OSBOE Supervision Rules
Osteopathic Supervision of Mid-Level Practitioners
The below rule outlines the requirements for osteopathic physicians supervising mid-level practitioners.
Supervising osteopathic physicians must hold a full and unrestricted Oklahoma license, DEA permit, and OBNDD permit. They also must be qualified in the practitioner’s specialty. Each physician may supervise up to six (6) mid-level practitioners unless granted an exception by the Board.
A written supervision agreement is required for each mid-level practitioner. Physicians must visit each practice site at least monthly, review a minimum of 15% of patient charts each month and review any identified high-risk procedures within twenty-four (24) hours. Proper supervision includes ongoing review of prescriptive practices. Physicians may not supervise immediate family members, except relatives beyond the second degree of consanguinity or affinity.
Policy approved by the Board has set a maximum supervision fee for APRN's of $300 per hour.
The purpose of this Subchapter is to set forth the requirements for osteopathic physicians to supervise any mid-level medical practitioner with prescriptive authority.
[Source: Added at 15 Ok Reg 2762, eff 6-25-98; Amended at 33 Ok Reg 1771, eff 9-11-16; Amended 9-11-22]
The following words and terms used in this Subchapter, shall have the following meaning unless the context clearly indicates otherwise:
"Board" means the State Board of Osteopathic Examiners.
"Mid-level practitioners" include physician assistants and advanced practice nurses.
"Primary Care Medicine" means the practice of medicine with emphasis on emergency medicine, family medicine, general internal medicine, general pediatrics, and obstetrics and gynecology.
"Proper physician supervision" means the supervising physician regularly and routinely reviews the prescriptive practices and patterns of the mid-level practitioners. Proper physician supervision of mid level practitioners is essential.
[Source: Added at 15 Ok Reg 2762, eff 6-25-98; Amended at 33 Ok Reg 1771, eff 9-11-16; Amended at 39 Ok Reg 2050, eff 9-11-22; Amended at 42 Ok Reg, Number 20, effective 7-11-25)
(a) To be eligible to serve as a supervising physician for mid-level practitioners, an osteopathic physician shall meet the following criteria:
(1) Have possession of a full and unrestricted Oklahoma license to practice osteopathic medicine; with Drug Enforcement Agency (DEA) and Oklahoma Bureau of Narcotics and Dangerous Drugs Control (OBNDD) permits.
(2) The supervising physician shall be trained and fully qualified in the field of the mid-level practitioners specialty.
(b) No physician shall supervise more than six (6) mid-level practitioners.
(c) The Board may make an exception to any limit set herein upon written request of the physician. Exception requests for rural primary care shall be given priority by the Board.
(d) Subject to approval, disapproval, or modification by the Board, the Executive Director of the Board may temporarily approve a written request to supervise up to seven (7) or more mid-level practitioners between regularly scheduled meeting of the Board.
(e) All supervising osteopathic physicians shall have a written agreement with each mid-level practitioner they supervise to memorialize the extent of the authority of the mid-level practitioner to practice under the supervision of the physician. The written agreement shall comply with Oklahoma law.
(f) All supervising osteopathic physicians shall visit each location in which he or she supervises mid-level practitioners at least once a month.
(g) To ensure appropriate levels of chart review of mid-level practice, all supervising osteopathic physicians shall ensure a physician shall review at least fifteen percent (15%) of patient charts recording treatment by the supervised mid-level practitioners each month.
(h) To ensure appropriate levels of chart review, a supervising physician shall develop a list of High-risk procedures, for each mid-level practitioner. The performance of any of those procedures by the respective mid-level practitioner shall, in each instance, be reviewed within twenty-four (24) hours of treatment by the physician.
(i) A physician may not supervise a mid-level provider who is an immediate family member, however, this prohibition shall not apply to family members outside the second degree of consanguinity or affinity.
[Source: Added at 15 Ok Reg 2762, eff 6-25-98; Amended at 33 Ok Reg 1771, eff 9-11-16; Amended at 39 Ok Reg 2050, eff 9-11-22; Amended at 42 Ok Reg, Number 20, effective 7-11-25]
