposure therefore runs to the licensee who lets an unlicensed person perform, not only to that person.

• Misconduct that constitutes grounds for disciplinary action is a showing to the board by the preponderance of evidence that a licensee has knowingly performed an act that in any way assists an unlicensed person to practice.

  S.C. Code §40-47-110(B)(7) · verified Sep 3, 2026

• Misconduct that constitutes grounds for disciplinary action is a showing to the board by the preponderance of evidence that a licensee has been convicted of or sanctioned for illegal or unauthorized practice.

  S.C. Code §40-47-110(B)(6) · verified Sep 3, 2026

South Dakota defines the esthetician's limit anatomically, which is rare and worth reading twice. The practice of esthetics is confined to the NONINVASIVE care of the skin, and the statute says what noninvasive means: Confined to the nonliving cells of the stratum corneum of the epidermis. It adds two limits in the same breath — the practices must be in a superficial mode and not for the treatment of medical disorders, and living cells may never be altered, cut, or damaged. On the medical side the practice of medicine includes, without limitation, recommending, prescribing or directing for the use of any person any drug, medicine, APPARATUS, or other agency for the cure, relief or palliation of any ailment or disease of the mind or body. And within a medical corporation, medical or surgical treatment, consultation or advice may be given by employees of the corporation only if they are licensed under the Medical Practice Act.

• A person is engaged in the practice of esthetics if that person, for compensation, a fee, or any valuable consideration, engages in beautifying, massaging, cleansing, exfoliating, stimulating, or applying oils, creams, cosmetic preparations, make-up, facial treatments, body treatments, body wraps, antiseptics, scrubs, clays, lotions, masks, waxes, or other preparations for the noninvasive care of the skin. For purposes of this subdivision, noninvasive means confined to the nonliving cells of the stratum corneum of the epidermis. Such practices shall be in a superficial mode and not for the treatment of medical disorders, and living cells may never be altered, cut, or damaged.

  S.D. Codified Laws §36-15-2.2(1) · verified Sep 3, 2026

• For the purpose of this chapter, "practice of medicine or osteopathy" includes, but not by way of limitation, to append or prefix the letters M.D., or D.O. or the title of Doctor or Dr. or Specialist or Osteopath or any other sign or appellation in a medical sense to one's name or to profess publicly to be a physician or surgeon or to recommend, prescribe or direct for the use of any person any drug, medicine, apparatus, or other agency for the cure, relief or palliation of any ailment or disease of the mind or body or the cure or relief of any wound, fracture or bodily injury or deformity.

  S.D. Codified Laws §36-4-9 · verified Sep 3, 2026

Tennessee treats a laser procedure as the practice of medicine and requires the person performing it to be under a physician’s supervision, while its definition of aesthetics covers surface work only. For a fully licensed physician assistant it writes out what supervision means — not continuous presence, but available for consultation at all times, with a protocol reviewed every two years. A PA on a TEMPORARY license is outside that rule and may not provide services at all unless a supervising physician is on site.

• ⚠️ a laser procedure is the practice of medicine. Any procedure encompassed within the definition of the practice of medicine that is to be performed BY USE OF A LASER shall be considered the practice of medicine, and any person performing such a procedure must be under the supervision of a licensed physician — subject only to the narrow exceptions the rule cross-references for other licensed professions.

  Tenn. Comp. R. & Regs. 0880-02-.14(10) · verified Sep 2, 2026

• Supervision of a physician assistant DOES NOT require the continuous and constant presence of the supervising physician — but the physician must be available for consultation at all times, or must arrange for a substitute physician to be available. The supervising physician and any substitute must hold a current, unencumbered Tennessee license.

  Tenn. Comp. R. & Regs. 0880-02-.18(1) and (2) · verified Sep 2, 2026

Cosmetic injections, dermal fillers and cosmetic laser use are medical acts a Texas physician may delegate to a qualified, properly trained person under supervision — with a written order that identifies the physician and sets patient-screening criteria. ⚠️ laser hair removal sits outside that route entirely: it is separately licensed under the Health & Safety Code, on a tiered certificate.

• A Texas physician may delegate a medical act — including cosmetic injections, dermal fillers, and cosmetic laser use — to a qualified, properly trained person acting under the physician’s supervision, where a reasonable and prudent physician would find it consistent with sound medical judgment. The delegating physician remains responsible for the delegated act.

  Tex. Occ. Code §157.001 · verified Jul 26, 2026

• The Texas Medical Board classifies nonsurgical medical cosmetic procedures — including the injection of medications or substances for cosmetic purposes and the use of a prescription medical device for cosmetic purposes — as the practice of medicine that may be properly delegated and supervised.

  22 TAC §169.25 · verified Jul 26, 2026 · read at Cornell Legal Information Institute

Utah legislates this in groups and in miles. Section 58-1-506 sorts who may be delegated a cosmetic medical procedure into delegation group a (physician assistant, registered nurse, master esthetician, and an electrologist for laser hair removal) and GROUP B (practical nurse, esthetician, medical assistant), then grades supervision — GENERAL supervision requires the supervisor to be available in person to evaluate a suspected adverse reaction and located within 60 minutes or 60 MILES of the cosmetic medical facility. For a NONABLATIVE cosmetic medical procedure the supervisor may perform it personally, authorize GENERAL supervision where a registered nurse or master esthetician performs it, or authorize DIRECT supervision where an esthetician or practical nurse performs it. And Utah answers the medical-assistant question flatly: a medical assistant under the indirect supervision of a physician MAY NOT diagnose, MAY NOT establish a treatment plan, and MAY NOT inject a medication or substance — including a neurotoxin or filler — for cosmetic purposes. The nursing rules define delegation as transferring authority to another nurse, or to an unlicensed individual only a task that does not require a nursing assessment.

• "Delegation group A" means the following who are licensed under this title, acting within their respective scopes of practice, and qualified under Subsections (2)(f)(i) and (iii): (i) a physician assistant, if acting in accordance with Chapter 70a, Utah Physician Assistant Act; (ii) a registered nurse; (iii) a master esthetician; and (iv) an electrologist, if evaluating for or performing laser hair removal. (b) "Delegation group B" means: (i) a practical nurse or an esthetician who is licensed under this title, acting within the nurse or esthetician’s respective scopes of practice, and qualified under Subsections (2)(f)(i) and (iii); and (ii) a medical assistant who is qualified under Subsections (2)(f)(i) and (iii).

  Utah Code § 58-1-506(1)(a)-(b) (Supervision of cosmetic medical procedures) · verified Sep 4, 2026

• "General cosmetic medical procedure supervision" means the supervisor: (i) has authorized the procedure to be done on the patient by the supervisee; (ii) is available in a timely and appropriate manner in person to evaluate and initiate care for a patient with a suspected adverse reaction or complication; and (iii) is located within 60 minutes or 60 miles of the cosmetic medical facility.

  Utah Code § 58-1-506(1)(d) (definition of “General cosmetic medical procedure supervision”) · verified Sep 4, 2026

Vermont names the delegation failure directly: handing health care services to someone the licensee knows, or has reason to know, is not qualified by training, experience, education or licensing credentials is unprofessional conduct. Practicing medicine with a physician who is not legally practicing in the State, or aiding such a physician, is a separate ground. The cosmetology chapter draws the esthetics line from both directions: esthetics MEANS skin-care services to enhance or improve the appearance of the skin — cleansing, toning, stimulating, manipulating, beautifying, exfoliating or similar procedures using only cosmetic preparations, hands, mechanical or electrical apparatus, tonics, lotions, creams or makeup, plus lash and brow work and manual or mechanical hair removal — and esthetics does not include any practice that constitutes the practice of medicine, including injections of any substance and the use of lasers.

• The Board shall find that the following constitutes unprofessional conduct: delegation of professional responsibilities, including delivery of any health care services, to a person whom the licensed professional knows, or has reason to know, is not qualified by training, experience, education, or licensing credentials to perform them.

  Vt. Stat. tit. 26, §1354(a)(29) · verified Sep 3, 2026

• The Board shall find that the following constitutes unprofessional conduct: practicing medicine with a physician who is not legally practicing within the State, or aiding or abetting such physician in the practice of medicine.

  Vt. Stat. tit. 26, §1354(a)(15) · verified Sep 3, 2026

Virginia’s procedure-specific rule here is about laser hair removal. It requires a named training curriculum including ten proctored cases, lets the physician delegate to a properly trained person, and defines supervision as “readily available” rather than physically present — with one duty the physician cannot delegate at all.

• A doctor of medicine or osteopathic medicine may perform or supervise laser hair removal only on completing training in six named subjects: skin physiology and histology; skin type and appropriate patient selection; laser safety; operation of the laser device to be used; recognition of and response to potential complications; and a minimum of ten proctored patient cases with demonstrated competency in treating various skin types.

  18 Va. Admin. Code § 85-20-91(A) · verified Sep 2, 2026

• Doctors who were performing laser hair removal before 7 August 2019 are not required to complete that training. The rule grandfathers experience rather than requiring everyone to re-qualify — so the training file a practice holds may legitimately be empty for a long-serving physician and complete for a recent one.

  18 Va. Admin. Code § 85-20-91(B) · verified Sep 2, 2026

Washington answers the supervision question twice, because it has two rules and they disagree on purpose. For a delegated llrp device — a laser, noncoherent light, IPL, radiofrequency or plasma device that topically penetrates and alters tissue — the physician must be on the premises for the patient’s first treatment. For a cosmetic INJECTION it turns on the label: on-site for the whole procedure if the substance is used off-label, and merely reachable within thirty minutes if it is FDA-approved for that use.

• Using a laser, noncoherent light, intense pulsed light, radiofrequency or plasma device that topically penetrates skin and alters human tissue — an “LLRP device”, and one the FDA classifies as a prescription device — is the practice of medicine under RCW 18.71.011. Washington settles the threshold question in the rule itself rather than leaving it to be argued.

  Wash. Admin. Code 246-919-605(1) and (2) · verified Sep 2, 2026

• ⚠️ and any other energy device that penetrates tissue is surgery. Use of a medical device using any form of energy to penetrate or alter human tissue for a purpose other than the topical one defined above constitutes SURGERY and is outside this rule entirely — which means outside everything the rule permits a physician to delegate.

  Wash. Admin. Code 246-919-605(3) · verified Sep 2, 2026

West Virginia puts energy devices inside the definition of surgery, and that is the first thing a med spa here needs to know. The Medical Practice Act defines the practice of medicine and surgery as the diagnosis or treatment of, or operation or prescription for, any human disease, pain, injury, deformity or other physical or mental condition — and says in terms that “surgery” includes the use on humans of lasers, ionizing radiation, pulsed light and radiofrequency devices. The same section carries an exception for a person who is a duly licensed health care provider under other provisions of the code and who is acting within the scope of that license. On the delegation side the statute is unusually blunt: a physician assistant may not practice independent of a collaborating physician, and may perform medical acts in collaboration with physicians only within their own education, training and experience AND the collaborating physician’s scope of practice. Aiding, assisting, procuring or advising any unauthorized person to practice medicine is a ground for discipline.

• West Virginia enumerates what aesthetics is, so the microneedling answer is read off the list rather than inferred. “Aesthetics” or “esthetics” means any one or any combination of the following acts when done on the human body for compensation and not for the treatment of disease: (1) Administering cosmetic treatments to enhance or improve the appearance of the skin, including cleansing, toning, performing effleurage or other related movements, stimulating, exfoliating, or performing any other similar procedure on the skin of the human body or scalp; The list is closed — "any one or any combination of the following acts" — and every act on it is worked ON the skin. Microneedling punctures it. Nothing in this definition describes penetrating the skin, and the whole definition is bounded by "not for the treatment of disease".

  W. Va. Code § 30-27-3(a) (aesthetics is a CLOSED list of surface acts, and none of them break skin) · verified Sep 7, 2026

• The remaining limbs are topical and anatomically bounded, which is the same answer from the other direction. (2) Applying, by hand or with a mechanical or electrical apparatus, any cosmetics, makeups, oils, powders, clays, antiseptics, tonics, lotions, creams, or chemical preparations necessary for the practice of aesthetics to another person’s face, neck, back, shoulders, hands, elbows and feet up to and including the knee; (3) The rubbing, cleansing, exercising, beautifying, or grooming of another person’s face, neck, back, shoulders, hands, elbows, and feet, up to and including the knee; Even the mechanical or electrical apparatus limb is about APPLYING preparations, not about a device that penetrates.

  W. Va. Code § 30-27-3(a)(2)-(3) (what an aesthetician applies, and to which parts of the body) · verified Sep 7, 2026

Wisconsin works from both ends. The medical board defines adequate supervision as a two-sided competence test — the physician must be competent to do the delegated act, and must have reasonable evidence the delegate is minimally competent to do it — and failing to supervise adequately is unprofessional conduct, expressly including delegation to UNLICENSED personnel. The cosmetology board comes at it from the other side and names procedures: microneedling is listed as a delegated medical procedure, alongside a catch-all for any treatment reaching below the stratum corneum, so an esthetician may perform it only under a physician’s direction.

• “Adequate supervision” is defined as a two-sided competence test: a physician should be competent to perform the delegated medical act, and must have reasonable evidence that the supervised individual is minimally competent to perform the act under the circumstances. Both halves have to hold — a competent delegate supervised by a physician who could not do the procedure themselves does not satisfy it.

  Wis. Admin. Code Med § 10.02(1) · verified Sep 2, 2026

• ⚠️ and failing it is unprofessional conduct by name. “Failure to adequately supervise delegated medical acts performed by licensed or unlicensed personnel” is listed as unprofessional conduct. Wisconsin does not restrict delegation to licensed people; it makes the supervising physician answerable for whoever performs the act.

  Wis. Admin. Code Med § 10.03(1)(L) · verified Sep 2, 2026

Wyoming defines “practicing medicine” broadly, and it reaches conduct a med spa does daily. a person is practicing medicine who advertises, holds out or represents to the public that they are authorized to practice medicine; who offers or undertakes to prevent, diagnose, correct or treat, in any manner, by any means, method or device, any human disease, illness, pain, wound, infirmity, defect or abnormal condition; who offers or undertakes to prescribe, order, give or administer drugs obtainable only by prescription; or who renders a determination of medical necessity or appropriateness of proposed treatment. Aiding or abetting the practice of medicine by a person not licensed by the board is a ground for discipline. On the cosmetology side the practice of esthetics is defined by purpose — the improvement and beautification of the skin for cosmetic purposes — and the Cosmetology Act does not prohibit services rendered by licensed physicians, nurses, dentists, podiatrists, chiropractors, physical therapists, morticians or barbers when exclusively engaged in the practice of their respective professions. The cosmetology board’s own scope rule then closes the esthetics question the statute leaves open: the rule enumerates the esthetics scope — massaging, cleansing, exfoliating, stimulating, manipulating, beautifying and applying preparations to the skin, brow and lash work, and extractions of the face are among the acts it lists — and then states that procedures which pierce the epidermal or dermal layer of the skin are considered invasive and are prohibited; the same rule says that using the term or title “Medical Esthetician” is not allowed.

• "Practicing medicine" means any person who in any manner: Advertises, holds out, or represents to the public that he is authorized to practice medicine in this state; or Offers or undertakes to prevent, diagnose, correct or treat, in any manner, by any means, method or device, any human disease, illness, pain, wound, fracture, infirmity, defect or abnormal physical or mental condition, injury, deformity or ailment, including the management of pregnancy and parturition.

  Wyo. Stat. Ann. §33-26-102(a)(xi)(A)-(B) · verified Sep 3, 2026

• "Practicing medicine" means any person who in any manner offers or undertakes to prescribe, order, give or administer drugs which can only be obtained by prescription according to law; or renders a determination of medical necessity or appropriateness of proposed treatment.

  Wyo. Stat. Ann. §33-26-102(a)(xi)(E)-(F) · verified Sep 3, 2026

Alabama puts the consent duty on the delegating physician and names what it must cover. Before a delegated non-ablative treatment the physician must ensure the patient is adequately informed and has SIGNED a consent form setting out Risks, Benefits, Alternatives and Complications — including reasonably foreseeable side effects, and the name of the device and the procedure. The protocol must also carry selection criteria to screen patients for the appropriateness of a non-ablative treatment. On the clinical side, obtaining patient histories, performing physical examinations, formulating a working diagnosis and developing a treatment plan are named services a physician assistant performs under delegation from the supervising physician.

