Must someone be on site while a patient is treated, state by state
The same question, answered for 29 states from each state’s own law. States disagree on this, which is the point — an answer that is right in one is wrong next door. Every entry below is a statute or board rule we verified, most recently Sep 8, 2026.
Oversight · part of The Practice Perimeter
| State | What its rule says | Cited to |
|---|---|---|
| Alabama | Not always — the delegating physician must provide either on-site or locally remote supervision for non-ablative treatments by a Level 1 or 2 delegate, with the choice driven by that delegate's training and experience and the risk of harm to the patient. | Ala. Admin. Code r. 540-X-11-.04(2)(f)-(g) (Delegation and supervision) Sep 4, 2026 |
| Alaska | Not always — the delegating physician, PA, podiatrist or osteopath need only be readily available for consultation, in person or by phone; but a delegated single IM, intradermal or subcutaneous injection requires them immediately available on site. | 12 AAC 40.920(b) (Availability for consultation) Sep 5, 2026 |
| Arkansas | (d)(1) The person administering anesthesia shall be physically present during the intraoperative period and shall be available until the patient has been discharged from anesthesia care. | 17 CAR § 140-2904(d) (Office-based surgery — anesthesia) Sep 4, 2026 |
| California | California does NOT require the supervising physician to be in the building, and the Medical Board says so in terms for physician assistants: physicians must be in the facility with the PA OR be immediately available by electronic communication where the PA works under a delegation of services agreement. | Medical Board of California — Medical Spas: What You Need to Know (Physician Assistants) Sep 1, 2026 |
| Connecticut | Only for a PA on a temporary permit — the supervising physician must be physically on the premises and immediately available. Otherwise the cited rules don't settle on-site presence, though they do require an in-person pre-procedure assessment. | Conn. Gen. Stat. §20-12b(a) (Temporary permit) Sep 8, 2026 |
| Delaware | Not always — a collaborating physician need only be reachable electronically while a PA treats. But for non-physician delegates, the delegating physician must be physically on the premises if a diagnosis or a prescription treatment plan is involved. | 24 Del. C. §1770A(2) (Physician associates — “Collaboration”) Sep 8, 2026 |
| Florida | Florida does not require a physician on the premises during every treatment — it regulates the ALTERNATIVE. | Fla. Stat. §458.348(3) Sep 1, 2026 |
| Georgia | It depends on the treatment: an assistant laser practitioner's patients must first be examined by a consulting physician, or a PA or APRN licensed as a cosmetic laser practitioner. Laser hair removal and pulsed light need no on-site supervision or prior exam. | Ga. Comp. R. & Regs. 360-35-.05(1)(c) Aug 17, 2026 |
| Hawaii | The cited rules do not settle this generally — only for physician assistants, whose supervision must be continuous but need not always be in person, at a degree the board sets; nothing cited fixes on-site presence for nurses, their delegatees or estheticians. | Haw. Rev. Stat. § 453-2(b)(5) Sep 8, 2026 |
| Illinois | Yes for ablative laser procedures — the physician must be on site; for non-ablative, the physician may instead be available by phone or other electronic means. Delegating to an unlicensed person also requires a health care professional on site. | 68 Ill. Adm. Code 1285.336(b)(2)–(3) Sep 8, 2026 |
| Indiana | The cited rules do not settle this — a med spa's responsible practitioner (physician, qualifying APRN, or PA with delegated prescriptive authority) must be physically present enough to ensure compliance, with no stated per-treatment presence rule. | Ind. Code §25-22.5-12.5-2, §25-22.5-12.5-5 (SEA 282, 2026) Jul 26, 2026 |
| Iowa | The cited rules do not settle this — they set a floor of direct, in-person, on-site supervision at least four hours each week, documented, plus the supervisor physically within 60 miles at all times; they do not address presence during each treatment. | Iowa Admin. Code r. 481—655.6(5)(c) (Supervision) Sep 4, 2026 |
| Maryland | Depends on the act — delegated injections and IV lines require a physician on site, and surgical acts require the physician scrubbed and personally operating in the same field; microdermabrasion, oral drugs and patient prep need no on-site supervision. | Md. Code Regs. 10.32.12.04(B)(1), (D)(1), (D)(2) Sep 8, 2026 |
| Michigan | The cited rules do not settle this generally — they require a physician physically present only where a surgical-instrumentation procedure is delegated to a medical or PA student, and they let boards impose closer supervision for specific acts or individuals. | Mich. Comp. Laws § 333.16215(2) Sep 2, 2026 |
| Mississippi | Not always — telemedicine needs no on-site presenter if the technology gives the physician the same information as an in-person exam; an on-site licensed provider is only an option when physical findings are needed. Laser use does require a physician on site. | Miss. Admin. Code Title 30, Part 2635, Rule 5.5 Sep 8, 2026 |
