Tennessee Code Annotated

Tenn. Code Ann. § 63-19-106 (2026)

Authorized services - Practice protocols for non-endorsed physician assistants - Endorsed physician assistants - Collaboration agreement requirements - Standard of care - Promulgation of rules

✓ current as of May 2026

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(a) A physician assistant is authorized to:
- (1) Perform medical diagnosis and treatment as a physician assistant pursuant either to a protocol or collaborative agreement, as applicable, for which the physician assistant has been prepared by education, training, and experience, and that the physician assistant is competent to perform only if licensed by the board and only within the usual scope of practice of the collaborating physician;
- (2) Perform minor surgical procedures, including, but not limited to:
  - (A) Simple laceration or surgery repair;
  - (B) Excision of skin lesions, moles, warts, cysts, or lipomas;
  - (C) Incision and draining of superficial abscesses;
  - (D) Skin biopsies;
  - (E) Arthrocentesis;
  - (F) Thoracentesis;
  - (G) Paracentesis;
  - (H) Endometrial biopsies;
  - (I) IUD insertion; and
  - (J) Colposcopy;
- (3) Assist a physician who performs procedures considered Level II office-based surgery or Level III office-based surgery, as those are defined in §§ 63-6-221 and 63-9-117, or a more complex procedure; provided, that:
  - (A) The physician assistant is credentialed or receives privileges from the medical staff of the facility to assist a physician with enumerated procedures;
  - (B) The physician performing the procedure is credentialed or privileged to perform the procedure by the medical staff of the facility; and
  - (C) The physician is present or immediately available for consultation with the physician assistant during and after the procedure;
- (4) Issue drugs authorized by law pursuant to protocols or collaborative agreement, and as applicable:
  - (A) Prescribe, dispense, order, administer, and procure appropriate medical devices, legend drugs, and controlled substances that are within the physician assistant's scope of practice if the physician assistant has registered and complied with all applicable requirements of state law and rule and the federal drug enforcement administration; and
  - (B) Only prescribe or issue a Schedule II or Schedule III opioid for a maximum of a nonrefillable, thirty-day course of treatment. This subdivision (a)(4)(B) does not apply to a prescription issued in a hospital, a nursing home licensed under title 68, or an inpatient facility licensed under title 33;
- (5) Unless a physician assistant's protocols or collaborative agreement indicate otherwise, plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including:
  - (A) Durable medical equipment;
  - (B) Nutrition;
  - (C) Blood and blood products; and
  - (D) Diagnostic support services that include, but are not limited to, home health care, hospice, and physical and occupational therapy; and
- (6) Complete, sign, and file medical certifications of death pursuant to § 68-3-502, if authorized to do so in the physician assistant's protocol or collaborative agreement.

(b)
- (1) A physician assistant who has not received endorsement from the board of physician assistants shall practice under protocols jointly developed by the collaborating physician and the physician assistant.
- (2) The physician assistant shall maintain a copy of the protocols either on paper or electronically at each of the physician assistant's practice locations and shall make the protocols available upon request by the board of physician assistants, the licensing board of the collaborating physician, or an authorized agent thereof.
- (3) The protocols must set forth the range of services that may be provided by the physician assistant and must also contain a discussion of the problems and conditions likely to be encountered by the physician assistant and the appropriate treatment for such problems and conditions.
- (4) Physician assistant practice under protocols requires active and continuous overview of the physician assistant's activities to ensure that the physician's directions and advice are implemented, but does not require the continuous and constant physical presence of the collaborating physician.
- (5) A physician assistant may perform only those tasks that are within the physician assistant's range of skills and competence, that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of the patients.
- (6) Protocols must also include, at a minimum, the following:
  - (A) The physician assistant's name, license number, and primary practice location;
  - (B) The collaborating physician's name, license number, medical specialty, and primary practice location;
  - (C) A general description of the oversight of the physician assistant by the collaborating physician;
  - (D) A general description of the physician assistant's process for collaboration with physicians and other members of the healthcare team;
  - (E) A process by which one hundred percent (100%) of patient charts are reviewed by the collaborating physician within ten (10) days when a prescription for a controlled drug is issued by the physician assistant;
  - (F) A process by which at least twenty percent (20%) of the physician assistant's patient charts are reviewed by the collaborating physician every thirty (30) days;
  - (G) If the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which the patient medical charts prepared by the physician assistant described in subdivisions (b)(6)(E) and (F) are reviewed by the collaborating physician for a minimum of six (6) months or until the physician assistant becomes eligible for endorsement, whichever period is longer;
  - (H) If the physician assistant practices in a remote location site from the collaborating physician's practice site, that the collaborating physician shall conduct a remote site visit at least every thirty (30) days as provided in § 63-19-107;
  - (I) That the physician assistant collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care when a patient presents with a condition that is outside of the competence, scope of practice, or experience of the physician assistant or collaborating physician; and
  - (J) Designation of one (1) or more alternative physicians for consultation in situations in which the collaborating physician is not available for consultation.