• (3) Selection criteria to screen patients for the appropriateness of non-ablative treatments;

  Ala. Admin. Code r. 540-X-11-.05(3) (Written protocols — patient selection) · verified Sep 4, 2026

• (a) Ensuring that patients are adequately informed and, prior to treatment, have signed consent forms that outline Risks, Benefits, Alternatives, and Complications, including the disclosure of reasonably foreseeable side effects and complications that may result from the non-ablative treatment, as well as the name of the device and the procedure;

  Ala. Admin. Code r. 540-X-11-.04(2)(a) (Delegation and supervision — informed consent) · verified Sep 4, 2026

AS 08.64.364 reaches the pre-treatment examination from the opposite direction to most states: rather than requiring an exam, it tells the Medical Board when it may NOT discipline a physician or physician assistant for prescribing without a physical examination. The safe harbor sets two conditions: the prescriber or another licensed provider in the practice must be available for follow-up care, and the prescriber must ask the person to consent to sending the encounter records to their primary care provider — and send them if the person consents — where the prescriber is not that provider. Two limits matter for a med spa: the drug must not be a controlled substance for the (a) safe harbor to apply on its own terms, and no physician or physician assistant may prescribe, dispense or administer in response to an internet questionnaire or email to a person with whom they have no prior physician-patient relationship. The chapters quoted here scope that bar to physicians and physician assistants; they do not establish what binds other licensees.

• The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

  AS 08.64.364(a) (Prescription of drugs without physical examination) · verified Sep 5, 2026

• the physician, physician assistant, or another licensed health care provider in the medical practice is available to provide follow-up care; and

  AS 08.64.364(a)(1) (Follow-up care condition) · verified Sep 5, 2026

Arizona states a condition: a prescription-drug injectable needs an order from an authorized prescriber acting within the standard of care. The telehealth statute lets the relationship be established and the drug prescribed remotely on documented informed consent — with Schedule II drugs the one situation where a board may still require a prior in-person examination. The consent requirement is a precondition and it is explicit: except as subsection G provides, BEFORE a health care provider delivers health care through telehealth the treating provider must obtain verbal or written informed consent, including by electronic means, from the patient or the patient’s health care decision maker — and must DOCUMENT it on the medical record if it was given verbally. All medical reports resulting from a telehealth consultation are part of the patient’s medical record.

• Because Botox and fillers are prescription drugs/devices, they require a valid order from an authorized prescriber acting within the standard of care; failing to meet the standard of care is unprofessional conduct.

  A.R.S. §32-1401(27) · verified Jul 26, 2026

• Arizona’s telehealth statute allows the provider-patient relationship to be established and prescribing to occur via telehealth with documented informed consent; a board may not require a prior in-person exam except for Schedule II drugs (which Botox and fillers are not).

  A.R.S. §36-3602 · verified Jul 26, 2026

Arkansas puts the diagnosis on the physician personally, as the first step of the laser protocol. Within that laser rule, before a delegated minor procedure the physician must PERSONALLY diagnose the condition of the patient and prescribe the treatment and procedure to be performed. The delegation rule reaches the same place from the other direction: before delegating anything the physician must determine that the task is indicated for the patient and fix the appropriate level of supervision, and where drugs are involved must evaluate the acuity of the patient and judge that delegation is appropriate at all.

• (a)(1) A patient/provider relationship must be established in accordance with 17 CAR § 140-202(b)(8) before the delivery of services via telemedicine. (2) “Provider” means a person licensed by the Arkansas State Medical Board. (3) A patient completing a medical history online and forwarding it to a provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

  17 CAR § 140-3201(a) (Telemedicine — patient/provider relationship) · verified Sep 4, 2026

• (1) The practice of medicine via telemedicine shall be held to the same standards of care as traditional in-person encounters;

  17 CAR § 140-3201(b)(1) (Telemedicine — standard of care) · verified Sep 4, 2026

California requires an appropriate good-faith exam before prescriptive drugs or devices are used — and it may not be delegated to an RN.

• Prescribing, dispensing, or furnishing a dangerous drug (such as Botox or fillers) without an appropriate prior examination and a medical indication is unprofessional conduct.

  Cal. Bus. & Prof. Code §2242(a) · verified Jul 26, 2026 · read at Public.Law — California Codes

• Per the Medical Board, the required prior examination may NOT be delegated to a registered nurse — a physician (or an NP or PA under standardized procedures) must perform the good-faith exam and issue a patient-specific order before an RN performs the injection or laser treatment.

  Medical Board of California — Medical Spas guidance · verified Jul 26, 2026

⚠️ read the limit on this section first. article 240 imposes no pre-treatment examination requirement — but the Colorado Medical Board’s rules (3 CCR 713) are published on a host whose robots.txt disallows the rule-display endpoint, so WE HAVE NOT READ THEM and claim no absence about them. What follows is what the STATUTE provides.

• ⚠️ ARTICLE 240 imposes no pre-treatment examination duty. The Colorado Medical Practice Act was surveyed in full for this entry. Its only uses of “physical examination” are in § 12-240-125, where the BOARD compels an examination of a licensee and restricts the use of the results; its only uses of “good faith” are a board examiner’s findings and a reporting immunity; and “physician-patient” appears only as a reference to the evidentiary privilege. No provision requires a history, examination, diagnosis or treatment plan before prescribing or treating. ⚠️ read that strictly — it is a statement about ARTICLE 240, not about Colorado: the Medical Board’s rules at 3 CCR 713 sit on a host whose robots.txt disallows the rule-display endpoint, and no absence is claimed for them.

  Colo. Rev. Stat. art. 240 of tit. 12, surveyed in full; the examination provisions are at § 12-240-125 · verified Sep 2, 2026

• The general standard is a single ground with no injury requirement: “Any act or omission that fails to meet generally accepted standards of medical practice” is unprofessional conduct. Colorado states the duty at that level of generality rather than enumerating steps, which means a med spa is measured against prevailing practice rather than against a checklist it can complete.

  Colo. Rev. Stat. § 12-240-121(1)(j) · verified Sep 2, 2026

Connecticut requires an initial IN-PERSON physical assessment of every person before a cosmetic medical procedure is performed at a medical spa, and it must be performed by the physician, physician assistant or advanced practice registered nurse the spa employs or contracts with. The word “in-person” was added to the statute by amendment, so a remote assessment does not satisfy it.

• A physician, physician assistant or advanced practice registered nurse who is employed by, or under contract with, the medical spa shall perform an initial in-person physical assessment of each person undergoing a cosmetic medical procedure at the medical spa prior to such procedure being performed.

  Conn. Gen. Stat. §19a-903c(c) · verified Sep 3, 2026

• Public Act 15-242 amended subsection (c) of section 19a-903c by adding the words “in-person” to the required initial physical assessment.

  Conn. Gen. Stat. §19a-903c, History (P.A. 15-242, S. 19) · verified Sep 3, 2026

Delaware puts its telehealth rule in a chapter of its own. A provider-patient relationship must exist before health-care services are delivered by telehealth, and the statute lets that relationship be established either in person OR remotely — but only through one of four named routes, one of which is an in-person examination and another the presence of a second Delaware-licensed provider with the patient at the originating site. Once the relationship is properly established, later treatment of the same patient by the same provider need not satisfy those limits again. Absent a proper relationship, issuing a prescription solely in response to an internet questionnaire, an internet consult or a telephone consult is prohibited.

• Except for the instances listed in this chapter, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine.

  24 Del. C. §6003(a) · verified Sep 3, 2026

• A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least 1 of the following: provide an appropriate examination in-person; require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis; make a diagnosis using audio or visual communication; or meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

  24 Del. C. §6004(a) · verified Sep 3, 2026

The District permits the practitioner-patient relationship itself to be established through telehealth, but ties it to the standard of care and the practitioner’s competence and scope — and expressly reserves to the Mayor the power to add requirements for specific health professions, INCLUDING an initial in-person physical examination.

• A practitioner-patient or practitioner-client relationship may be established through telehealth in accordance with the appropriate standard of care and the practitioner’s competence and scope of practice; provided, that the Mayor may through rulemaking issue additional requirements for specific health professionals to establish a practitioner-client relationship, including an initial in-person physical examination.

  D.C. Code §3-1201.05(b) · verified Sep 3, 2026

• A health professional licensed, registered, or certified in the District may provide a telehealth service to a District resident or person located in the District if doing so is consistent with the applicable standard of care in the District and the health professional’s scope of authorized practice in the District, and not otherwise prohibited by law or regulation.

  D.C. Code §3-1201.05(a) · verified Sep 3, 2026

Florida has no statute literally titled “good-faith exam.” The requirement is built from prescribing-practice and standard-of-care law.

• Prescribing, dispensing, administering, mixing or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice is a ground for discipline. This is the hook Florida hangs the pre-treatment evaluation on: the requirement is not that an exam happened, it is that the prescribing sat inside a genuine course of practice — and the Board decides that after the fact.

  Fla. Stat. §458.331(1)(q) · verified Sep 1, 2026

• An advanced practice registered nurse must perform their authorized functions within the framework of an established protocol, which has to be maintained ON SITE at every location where they practice — unless registered under §464.0123 — and a physician licensed under chapter 458, 459 or 466 must maintain supervision for directing the specific course of medical treatment. Within that framework the nurse may prescribe, dispense, administer or order any drug, and may manage selected medical problems and initiate, monitor or alter therapies.

  Fla. Stat. §464.012(3) and (4)(a) · verified Sep 1, 2026

Where an assistant laser practitioner treats the patient, Georgia requires a prior examination by a consulting physician, a PA-cosmetic laser practitioner or an APRN-cosmetic laser practitioner — and then names the exception explicitly: Hair removal and pulsed light treatments are carved out of both the examination and the on-site supervision requirement.

• Patients treated by an assistant laser practitioner must be examined before the service by a consulting physician, or by a physician assistant who is a licensed cosmetic laser practitioner, or by an advanced practice registered nurse who is a licensed cosmetic laser practitioner.

  Ga. Comp. R. & Regs. 360-35-.05(1)(b) · verified Aug 17, 2026

• On-site supervision and a prior examination are NOT required for the performance of laser hair removal and pulsed light treatments — the one place Georgia grades the requirement by procedure rather than applying it across the board.

  Ga. Comp. R. & Regs. 360-35-.05(1)(c) · verified Aug 17, 2026

The sections cited here govern the pre-treatment encounter through Hawaii’s telehealth statute. Telehealth services must include a documented patient evaluation, including a history and a discussion of physical symptoms adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended. Treatment recommendations made by telehealth, including an electronic prescription, are held to the same standards as traditional physician-patient settings, and a prescription issued on an online questionnaire alone is not treatment and is not an acceptable standard of care. A physician-patient relationship may be established through a telehealth interaction by a physician licensed in Hawaii, and once established, telehealth may be used for any authorized purpose. Telehealth is defined by its modalities and excludes standard telephone, facsimile, or e-mail contact except through an interactive telecommunications system. The pharmacy act defines the practice of pharmacy to include the compounding, dispensing, and labeling of drugs, and defines a prescription as a practitioner’s order for the compounding or dispensing of drugs; neither cited pharmacy definition names a drug or mentions office stock.

• A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State. (f) Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

  Haw. Rev. Stat. § 453-1.3(e)-(f) · verified Sep 8, 2026

• Telehealth services shall include a documented patient evaluation, including history and a discussion of physical symptoms adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended or provided.

  Haw. Rev. Stat. § 453-1.3(b) · verified Sep 8, 2026

Idaho’s Virtual Care Access Act permits virtual care where a provider-patient relationship already exists, where the patient has that relationship with another provider in the same provider group, where the provider is covering calls for a provider who has it, or where the provider is performing activities set out in §54-1733(3). The relationship itself MAY be established by use of virtual care technologies — but the statute attaches a condition rather than a technology list: the applicable Idaho community standard of care must be satisfied. These claims survey section 54-5705; requirements imposed elsewhere in the Act or by board rule are not surveyed here.

• A provider may provide virtual care to a patient if such provider has first established a provider-patient relationship with the patient, the patient has a provider-patient relationship with another provider in the provider group, the provider is covering calls for a provider with an established relationship with the patient, or the provider is performing any activities set forth in section 54-1733(3), Idaho Code.

  Idaho Code §54-5705 · verified Sep 3, 2026

• A provider-patient relationship may be established by use of virtual care technologies, provided that the applicable Idaho community standard of care is satisfied.

  Idaho Code §54-5705 · verified Sep 3, 2026

The physician has to examine the patient and set a course of treatment before any laser procedure — with one carve-out, new in 2025, letting a non-ablative laser proceed on an APRN examination and a physician reachable by phone. ⚠️ the carve-out carries four conditions, and dropping any one of them puts the procedure back under the general rule.

• The physician must examine the patient and determine a course of treatment appropriate to that patient before any procedure. A repeat examination is not required for each of several procedures carried out under an already established treatment plan.

  68 Ill. Adm. Code 1285.336(b) · verified Aug 17, 2026

• Effective January 1, 2025, an on-site physician examination before a non-ablative laser procedure is not required where four conditions are met: the facility follows a physician delegation protocol available to the Department on request; the examination is performed by an advanced practice registered nurse; the procedure is delegated by a physician and performed by an RN or LPN with documented training in each system; and a physician is available remotely by telephone or other electronic means to respond promptly to questions or complications.

  225 ILCS 60/54.2(e) · verified Aug 17, 2026

Indiana states the prescribing condition directly: a prescriber may issue a prescription without a prior in-person examination only where the standard of care is met, the prescriber is acting within scope, and a valid provider-patient relationship exists.

• A prescriber may issue a prescription without a prior in-person exam only if the applicable standard of care is satisfied, the prescription is within the prescriber’s scope, and a valid provider-patient relationship has been established — including identity/location verification, informed consent, a medical history sufficient to establish a diagnosis, and discussion of the diagnosis and risks/benefits.

  Ind. Code §25-1-9.5-7, §25-1-9.5-8 · verified Jul 26, 2026

Iowa puts the consent and the record on the medical director and names who may DO the assessment. The director must ensure that each patient gives appropriate informed consent for every medical aesthetic service, performed by whoever performs it, and that the consent is timely documented in the medical record, and that accurate and timely medical records are kept for each delegated service. On the nursing side an ARNP may assess health status, obtain a relevant health and medical history, perform physical examinations, formulate a differential diagnosis and develop a treatment plan. Where the encounter is remote, Iowa defines TELEMEDICINE to exclude audio-only telephone, email, fax and post.

• Ensure that each patient provides appropriate informed consent for medical aesthetic services performed by the medical director or other qualified licensed physician and all qualified licensed or certified nonphysician persons or qualified laser technicians and that such informed consent is timely documented in the patient’s medical record;

  Iowa Admin. Code r. 481—655.6(5)(j) (Supervision — informed consent) · verified Sep 4, 2026

• Ensure that all qualified licensed or certified nonphysician persons or qualified laser technicians maintain accurate and timely medical records for the delegated medical aesthetic services they perform;

  Iowa Admin. Code r. 481—655.6(5)(i) (Supervision — records) · verified Sep 4, 2026

Kansas permits telemedicine to establish the relationship, and then holds it to the in-person standard. The Act says in one line that telemedicine MAY be used to establish a valid provider-patient relationship, and in the next that the same standards of practice and conduct that apply to healthcare services delivered in person also apply to services delivered by telemedicine — as do the same HIPAA patient privacy and confidentiality requirements. It adds two follow-through duties: the provider must give the patient guidance on appropriate follow-up care, and where the patient consents and has a primary care or other treating physician, must send that physician a report of the treatment and services rendered within three business days. Prescribing, dispensing, administering or distributing a prescription drug in an improper or inappropriate manner, or for other than a valid medical purpose, or not in the course of the licensee’s professional practice, is unprofessional conduct.

• Telemedicine may be used to establish a valid provider-patient relationship.

  Kan. Stat. Ann. §40-2,212(b) · verified Sep 3, 2026

• The same standards of practice and conduct that apply to healthcare services delivered via in-person contact shall also apply to healthcare services delivered via telemedicine.

  Kan. Stat. Ann. §40-2,212(c) · verified Sep 3, 2026

Kentucky writes the online-prescribing rule as three named steps, and missing any of them is dishonorable conduct. Separately, a treating physician who provides or facilitates telehealth must ensure the patient's informed consent is obtained before services are provided through telehealth, and that confidentiality of the patient's medical information is maintained; the board is directed to promulgate regulations as necessary to prevent abuse and fraud through telehealth services and to prevent fee-splitting through them. Prescribing or dispensing medication in response to any communication transmitted or received by computer or other electronic means is dishonorable, unethical or unprofessional conduct where the licensee fails to take three actions to establish and maintain a proper physician-patient relationship: VERIFICATION that the person requesting medication is in fact who the patient claims to be; establishment of a documented diagnosis through the use of accepted medical practices; and maintenance of a current medical record. The same section reaches prescribing with the intent or knowledge that a medication will be used other than medicinally or for an accepted therapeutic purpose, and prescribing in amounts the licensee knows or has reason to know are excessive under accepted and prevailing medical practice standards.