| Missouri | The cited rules do not settle this for all staff — they require a collaborating physician to be continuously present for an APRN's first documented month before that nurse practices without it, and say nothing about on-site presence for PAs or estheticians. | Mo. Rev. Stat. §334.104.9 Sep 8, 2026 |
| Montana | Yes, for medical assistants — a physician, PA, or podiatrist must be in the facility and quickly available for invasive procedures, injections other than immunizations, or medication administration; the cited rules set no general onsite rule for other staff. | Mont. Code Ann. § 37-3-104(1)(b) Sep 8, 2026 |
| Nevada | The cited rules do not settle this — during a nonablative esthetic medical procedure by an advanced esthetician, the supervising health care professional must be readily available at all times to intervene, but readily available is not defined as on-site. | Nev. Admin. Code §644A.846(3) Sep 8, 2026 |
| New Jersey | Yes — the delegating physician must stay on the premises the entire time an assistant is carrying out treatment orders, within reasonable proximity to the treatment room and available in an emergency. | N.J.A.C. 13:35-6.14(e)5 Aug 17, 2026 |
| New Mexico | Yes — for devices delegated to a medical assistant, the certified assistant may use a non-incisive, non-ablative therapeutic or cosmetic device only while the supervising physician is immediately available on the premises. | 16.10.13.8 NMAC (Use of medical therapeutic and cosmetic devices) Sep 4, 2026 |
| New York | All treatments with energy devices require an assessment of the patient's condition before, during and after the procedure, and registered professional nurses are the only professionals other than licensed medical practitioners authorized to perform general patient assessments. | N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Practitioner Guidelines — general supervision) Sep 8, 2026 |
| North Carolina | An RN does not require the on-site presence of a physician, nurse practitioner or physician assistant to perform a prescribed cosmetic procedure. | NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) Aug 17, 2026 |
| Ohio | Yes — for a vascular laser delegated to a nurse, the physician must provide on-site supervision at all times the device is being applied, and may supervise no more than two such delegates at the same time. | Ohio Admin. Code 4731-18-03(A)(8) and (A)(9) Sep 1, 2026 |
| Oklahoma | No — for a physician assistant, the supervising physician need not be physically present or consulted before each delegated service, so long as the two can easily reach each other by telecommunication for consultation, emergencies, or referral. | Okla. Stat. tit. 59, § 519.6(B) (Supervision — physical presence not required) Sep 8, 2026 |
| South Carolina | Only for delegated tasks — a certified medical assistant may perform one only while the delegating physician, PA, or APRN is close enough to be immediately available, which for unlicensed staff means within the office. No broader on-site rule is stated. | S.C. Code §40-47-196(B)(1)–(3) Sep 8, 2026 |
| Tennessee | Yes for remote evaluations — a facilitator must be physically present with the patient to verify identity and location and to originate, collect and transmit images and clinical data to the remote physician. The cited rule addresses no other setting. | Tenn. Comp. R. & Regs. 0880-02-.16(1)(a) Sep 2, 2026 |
| Texas | Yes — for a delegated cosmetic procedure, at least one person trained in basic life support must be present the whole time the patient is onsite; the supervising physician, PA, or APRN may be onsite or merely immediately available for emergency consultation. | 22 TAC §169.26 Jul 26, 2026 |
| Virginia | The cited rules settle this only for laser hair removal — there the supervising doctor need only be readily available, not physically present, but must personally see and evaluate any patient whose treatment caused complications before it continues. | 18 Va. Admin. Code § 85-20-91(E) Sep 2, 2026 |
| Washington | If the delegated procedure uses a medication or substance the FDA has NOT approved, or has not approved for the particular purpose it is being used for, the physician must be on-site for the entire duration of the procedure. | Wash. Admin. Code 246-919-606(12) and (13) Sep 2, 2026 |
Every state, in its own words
Alabama
(f) On-site or locally remote supervision for non-ablative treatments performed by Level 1 and 2 Delegates consistent with these rules, the training and experience of the delegate performing the procedure, and the risk of harm to the patient; (g) Personal evaluation and care for complications that arise;
Ala. Admin. Code r. 540-X-11-.04(2)(f)-(g) (Delegation and supervision) · verified Sep 4, 2026
The full Alabama answer, with the rest of the section → · Every Alabama rule on physician supervision & delegation →Alaska
shall remain readily available for consultation by the person to whom the duty is delegated, either in person or by telecommunication.