(c)
- (1) A physician assistant who has received an endorsement from the board shall have a collaborative agreement with a physician.
- (2) The physician assistant shall maintain a copy of the collaborative agreement either on paper or electronically at each of the physician assistant's practice locations and make the collaborative agreement available upon request by the board of physician assistants, the licensing board of the collaborating physician, or an authorized agent of such boards.
- (3) To be eligible to receive endorsement from the board, a physician assistant must, at a minimum, have six thousand (6,000) hours of documented postgraduate clinical experience, have a physician willing to enter into a collaborative agreement with the physician assistant, and meet such other requirements as set forth in rules promulgated by the board. A physician assistant with six thousand (6,000) hours or more of documented postgraduate clinical experience shall not practice pursuant to the requirements in this chapter or rules promulgated thereto for endorsed physician assistants without first receiving endorsement by the board. This chapter does not require a physician assistant to become endorsed by the board. Unless a physician assistant has received an endorsement from the board, the requirements of subsection (b) apply.

(d) Collaborative agreements governing physician assistants who have six thousand (6,000) or more hours of documented postgraduate clinical experience and are endorsed by the board must include, at a minimum, the following:
- (1) The physician assistant's name, license number, and primary practice location;
- (2) The collaborating physician's name, license number, medical specialty, and primary practice location;
- (3) That the physician assistant performs only those services that are within the physician assistant's competence, knowledge, and skills that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of patients;
- (4) A process by which one hundred percent (100%) of patient charts are reviewed by the collaborating physician within thirty (30) days when a prescription for any drug containing buprenorphine for use in recovery or medication treatment or a Schedule II controlled drug is issued by the physician assistant;
- (5) That if the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which a sample of patient medical charts prepared by the physician assistant are reviewed by the collaborating physician, or a physician designated by the collaborating physician, for a minimum of six (6) months;
- (6) That the physician assistant collaborates with, consults with, or refers to the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care;
- (7) Methods of communication between the physician assistant and collaborating physician; and
- (8) Requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the physician assistant within the expected scope of practice of the physician assistant.

(e) A physician assistant practicing in collaboration with a licensed podiatrist, in addition to meeting the requirements of this chapter:
- (1) Shall not provide services that are outside the scope of practice of a podiatrist as set forth in § 63-3-101;
- (2) Shall comply with the requirements of, and rules adopted pursuant to, this section and § 63-19-107 governing the collaboration with a physician assistant; and
- (3) May only prescribe drugs that are rational to the practice of podiatry.

(f) A physician assistant may render emergency medical services in cases where immediate diagnosis and treatment are necessary to avoid patient death or disability.

(g) The standard of care for a physician assistant is the same standard of care as applicable to a physician who performs the same service.

(h)
- (1) The initial rules governing the collaborative agreements of physician assistants with physicians licensed under chapter 3, 6, or 9 of this title must be established and promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, by a task force composed of:
  - (A) One (1) member from the board of medical examiners;
  - (B) One (1) member from the board of osteopathic examination;
  - (C) One (1) member from the board of podiatric medical examiners; and
  - (D) Three (3) members from the board of physician assistants.
- (2) The task force must create uniform rules governing the collaboration of physician assistants with physicians licensed under chapter 3, 6, or 9 pursuant to this section, which are binding on each board listed in subdivision (h)(1).
- (3) The rules created by the task force must create standard procedures to determine the responsibility for the review of patient medical charts.
- (4) Each board listed in subdivision (h)(1) shall select and appoint by a majority vote of its members a board member to serve on the task force before September 1, 2024.
- (5) The task force shall select and appoint a member to serve as chair of the task force.
- (6) A majority of the task force constitutes a quorum, and a majority vote of the task force members present is required for any action.
- (7) Notwithstanding the Uniform Administrative Procedures Act to the contrary, the task force shall hear public comment at any required hearing on behalf of all boards listed in subdivision (h)(1) when a hearing is required. The task force is authorized to vote to promulgate the rules governing the collaboration of physician assistants with physicians licensed under chapter 3, 6, or 9 for each board listed in subdivision (h)(1).
- (8) The task force shall terminate upon the effective date of a permanent rule establishing collaboration pursuant to this section. All future rules regarding collaboration pursuant to this section after the termination of the task force must be adopted jointly by each relevant board in subdivision (h)(1).
- (9) This part does not prohibit the licensing boards listed in subdivision (h)(1) from promulgating additional rules regarding the licensees of such boards.