• A treating physician who provides or facilitates the use of telehealth shall ensure that the informed consent of the patient, or another appropriate person with authority to make the health care treatment decision for the patient, is obtained before services are provided through telehealth; and that the confidentiality of the patient's medical information is maintained as required by this chapter and other applicable law.

  Ky. Rev. Stat. §311.5975(1) · verified Sep 3, 2026

• Dishonorable, unethical, or unprofessional conduct includes prescribing or dispensing any medication in response to any communication transmitted or received by computer or other electronic means, when the licensee fails to take the following actions to establish and maintain a proper physician-patient relationship: verification that the person requesting medication is in fact who the patient claims to be; establishment of a documented diagnosis through the use of accepted medical practices; and maintenance of a current medical record.

  Ky. Rev. Stat. §311.597(1)(e) · verified Sep 3, 2026

These claims survey the medical practice act, not a telehealth statute, and should be read that way. Louisiana's licensing section itself points elsewhere for remote care — it requires a license to practice medicine “except as provided in the Louisiana Telehealth Access Act, R.S. 40:1223.1 et seq.” — and that Act is NOT surveyed by these claims. What is on record here is the standard the treatment must meet however it is delivered: prescribing, dispensing or administering legally controlled substances or any dependency-inducing medication without legitimate medical justification, or in other than a legal or legitimate manner, is a cause for discipline; so is medical incompetency, which the statute defines to include continuing or recurring medical practice that fails to satisfy the prevailing and usually accepted standards of medical practice in this state; and so is abandonment of a patient. Confirm the telehealth intake requirements against R.S. 40:1223.1 et seq. with the board or counsel.

• Prescribing, dispensing, or administering legally controlled substances or any dependency-inducing medication without legitimate medical justification therefor or in other than a legal or legitimate manner is a cause for which the board may refuse to issue, or may suspend or revoke any license or permit.

  La. Rev. Stat. §37:1285(A)(6) · verified Sep 3, 2026

• Medical incompetency, including but not limited to, incompetency manifested by continuing or recurring medical practice which fails to satisfy the prevailing and usually accepted standards of medical practice in this state, is a cause for which the board may refuse to issue, or may suspend or revoke any license or permit.

  La. Rev. Stat. §37:1285(A)(14) · verified Sep 3, 2026

Maine’s telehealth subchapter permits a licensee of the medical chapter to provide telehealth services so long as the licensee acts within the scope of the license, within the subchapter’s own requirements and restrictions, and in accordance with standards of practice — and it carries the rest of the licensee’s obligations across unchanged: all laws and rules on professional responsibility, unprofessional conduct and generally accepted standards of practice apply while providing telehealth, as do state and federal confidentiality and privacy laws. The subchapter defines telehealth services broadly enough to include asynchronous encounters and store-and-forward transfers, not only real-time video. These claims survey subchapter 4 of chapter 48; requirements imposed elsewhere in Maine law or by board rule are not surveyed here.

• A person licensed under this chapter may provide telehealth services as long as the licensee acts within the scope of practice of the licensee’s license, in accordance with any requirements and restrictions imposed by this subchapter and in accordance with standards of practice.

  32 M.R.S. §3300-BB · verified Sep 3, 2026

• All laws and rules governing professional responsibility, unprofessional conduct and generally accepted standards of practice that apply to a person licensed under this chapter also apply to that licensee while providing telehealth services.

  32 M.R.S. §3300-DD · verified Sep 3, 2026

Maryland requires a clinical patient evaluation appropriate to the patient and the presenting condition BEFORE treatment is provided or a prescription issued through telehealth, and requires referral to in-person care where that is clinically appropriate.

• A telehealth practitioner shall perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth.

  Md. Code Regs. 10.32.05.05(A) (Patient Evaluation) · verified Sep 3, 2026

• A telehealth practitioner shall, if clinically appropriate for the patient, provide or refer a patient to in-person health care services or another type of telehealth service.

  Md. Code Regs. 10.32.05.05(B) · verified Sep 3, 2026

CHAPTER 112 sets no pre-treatment examination rule — the chapter was surveyed in full and contains none. ⚠️ That is a statement about chapter 112, not about Massachusetts: the Board’s own regulations at 243 CMR are published on a host we do not fetch, so no absence is claimed for them. What chapter 112 does do is define telehealth expressly widely, leaving the clinical standard to the Board.

• Massachusetts defines telehealth expressly widely: synchronous OR asynchronous audio, video, electronic media or other telecommunications technology — including interactive audio-video, remote patient monitoring devices, audio-only telephone, and online adaptive interviews — used for evaluating, diagnosing, consulting, PRESCRIBING, treating or monitoring a patient. Prescribing is named in the definition, and so is audio-only.

  Mass. Gen. Laws ch. 112, § 5O(a) · verified Sep 1, 2026

• The Board must allow a physician it licenses to obtain proxy credentialing and privileging for telehealth services with other health care providers or facilities that comply with the federal CMS conditions of participation for telehealth. The statute removes a credentialing obstacle to remote care; it does not lower any clinical standard.

  Mass. Gen. Laws ch. 112, § 5O(b) · verified Sep 1, 2026

⚠️ Michigan splits by drug schedule, not by procedure. part 161 of the Public Health Code was surveyed via its section index and imposes no pre-treatment examination requirement for cosmetic injectables. But § 333.7303a(2) bars prescribing any SCHEDULE 2 TO 5 controlled substance outside a bona fide prescriber-patient relationship, with a follow-up care duty attached. Testosterone is Schedule III, so a hormone-therapy practice is inside that rule.

• ⚠️ no examination rule for cosmetic injectables. Part 161 of the Public Health Code was surveyed via the section index and imposes no pre-treatment or “good faith” examination requirement for botulinum toxin or fillers. ⚠️ read that strictly — it is about NON-CONTROLLED cosmetic drugs. Controlled substances are governed separately by § 333.7303a(2) below, and testosterone is Schedule III.

  Mich. Comp. Laws pt. 161 — section index (surveyed in full) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

• ⚠️ and the controlled-substance rule is a relationship test with a follow-up duty. “a licensed prescriber shall not prescribe a controlled substance listed in schedules 2 TO 5 unless the prescriber is in a bona fide prescriber-patient relationship with the patient for whom the controlled substance is being prescribed”, and the prescriber “shall provide follow-up care to the patient to monitor the efficacy” of the treatment — or refer the patient to their primary care provider, or to another geographically accessible prescriber, if unable to.

  Mich. Comp. Laws § 333.7303a(2) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

⚠️ Minnesota’s documented-examination duty sits in the drug chapter, not the medical practice act, and is scoped by drug class. § 151.37 subd. 2(d) makes a prescription INVALID — for a closed list of drug classes — without a documented evaluation including an examination. Testosterone is a Schedule III controlled substance, so a hormone-therapy med spa is inside that list; botulinum toxin, fillers and semaglutide are not on it.

• ⚠️ the rule, and it voids the prescription rather than merely exposing the prescriber. “a prescription drug order for the following drugs IS NOT VALID, unless it can be established that the prescription drug order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment.” The list is closed: controlled substances under § 152.02, board-defined controlled substances, muscle relaxants, centrally acting analgesics with opioid activity, drugs containing butalbital, and PDE5 inhibitors used to treat erectile dysfunction.

  Minn. Stat. § 151.37, subd. 2(d) · verified Sep 2, 2026

• ⚠️ which med spa services this actually reaches — the list is by DRUG CLASS, not by procedure. Testosterone is a schedule III controlled substance, so a practice offering hormone or “optimization” therapy is inside the rule and its prescription is not valid without a documented examination. Botulinum toxin, dermal fillers and semaglutide are not controlled substances and appear nowhere on the list, so they fall OUTSIDE subd. 2(d); for those the duty is the general standard of care rather than this checklist.

  Minn. Stat. § 151.37, subd. 2(d)(1)–(6) · verified Sep 2, 2026

The sections cited here govern the pre-treatment encounter through the medical board’s telemedicine and internet-prescribing rules and the nursing board’s prescribing rule. a valid physician-patient relationship for telemedicine requires verifying the patient’s identity, an appropriate history and physical examination meeting the standard of care, a diagnosis established through accepted practices, a discussion of the diagnosis and treatment options to obtain informed consent, follow-up care, and a complete medical record. Providers using telemedicine must examine before diagnosing and treating, and the examination need not be in person if the technology gives the physician the same information as a face-to-face exam; a simple questionnaire without an appropriate exam violates the rule. The internet-prescribing rule says prescribing to a person the physician has never met, based solely on answers to a set of questions, fails an acceptable standard of care. An advanced practice registered nurse may not prescribe any medication without a good faith agreement subsequent to examination and medical indication. Telemedicine is the practice of medicine through HIPAA-compliant telecommunication systems capable of replicating an in-person encounter, and practicing it into Mississippi from out of state requires a Mississippi license. The pharmacy act defines the practice of pharmacy to include compounding and dispensing; that definition names no drug and says nothing about office stock.

• In order to practice any form of telemedicine, as defined in R.5.1 , a valid “physician patient relationship” must be established. The elements of this valid relationship are: A. verify that the person requesting the medical treatment is in fact who they claim to be; B. conducting an appropriate history and physical examination of the patient that meets the applicable standard of care; C. establishing a diagnosis through the use of accepted medical practices, i.e., a patient history, mental status exam, physical exam and appropriate diagnostic and laboratory testing; D. discussing with the patient the diagnosis, risks and benefits of various treatment options to obtain informed consent; E. insuring the availability of appropriate follow-up care; and F. maintaining a complete medical record available to patient and other treating health care providers.

  Miss. Admin. Code Title 30, Part 2635, Rule 5.4 · verified Sep 8, 2026

• Providers using telemedicine technologies to provide medical care to patients located in Mississippi must provide an appropriate examination prior to diagnosis and treatment of the patient. However, this exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face. Store-and-Forward Transfer Technology may be used to enhance, but never replace, real-time provider-patient interaction. Provider-patient interaction may be audio-visual or audio only where medically appropriate. Other exams may be appropriate if a licensed health care provider is on site with the patient and is able to provide various physical findings that the physician needs to complete an adequate assessment. However, a simple questionnaire without an appropriate exam is in violation of this policy and may subject the physician to discipline by the Board.

  Miss. Admin. Code Title 30, Part 2635, Rule 5.5 · verified Sep 8, 2026

Missouri answers the online-intake question directly, and the answer is conditional. a physician using telemedicine must ensure a properly established physician-patient relationship exists, and the statute names the three ways it may be established: an in-person encounter through a medical evaluation and physical examination; consultation with another physician who has an established relationship with the patient and an agreement to participate in that patient’s care; or a telemedicine encounter, IF the standard of care does not require an in-person encounter. To establish the relationship through telemedicine the technology must be sufficient to reach an informed diagnosis as though the evaluation, and any physical examination the standard of care requires, had been performed in person. A questionnaire — internet or telephone — must be reviewed by the treating health care professional and must itself carry information sufficient to serve as though the medical evaluation had been performed in person; otherwise the statute says in terms that it DOES NOT constitute an acceptable medical evaluation and examination for providing treatment by telehealth. Before prescribing through telemedicine or the internet, the physician must obtain a reliable medical history and, if the standard of care requires, perform a physical examination adequate to establish the diagnosis and identify underlying conditions or contraindications.

• Physicians licensed under chapter 334 who use telemedicine shall ensure that a properly established physician-patient relationship exists with the person who receives the telemedicine services. The physician-patient relationship may be established by: an in-person encounter through a medical evaluation and physical examination; consultation with another physician, or that physician's delegate, who has an established relationship with the patient and an agreement with the physician to participate in the patient's care; or a telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

  Mo. Rev. Stat. §191.1146.1 · verified Sep 3, 2026

• In order to establish a physician-patient relationship through telemedicine the technology utilized shall be sufficient to establish an informed diagnosis as though the medical evaluation and, if required to meet the standard of care, the physical examination has been performed in person.

  Mo. Rev. Stat. §191.1146.2(1) · verified Sep 3, 2026

The sections cited here govern the pre-treatment encounter through a telemedicine definition, a telehealth authorization, and a board rule that says when a provider-patient relationship exists. The Code defines telemedicine as the practice of medicine by interactive electronic communications, information technology, or audio-only conversation between a licensee and a patient in different locations, and permits a person licensed under Title 37 to provide health care to do so by telehealth when that is appropriate, meets the standard of care, and complies with the licensing board’s rules. The Board of Medical Examiners’ telemedicine rule then sets the terms of that relationship: treatment occurs where the patient is, the same standard of care applies as in person, and a provider-patient relationship may be established by an in-person interview and examination when the standard of care requires one, by consultation with another provider who has a documented relationship with the patient, or through telemedicine if the standard of care does not require an in-person encounter. Before treating, prescribing, or delegating, the licensee must establish that relationship and obtain a medical history sufficient for diagnosis and treatment, and may delegate the patient’s care only to providers the licensee knows to be qualified, who have their own relationship with the patient, or who can reach the licensee for consultation. The pharmacy act defines compounding and says it does not prevent a medical practitioner from compounding or using drugs in the practitioner’s practice or furnishing drugs to a patient; neither cited pharmacy section names a drug or mentions office stock.

• "Telemedicine" means the practice of medicine using interactive electronic communications, information technology, audio-only conversations, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes the application of secure videoconferencing or store-and-forward technology. (b) The term does not mean an e-mail or instant messaging conversation or a message sent by facsimile transmission.

  Mont. Code Ann. § 37-3-102(14)(a)-(b) · verified Sep 8, 2026

• A person licensed under this title to provide health care in the ordinary course of business or practice of a profession may provide services by means of telehealth when the use of telehealth: (a) is appropriate for the services being provided; (b) meets the standard of care for delivery of services; and (c) complies with any administrative rules for telehealth adopted by the board that licenses the health care provider.

  Mont. Code Ann. § 37-2-305(1) · verified Sep 8, 2026

What these claims establish in Nebraska is a therapeutic-purpose and record-keeping standard rather than a pre-treatment examination requirement. Prescribing, administering, distributing, dispensing, giving or selling a controlled or dangerous drug for other than a medically accepted therapeutic purpose is unprofessional conduct, as is prescribing a controlled substance to oneself or to close family outside a medical emergency, and as is failing to keep and maintain adequate records of treatment or service.

• Unprofessional conduct includes prescribing, administering, distributing, dispensing, giving, or selling any controlled substance or other drug recognized as addictive or dangerous for other than a medically accepted therapeutic purpose.

  Neb. Rev. Stat. §38-179(11) · verified Sep 3, 2026

• Unprofessional conduct includes prescribing any controlled substance to oneself or, except in the case of a medical emergency, to one’s spouse, child, parent, sibling, or any other person living in the same household as the prescriber.

  Neb. Rev. Stat. §38-179(12) · verified Sep 3, 2026

Nevada regulates how the patient relationship itself may be formed. A provider may establish a relationship using telehealth only when it is clinically appropriate to do so, must hold a valid Nevada license before directing care or prescribing remotely, and gains no additional scope of practice by working this way — telehealth expressly may not be read to modify, expand or alter a provider’s scope, or to authorize a setting not otherwise authorized by law.

• A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.

  Nev. Rev. Stat. §629.515(4) · verified Sep 3, 2026

• Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State.

  Nev. Rev. Stat. §629.515(1) · verified Sep 3, 2026

New Hampshire defines the physician-patient relationship itself: it requires an in-person exam OR an exam using telemedicine. Where the telemedicine route is used the statute attaches conditions — verifying the identity of the patient receiving services through telemedicine, disclosing the physician’s name, contact information and license type, obtaining consent where a parent or guardian’s consent is required for telemedicine, and meeting the standard of care. Prescribing to someone with whom no physician-patient relationship exists is unprofessional conduct.

• Physician-patient relationship means a medical connection between a licensed physician and a patient that includes an in-person exam or an exam using telemedicine, provided the physician: verifies the identity of the patient receiving health care services through telemedicine; discloses to the patient the physician’s name, contact information, and the type of health occupation license held by the physician; obtains oral or written consent from the patient or from the patient’s parent or guardian, if state law requires the consent of a parent or guardian for use of telemedicine services; and meets the standard of care.

  N.H. Rev. Stat. §329:1-c (Physician-Patient Relationship) · verified Sep 3, 2026

• Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI.

  N.H. Rev. Stat. §329:1-c · verified Sep 3, 2026

Where a modality is administered by someone else, New Jersey stacks three duties on the physician: examine the patient before it is applied, see them again before every subsequent scheduled application, and remain on the premises throughout. A course of treatment does not buy a standing clearance.

• The physician must examine the patient to assess the trauma or disease, determine whether the modality will help, and weigh the risks against the benefits before it is administered by anyone else.