12 AAC 40.920(b) (Availability for consultation) · verified Sep 5, 2026
The full Alaska answer, with the rest of the section → · Every Alaska rule on physician supervision & delegation →Arkansas
(d)(1) The person administering anesthesia shall be physically present during the intraoperative period and shall be available until the patient has been discharged from anesthesia care. (2) They must be licensed, qualified, and working within their scope of practice as defined by state law.
17 CAR § 140-2904(d) (Office-based surgery — anesthesia) · verified Sep 4, 2026
The full Arkansas answer, with the rest of the section → · Every Arkansas rule on physician supervision & delegation →California
California does NOT require the supervising physician to be in the building, and the Medical Board says so in terms for physician assistants: physicians must be in the facility with the PA OR be immediately available by electronic communication where the PA works under a delegation of services agreement. The Board pairs that with a hard cap — a physician may supervise only FOUR physician assistants at any given time.
Medical Board of California — Medical Spas: What You Need to Know (Physician Assistants) · verified Sep 1, 2026
The full California answer, with the rest of the section → · Every California rule on physician supervision & delegation →Connecticut
A physician assistant practicing under a temporary permit may practice only in those settings where the supervising physician is physically present on the premises and is immediately available to the physician assistant when needed, and the permit does not authorize the holder to prescribe or dispense drugs.
Conn. Gen. Stat. §20-12b(a) (Temporary permit) · verified Sep 8, 2026
The full Connecticut answer, with the rest of the section → · Every Connecticut rule on physician supervision & delegation →Delaware
Collaboration is a process in which the physician who oversees patient services and the physician associate jointly contribute to the medical evaluation and treatment of patients, and the collaborating physician must be available for consultation during the patient encounter if needed. The constant physical presence of the collaborating physician is not required on-site in the practice setting, provided the collaborating physician is readily accessible by some form of electronic communication.
24 Del. C. §1770A(2) (Physician associates — “Collaboration”) · verified Sep 8, 2026
The full Delaware answer, with the rest of the section → · Every Delaware rule on physician supervision & delegation →Florida
Florida does not require a physician on the premises during every treatment — it regulates the ALTERNATIVE. Where an advanced practice registered nurse or physician assistant works at an office other than the supervising physician’s primary practice location and is NOT under that physician’s onsite supervision, §458.348(3) imposes a set of standards, and a med spa falls inside them: the subsection reaches practices providing primarily dermatologic and skin care services, which it says expressly include aesthetic skin care services.
Fla. Stat. §458.348(3) · verified Sep 1, 2026
The full Florida answer, with the rest of the section → · Every Florida rule on physician supervision & delegation →Georgia
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 full Georgia answer, with the rest of the section → · Every Georgia rule on good-faith examination →Hawaii
(5) Prohibit services rendered by any person licensed under part II of this chapter to provide emergency medical services, or any physician assistant, when the services are rendered under the direction and control of a physician or osteopathic physician licensed in this State except for final refraction resulting in a prescription for spectacles, contact lenses, or visual training as performed by an oculist or optometrist duly licensed by the State. The direction and control shall not be construed in every case to require the personal presence of the supervising and controlling physician or osteopathic physician. Any physician or osteopathic physician who employs or directs a person licensed under part II of this chapter to provide emergency medical services, or a physician assistant, shall retain full professional and personal responsibility for any act that constitutes the practice of medicine when performed by the licensed person or physician assistant;
Haw. Rev. Stat. § 453-2(b)(5) · verified Sep 8, 2026
The full Hawaii answer, with the rest of the section → · Every Hawaii rule on physician supervision & delegation →Illinois
A physician may delegate the performance of ablative procedures to a licensed practical nurse, a registered professional nurse, or other persons, with on-site supervision by the physician; and may delegate the performance of non-ablative procedures to the same persons with on-site supervision by the physician, or the physician must be available by telephone or other electronic means to respond promptly to any question or complication that may occur.
