Missouri medical director requirements for med spas

Physician supervision & delegation in Missouri

⛔ 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

• The description shall include provisions that the advanced practice registered nurse shall submit a minimum of ten percent of the charts documenting the advanced practice registered nurse's delivery of health care services to the collaborating physician for review by the collaborating physician, or any other physician designated in the collaborative practice arrangement, every fourteen days.

  Mo. Rev. Stat. §334.104.3(9) · verified Sep 3, 2026

• The collaborating physician, or any other physician designated in the collaborative practice arrangement, shall review every fourteen days a minimum of twenty percent of the charts in which the advanced practice registered nurse prescribes controlled substances. The charts reviewed under this subdivision may be counted in the number of charts required to be reviewed under subdivision (9) of this subsection.

  Mo. Rev. Stat. §334.104.3(10) · verified Sep 3, 2026

• If a collaborative practice arrangement is used in clinical situations where a collaborating advanced practice registered nurse provides health care services that include the diagnosis and initiation of treatment for acutely or chronically ill or injured persons, then the collaborating physician or any other physician designated in the collaborative practice arrangement shall be present for sufficient periods of time, at least once every two weeks.

  Mo. Rev. Stat. §334.104.3(11) · verified Sep 3, 2026

• The collaborating physician and the advanced practice registered nurse shall maintain geographic proximity, except as specified in this paragraph.

  Mo. Rev. Stat. §334.104.3 · verified Sep 3, 2026

• Misconduct, fraud, misrepresentation, dishonesty, unethical conduct or unprofessional conduct in the performance of the functions or duties of any profession licensed or regulated by this chapter includes delegating professional responsibilities to a person who is not qualified by training, skill, competency, age, experience or licensure to perform such responsibilities.

  Mo. Rev. Stat. §334.100.2(4)(d) · verified Sep 3, 2026

• 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

Recent Missouri changes

• MO SB841: Modifies provisions relating to health careJan 7, 2026