  N.J.A.C. 13:35-6.14(e)1 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• The doctor must see the patient again before any subsequent scheduled application, to confirm that continued treatment remains appropriate and that no contraindication has become apparent. A course of treatment does not buy a standing clearance.

  N.J.A.C. 13:35-6.14(e)4 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

New Mexico puts the exam beyond delegation in so many words. Before any aesthetic healthcare procedure, an APRN or other licensed independent practitioner must conduct a FACE-TO-FACE assessment, determine a diagnosis and prescribe a treatment plan — and "may never delegate the examination, diagnosis, or treatment plan". The initial examination must review the health history and physically examine the treatment sites. For continuing patients the face-to-face is required at least once every twelve months, and sooner on any change in health status or treatment plan. Telemedicine is permitted for that examination, provided the video quality does not adversely affect the assessment or diagnosis. Where a medical assistant runs the device, the supervising physician must personally supply the history, physical examination, diagnosis, treatment protocol and record before treatment begins.

• Prior to a licensee providing any aesthetic healthcare procedure, an APRN or other licensed independent practitioner must conduct an assessment in a face-to-face examination, determine a diagnosis and prescribe a treatment plan for the patient. The APRN or other licensed independent practitioner may never delegate the examination, diagnosis, or treatment plan.

  16.12.14.10(B) NMAC (Patient care) · verified Sep 4, 2026

• The initial examination must consist of a review of the patient’s health history, and a physical examination that includes treatment sites, and the determination of a diagnosis.

  16.12.14.10(B)(1) NMAC (Patient care — initial examination) · verified Sep 4, 2026

New York builds the requirement rather than naming it. PRESCRIBING sits inside the statutory definition of the practice of medicine, and the enforcement route is the misconduct grounds of practicing with negligence on more than one occasion or incompetence on more than one occasion.

• Prescribing is within the statutory definition of the practice of medicine: the practice of medicine is defined as diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition.

  N.Y. Educ. Law §6521 · verified Aug 17, 2026

• Practicing the profession with negligence on more than one occasion, or with incompetence on more than one occasion, is professional misconduct — the grounds through which a failure to evaluate a patient before treatment is reached in New York.

  N.Y. Educ. Law §6530(3), §6530(5) · verified Aug 17, 2026

Both boards land in the same place from different directions: someone with prescriptive authority has to evaluate the patient and order the treatment before a nurse touches them, and for laser hair or tattoo removal a physician, physician assistant or nurse practitioner must examine the patient before the first treatment.

• A licensed physician, nurse practitioner, physician assistant or other practitioner with prescriptive authority must complete the client evaluation and assessment for the appropriateness of the procedure and issue the prescription or order before a licensed nurse carries it out. That evaluation may not be delegated to the nurse who will perform the treatment.

  NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) · verified Aug 17, 2026

• The Medical Board’s position is that each patient be examined by a physician, physician assistant, or nurse practitioner licensed or approved by the Board prior to receiving the first laser hair or tattoo removal treatment, and at other times as medically indicated.

  NCMB Position Statement 5.1.2 · verified Aug 17, 2026

North Dakota wrote its pre-treatment rule inside a telemedicine section, and the scope of each part matters. Section 43-17-44 opens by holding a licensee to the same standard of care and the same ethical standards whether the practice is traditional in-person medicine or telemedicine. The requirements that follow are stated in the context of telemedicine: a bona fide relationship with the patient before any diagnosis or treatment, and — before initially diagnosing or treating a patient for a specific illness or condition — an examination or evaluation must be performed. a licensee practicing telemedicine must also verify the patient’s identity and let the patient verify that licensee’s own identity and licensure status. Prescribing follows the examination: 43-17-45 permits it where the telemedicine examination met the chapter’s requirements.

• A licensee is held to the same standard of care and same ethical standards, whether practicing traditional in - person medicine or telemedicine.

  N.D.C.C. § 43-17-44 (Standard of care — telemedicine and in-person alike) · verified Sep 5, 2026

• shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient.

  N.D.C.C. § 43-17-44(2) (A bona fide relationship must exist first) · verified Sep 5, 2026

Ohio’s examination rule in this chapter is delegation-specific rather than general: for photodynamic therapy and for phototherapy for psoriasis, the physician must have seen and evaluated the patient before delegating, and on a report of a clinically significant side effect in those same delegated treatments the physician must see and personally evaluate the patient. What Ohio says without qualification is about the remote visit — the standard of care for a telehealth visit is the same as for an in-person visit, and telephone calls qualify only when every element of a bona fide health care visit meeting that standard is performed.

• For photodynamic therapy, and for phototherapy for psoriasis, the physician must have seen and evaluated the patient to determine whether the proposed application is appropriate before it is delegated.

  Ohio Admin. Code 4731-18-04 · verified Aug 17, 2026

• Anyone to whom phototherapy or photodynamic therapy has lawfully been delegated must immediately report to the supervising physician any clinically significant side effect, or any failure of the treatment to progress as expected.

  Ohio Admin. Code 4731-18-04 · verified Aug 17, 2026

Oklahoma states its pre-treatment rule as a disciplinary ground rather than a standalone requirement, and it is easy to miss because it does not use the words most states use. § 509 makes it unprofessional conduct to prescribe or administer a drug or treatment without sufficient examination and the establishment of a valid physician-patient relationship. That is the good-faith-examination rule; it is not titled one.

• Prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician- patient relationship;

  Okla. Stat. tit. 59, § 509 (Examination and a valid relationship before prescribing) · verified Sep 5, 2026

• Unless otherwise prohibited by law, a valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in Oklahoma through telemedicine, provided that the physician holds a license to practice medicine in the state, confirms with the patient the patient's identity and physical location, and provides the patient with the treating physician's identity and professional credentials; telemedicine encounters shall not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, or benzodiazepines.

  Okla. Stat. tit. 59, § 478.1(A), (C) (Establishment of physician-patient relationship through telemedicine) · verified Sep 8, 2026

Oregon permits the provider-patient relationship itself to be established by telemedicine. A physician or physician associate may use telemedicine to practice medicine and provide health care services, including establishing the relationship, diagnosing or treating a condition, and prescribing.

• A physician licensed under ORS 677.100 to 677.228, a physician associate licensed under ORS 677.505 to 677.525 or a physician or physician associate licensed under ORS 677.139 may use telemedicine to engage in the practice of medicine and provide health care services, including the establishment of a provider-patient relationship, the diagnosis or treatment of a medical condition or the prescription of drugs.

  Or. Rev. Stat. §677.494(2) · verified Sep 3, 2026

• As used in this section, telemedicine means the practice of medicine and provision of health care services to a patient by a physician or physician associate from a distance using electronic communications, including synchronous technologies to facilitate an exchange of information between a patient and physician or physician associate in real time or asynchronous technologies to facilitate an exchange of information in other than real time.

  Or. Rev. Stat. §677.494(1) · verified Sep 3, 2026

Pennsylvania approaches the pre-treatment question from the DELEGATION side: the physician has to make a patient-specific judgment before anyone else touches the patient, and some services cannot be handed over at all.

• A medical service may not be delegated where it is sufficiently complicated, difficult or dangerous that it requires knowledge and skill possessed by medical doctors but not commonly held by non-physicians, or where potential adverse reactions may not be readily apparent to someone without medical doctor training.

  49 Pa. Code §18.402(b) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• A physician may not delegate a procedure they are not themselves trained, qualified and competent to perform. The ceiling on what can be handed to staff is the delegating physician’s own competence, not the staff member’s.

  49 Pa. Code §18.402 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

These claims survey the unprofessional conduct section of the medical practice chapter, not a telehealth-specific statute, and should be read that way. What they establish is the standard the treatment itself must meet however it is delivered. Incompetent, negligent or willful misconduct in the practice of medicine is unprofessional conduct, and the statute says in terms that this INCLUDES the rendering of medically unnecessary services and any departure from, or failure to conform to, the minimal standards of acceptable and prevailing medical practice in the licensee’s area of expertise as determined by the board — and that the board need NOT establish actual injury to the patient to find it. Offering, undertaking or agreeing to cure or treat disease by a secret method, procedure, treatment or medicine is separately unprofessional conduct, as is making willful misrepresentations in treatments. The remote question is now surveyed, and it is answered in the board’s own rule rather than the statute. 216-ricr-40-05-1 § 1.5.9(H)(2) holds an online treatment or consultation recommendation — a prescription issued electronically included — to the same standards of appropriate practice as a face-to-face one, treats a prescription based solely on an online questionnaire without an appropriate evaluation as unprofessional conduct, and says an asynchronous evaluation without a contemporaneous real-time interactive exchange is not appropriate. What these claims do NOT survey is any intake requirement specific to cosmetic medicine; confirm that with the board or counsel.

• Unprofessional conduct includes incompetent, negligent, or willful misconduct in the practice of medicine, which includes the rendering of medically unnecessary services, and any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing medical practice in his or her area of expertise as is determined by the board. The board does not need to establish actual injury to the patient in order to adjudge a physician or limited registrant guilty of the unacceptable medical practice in this subsection.

  R.I. Gen. Laws §5-37-5.1(19) · verified Sep 3, 2026

• Unprofessional conduct includes offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment, or medicine.

  R.I. Gen. Laws §5-37-5.1(17) · verified Sep 3, 2026

South Carolina does not lower the standard for remote care: a licensee practicing medicine by telemedicine must meet the SAME standard of care as in-person medical care, failing which is expressly designated unprofessional conduct, and the licensee must hold a South Carolina medical license. The record and prescribing discipline sits alongside it — failing to prepare or maintain an adequate patient record of the care provided, and signing a blank prescription form, are each grounds for disciplinary action.

• Misconduct that constitutes grounds for disciplinary action is a showing to the board by the preponderance of evidence that a licensee has failed to prepare or maintain an adequate patient record of care provided.

  S.C. Code §40-47-110(B)(17) · verified Sep 3, 2026

• Misconduct that constitutes grounds for disciplinary action is a showing to the board by the preponderance of evidence that a licensee has signed a blank prescription form.

  S.C. Code §40-47-110(B)(21) · verified Sep 3, 2026

South Dakota's telehealth chapter states WHO may treat. Any health care professional treating a patient in the state through telehealth shall be fully licensed to practice in the state — or employed by one of the named licensed or accredited facilities — AND subject to any rule adopted by the applicable South Dakota licensing body. Telehealth itself is defined broadly: the use of secure electronic information, imaging and communication technologies by a health care professional to deliver health care services to a patient, INCLUDING interactive audio-video, interactive audio with store and forward, store-and-forward technology, and remote patient monitoring. Because the operative requirements are pushed to the licensing body's rules, these claims do not themselves fix an examination requirement; what they do fix is the standard the board measures against — professional incompetence is a deviation from the statewide standard of competence, being the minimum degree of skill and knowledge necessary to perform the characteristic tasks of a physician in at least a reasonably effective way.

• Any health care professional treating a patient in the state through telehealth shall be fully licensed to practice in the state or employed by a licensed health care facility, an accredited prevention or treatment facility, a community support provider, a nonprofit mental health center, or a licensed child welfare agency under §36-32-76; and subject to any rule adopted by the applicable South Dakota licensing body.

  S.D. Codified Laws §34-52-2 · verified Sep 3, 2026

• "Telehealth," the use of secure electronic information, imaging, and communication technologies by a health care professional to deliver health care services to a patient, including interactive audio-video, interactive audio with store and forward, store-and-forward technology, and remote patient monitoring.

  S.D. Codified Laws §34-52-1(5) · verified Sep 3, 2026

⚠️ Tennessee has one of the strongest examination rules in this corpus, and it is not optional. Rule 0880-02-.14(7) makes it a prima facie violation to prescribe or dispense ANY DRUG without a documented history, examination, diagnosis, discussed plan and follow-up — and says outright that a questionnaire is not an examination. The telemedicine rules then disclaim any effect on that duty rather than relaxing it.

• Tennessee’s telemedicine rules disclaim any effect on the underlying duty: they are not meant to alter or amend the applicable standard of care in any particular field of medicine, nor to amend any requirement for the establishment of a physician-patient relationship. Remote delivery changes the channel, not the threshold.

  Tenn. Comp. R. & Regs. 0880-02-.16 (scope) · verified Sep 2, 2026

• Where a remote evaluation is used the rules put a named person in the room: a FACILITATOR must be physically present with the patient and is responsible for verifying the patient’s identity and location and for the origination, collection and transmission of images or clinical data to the physician performing the evaluation remotely.

  Tenn. Comp. R. & Regs. 0880-02-.16(1)(a) · verified Sep 2, 2026

Before a delegated cosmetic act Texas requires a practitioner-patient relationship to be established — by a physician, or by a PA or APRN acting under the physician’s delegation — and an adequate medical RECORD to be maintained. A physician, PA or APRN must be onsite or immediately available, and at least one person trained in basic life support must be present.

• Before a delegated cosmetic act, a practitioner-patient relationship must be established by a physician, or by a PA or APRN acting under the physician’s delegation, and an adequate medical record must be maintained. The identity and title of the person who will perform the act must be disclosed to the patient.

  22 TAC §169.26 · verified Jul 26, 2026 · read at Cornell Legal Information Institute

• A physician, PA, or APRN must be onsite during the procedure or immediately available for emergency consultation, and at least one person trained in basic life support must be present while the patient is onsite.

  22 TAC §169.26 · verified Jul 26, 2026 · read at Cornell Legal Information Institute

Utah requires the evaluation by statute and names who may DO IT. Before a treatment protocol or series of treatments begins for a NONABLATIVE cosmetic medical procedure, a physician, a nurse practitioner or a physician assistant — each holding an unrestricted license — must develop the treatment plan for that procedure AND conduct an evaluation of the patient, either in person or by a live telemedicine visit. Utah reinforces it from the other end: a medical assistant under the indirect supervision of a physician may not diagnose and may not establish a treatment plan. The statute also defines DIRECT cosmetic medical procedure supervision as the supervisor being present and available for face-to-face communication when and where the procedure is performed.

• a physician who has an unrestricted license to practice medicine, a nurse practitioner who has an unrestricted license for advanced practice registered nursing, or a physician assistant acting in accordance with Chapter 70a, Utah Physician Assistant Act, who has an unrestricted license to practice as a physician assistant, shall: (i) develop a treatment plan for the nonablative cosmetic medical procedure; and (ii) conduct an evaluation of the patient either in-person or utilizing a live telemedicine visit before the initiation of a treatment protocol or series of treatments;

  Utah Code § 58-1-506(3)(a) (Supervision of cosmetic medical procedures) · verified Sep 4, 2026

• "Direct cosmetic medical procedure supervision" means the supervisor: (i) has authorized the procedure to be done on the patient by the supervisee; and (ii) is present and available for a face-to-face communication with the supervisee when and where a cosmetic medical procedure is performed.

  Utah Code § 58-1-506(1)(c) (definition of “Direct cosmetic medical procedure supervision”) · verified Sep 4, 2026

Vermont requires an appropriate examination of the patient — in person, through telemedicine, or by instrumentation and diagnostic equipment through which images and records may be transmitted — before a licensed health care provider prescribes, dispenses or administers drugs, and holds treatment recommendations made electronically to the same standards of appropriate practice as those in traditional provider-patient settings. The rest of what these claims establish is narrower: signing a blank or undated prescription form is unprofessional conduct, as is prescribing, selling, administering, distributing, ordering or dispensing a controlled substance for the licensee’s own use or for an immediate family member. Separately, the Board may require a licensee to submit to a mental or physical examination and an evaluation of medical knowledge and skill where it has a reasonable basis to doubt competence.

• The Board shall find that the following constitutes unprofessional conduct: signing a blank or undated prescription form.

  Vt. Stat. tit. 26, §1354(a)(38) · verified Sep 3, 2026

• The Board shall find that the following constitutes unprofessional conduct: prescribing, selling, administering, distributing, ordering, or dispensing any drug legally classified as a controlled substance for the licensee’s own use or to an immediate family member as defined by rule.

  Vt. Stat. tit. 26, §1354(a)(37) · verified Sep 3, 2026

⚠️ Virginia’s examination duty is in the pharmacy chapter, not the board of medicine regulations. § 54.1-3303 lets a prescription issue ONLY to a patient with whom the practitioner has a bona fide practitioner-patient relationship, and defines that by four elements — history, risk disclosure, an appropriate examination, and follow-up. Botulinum toxin and fillers are prescription drugs, so a Virginia med spa is inside it. The Board of Medicine regulations then add a separate duty about WHO may be handed the patient.

• No practitioner shall knowingly allow subordinates to jeopardize patient safety or to provide patient care outside the subordinate’s scope of practice or area of responsibility, and practitioners shall delegate patient care only to subordinates who are properly trained and supervised. In Virginia the pre-treatment question is framed as a delegation question rather than an examination one.