68 Ill. Adm. Code 1285.336(b)(2)–(3) · verified Sep 8, 2026
The full Illinois answer, with the rest of the section → · Every Illinois rule on good-faith examination →Indiana
Each med spa must have a responsible practitioner (a physician, a qualifying APRN, or a PA with delegated prescriptive authority) with relevant training, who must be physically present enough to ensure compliance and must ensure every worker is licensed and trained for the services they perform.
Ind. Code §25-22.5-12.5-2, §25-22.5-12.5-5 (SEA 282, 2026) · verified Jul 26, 2026
The full Indiana answer, with the rest of the section → · Every Indiana rule on physician supervision & delegation →Iowa
Ensure that all qualified licensed or certified nonphysician persons or qualified laser technicians receive direct, in-person, on-site supervision from the medical director or other qualified licensed physician or other qualified supervising nonphysician licensed health professional at least four hours each week and that the regular supervision is documented;
Iowa Admin. Code r. 481—655.6(5)(c) (Supervision) · verified Sep 4, 2026
The full Iowa answer, with the rest of the section → · Every Iowa rule on physician supervision & delegation →Maryland
Maryland sets the required physical presence by tier rather than by procedure. Patient preparation, history interviews, specimen collection, tuberculin skin tests, electrocardiography, transmitting prescriptions to a pharmacy, preparing and administering oral drugs and microdermabrasion may be delegated without on-site supervision. Injections and peripheral intravenous lines require on-site supervision. Surgical technical acts require the delegating physician to be present, scrubbed and personally performing the surgery in the same surgical field.
Md. Code Regs. 10.32.12.04(B)(1), (D)(1), (D)(2) · verified Sep 8, 2026
The full Maryland answer, with the rest of the section → · Every Maryland rule on physician supervision & delegation →Michigan
Surgical instrumentation is the bright line. A physician SHALL delegate an act involving a procedure that requires the use of SURGICAL INSTRUMENTATION only to an individual licensed under the article. The narrow exceptions — medical students and physician-assistant students — require the procedure to be DIRECTLY SUPERVISED by a physician who is PHYSICALLY PRESENT during it.
Mich. Comp. Laws § 333.16215(2) · verified Sep 2, 2026 · read at Internet Archive snapshot — evidence of a page, not the current rule
The full Michigan answer, with the rest of the section → · Every Michigan rule on physician supervision & delegation →Mississippi
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
The full Mississippi answer, with the rest of the section → · Every Mississippi rule on good-faith examination →Missouri
It is the responsibility of the collaborating physician to determine and document the completion of at least a one-month period during which the advanced practice registered nurse shall practice with the collaborating physician continuously present, before the nurse practices in a setting where the collaborating physician is not continuously present.
Mo. Rev. Stat. §334.104.9 · verified Sep 8, 2026
The full Missouri answer, with the rest of the section → · Every Missouri rule on physician supervision & delegation →Montana
The board shall adopt guidelines by administrative rule for the level of physician, physician assistant, or podiatrist supervision required for a medical assistant performing delegated tasks, and 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)(b) · verified Sep 8, 2026
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At all times during the performance of a nonablative esthetic medical procedure, the health care professional supervising the procedure must be readily available in accordance with NRS 644A.545 to provide care if medical intervention is required, and shall not direct the advanced esthetician performing the procedure to take any action that is outside the scope of practice.
Nev. Admin. Code §644A.846(3) · verified Sep 8, 2026
The full Nevada answer, with the rest of the section → · Every Nevada rule on physician supervision & delegation →New Jersey
The doctor must remain on site — on the premises — at all times that treatment orders are being carried out by the assistant, within reasonable proximity to the treatment room and available in the event of an emergency.
N.J.A.C. 13:35-6.14(e)5 · verified Aug 17, 2026 · read at Cornell Legal Information Institute
The full New Jersey answer, with the rest of the section → · Every New Jersey rule on good-faith examination →New Mexico
The use of medical therapeutic and cosmetic devices is the practice of medicine as defined in Section 61-6-1 NMSA 1978. A. Limitations. (1) Medical assistants are limited to using medical therapeutic and cosmetic devices that are non-incisive and non-ablative. (2) Medical therapeutic and cosmetic devices may only be used by a medical assistant who is certified pursuant to Subsection D of 16.10.13.7 NMAC and when the supervising physician is immediately available on the premises.