Amended by 2024 Tenn. Acts, ch. 1042,s 2, eff. upon promulgation of rules governing the collaborative agreements of physician assistants with physicians; see T.C.A. § 63-19-106(h)(1).

Amended by 2021 Tenn. Acts, ch. 565, s 6, eff. 5/26/2021.

Amended by 2018 Tenn. Acts, ch. 610, Secs.s 6, s 7, s 8, s 9, s 10, s 11, s 12, s 13 eff. 7/1/2018.

Amended by 2018 Tenn. Acts, ch. 610, s 5, eff. 7/1/2018.

Amended by 2016 Tenn. Acts, ch. 946, s 4, eff. 4/27/2016.

Amended by 2015 Tenn. Acts, ch. 189, s 1, eff. 7/1/2015.

Acts 1985, ch. 376, § 1; T.C.A., § 63-19-206; Acts 1994, ch. 722, § 1; 1995, ch. 358, § 2; 1996, ch. 659, § 3; 1998, ch. 842, § 4; 1999, ch. 33, § 1.

Notes of Decisions

Cited in 5 cases, 2009–2019 · leading case: Cox v. MA Primary & Urgent Care Clinic, 313 S.W.3d 240 (Tenn. 2010).

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Cox v. MA Primary & Urgent Care Clinic, 313 S.W.3d 240 (Tenn. 2010). · cites it 9× “§ 63-19-105 may provide selected medical/surgical services as outlined in a written protocol according to T.C.A. § 63-19-106, and when such services are within his skills.”

Melissa Michelle Cox v. M. A. Primary (Tenn. Ct. App. 2009). · cites it 14× “Cox contends that Tenn. Code Ann. § 63-19-106 “sets forth a vicarious standard based upon the supervision rendered by the primary care physician.”

Marchelle Buman, of the Est. of Kenneth Jenkins v. Alycia D. Gibson, P.A., Thomas Paul Evans, M.D., Andrew H. Lundberg, M.D., & Paris Surgical Specialists, PLLC (Tenn. Ct. App. 2014). · cites it 14× “Tenn. Code Ann. § 63-19-106 (a)(1). Buman contends the first sentence of subsection (1) requires that supervising physicians maintain an “active and continuous overview of the physician assistant’s activities.”

Tennessee Dep't of Health v. Norma J. Sparks (2019). · cites it 6× “See Tenn. Code Ann. § 63-19-106 (a)(1). Beginning in November 2010, Sparks worked as a physician assistant at Beersheba Springs Medical Clinic (“Clinic”).”

Daniels, Cathy v. Cracker Barrel Old Country Store, Inc., 2015 TN WC 19 (Tenn. Ct. Work. Comp. Cl. 2015). · cites it 2× “Section 63-19-106(a) provides that: "A physician assistant is authorized to perform selected medical services only under the supervision of a licensed physician" (emphasis added).”

— Tenn. Code Ann. § 63-19-106(a) — 2 cases

Cox v. MA Primary & Urgent Care Clinic, 313 S.W.3d 240 (Tenn. 2010). “§ 63-19-105 may provide selected medical/surgical services as outlined in a written protocol according to T.C.A. § 63-19-106, and when such services are within his skills.”

Daniels, Cathy v. Cracker Barrel Old Country Store, Inc., 2015 TN WC 19 (Tenn. Ct. Work. Comp. Cl. 2015). “Section 63-19-106(a) provides that: "A physician assistant is authorized to perform selected medical services only under the supervision of a licensed physician" (emphasis added).”

— Tenn. Code Ann. § 63-19-106(a)(3) — 2 cases

Marchelle Buman, of the Est. of Kenneth Jenkins v. Alycia D. Gibson, P.A., Thomas Paul Evans, M.D., Andrew H. Lundberg, M.D., & Paris Surgical Specialists, PLLC (Tenn. Ct. App. 2014). “Tenn. Code Ann. § 63-19-106 (a)(1). Buman contends the first sentence of subsection (1) requires that supervising physicians maintain an “active and continuous overview of the physician assistant’s activities.”

— Tenn. Code Ann. § 63-19-106(b) — 2 cases

Melissa Michelle Cox v. M. A. Primary (Tenn. Ct. App. 2009). “Cox contends that Tenn. Code Ann. § 63-19-106 “sets forth a vicarious standard based upon the supervision rendered by the primary care physician.”

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