  18 Va. Admin. Code § 85-20-29(A)(1) · verified Sep 2, 2026

• The same rule bars exploiting the practitioner-patient relationship for personal gain, and treats an egregious pattern of disruptive behavior in a health care setting as professional misconduct where it interferes with patient care or could reasonably be expected to affect its quality.

  18 Va. Admin. Code § 85-20-29(A)(2) and (3) · verified Sep 2, 2026

Washington writes out SEVEN things a physician must do before authorizing a nonsurgical medical cosmetic procedure, rather than naming a “good-faith exam”. The same seven attach whether the procedure is an injection or an energy device.

• Before authorizing a nonsurgical medical cosmetic procedure a physician must take a history, perform an appropriate physical examination, make an appropriate diagnosis, recommend appropriate treatment, obtain the patient’s informed consent, provide instructions for emergency and follow-up care, and prepare an appropriate medical record. All seven, before the procedure is authorized.

  Wash. Admin. Code 246-919-606(5) · verified Sep 2, 2026

• The same seven duties apply before treatment with an energy device, with one addition that is easy to miss: the informed consent must include informing the patient that a nonphysician may operate the device. The patient is entitled to know who will be holding it before they consent.

  Wash. Admin. Code 246-919-605(6) · verified Sep 2, 2026

West Virginia legislates the telemedicine encounter in detail, and the detail is restrictive at the front end. A physician-patient relationship MAY NOT be established through text-based communications such as e-mail, Internet questionnaires, text-based messaging or other written forms of communication. Where no relationship existed beforehand, or where services are rendered solely by telemedicine, it may be established only through interactive audio using store and forward technology, real-time videoconferencing or similar secure video services at the initial encounter — or through real-time audio-only calls, with the statute stating that audio-visual communication is preferable if available or possible. Once the relationship exists, whether in person or by those routes, the physician may use any telemedicine technology that meets the standard of care and suits the presentation. The Act also fixes jurisdiction: the practice of medicine occurs where the PATIENT is located when the technology is used.

• A physician-patient or podiatrist-patient relationship may not be established through: Text-based communications such as e-mail, Internet questionnaires, text-based messaging, or other written forms of communication.

  W. Va. Code §30-3-13a(c)(1) · verified Sep 3, 2026

• If an existing physician-patient or podiatrist-patient relationship does not exist prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient or podiatrist-patient relationship may only be established through the use of telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial physician-patient or podiatrist-patient encounter.

  W. Va. Code §30-3-13a(c)(2)(A) · verified Sep 3, 2026

Wisconsin imposes an informed consent duty by statute and measures it against a reasonable-physician standard — and its telemedicine rules refuse to lower any of it.

• Any physician who treats a patient shall inform the patient about the availability of reasonable alternate medical modes of treatment and about the benefits and risks of those treatments. The measure is the reasonable physician standard — disclosure of what a reasonable physician in the same or a similar specialty would know and disclose in the circumstances.

  Wis. Stat. § 448.30 · verified Sep 2, 2026

• The statute also names what the duty does NOT require, which is where a practice usually over- or under-discloses: detailed technical information a patient would in all probability not understand; risks apparent or already known to the patient; extremely remote possibilities that might falsely or detrimentally alarm them; and information in emergencies where withholding treatment would be more harmful.

  Wis. Stat. § 448.30(2)–(5) · verified Sep 2, 2026

Wyoming defines both halves of the question in the Medical Practice Act. A “physician-patient relationship” means a relationship between a licensee and any person formed for the purpose of the licensee providing medical diagnosis or treatment, whether or not for compensation — a purpose test, with no in-person requirement stated in the definition. “Telemedicine” means the practice of medicine by electronic communication or other means from a physician in one location to a patient in another, with or without an intervening health care provider. The licensing statute then says a board MAY adopt rules allowing telemedicine and telehealth within the applicable profession, with the term to be defined inside each promulgated rule. Whether any examination or intake requirement applies to a Wyoming med spa, in statute or in board rules, is NOT surveyed by these claims; confirm it with the board or counsel. What the statute does supply is the standard: making false or misleading statements regarding the licensee's skill or the efficacy or value of a treatment or remedy is a ground for discipline.

• "Physician-patient relationship" means a relationship between a licensee and any person formed for the purpose of the licensee providing medical diagnosis or treatment to the person, whether or not for compensation.

  Wyo. Stat. Ann. §33-26-102(a)(xx) · verified Sep 3, 2026

• "Telemedicine" means the practice of medicine by electronic communication or other means from a physician in a location to a patient in another location, with or without an intervening health care provider.

  Wyo. Stat. Ann. §33-26-102(a)(xxix) · verified Sep 3, 2026

Alabama sorts the staff into two named tiers for energy-device work. a level 1 DELEGATE is a physician assistant, a certified registered nurse practitioner or a registered nurse authorized in a written job description or protocol to use a specific device for non-ablative procedures, who has met the Level 1 educational requirements. A LEVEL 2 DELEGATE is an LPN or a medical assistant — the rule names aestheticians, cosmetologists and laser technicians in that tier — on the same written-authorization and education conditions. Separately, a certified registered nurse practitioner in collaborative practice may evaluate health status from a comprehensive history and physical examination, formulate a working diagnosis and develop a treatment plan.

• (5) Level 1 Delegate - A Level 1 Delegate is an assistant to physicians (PA) as defined in Ala. Code § 34-24-290, a certified registered nurse practitioner, or registered nurse (RN) authorized in a written job description or protocol to use a specific laser/pulsed light device or other energy source, chemical or other modality for non-ablative procedures, as designated in the written job description or protocol, and who has met the educational requirements for a Level 1 Delegate stated in these rules.

  Ala. Admin. Code r. 540-X-11-.02(5) (definition of “Level 1 Delegate”) · verified Sep 4, 2026

• (6) Level 2 Delegate - A Level 2 Delegate is a licensed practicing nurse (LPN) or medical assistant to include Medical Examiners Chapter 540-X-11 Revised 3/16/26 11-3 aestheticians, cosmetologists, and laser technicians authorized in a written job description or protocol to use a specific laser/pulsed light device or other energy source, chemical or other modality for non-ablative procedures, as designated in the written job description or protocol, and who has met the educational requirements for a Level 2 Delegate as stated in these rules.

  Ala. Admin. Code r. 540-X-11-.02(6) (definition of “Level 2 Delegate”) · verified Sep 4, 2026

The Alaska Nursing statutes let a registered, advanced practice registered or practical nurse delegate nursing duties to other persons including unlicensed assistive personnel, under board regulations, and a delegate may perform those duties without any nursing license of their own provided they meet the board’s requirements. AS 08.68.850 defines an advanced practice registered nurse as one certified to perform acts of medical diagnosis and to prescribe and dispense medical, therapeutic or corrective measures under board regulations. And the regulation that would require physician collaboration is no longer there. In the board’s advanced-practice article the collaboration slot reads “12 AAC 44.410. Collaborative relationship. Repealed 12/1/84.”, as does the remote-location rule beside it; prescriptive authority runs from the board to the nurse on the nurse’s own application; and scope is set by the national certifying bodies the board recognizes. These claims survey AS 08.68 and 12 AAC 44.400 through 44.480; they do not survey the rest of Title 12, and the physician assistant rules on this page are a different article with a different answer — 12 AAC 40.410 requires a collaborative plan.

• A registered, advanced practice registered, or practical nurse licensed under this chapter may delegate nursing duties to other persons, including unlicensed assistive personnel, under regulations adopted by the board.

  AS 08.68.805 (Delegation of nursing functions) · verified Sep 5, 2026

• A person to whom the nursing duties are delegated may perform the delegated duties without a license or certificate under this chapter if the person meets the applicable requirements established by the board.

  AS 08.68.805 (Delegate may act without a nursing license) · verified Sep 5, 2026

The Arizona rules on this, verbatim from the source:

• The Nurse Practice Act defines registered nursing as diagnosing and treating human responses, establishing a nursing diagnosis, prescribing and delegating nursing interventions, and related acts. Prescriptive authority for legend drugs is granted separately, to registered nurse practitioners, and not by this definition.

  A.R.S. §32-1601(24) · verified Jul 26, 2026

• A registered nurse practitioner may diagnose and may prescribe, administer, and dispense legend drugs and devices within the NP scope — so an NP may both order and administer cosmetic injectables.

  A.R.S. §32-1601(23) · verified Jul 26, 2026

• The board may issue limited licenses or certificates if it determines that an applicant or licensee cannot function safely in a specific setting or within the full scope of practice.

  A.R.S. §32-1606(A)(3) · verified Sep 3, 2026

Arkansas draws its line at where the drug is given and how close the supervisor is. Delegated administration of drugs covers only drugs that do not require substantial, specialized judgment and skill, and is permissible only within the physical boundaries of the delegating physician’s offices. For a physician assistant, a supervising or back-up supervising physician should be available for immediate telephone contact any time the assistant is rendering services to the public.

• A supervising physician and/or back-up supervising physician or physicians should be available for immediate telephone contact with the physician assistant any time the physician assistant is rendering services to the public.

  17 CAR § 140-1806 (Availability of supervising physician) · verified Sep 4, 2026

• (a) A physician may only delegate the administration of drugs that do not require substantial, specialized judgment and skill based on knowledge and application of the principles of biological, physical, and social sciences. (b) Administration of drugs, delegated pursuant to this section, shall only be permissible within the physical boundaries of the delegating physician’s offices.

  17 CAR § 140-2505(a)-(b) (Additional requirements for delegating the administration of drugs) · verified Sep 4, 2026

The California rules on this, verbatim from the source:

• A registered nurse administering medications or therapeutic agents must be implementing a regimen ordered by, and within the scope of licensure of, a physician, dentist, podiatrist or clinical psychologist. Functions shared with other practitioners are performed under standardized procedures developed within an organized health care system.

  Cal. Bus. & Prof. Code §2725 · verified Jul 26, 2026 · read at Public.Law — California Codes

• AB 890 permits a qualifying nurse practitioner to practice in specified settings without standardized procedures, and bars the listed entities from interfering with or directing that nurse practitioner’s professional judgment in a manner prohibited by Section 2400. It creates no carve-out for aesthetic practice.

  Cal. Bus. & Prof. Code §2837.103 · verified Jul 26, 2026 · read at Public.Law — California Codes

Colorado APRNs prescribe only with separate, earned authority: THREE YEARS of clinical experience, then 750 HOURS of documented prescribing mentorship. Two details matter to a med spa — remote mentoring must be SYNCHRONOUS (e-mail does not count), and a mentor may not require payment or employment as the price of the relationship.

• Prescriptive authority is not part of APRN registration; the board grants it separately to an APRN on the advanced practice registry whose license is in good standing without disciplinary sanctions and who has met the requirements of § 12-255-112. Authority extends to prescribing “to provide treatment to clients within the role and population focus of the advanced practice registered nurse” — so a pediatric focus is not a warrant to prescribe cosmetically to adults.

  Colo. Rev. Stat. § 12-255-112(1)(a), (3)(a) · verified Sep 2, 2026

• An APRN applying for prescriptive authority must provide the board with an appropriate graduate degree, education in controlled substances and prescription drugs, national certification, professional liability insurance, inclusion on the advanced practice registry, and “a signed attestation stating that the advanced practice registered nurse has completed at least three years of combined clinical work experience as a professional nurse or as an advanced practice registered nurse.”

  Colo. Rev. Stat. § 12-255-112(4)(a) · verified Sep 2, 2026

Connecticut defines registered nursing as a list of functions — diagnosing human responses to actual or potential health problems, supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health care regimen, and executing the medical regimen under the direction of a licensed physician, dentist or advanced practice registered nurse. An advanced practice registered nurse must collaborate with a Connecticut-licensed physician for the first three years after licensure, and the statute defines what that collaboration must address: consultation and referral, coverage in the nurse’s absence, a method to review patient outcomes, and disclosure of the relationship to the patient.

• An advanced practice registered nurse having been issued a license pursuant to section 20-94a shall, for the first three years after having been issued such license, collaborate with a physician licensed to practice medicine in this state. In all settings, such advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures.

  Conn. Gen. Stat. §20-87a(b)(2)(A) · verified Sep 3, 2026

• Collaboration means a mutually agreed upon relationship between such advanced practice registered nurse and a physician who is educated, trained or has relevant experience that is related to the work of such advanced practice registered nurse. The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of such advanced practice registered nurse, a method to review patient outcomes and a method of disclosure of the relationship to the patient.

  Conn. Gen. Stat. §20-87a(b)(2)(A) (definition of collaboration) · verified Sep 3, 2026

Delaware is an independent-practice state for advanced practice registered nurses, and says so inside the definition: advanced practice nursing is “licensed as an independent licensed practitioner” in a role and population focus approved by the Board of Nursing, and the APRN scope includes performing acts of advanced assessment, diagnosing, prescribing and ordering. The Nursing chapter sets who qualifies — an RN who has completed a graduate-level APRN program accredited by a national accrediting body and holds current certification by a national certifying body in the appropriate role and at least 1 population focus — and gives the Board of Nursing authority to grant, restrict, suspend or revoke practice or prescriptive authority.

• Advanced practice nursing is an expanded scope of nursing licensed as an independent licensed practitioner in a role and population focus approved by the Board of Nursing, with or without compensation or personal profit, and includes the RN scope of practice. The scope of an APRN includes performing acts of advanced assessment, diagnosing, prescribing, and ordering.

  24 Del. C. §1902(b) · verified Sep 3, 2026

• "Advanced practice registered nurse" ("APRN") means an individual with knowledge and skills in basic nursing education; licensure as a registered nurse ("RN"); and graduation from or completion of a graduate-level APRN program accredited by a national accrediting body and current certification by a national certifying body in the appropriate APRN role and at least 1 population focus. "Advanced practice registered nurse" includes certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, or clinical nurse specialist.

  24 Del. C. §1902(b) · verified Sep 3, 2026

The District defines registered nursing broadly — the full scope of nursing services, including diagnosis and treatment of human response. It then adds a savings clause: nothing in the definition of practicing medicine is to be construed as preventing or restricting advanced practice registered nurses from performing their duties, so the breadth of the medicine definition does not read down APRN practice. Telehealth is separately defined to cover supervision as well as assessment, diagnosis and consultation.

• Practice of registered nursing means the performance of the full scope of nursing services, with or without compensation, designed to promote, protect, optimize, and maintain health and abilities, prevent illness and injury, facilitate healing, alleviate suffering through the diagnosis and treatment of human response, and advocate for the care of individuals, families, groups.

  D.C. Code §3-1201.02(17) (“Practice of registered nursing” defined) · verified Sep 3, 2026

• Nothing in this paragraph shall be construed as preventing or restricting advanced practice registered nurses from performing their duties as advanced practice registered nurses.

  D.C. Code §3-1201.02(7)(C) · verified Sep 3, 2026

The Florida rules on this, verbatim from the source:

• A registered nurse may administer medications and treatments — including injectables — as prescribed or authorized by a duly licensed practitioner. RNs are not independent prescribers.

  Fla. Stat. §464.003 · verified Jul 26, 2026

• An APRN performs authorized functions within the framework of an established protocol maintained on-site, unless the APRN is registered for autonomous practice.

  Fla. Stat. §464.012(3) · verified Jul 26, 2026

• APRN autonomous practice (without a supervising physician) is available only in primary care — family medicine, general pediatrics, and general internal medicine — which does not encompass cosmetic/aesthetic injectable practice.

  Fla. Stat. §464.0123 · verified Jul 26, 2026

The Georgia rules on this, verbatim from the source:

• A nurse acting under a nurse protocol may administer and order drugs, but ordering under delegation is expressly not prescribing: it does not authorize the issuance of a written prescription. Ordering means selecting a drug, medical treatment, or diagnostic study through physician delegation under a nurse protocol or a physician assistant job description.

  O.C.G.A. §43-34-23(a) · verified Aug 17, 2026 · read at FindLaw Codes

• Georgia lets an advanced practice registered nurse stand in for the physician at the cosmetic-laser examination, but only by delegation and only under a board-approved protocol. The consulting physician may have “delegated the authority to perform such examination to a physician assistant in a job description who is a licensed cosmetic laser practitioner, or to an advanced practice registered nurse in a protocol approved by the Board and who is a licensed cosmetic laser practitioner”. In a physician office the same delegation runs “by an advanced practice registered nurse in a protocol approved by the Board”. The authority is derived from the physician in both settings; the rule states no route by which the nurse holds it independently.