16.10.13.8 NMAC (Use of medical therapeutic and cosmetic devices) · verified Sep 4, 2026
The full New Mexico answer, with the rest of the section → · Every New Mexico rule on physician supervision & delegation →New York
All treatments with energy devices require an assessment of the patient's condition before, during and after the procedure, and registered professional nurses are the only professionals other than licensed medical practitioners authorized to perform general patient assessments. Under general supervision the supervising physician or nurse practitioner need not be physically present, but must be available to provide guidance or intervene within a reasonable period, depending on the treatment rendered.
N.Y. State Board for Medicine — Use of Energy Devices Including Lasers as the Practice of Medicine (Practitioner Guidelines — general supervision) · verified Sep 8, 2026
The full New York answer, with the rest of the section → · Every New York rule on physician supervision & delegation →North Carolina
An RN does not require the on-site presence of a physician, nurse practitioner or physician assistant to perform a prescribed cosmetic procedure. An LPN does: an LPN must have the on-site presence and supervision of an RN, physician, nurse practitioner, physician assistant or other licensed practitioner acting within their scope.
NC Board of Nursing, Cosmetic/Aesthetic Dermatological Procedures Position Statement (rev. 9/2022) · verified Aug 17, 2026
The full North Carolina answer, with the rest of the section → · Every North Carolina rule on good-faith examination →Ohio
For a vascular laser the physician must provide on-site supervision at all times the nurse is applying it, and may supervise no more than TWO such people at the same time. This is the cap that applies to vascular work only — hair removal has its own, and it is higher.
Ohio Admin. Code 4731-18-03(A)(8) and (A)(9) · verified Sep 1, 2026
The full Ohio answer, with the rest of the section → · Every Ohio rule on physician supervision & delegation →Oklahoma
The supervising physician need not be physically present nor be specifically consulted before each delegated patient care service is performed by a physician assistant, so long as the supervising physician and physician assistant are or can be easily in contact with one another by means of telecommunication; and in all patient care settings the supervising physician shall provide appropriate methods of supervising the health care services provided by the physician assistant.
Okla. Stat. tit. 59, § 519.6(B) (Supervision — physical presence not required) · verified Sep 8, 2026
The full Oklahoma answer, with the rest of the section → · Every Oklahoma rule on physician supervision & delegation →South Carolina
A physician, physician assistant, or advanced practice registered nurse may delegate specified tasks to a certified medical assistant only if the task is delegated directly and not through another licensed practitioner, the task is performed when the delegating practitioner is in such close proximity as to be immediately available to the CMA if needed, and the delegating practitioner determines that the task is within the training and competency of the CMA and will not pose a significant risk to the patient if improperly performed.
S.C. Code §40-47-196(B)(1)–(3) · verified Sep 8, 2026
The full South Carolina answer, with the rest of the section → · Every South Carolina rule on physician supervision & delegation →Tennessee
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
The full Tennessee answer, with the rest of the section → · Every Tennessee rule on good-faith examination →Texas
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
The full Texas answer, with the rest of the section → · Every Texas rule on good-faith examination →Virginia
⚠️ SUPERVISION MEANS READILY AVAILABLE, NOT PRESENT — WITH ONE THING THE DOCTOR MUST DO PERSONALLY. A doctor may delegate laser hair removal to a properly trained person under the doctor’s direction and supervision, which the rule defines as the doctor being READILY AVAILABLE at the time it is performed. The doctor is NOT required to be physically present, but IS required to SEE AND EVALUATE any patient whose treatment has resulted in complications BEFORE that patient’s treatment continues.
18 Va. Admin. Code § 85-20-91(E) · verified Sep 2, 2026
The full Virginia answer, with the rest of the section → · Every Virginia rule on physician supervision & delegation →Washington
⚠️ AND THE ON-SITE ANSWER TURNS ON THE LABEL. If the delegated procedure uses a medication or substance the FDA has NOT approved, or has not approved for the particular purpose it is being used for, the physician MUST BE ON-SITE FOR THE ENTIRE DURATION of the procedure. If it is FDA-approved for that purpose, the physician need not be on site but must be reachable by phone and able to RESPOND WITHIN THIRTY MINUTES to treat complications.
Wash. Admin. Code 246-919-606(12) and (13) · verified Sep 2, 2026
The full Washington answer, with the rest of the section → · Every Washington rule on physician supervision & delegation →Which states this covers
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