Administrative Code

Virginia Administrative Code
6/13/2024

Part III. Practice Requirements

18VAC90-40-90. Practice agreement.

A. With the exceptions listed in subsection E of this section, an advanced practice registered nurse with prescriptive authority may prescribe only within the scope of the written or electronic practice agreement with a patient care team physician.

B. At any time there are changes in the patient care team physician, authorization to prescribe, or scope of practice, the advanced practice registered nurse shall revise the practice agreement and maintain the revised agreement.

C. The practice agreement shall contain the following:

1. A description of the prescriptive authority of the advanced practice registered nurse within the scope allowed by law and the practice of the advanced practice registered nurse.

2. An authorization for categories of drugs and devices within the requirements of § 54.1-2957.01 of the Code of Virginia.

3. The signature of the patient care team physician who is practicing with the advanced practice registered nurse or a clear statement of the name of the patient care team physician who has entered into the practice agreement.

D. In accordance with § 54.1-2957.01 of the Code of Virginia, a physician shall not serve as a patient care team physician to more than six advanced practice registered nurses with prescriptive authority at any one time.

E. Exceptions.

1. An advanced practice registered nurse licensed in the category of certified nurse midwife and holding a license for prescriptive authority may prescribe in accordance with a written or electronic practice agreement with a consulting physician or with a certified nurse midwife who has practiced for at least two years prior to entering into a practice agreement. An advanced practice registered nurse in the category of certified nurse midwife who has qualified for autonomous practice as set forth in 18VAC90-30-87 may prescribe without a practice agreement.

2. An advanced practice registered nurse licensed in the category of a clinical nurse specialist and holding authorization for prescriptive authority may prescribe in accordance with a written or electronic practice agreement with a consulting physician or may prescribe Schedule VI controlled substances without the requirement for inclusion of such prescriptive authority in a practice agreement.

3. An advanced practice registered nurse who is licensed in a category other than certified nurse midwife, certified registered nurse anesthetist, or clinical nurse specialist, and who has met the qualifications for autonomous practice as set forth in 18VAC90-30-86 may prescribe without a practice agreement with a patient care team physician.

Statutory Authority

§§ 54.1-2400 and 54.1-2957 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.2, eff. August 15, 1992; amended, Virginia Register Volume 16, Issue 21, eff. August 2, 2000; Volume 25, Issue 5, eff. December 25, 2008; Volume 31, Issue 21, eff. July 15, 2015; Volume 33, Issue 1, eff. October 5, 2016; Volume 36, Issue 22, eff. July 22, 2020; Volume 38, Issue 4, eff. November 10, 2021; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-40-100. (Repealed.)

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.3, eff. August 15, 1992; amended, Virginia Register Volume 13, Issue 20, eff. July 23, 1997; Volume 19, Issue 7, eff. January 15, 2003; Volume 24, Issue 6, eff. January 11, 2008; Volume 25, Issue 5, eff. December 25, 2008; repealed, Virginia Register Volume 31, Issue 21, eff. July 15, 2015.

18VAC90-40-110. Disclosure.

A. The advanced practice registered nurse shall include on each prescription issued or dispensed his signature and the Drug Enforcement Administration (DEA) number, when applicable. If the advanced practice registered nurse's practice agreement authorizes prescribing of only Schedule VI drugs and the advanced practice registered nurse does not have a DEA number, he shall include the prescriptive authority number as issued by the boards.

B. The advanced practice registered nurse shall disclose to patients at the initial encounter that he is a licensed advanced practice registered nurse. Such disclosure may be included on a prescription pad or may be given in writing to the patient.

C. The advanced practice registered nurse shall disclose, upon request of a patient or a patient's legal representative, the name of the patient care team physician and information regarding how to contact the patient care team physician.

Statutory Authority

§§ 54.1-2400 and 54.1-2957.1 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.4, eff. August 15, 1992; amended, Virginia Register Volume 19, Issue 7, eff. January 15, 2003; Volume 31, Issue 21, eff. July 15, 2015; Volume 36, Issue 12, eff. March 4, 2020; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-40-120. Dispensing.

An advanced practice registered nurse may dispense only those manufacturers' samples of drugs that are included in the written or electronic practice agreement.

Statutory Authority

§§ 54.1-2400, 54.1-2957, and 54.1-2957.01 of the Code of Virginia.

Historical Notes

Derived from VR495-03-1 and VR465-12-1 § 3.5, eff. August 15, 1992; amended, Virginia Register Volume 16, Issue 21, eff. August 2, 2000; Volume 19, Issue 7, eff. January 15, 2003; Volume 34, Issue 9, eff. February 8, 2018; Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-40-121. Prescribing for self or family.

A. Treating or prescribing shall be based on a bona fide practitioner-patient relationship, and prescribing shall meet the criteria set forth in § 54.1-3303 of the Code of Virginia.

B. An advanced practice registered nurse shall not prescribe a controlled substance to himself or a family member, other than Schedule VI as defined in § 54.1-3455 of the Code of Virginia, unless the prescribing occurs in an emergency situation or in isolated settings where there is no other qualified practitioner available to the patient, or it is for a single episode of an acute illness through one prescribed course of medication.

C. When treating or prescribing for self or family, the advanced practice registered nurse shall maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 25, Issue 5, eff. December 25, 2008; amended, Virginia Register Volume 40, Issue 4, eff. November 8, 2023.

18VAC90-40-122. Waiver for electronic prescribing.

A. Beginning July 1, 2020, a prescription for a controlled substance that contains an opioid shall be issued as an electronic prescription consistent with § 54.1-3408.02 of the Code of Virginia, unless the prescription qualifies for an exemption as set forth in subsection C of § 54.1-3408.02.

B. Upon written request, the boards may grant a one-time waiver of the requirement of subsection A of this section for a period not to exceed one year, due to demonstrated economic hardship, technological limitations that are not reasonably within the control of the prescriber, or other exceptional circumstances demonstrated by the prescriber.

Statutory Authority

§§ 54.1-2400 and 54.1-3408.02 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 38, Issue 10, eff. February 2, 2022.

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