  Ga. Comp. R. & Regs. 360-35-.07(1)(a), (2)(a) · verified Sep 8, 2026

The nursing act sections cited here describe each level of nursing and give the advanced practice registered nurse a scope of its own. Registered nurse practice is the full scope of nursing guided by the chapter, the board’s rules, and board-recognized standards, and includes carrying out prescribed medical orders of a physician, an advanced practice registered nurse, or a supervised physician assistant; licensed practical nurse practice is a directed scope under the direction of a registered nurse, advanced practice registered nurse, physician, or other authorized provider. An advanced practice registered nurse’s scope includes advanced assessment, telehealth, and the diagnosis, prescription, selection, and administration of therapeutic measures including legend drugs and controlled substances within the nurse’s role and certification, supersedes the registered nurse scope, and, once the board grants prescriptive authority, includes prescribing and administering legend drugs and controlled substances and dispensing manufacturers’ prepackaged samples of over-the-counter and non-controlled legend drugs, never controlled-substance samples; only a board-licensed advanced practice registered nurse may use that title. A physician assistant’s supervising physician must review a set share of the physician assistant’s medical records within thirty days during the first year and audit a sample for at least thirty minutes each month thereafter. None of the sections cited here mentions injectables, neuromodulators, or fillers by name.

• Practice as an advanced practice registered nurse means the scope of nursing in a category approved by the board, regardless of compensation or personal profit, and includes the registered nurse scope of practice. The scope of an advanced practice registered nurse includes but is not limited to advanced assessment; telehealth; and the diagnosis, prescription, selection, and administration of therapeutic measures including over the counter drugs, legend drugs, and controlled substances within the advanced practice registered nurse's role and specialty-appropriate education and certification. (b) The advanced practice registered nurse's scope of practice supersedes the registered nurse's scope of practice.

  Haw. Rev. Stat. § 457-2.7(a)-(b) · verified Sep 8, 2026

• use of reasonable judgment in carrying out prescribed medical orders of a licensed dentist, physician, osteopathic physician, or podiatrist licensed in accordance with chapter 448, 453, or 463E; orders of an advanced practice registered nurse licensed in accordance with this chapter; or the orders of a physician assistant licensed pursuant to chapter 453, practicing with physician supervision as required by chapter 453, and acting as the agent of the supervising physician

  Haw. Rev. Stat. § 457-2 ("The practice of nursing as a registered nurse") · verified Sep 8, 2026

An Idaho advanced practice registered nurse is a registered nurse licensed in the state who has gained additional specialized knowledge, skills and experience through a program of study recognized or defined by the board. The statute authorizes the APRN to perform advanced nursing practice, which may include the prescribing, administering and dispensing of therapeutic pharmacologic agents as defined by board rules — and then bounds it twice: the APRN shall perform only those acts as provided by the board and for which the individual is educationally prepared, and the APRN collaborates with other health professionals in providing health care. Four roles are named: certified nurse-midwife, clinical nurse specialist, certified nurse practitioner and certified registered nurse anesthetist. Because the operative limits are set by BOARD RULE, the statute alone does not fix the scope of any particular procedure.

• "Advanced practice registered nurse" means a registered nurse licensed in this state who has gained additional specialized knowledge, skills and experience through a program of study recognized or defined by the board. An advanced practice registered nurse is authorized to perform advanced nursing practice, which may include the prescribing, administering and dispensing of therapeutic pharmacologic agents, as defined by board rules.

  Idaho Code §54-1402(1) · verified Sep 3, 2026

• An advanced practice registered nurse shall perform only those acts as provided by the board and for which the individual is educationally prepared. Advanced practice registered nurses shall include the following four (4) roles: certified nurse-midwife; clinical nurse specialist; certified nurse practitioner; and certified registered nurse anesthetist as defined in board rule. An advanced practice registered nurse collaborates with other health professionals in providing health care.

  Idaho Code §54-1402(1) · verified Sep 3, 2026

Illinois grants APRNs full practice authority on conditions, and the regulator spells out where that authority stops. It is unusually explicit about the ceiling: local anesthetic only, and no operative surgery.

• An advanced practice registered nurse with full practice authority may practice without a written collaborative agreement in all settings consistent with national certification, and may prescribe legend drugs and Schedule II to V controlled substances. That authority expressly does not include operative surgery, and extends to the use of local anesthetic only.

  225 ILCS 65/65-43 · verified Aug 17, 2026

• A registered professional nurse may delegate nursing interventions to other registered nurses, licensed practical nurses and unlicensed personnel, but only on a comprehensive nursing assessment covering the stability and condition of the patient, the potential for harm, the complexity of the intervention, the predictability of outcomes and the competency of the person being delegated to. The nurse may refuse to delegate, or stop or rescind a delegation already given.

  225 ILCS 65/50-75 · verified Aug 17, 2026

The Indiana rules on this, verbatim from the source:

• Registered nursing includes executing regimens delegated by a physician or other authorized prescriber. An RN does not independently prescribe; an RN administers injectables pursuant to a valid order within the delegated regimen.

  Ind. Code §25-23-1-1.1 · verified Jul 26, 2026

• An advanced practice registered nurse may prescribe drugs, including controlled substances, only under authority granted through a program the Board of Nursing establishes. That authority expires on October 31 of the odd-numbered year following the year it was granted or renewed, and is renewable indefinitely for successive two-year periods.

  Ind. Code §25-23-1-19.5(b) and (c) · verified Sep 1, 2026

• ⚠️ That authority is NOT independent. An advanced practice registered nurse shall operate in collaboration with a licensed practitioner as evidenced by a practice agreement, or under privileges granted by a hospital governing board setting out how the nurse and a licensed practitioner will cooperate, coordinate and consult. Certified registered nurse anesthetists are outside this section.

  Ind. Code §25-23-1-19.4(a) and (c) · verified Sep 1, 2026

• And the collaboration bounds what may be prescribed. Prescriptive authority may be granted only within the scope of practice of the advanced practice registered nurse AND the scope of the licensed collaborating health practitioner — so the collaborator’s specialty is a ceiling on the nurse’s prescribing, not merely a formality on a signature page.

  Ind. Code §25-23-1-19.6(c) · verified Sep 1, 2026

• A collaborating physician may delegate authority to a physician assistant to prescribe legend drugs and medical devices.

  Ind. Code §25-27.5-5-6 · verified Jul 26, 2026

Iowa gives the arnp a named list and the medical spa rule a named category. An ARNP practices to the full extent of their license, education and experience within their population foci. Inside a medical spa, a nurse falls within the rule’s category of a qualified licensed or certified nonphysician person — someone licensed by another health or skin-care board who may perform a medical aesthetic service the medical director has delegated, under that director’s supervision.

• An ARNP has the authority to practice to the full extent of the ARNP’s license, education, and experience in the ARNP’s respective population foci.

  Iowa Admin. Code r. 481—621.4(4) (Advanced registered nurse practitioners — scope) · verified Sep 4, 2026

• “Qualified licensed or certified nonphysician person” means any person who is not licensed to practice medicine and surgery or osteopathic medicine and surgery but who is licensed or certified by another health- or skin care-related licensing board in Iowa and is qualified to perform delegated medical aesthetic services under the supervision of a qualified supervising physician at a medical spa.

  Iowa Admin. Code r. 481—655.6(1) (definition of “Qualified licensed or certified nonphysician person”) · verified Sep 4, 2026

Kansas gates the advanced practice registered nurse TITLE on board licensure: no professional nurse may announce or represent to the public that they are an advanced practice registered nurse unless they have complied with the requirements established by the board and hold a valid APRN license. The board establishes those standards and requirements, including standards and requirements relating to the education of advanced practice registered nurses. The healing arts act separately makes it unprofessional conduct to use any letters, words or terms as an affix, on stationery, in advertisements or otherwise indicating that a person is entitled to practice a branch of the healing arts for which that person is not licensed.

• No professional nurse shall announce or represent to the public that such person is an advanced practice registered nurse unless such professional nurse has complied with requirements established by the board and holds a valid license as an advanced practice registered nurse in accordance with the provisions of this section.

  Kan. Stat. Ann. §65-1130(a) · verified Sep 3, 2026

• The board shall establish standards and requirements for any professional nurse who desires to obtain licensure as an advanced practice registered nurse. Such standards and requirements shall include, but not be limited to, standards and requirements relating to the education of advanced practice registered nurses.

  Kan. Stat. Ann. §65-1130(b)(1) · verified Sep 3, 2026

A Kentucky physician assistant may render no medical service at all without a signed, in-effect supervision agreement, and a physician may not supervise one without board approval — failing to obtain that approval is itself unprofessional conduct. The agreement must state the scope of medical services and procedures the supervising physician approves, and the level and method of supervision. Kentucky defines advanced practice registered nursing as the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program preparing them for one of the four APRN roles, who are nationally certified as a certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife or clinical nurse specialist. Those additional acts, subject to approval of the board, include but are not limited to prescribing treatment, drugs and devices and ordering diagnostic tests. Registered nursing practice is defined separately and includes the administration of medication and treatment as prescribed by a physician, physician assistant, dentist, or advanced practice registered nurse, and as further authorized or limited by the board. An APRN applicant must file a written application with evidence, verified by oath, of an accredited APRN education program, national certification, English proficiency, and a passed jurisprudence examination.

• A physician shall not supervise a physician assistant without approval of the board. Failure to obtain board approval as a supervising physician or failure to comply with the requirements of KRS 311.840 to 311.862 or related administrative regulations shall be considered unprofessional conduct and shall be subject to disciplinary action by the board.

  Ky. Rev. Stat. §311.854(1) · verified Sep 3, 2026

• A physician assistant shall not render any medical service or procedure unless the required supervision agreement is completed and signed by the supervising physician and physician assistant, and in effect. The supervision agreement shall include the scope of medical services and procedures approved by the supervising physician to be performed by the physician assistant, and the level and method of supervision to be provided by the supervising physician.

  Ky. Rev. Stat. §311.854(3) · verified Sep 3, 2026

Louisiana defines the advanced practice registered nurse by national certification plus board criteria: an APRN is a licensed registered nurse certified by a nationally recognized certifying body, such as the American Nurses Credentialing Center, as having an advanced nursing specialty described in the Part, and who meets the criteria for an APRN established by the board. Where no national certification examination exists in a selected clinical area, the board may establish commensurate requirements. The definition then names the roles it includes — among them the certified nurse midwife, educated in the disciplines of nursing and midwifery and authorized to manage nurse midwifery care in the antepartum, intrapartum, postpartum and gynecological periods, and the certified registered nurse anesthetist, educated in the field of nurse anesthesia and certified to the requirements of a nationally recognized certifying body. Because the operative criteria are set by the BOARD, these claims do not fix the scope of any particular procedure.

• "Advanced practice registered nurse" or "APRN" means a licensed registered nurse who is certified by a nationally recognized certifying body, such as the American Nurses Credentialing Center, as having an advanced nursing specialty as described in this Part and who meets the criteria for an advanced practice registered nurse as established by the board.

  La. Rev. Stat. §37:913(1) · verified Sep 3, 2026

• In the absence of the availability of a national certification examination in a selected clinical area, the board may establish commensurate requirements.

  La. Rev. Stat. §37:913(1) · verified Sep 3, 2026

Maine is not a day-one independent-practice state for nurse practitioners, and this is the section to read before staffing. a certified nurse practitioner qualifying as an advanced practice registered nurse must practice for AT LEAST 24 MONTHS under the supervision of a licensed physician or a supervising nurse practitioner, or be employed by a clinic or hospital with a medical director who is a licensed physician, and must submit written evidence to the board on completing that clinical experience. Certified nurse practitioners and certified nurse midwives may prescribe and dispense drugs or devices in accordance with board rules. Advanced practice registered nursing is defined by reference to the board’s own rulemaking on scope and standards, and expressly includes consultation with or referral to medical and other health care providers when required by client health care needs.

• A certified nurse practitioner who qualifies as an advanced practice registered nurse must practice, for at least 24 months, under the supervision of a licensed physician or a supervising nurse practitioner or must be employed by a clinic or hospital that has a medical director who is a licensed physician. The certified nurse practitioner shall submit written evidence to the board upon completion of the required clinical experience.

  32 M.R.S. §2102(2-A) · verified Sep 3, 2026

• A certified nurse practitioner or a certified nurse midwife who qualifies as an advanced practice registered nurse may prescribe and dispense drugs or devices, or both, in accordance with rules adopted by the board.

  32 M.R.S. §2102(2-A) · verified Sep 3, 2026

Maryland defines registered nursing to include execution of a therapeutic regimen — expressly including the administration of medication and treatment — and both independent nursing functions and delegated medical functions, which is the frame an injecting RN works inside. Separately, a certified nurse practitioner may INDEPENDENTLY diagnose common short-term and chronic stable problems, order and perform therapeutic and corrective measures, and prescribe drugs.

• A nurse practitioner may independently perform the following functions: a comprehensive physical assessment of patients; establish medical diagnosis for common short-term and chronic stable health problems; order, perform, and interpret laboratory and diagnostic tests; order and perform diagnostic, therapeutic, and corrective measures; prescribe drugs; provide emergency care; and refer patients to appropriate licensed physicians or other health care providers.

  Md. Code Regs. 10.27.07.03(A) (Nurse Practitioner — Scope and Standards of Practice) · verified Sep 3, 2026

• Practice registered nursing means the performance of acts requiring substantial specialized knowledge, judgment, and skill based on the biological, physiological, behavioral, or sociological sciences as the basis for assessment, nursing diagnosis, planning, implementation, and evaluation of the practice of nursing in order to maintain health, prevent illness, or care for or rehabilitate the ill, injured, or infirm.

  Md. Code, Health Occ. §8-101 (“Practice registered nursing” defined) · verified Sep 3, 2026

Massachusetts already grants nurse practitioners independent practice authority — after not less than 2 years of supervised practice following board-recognized certification, or 2 years of alternative experience the Board accepts. ⚠️ but the grant is over prescribing, not procedures: it runs to issuing prescriptions and medication orders and ordering tests and therapeutics, and § 80E leaves everything else to regulations the Board is directed to promulgate. Before those 2 years, prescribing runs on mutually agreed written guidelines and every prescription names the supervisor. Nursing practice separately includes administering what an authorized prescriber has ordered, and every licensee is directly accountable for the safety of the care they personally deliver.

• Advanced practice is authorized by the Board, on evidence, not assumed from a license. A registered nurse applying for initial authorization in advanced nursing practice must furnish documentation of either a graduate degree in advanced nursing practice from a school approved by a national accrediting body acceptable to the Board, or a certificate of completion of an approved advanced-practice educational program — AND documentation of current national certification in advanced nursing practice from a professional or specialty certifying organization acceptable to the Board.

  Mass. Gen. Laws ch. 112, § 80B · verified Sep 1, 2026

• What that authorization permits is set by regulation rather than by the statute: the Board shall promulgate advanced practice nursing regulations governing the provision of advanced practice nursing services and related care, INCLUDING the ordering and interpreting of tests, the ordering and evaluation of treatment, and the use of therapeutics — with an express limit that such care shall not include interpreting tests beyond the scope of the nurse’s licensure and training.

  Mass. Gen. Laws ch. 112, § 80B · verified Sep 1, 2026

Michigan reaches advanced practice through a specialty certification granted by the Board of Nursing rather than a separate license, and defines practical nursing as performed under the supervision of an RN, physician or dentist.

• ⚠️ § 17201 defines what an advanced practice registered nurse IS in Michigan; it does not settle whether one may practice or prescribe without physician involvement. Michigan routes prescriptive and delegated authority through § 333.16215 and the specialty-certification rules, and this corpus has not yet read the provisions that govern an APRN’s independence — so do not read the definition below as an answer to that question.

  Mich. Comp. Laws § 333.17201 (scope of this section) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

• An “advanced practice registered nurse” in Michigan is a registered professional nurse who has been granted a specialty certification under § 17210 in nurse midwifery, nurse practitioner, or clinical nurse specialist. The status is a certification layered on the RN license, not a distinct license of its own. (Complete through PA 9 of 2026.)

  Mich. Comp. Laws § 333.17201(1)(a) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule

Minnesota is a full practice authority state for APRNs — but only after 2,080 postgraduate hours under a collaborative agreement. Who may INJECT is answered by the drug statute rather than the medical practice act: § 151.37 lets a practitioner have a legend drug administered by a nurse under their direction. The nurse practice act then supplies the standing-order route — § 148.235 subd. 8 lets an RN work to a protocol without reference to a specific patient. Both chapters are load-bearing.

• A licensed practitioner in the course of professional practice only may prescribe, administer, and dispense a legend drug, and may cause the same to be administered by a nurse or medical student or resident under the practitioner’s direction and supervision, and may cause an appropriately certified, registered, or licensed health care professional to prescribe, dispense, and administer the same within the expressed legal scope of the person’s practice as defined in Minnesota Statutes. Botulinum toxin and dermal fillers are legend drugs, so this — not the medical practice act — is the provision that answers who may inject in Minnesota.

