Supervision

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.

"High-risk Procedures" means a procedure that, due to its technical nature, the patient's health status, or potential complications, requires time-sensitive supervisory review by a physician.

"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; Amended at 43 Ok Reg, Number 21, effective 7-27-2026]

(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 meetings 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 physician shall report to the Board and any mid-level practitioner under their supervision of any changes to the supervising relationship within thirty (30) days and update the supervision agreement as necessary. The written agreement shall comply with Oklahoma law. and should include, to the extent necessary, the following:

(1) Defining the oversight and acceptance of responsibility for the ordering and transmission of written, telephonic, electronic or oral prescriptions for drugs and other medical supplies;

(2) Provisions for continuous availability of direct communication either in person or by electronic communication;

(3) A review process of prescribing patterns of the mid-level provider;

(4) The delegation of one or more alternative physicians in the absence of the supervising physician; and

(5) delineation of a plan for emergencies.

(f) Supervising physicians who choose to charge for their time related to supervision, may charge a reasonable fee to provide supervision services. The fee should be negotiated considering fair market value hourly rate not to exceed the rate set in Board Policy. The fee shall be disclosed in the supervision agreement.

(fg) All supervising osteopathic physicians, or their delegate, shall visit each location in which he or she supervises mid-level practitioners at least once a month.

(h) The Board may make an exception to the monthly in person visit requirement at the request of the physician for an exclusively telemedicine practice in which the physician is located out of state at an unreasonable distance for monthly visits. Exception requests for rural primary care shall be given priority by the Board.

(gi) 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. The supervising osteopathic physician, or their delegate, will make a note in the chart attesting that it has been appropriately reviewed.

(hj) 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. The supervising ostepathic physician, or their delegate, will make a note in the chart attesting that it has been appropriately reviewed.

(ik) 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; Amended at 43 Ok Reg, Number 21, effective 7-27-2026]