  Minn. Stat. § 151.37, subd. 2(a) · verified Sep 2, 2026

• ⚠️ and Minnesota expressly authorizes the standing order. a registered nurse may implement a protocol that does not reference a specific patient and results in a prescription of a legend drug that has been predetermined and delegated by a licensed practitioner, when caring for a patient whose condition falls within the protocol and when the protocol specifies the circumstances under which the drug is to be prescribed or administered. Two conditions do the work: the patient must fall inside the protocol, and the protocol must state the circumstances.

  Minn. Stat. § 148.235, subd. 8 · verified Sep 2, 2026

The nursing sections cited here define each level of nursing by the order it follows and tie the advanced practice registered nurse to a collaborating physician. Registered-nurse practice includes executing the medical regimen, including administering medications and treatments prescribed by a licensed physician or dentist, and excludes medical diagnosis and prescribing except as the Board of Nursing provides by rule; licensed practical nursing is performed under the direction of a registered nurse, physician, or dentist using standardized procedures. An advanced practice registered nurse may diagnose, treat, and manage medical conditions and may hold prescriptive authority, but must practice in a collaborative/consultative relationship with a physician or dentist holding an unrestricted Mississippi license, within a board-approved protocol filed with the board, and may not practice as an APRN without that relationship and protocol; the Board of Nursing requires reliable communication with the collaborating physician and a formal collaborative agreement submitted before practice, and lets an authorized APRN prescribe Schedules II through V. Nurse practitioners may engage in that nursing practice without a physician’s license. The medical board files each collaboration and reviews protocols for practices more than seventy-five miles from the physician. Physician assistants are licensed and regulated by the medical board and supervised by a physician who practices in Mississippi at least twenty hours a week and is approved to supervise. None of the sections cited here mentions injectables, neuromodulators, or fillers by name.

• The Nursing Practice Law includes in registered-nurse practice the execution of the medical regimen, including the administration of medications and treatments prescribed by any licensed or legally authorized physician or dentist. It adds that this shall not be deemed to include acts of medical diagnosis or prescriptions of medical, therapeutic or corrective measures, except as may be set forth by rules and regulations promulgated and implemented by the Mississippi Board of Nursing.

  Miss. Code Ann. § 73-15-5(2) · verified Sep 8, 2026

• The advanced practice registered nurse may diagnose, treat and manage medical conditions. This may include prescriptive authority as identified by the board. Advanced practice registered nurses must practice in a collaborative/consultative relationship with a physician or dentist with an unrestricted license to practice in the State of Mississippi and within the framework of a standing protocol or practice guidelines.

  Miss. Code Ann. § 73-15-5(4) · verified Sep 8, 2026

An advanced practice registered nurse in Missouri is a person licensed under the nursing chapter to practice advanced practice nursing as a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner or certified registered nurse anesthetist. Prescribing runs through the written arrangement on the face of these claims: a collaborative practice arrangement MAY delegate to an APRN the authority to administer, dispense or prescribe drugs and provide treatment, and may delegate authority over controlled substances in Schedules III, IV and V and Schedule II hydrocodone. The delegation runs through the written arrangement described in the supervision section of this reference; whether any independent route exists elsewhere in the nursing chapter is not surveyed by these claims. Physician assistants are bounded differently again: the statute enumerates their scope of practice as consisting ONLY of nine listed services and procedures, and says a physician assistant may not prescribe any drug, medicine, device or therapy except pursuant to a collaborative practice arrangement.

• "Advanced practice registered nurse" or "APRN", a person who is licensed under the provisions of this chapter to engage in the practice of advanced practice nursing as a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner, or certified registered nurse anesthetist.

  Mo. Rev. Stat. §335.016(2) · verified Sep 3, 2026

• Collaborative practice arrangements, which shall be in writing, may delegate to a registered professional nurse the authority to administer, dispense or prescribe drugs and provide treatment if the registered professional nurse is an advanced practice registered nurse as defined in subdivision (2) of section 335.016.

  Mo. Rev. Stat. §334.104.2(1) · verified Sep 3, 2026

The nursing act sections cited here define the practice by the order it follows, not by procedure. Professional nursing includes the administration of medications and treatments prescribed by physicians, physician assistants, advanced practice registered nurses, and the other prescribers the statute lists, and practical nursing is the same administration under the supervision of a registered nurse or a prescriber; the chapter confers no authority to practice medicine. An APRN is a registered nurse who has completed the board-specified education for a role, practices on board approval of a certificate in that role, and, under the Board of Nursing’s rules, practices independently and/or collaboratively, including establishing medical diagnoses and treating patients, and prescribes legend and controlled substances only after the Board grants prescriptive authority. Certified nurse practitioner practice is defined as independent and/or collaborative management of primary or acute care. Performing procedures beyond the authorized scope, delegating contrary to the nursing laws, and failing to supervise are unprofessional conduct for a nurse. A physician assistant must be licensed by the Board of Medical Examiners and practice within the PA’s competency; a PA with fewer than 8,000 hours of postgraduate clinical experience commits unprofessional conduct by practicing without a collaborative agreement, and chart review frequency is set at the practice level in that agreement. None of the sections cited here mentions injectables, neuromodulators, or fillers by name.

• The APRN licensed in Montana may only practice in the role and population focus in which the APRN has current national certification. APRN practice is an independent and/or collaborative practice and may include: (a) establishing medical and nursing diagnoses, treating, and managing patients with acute and chronic illnesses and diseases; and (b) providing initial, ongoing, and comprehensive care, including: (i) physical examinations, health assessments, and/or other screening activities; (ii) prescribing legend and controlled substances when prescriptive authority is successfully applied for and obtained;

  Mont. Admin. R. 24.159.1406(1) · verified Sep 8, 2026

• The term also includes administration, teaching, counseling, supervision, delegation, and evaluation of nursing practice and the administration of medications and treatments prescribed by physicians, naturopathic physicians, physician assistants, optometrists, advanced practice registered nurses, dentists, osteopaths, or podiatrists authorized by state law to prescribe medications and treatments. Each registered nurse is directly accountable and responsible to the consumer for the quality of nursing care rendered.

  Mont. Code Ann. § 37-8-102(9) · verified Sep 8, 2026

Nebraska defines registered nursing as assuming responsibility and accountability for nursing actions — assessing human responses to actual or potential health conditions, establishing nursing diagnoses, establishing goals and outcomes, establishing and maintaining a plan of care, prescribing nursing interventions and implementing that plan. A nurse practitioner license additionally requires a graduate-level program in the nurse practitioner clinical specialty accredited by a national accrediting body, proof of passing an examination pertaining to the specific nurse practitioner role, and evidence of two thousand hours of practice as a nurse practitioner.

• The practice of nursing by a registered nurse means assuming responsibility and accountability for nursing actions. Nursing actions include assessing human responses to actual or potential health conditions; establishing nursing diagnoses; establishing goals and outcomes to meet identified health care needs; establishing and maintaining a plan of care; prescribing nursing interventions to implement the plan of care; and implementing the plan of care.

  Neb. Rev. Stat. §38-2212(1), (2) · verified Sep 3, 2026

• Practice of nursing means the performance for compensation or gratuitously of any act expressing judgment or skill based upon a systematized body of nursing knowledge.

  Neb. Rev. Stat. §38-2210 (“Practice of nursing” defined) · verified Sep 3, 2026

Nevada’s Nurse Practice Act grants an advanced practice registered nurse authority to engage in selected medical diagnosis and treatment and, where separately authorized, to prescribe — bounded by the rule that an APRN may not undertake anything he or she is not qualified to perform. Registered nurses, APRNs and physician assistants are each named on the statutory list of those who may inject dermal or soft tissue fillers, subject to their own scope of practice and to the location requirement.

• An advanced practice registered nurse may engage in selected medical diagnosis and treatment; order home health care for a patient; if authorized pursuant to NRS 639.2351 and subject to the limitations set forth in subsection 3, prescribe controlled substances, poisons, dangerous drugs and devices.

  Nev. Rev. Stat. §632.237(2) · verified Sep 3, 2026

• An advanced practice registered nurse shall not engage in any diagnosis, treatment or other conduct which the advanced practice registered nurse is not qualified to perform.

  Nev. Rev. Stat. §632.237(2) · verified Sep 3, 2026

An advanced practice registered nurse in New Hampshire is a registered nurse currently licensed by the board under RSA 326-B:18, and the statute defines the APRN-patient relationship in medical terms: an in-person or telemedicine exam, a history, a diagnosis, a treatment plan appropriate to the licensee’s specialty, and documentation of every prescription drug by name and dosage.

• Advanced practice registered nurse or APRN means a registered nurse currently licensed by the board under RSA 326-B:18.

  N.H. Rev. Stat. §326-B:2, I · verified Sep 3, 2026

• Nursing means assisting clients or groups of clients to attain or maintain optimal health by implementing a strategy of care to accomplish defined goals and by evaluating responses to nursing care and medical treatment.

  N.H. Rev. Stat. §326-B:2, VII · verified Sep 3, 2026

The delegation rule names the licensed people a physician may direct — physical therapists, registered and practical nurses, physician assistants, chiropractors, athletic trainers and occupational therapists — and treats them as a different category from the unlicensed aide. The examination, qualification and supervision duties are undiminished: delegating to a licensed person relaxes none of them.

• Licensed health care providers a physician may direct to administer modalities include physical therapists, registered nurses, licensed practical nurses, physician assistants, chiropractors, athletic trainers and occupational therapists, the last with restrictions on advanced modalities.

  N.J.A.C. 13:35-6.14(a) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• Where the modality is administered by a licensed provider rather than an aide, the physician must still examine the patient, determine the appropriate modality, satisfy themselves as to that provider’s qualifications, and supervise properly. Delegating to a licensed person lowers none of those duties.

  N.J.A.C. 13:35-6.14(c) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

New Mexico tiers the nursing licenses explicitly for this setting. An APRN with the appropriate population foci, licensure, national certification and education may perform aesthetic healthcare procedures and is the only nursing license that may serve as a clinical supervisor. An RN may perform them with appropriate education and training only if delegated by and under the INDIRECT supervision of an APRN or other clinical supervisor. An LPN may perform them only under DIRECT supervision — the supervisor physically in the facility — and may not perform aesthetic injections at all. An RN or LPN may not serve as a clinical supervisor.

• Scope of practice for APRNs may include aesthetic healthcare procedures with the appropriate population foci , licensure, national APRN certification and education.

  16.12.14.8(D) NMAC (Education and scope of practice) · verified Sep 4, 2026

• Scope of practice for RNs may include aesthetic healthcare procedures with the appropriate education and training only if delegated by, and under the indirect supervision of an APRN or other clinical supervisor.

  16.12.14.8(E) NMAC (Education and scope of practice) · verified Sep 4, 2026

The New York rules on this, verbatim from the source:

• Registered professional nursing includes executing medical regimens prescribed by a licensed physician, dentist or other authorized provider. A nursing regimen must be consistent with, and may not vary, an existing medical regimen — so a registered nurse administers an injectable pursuant to an order rather than on their own judgment.

  N.Y. Educ. Law §6902(1) · verified Aug 17, 2026

• A certified nurse practitioner may diagnose illness and physical conditions and perform therapeutic and corrective measures within a specialty area, in collaboration with a physician qualified to collaborate in that specialty, under a written practice agreement and written practice protocols. Where the agreement does not resolve a disagreement over diagnosis or treatment, the collaborating physician’s view prevails.

  N.Y. Educ. Law §6902(3)(a)(i) · verified Aug 17, 2026

• A nurse practitioner may issue prescriptions for drugs, devices and immunizing agents in accordance with the practice agreement and protocols, but only after obtaining a certificate from the department for completing an appropriate pharmacology program.

  N.Y. Educ. Law §6902(3)(a)(ii) · verified Aug 17, 2026

• A physician assistant may perform medical services only under the supervision of a physician, and only where the acts assigned are within the supervising physician’s own scope of practice. That supervision must be continuous, but is not construed as requiring the physician’s physical presence where the services are performed. No physician may employ or supervise more than six physician assistants in private practice at one time.

  N.Y. Educ. Law §6542 · verified Aug 17, 2026

North Carolina answers the injector question directly rather than by inference. Chemical peels, sclerotherapy, micropigmentation, light treatments, microdermabrasion, laser hair removal and neuromodulator and dermal filler injections are all inside a licensed nurse’s scope — on conditions.

• It is within the scope of practice of a licensed nurse (RN and LPN) to perform cosmetic and aesthetic dermatological procedures — expressly including neuromodulator and dermal filler injections, chemical peels, sclerotherapy, micropigmentation, light treatments, microdermabrasion and laser for aesthetics and hair removal — when prescribed or ordered by a physician, nurse practitioner, physician assistant or other practitioner with prescriptive authority acting within their legal scope.

  NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) · verified Aug 17, 2026

• The nurse must have documented knowledge, skill and competency to carry out the procedure safely, and the employing agency’s cosmetic procedure and emergency policies must be available in the facility. Nurses are accountable for practicing within the scope of their highest level of active licensure.

  NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022); 21 NCAC 36.0224, 36.0225 · verified Aug 17, 2026

The Nurse Practices Act defines an advanced practice registered nurse as one licensed in the state within one of four roles — certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife or certified clinical nurse specialist — and functioning in a population focus the board approves. On delegation, § 43-12.1-16 provides that a licensed nurse MAY delegate medication administration to a person the chapter exempts under two named subsections. These claims establish the APRN definition and the delegation limit; they do not establish whether an APRN may practice without physician collaboration.

• means an individual who holds a current license to practice in this state as an advanced practice registered nurse within one of the roles of certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, or certified clinical nurse specialist, and who functions in one of the population foci as approved by the board

  N.D.C.C. § 43-12.1-02 (Definition of advanced practice registered nurse) · verified Sep 5, 2026

• A licensed nurse may delegate medication administration to a person exempt under subsections 9 and 13 of section 43 - 12.1 - 04.

  N.D.C.C. § 43-12.1-16 (Delegation of medication administration) · verified Sep 5, 2026

Ohio is a collaboration state for nurse practitioners — a CNP practices in collaboration with one or more physicians, not independently — and the laser rule then treats nurses as delegatees rather than autonomous operators.

• A certified nurse practitioner, in collaboration with one or more physicians or podiatrists, may provide preventive and primary care services, provide services for acute illnesses, and evaluate and promote patient wellness within the nurse’s nursing specialty, and may prescribe drugs and therapeutic devices, within limits consistent with their education and certification.

  Ohio Rev. Code §4723.43(B) · verified Aug 17, 2026

• A physician assistant may be delegated light-based device application only where the physician holds an effective supervision agreement with that physician assistant, and the assistant meets the training requirements that apply to physician assistants under Chapter 4730.

  Ohio Admin. Code 4731-18-03 · Ohio Rev. Code §4730.21 · verified Aug 17, 2026

Oklahoma grants independent prescriptive authority, and it is earned in hours. § 567.4c opens it to an APRN recognized as a Certified Nurse Practitioner, Clinical Nurse Specialist or Certified Nurse-Midwife who has completed a minimum of 6,240 clinical practice hours with prescriptive authority. Prescribing remains formulary-bounded either way: the Board maintains an EXCLUSIONARY formulary listing drugs and categories an APRN may not prescribe, and its Formulary Advisory Council also recommends practice-specific prescriptive standards for each category of APRN. These claims establish the hours threshold, the exclusionary formulary and that recommendation duty; they do not establish which drugs the current formulary excludes.

• An Advanced Practice Registered Nurse recognized by the Oklahoma Board of Nursing as a Certified Nurse Practitioner, Clinical Nurse Specialist, or Certified Nurse - Midwife who has completed a minimum of six thousand two hundred forty (6,240) clinical practice hours with prescriptive author

  Okla. Stat. tit. 59, § 567.4c(A) (Independent prescriptive authority for APRNs) · verified Sep 5, 2026

• exclusionary formulary that shall list drugs or categories of drugs that shall not be prescribed by an Advanced Practice Registered Nurse recognized to prescribe by the Oklahoma Board of Nursing.

  Okla. Stat. tit. 59, § 567.4b (The exclusionary formulary limits APRN prescribing) · verified Sep 5, 2026

Oregon defines the practice of nursing as autonomous and collaborative care, and includes within it executing medical orders prescribed by a physician or other authorized provider. Nurse practitioners are licensed by the Board of Nursing and the title is reserved; prescribing authority is separate, requiring approval under ORS 678.390 and bounded by the scope of practice the board defines by rule.

• Practice of nursing means autonomous and collaborative care of persons of all ages, families, groups and communities, sick and well, and in all settings to promote health and safety, including prevention and treatment of illness and management of changes throughout a person’s life. Practice of nursing includes executing medical orders prescribed by a physician, dentist, clinical nurse specialist, nurse practitioner, certified registered nurse anesthetist or other licensed health care provider authorized by the board by rule to issue orders for medical treatment.

  Or. Rev. Stat. §678.010(9) (“Practice of nursing” defined) · verified Sep 3, 2026

• A person may not practice as a nurse practitioner or hold oneself out to the public or to an employer, or use the initials, name, title, designation or abbreviation as a nurse practitioner until and unless the person is licensed by the board.

  Or. Rev. Stat. §678.375(2) · verified Sep 3, 2026

Pennsylvania is a collaborative-agreement state for nurse practitioners, and it is prescriptive about the paperwork: the agreement must name a substitute physician for when the collaborating one is unavailable.

• A certified registered nurse practitioner with prescriptive authority approval may prescribe and dispense drugs and give written or oral orders for drugs and other therapeutic or corrective measures only when acting in collaboration with a physician as set out in a prescriptive authority collaborative agreement, and only within the CRNP’s own certified specialty.

  49 Pa. Code §21.283(a) · verified Aug 17, 2026 · read at Cornell Legal Information Institute

• The collaborative agreement must be in writing, identify the collaborating physician, the CRNP and at least one substitute physician who will collaborate when the primary one is unavailable, be signed and dated by both, identify the CRNP’s certified specialty, specify the professional liability insurance covering the CRNP, and be reviewed and updated at least once every two years or whenever it changes.

  49 Pa. Code §21.285 · verified Aug 17, 2026 · read at Cornell Legal Information Institute

Rhode Island writes APRN autonomy into the definition itself. “Advanced practice registered nursing” means an independent and expanded scope of nursing, in a role and population focus approved by the board of nurse registration and nursing education, that includes the registered nurse scope of practice and may include performing acts of advanced assessment, diagnosing, prescribing and ordering. The APRN title covers the certified nurse practitioner, the certified registered nurse anesthetist and the certified clinical nurse specialist, each functioning in a population focus, and an APRN may serve as a primary- or acute-care provider of record. The same definition attaches the accountability: each APRN is accountable to patients, the profession and the board for complying with the chapter and for the quality of care rendered, for recognizing the limits of their knowledge and experience, for planning for situations beyond their expertise, and for consulting with or referring patients to other healthcare providers as appropriate. Physician assistants are on a different footing: they shall practice in collaboration with physicians, and within that may provide any medical or surgical services within their own skills, education and training, including prescribing, administering, procuring and dispensing drugs and medical devices.

• “Advanced practice registered nursing” means an independent and expanded scope of nursing in a role and population focus approved by the board of nurse registration and nursing education that includes the registered nurse scope of practice and may include, but is not limited to, performing acts of advanced assessment, diagnosing, prescribing, and ordering.

  R.I. Gen. Laws §5-34-3(2) · verified Sep 3, 2026

• “Advanced practice registered nurse” (APRN) is the title given to an individual licensed to practice advanced practice registered nursing within one of the following roles: certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA) as defined in chapter 34.2 of this title, or certified clinical nurse specialist (CNS), and who functions in a population focus. An APRN may serve as a primary- or acute-care provider of record.

  R.I. Gen. Laws §5-34-3(1) · verified Sep 3, 2026

An advanced practice registered nurse in South Carolina may perform specified medical acts only pursuant to a written practice agreement with a physician or medical staff — the agreement must establish the medical aspects of care to be provided, including prescribing, and must contain mechanisms letting the physician ensure clinical quality and patient safety. The medical acts a nurse may perform are agreed jointly by the Board of Nursing and the Board of Medical Examiners.

• A practice agreement means a written agreement developed by an NP, CNM, or CNS and a physician or medical staff who agrees to work with and to support the NP, CNM, or CNS. The practice agreement must establish the medical aspects of care to be provided by the NP, CNM, or CNS, including the prescribing of medications. The practice agreement must contain mechanisms that allow the physician to ensure that quality of clinical care and patient safety is maintained in accordance with state and federal laws, as well as all applicable Board of Nursing and Board of Medical Examiners rules and regulations.

  S.C. Code §40-33-20(45) (“Practice agreement” defined) · verified Sep 3, 2026

• An APRN also may perform specified medical acts pursuant to a practice agreement as defined in item (45).

  S.C. Code §40-33-20 (advanced practice registered nurse) · verified Sep 3, 2026

South Dakota enumerates the certified nurse practitioner scope as a list of powers ADDED to the registered nurse scope. Within the CNP role and population focus, a certified nurse practitioner may conduct an advanced assessment; order and interpret diagnostic procedures; establish primary and differential diagnoses; and prescribe, order, administer and furnish therapeutic measures — including diagnosing, prescribing and instituting therapy or referrals, and prescribing, procuring, administering and furnishing pharmacological agents, over-the-counter, legend and controlled drugs listed on Schedule II included. The same subsection extends to planning and initiating a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, naming durable medical equipment and medical devices among them. Physician assistants are scoped by capability on the face of these claims: a PA may provide the enumerated medical and surgical services FOR WHICH THE PA has been prepared by education, training and experience and is competent to perform — and among the licensure criteria on record is that the board MAY grant a license to an applicant who has either filed an affidavit attesting to at least six thousand practice hours or entered into a collaborative agreement.

• In addition to the registered nurse scope of practice, as defined in §36-9-3, and within the certified nurse practitioner role and population focus, a certified nurse practitioner may perform the following advanced practice registered nursing scope: conduct an advanced assessment; order and interpret diagnostic procedures; establish primary and differential diagnoses; and prescribe, order, administer, and furnish therapeutic measures.

  S.D. Codified Laws §36-9A-12 · verified Sep 3, 2026

• A certified nurse practitioner may diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources; and prescribe, procure, administer, and furnish pharmacological agents, including over the counter, legend, and controlled drugs or substances listed on Schedule II in chapter 34-20B.

  S.D. Codified Laws §36-9A-12(4) · verified Sep 3, 2026

WHERE a physician supervises a Tennessee certified nurse practitioner who writes prescriptions, that physician must hold an UNENCUMBERED license — the same standard the Board of Medical Examiners applies to physician assistants, and set out in that board’s own rules.

• A physician supervising a certified nurse practitioner who writes prescriptions must hold an unencumbered license, the rule stating this is the same requirement already applying to physicians who supervise physician assistants. Tennessee sets one supervisory standard across both roles rather than two.

  Tenn. Comp. R. & Regs. 0880-02-.14(12), referring to 0880-02-.18(1) and 0880-06-.02(1) · verified Sep 2, 2026

• ⚠️ The detailed scope of certified nurse practitioner practice is set by rule 0880-06 and by the Board of Nursing, not by chapter 0880-02, so this corpus does not state from this source whether a Tennessee nurse practitioner may practice without physician involvement. What chapter 0880-02 establishes is the supervising physician’s side of the arrangement.

  Tenn. Comp. R. & Regs. ch. 0880-02 (scope of this chapter) · verified Sep 2, 2026

The Texas rules on this, verbatim from the source:

• A registered nurse who is not an APRN (and an LVN) may not perform medical diagnosis or prescribe, but may carry out a delegated medical act — such as administering a cosmetic injection ordered by an appropriately licensed practitioner — when the Board of Nursing’s criteria are met: documented competency/education, written policies and guidelines, an order from an appropriate licensed practitioner, and available medical and nursing support.

  Tex. BON Position Statement 15.11 · verified Jul 26, 2026

• For laser therapy performed by RNs or LVNs, the Board of Nursing directs nurses to the Texas Medical Board’s delegation rule for nonsurgical cosmetic procedures and to the Health & Safety Code’s laser provisions.

  Tex. BON Position Statement 15.9 · verified Jul 26, 2026

• The APRN acts independently, under the delegated authority of a physician and/or in collaboration with other health care professionals in the delivery of health care services, and APRNs utilize mechanisms, including protocols, prescriptive authority agreements, or other written authorization, that provide them with the authority to provide medical aspects of care, including the ordering of dangerous drugs, controlled substances, or devices that bear a federal prescription legend.

  Texas BON Position Statement 15.18 (Nurses Carrying out Orders from Advanced Practice Registered Nurses) · verified Sep 8, 2026

• Texas defines the physician assistant’s practice as delegated practice, and the injection sits inside it. “The practice of a physician assistant includes providing medical services delegated by a supervising physician that are within the education, training, and experience of the physician assistant.” The enumerated services include “ordering or performing diagnostic and therapeutic procedures” and “prescribing or ordering a drug or device as provided by Subchapter B” of Chapter 157. The relationship is stated as agency: “A physician assistant is the agent of the physician assistant’s supervising physician for any medical services that are delegated by that physician” and that “are delineated by protocols, practice guidelines, or practice directives established by the supervising physician”.

  Tex. Occ. Code § 204.202(a)-(b), (e) (Scope of practice) · verified Sep 8, 2026

• Prescribing takes a separate written instrument, and the physician’s side of it is capped. “a physician may delegate to an advanced practice registered nurse or physician assistant, acting under adequate physician supervision, the act of prescribing or ordering a drug or device as authorized through a prescriptive authority agreement” between them. “the combined number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement may not exceed seven”, or their full-time equivalent — a limit that does not apply to a practice serving a medically underserved population or to a facility-based practice.

  Tex. Occ. Code § 157.0512(a), (c)-(d) (Prescriptive authority agreement) · verified Sep 8, 2026

Utah routes prescribing through the license. Issuing a prescription for a prescription drug as an RN or LPN is listed as unprofessional conduct except under Section 58-17b, the section the rule itself names. The nursing rules name who may direct the tasks of a licensed practical nurse — an advanced practice registered nurse, a certified nurse midwife, a physician assistant, and other named practitioners —. On the medical side, the licensure-exemption rule for medical assistants places the injection of a neurotoxin or filler for cosmetic purposes outside what that exemption covers.

• as an RN or LPN, issuing a prescription for a prescription drug to a patient, except under Section 58-17b

  Utah Admin. Code R156-31b-502(1)(c) (Unprofessional conduct) · verified Sep 4, 2026

• "APRN" means advanced practice registered nurse. (4) "APRN-CRNA" means advanced practice registered nurse with registered nurse anesthetist certification.

  Utah Admin. Code R156-31b-102(3)-(4) (Definitions) · verified Sep 4, 2026

Vermont runs a transition-to-practice scheme rather than immediate independence. An APRN is licensed to perform acts of medical diagnosis and to prescribe medical, therapeutic or corrective measures; but an APRN with fewer than 24 months and 2,400 hours of licensed active advanced nursing practice must hold a formal collaborative provider agreement and MAY NOT engage in solo practice until those requirements are met.

• An APRN with fewer than 24 months and 2,400 hours of licensed active advanced nursing practice in an initial role and population focus, or fewer than 12 months and 1,600 hours for any additional role and population focus, shall have a formal agreement with a collaborating provider as required by Board rule.

  Vt. Stat. tit. 26, §1613(a)(1) (Transition to practice) · verified Sep 3, 2026

• Advanced practice registered nurse or APRN means a licensed registered nurse authorized to practice in this State who, because of specialized education and experience, is licensed and authorized to perform acts of medical diagnosis and to prescribe medical, therapeutic, or corrective measures under administrative rules adopted by the Board.

  Vt. Stat. tit. 26, §1572(4) · verified Sep 3, 2026

A Virginia nurse practitioner can reach autonomous practice, but only by meeting a statutory experience threshold; until then a written practice agreement with a named patient care team physician is mandatory.

• An advanced practice registered nurse requires a JOINT license from the Board of Medicine and the Board of Nursing, and it is unlawful to practice as one in the Commonwealth without it. Virginia does not treat advanced practice as a certification layered on a nursing license; it is its own joint license.

  Va. Code § 54.1-2957(B) · verified Sep 2, 2026

• ⚠️ autonomy is earned, not granted with the license. Every nurse practitioner who does not meet the requirements of subsection I SHALL maintain appropriate collaboration and consultation, evidenced in a written or electronic practice agreement, with at least one patient care team physician. A nurse practitioner who does meet those requirements may practice without one.

  Va. Code § 54.1-2957(C) · verified Sep 2, 2026

Registered nursing in Washington expressly includes executing a medical regimen prescribed by a physician, physician assistant or ARNP — and separately includes delegation. An ARNP’s expanded role is defined by the nursing board rather than by statute.

• Advanced registered nursing practice means the acts of a registered nurse plus an expanded role “the scope of which is defined by rule by the board”, and on board approval an ARNP may prescribe legend drugs and controlled substances in Schedule V, and Schedules II through IV subject to statutory conditions. The statute grants the authority and hands the scope to the nursing board.

  Wash. Rev. Code 18.79.050 · verified Sep 2, 2026

• A physician assistant may use an LLRP device on skin with the consent of a participating physician and in accordance with standard medical practice, provided they are appropriately trained in the physics, safety and techniques of the device beforehand and remain competent for as long as it is used. Washington gives physician assistants their own rule rather than treating them as a delegate under the physician’s.

  Wash. Admin. Code 246-918-125(4) and (5) · verified Sep 2, 2026

Prescribing is the hinge in West Virginia, and it is not automatic. The Board of Examiners for Registered Professional Nurses issues the advanced practice registered nurse license to an applicant nationally certified in one of four recognized roles, and an APRN is by virtue of that license also licensed as a registered professional nurse. Prescriptive authority is separate: an APRN becomes eligible to apply only after completing 45 contact hours of education in pharmacology and clinical management of drug therapy under a board-approved program, 15 of them within the two years immediately before entering a prerequisite collaborative relationship — and the board authorizes prescribing under the terms of a collaborative agreement, on being satisfied the collaborating physician is licensed in good standing. These claims survey the licensure and prescriptive-authority sections of the nursing article.

• An advanced practice registered nurse shall be eligible to apply for authorization to prescribe drugs pursuant to section fifteen-a of this article after having completed forty-five contact hours of education in pharmacology and clinical management of drug therapy under a program approved by the board, fifteen hours of which shall have been completed within the two-year period immediately prior to entering into a prerequisite collaborative relationship.

  W. Va. Code §30-7-15b(a)(3) · verified Sep 3, 2026

• The board shall authorize an applicant to prescribe prescription drugs under the terms of a collaborative agreement and in accordance with section fifteen-a of this article and applicable legislative rules if the applicant has met the prerequisites of subsection (a) of this section and the board is satisfied that the collaborating physician is licensed in good standing.

  W. Va. Code §30-7-15b(b) · verified Sep 3, 2026

Wisconsin’s medical board governs the physician’s side of a delegation; the nurse’s own scope sits with the Board of Nursing, and this corpus has not read that chapter.

• Whoever performs a delegated medical act in Wisconsin, the supervising physician remains answerable for it under the adequate-supervision test — which reaches licensed and unlicensed personnel alike. A nurse carrying out a delegated act is therefore working inside the physician’s duty, not outside it.

  Wis. Admin. Code Med §§ 10.02(1) and 10.03(1)(L) · verified Sep 2, 2026

• ⚠️ The scope of registered nursing and of advanced practice nursing in Wisconsin is set by ch. 441, Stats., and the Board of Nursing’s own rules — not by ch. 448 or Med 10. This corpus has not read that chapter, so nothing here states whether a Wisconsin nurse practitioner may practice without physician involvement.

  Wis. Admin. Code ch. Med 10 (scope of this chapter) · verified Sep 2, 2026

Wyoming writes prescribing authority into the DEFINITION of the advanced practice registered nurse. An APRN is a nurse who may prescribe, administer, dispense or provide nonprescriptive and prescriptive medications, including prepackaged medications, except Schedule I drugs; who has responsibility for the direct care and management of patients and clients in relation to their human needs, disease states and therapeutic and technological interventions; who holds a doctorate or master's degree in nursing or an APRN specialty, or completed an accredited APRN educational program before January 1, 1999; and who has completed an advanced program of study in a specialty area, passed a national certification examination in that same area, and been granted licensure by the board to practice as an APRN. The authority and the qualifications are stated together in one definition, so each element is a condition of the role. Physician assistants are described differently again: the statute says a physician assistant is an individual who practices medicine, qualified by education, training and experience to provide a broad range of diagnostic, therapeutic and preventive services, who may collaborate with or refer to the appropriate member of a healthcare team — and it puts the degree of collaboration at the practice level, which may include decisions made by the employer, group, hospital service or the credentialing and privileging systems.

• "Advanced practice registered nurse (APRN)" means a nurse who may prescribe, administer, dispense or provide nonprescriptive and prescriptive medications including prepackaged medications, except schedule I drugs as defined in W.S. 35-7-1013 and 35-7-1014.

  Wyo. Stat. Ann. §33-21-120(a)(i)(A) · verified Sep 3, 2026

• An advanced practice registered nurse has responsibility for the direct care and management of patients and clients in relation to their human needs, disease states and therapeutic and technological interventions.

  Wyo. Stat. Ann. §33-21-120(a)(i)(B) · verified Sep 3, 2026