South Carolina collaborating physician requirements apply to a restricted-practice state that is actively debating significant changes to its APRN framework in 2025 and 2026. For now, most APRNs performing medical acts in South Carolina must do so pursuant to a written practice agreement with a physician who is readily available for consultation. The collaboration requirement applies to nurse practitioners, certified nurse-midwives who have not obtained full practice authority, and clinical nurse specialists who perform medical acts.
For physicians entering collaboration roles in South Carolina, the compliance framework includes a specific usual practice standard that limits what can be delegated, an annual review obligation, a 72-hour board production requirement, a 15 business day notification window for any changes, and an important in-state active practice requirement. This guide covers every requirement a physician needs to understand in 2026, sourced directly from South Carolina statutes and current board guidance.
South Carolina Collaborating Physician Overview: Where South Carolina Stands
South Carolina classifies most APRNs in the restricted-practice category for performing medical acts. The practice agreement requirement is permanent for NPs and CNMs who have not been granted full practice authority, and for CNSs who perform medical acts.
Governing Bodies
Two regulatory bodies jointly govern practice agreement standards in South Carolina:
- South Carolina Board of Nursing: Governs APRN licensure, practice agreement requirements, and notifications about initiating, changing, or terminating agreements under SC Code § 40-33-34.
- South Carolina Board of Medical Examiners: Governs physician licensure, medical act standards, physician eligibility for practice agreements, and disciplinary oversight of physicians involved in these arrangements under SC Code Chapter 40-47.
Either board may request a copy of a practice agreement at any time. Failure to produce the agreement within 72 hours of a request may result in disciplinary action.
Full Practice Authority Pathway
South Carolina enacted a limited full practice authority framework for certain APRNs. Under SC Code § 40-33-31, APRNs who meet qualifying criteria may be granted full practice authority and are then exempt from the practice agreement requirement. The full practice authority framework remains limited in scope, and the majority of NP-operated clinics in South Carolina continue to operate under practice agreements. Multiple full practice authority expansion bills have been introduced in the 2025 to 2026 legislative session, and physicians should monitor this landscape for changes that could affect demand for physician collaboration in the state.
The 2025 to 2026 Legislative Context
South Carolina Senate Bill 669, the Team-Based Health Care Act, is pending in the 2025 to 2026 session and proposes significant restructuring of how practice agreements are governed. If enacted, it would create a Team-Based Health Care Committee to assist both boards, introduce fee transparency requirements for physician collaboration arrangements, and require practice agreements for NP-owned practices to be reviewed by the committee. As of the publication date of this guide, SB 669 has not been enacted, and the existing framework under SC Code § 40-33-34 remains in effect.
The Practice Agreement: South Carolina’s Core Compliance Document
Under SC Code § 40-33-20(45), a practice agreement is a written agreement developed by an NP, CNM, or CNS and a physician or medical staff who agrees to work with and to support the NP, CNM, or CNS. The practice agreement must establish the medical aspects of care to be provided, including the prescribing of medications, and must contain mechanisms that allow the physician to ensure that quality of clinical care and patient safety is maintained.
The practice agreement does not require prior approval from either board before the APRN begins practice. However, it must be produced to either board within 72 hours of a request. This on-demand availability obligation is one of the most operationally significant requirements in South Carolina’s framework.
Remote Collaboration Is Permitted
South Carolina does not impose a geographic proximity requirement. The prior 45-mile radius restriction was removed by law in 2018. A physician practicing anywhere in South Carolina may enter into a practice agreement with an APRN operating anywhere in the state. The physician must be readily available for consultation, meaning reachable in person or by telecommunications or other electronic means. Distance does not affect the availability standard.
What Must Be in a South Carolina Practice Agreement
SC Code § 40-33-34 and current board guidance specify the required content of a valid practice agreement. The agreement must address all of the following:
1. Medical Aspects of Care
The practice agreement must establish the medical aspects of care to be provided by the NP, CNM, or CNS, including the prescribing of medications. The scope of medical acts delegated must be consistent with the physician’s usual practice and within the physician’s training and experience.
2. Mechanisms for Quality and Patient Safety Oversight
The agreement must contain mechanisms that allow the physician to ensure that quality of clinical care and patient safety is maintained in accordance with state and federal laws and all applicable board rules and regulations. The method and frequency of chart or electronic health record review must be described. This requirement was strengthened in proposed Team-Based legislation and reflects both boards’ expectations for ongoing oversight documentation.
3. Physician Availability
The agreement must describe how the physician will be readily available for consultation. Under SC Code § 40-33-20(45), readily available means the physician who enters into a practice agreement with an NP must be able to be contacted either in person or by telecommunications or other electronic means to provide consultation and advice to the NP performing medical acts.
4. Annual Review Provision
The original practice agreement and any amendments must be reviewed at least annually, dated and signed by both the APRN and the physician, and made available to either board within 72 hours of request. The annual review requirement applies to the original agreement and to every amendment.
5. Prescriptive Authority Scope
The agreement must address prescriptive authority, including any controlled substances the APRN is authorized to prescribe. Prescription requirements must comply with SC Code § 39-24-40, and the specific number of refills must be designated on every prescription.
6. Prescription Form Requirements
Written prescription forms must include the name, address, and phone number of both the APRN and the physician. Electronic prescriptions must include the name, address, and phone number of the APRN and, where technically possible, the physician as well through the electronic system.
Physician Eligibility: The Usual Practice Standard and Active State Practice
A South Carolina collaborating physician must hold a permanent, active, and unrestricted authorization to practice medicine in South Carolina. Two requirements distinguish South Carolina’s eligibility standard from most other states.
The Usual Practice Standard
Under SC Code § 40-33-20(44) and confirmed in the 2018 FAQ issued jointly by both boards, a physician cannot enter into a practice agreement with an APRN performing a medical act, task, or function that is outside the usual practice of the physician or outside the physician’s training or experience. The Board of Medical Examiners may approve exceptions to this requirement.
This standard is more specific than a general specialty comparability rule. It is tied directly to what the physician actually does in their clinical practice. A physician who does not perform a particular medical act in their own daily practice generally cannot delegate that act to an APRN through a practice agreement. Physicians considering agreements that push the edges of this standard should confirm with the Board of Medical Examiners whether the specific acts being delegated fall within their usual practice.
Active Practice Within the Geographic Boundaries of South Carolina
Under SC Code § 40-33-20(44), a physician for purposes of APRN practice agreements means a physician licensed by the South Carolina Board of Medical Examiners who possesses an active, unrestricted, permanent license to practice medicine in this State and who actively is practicing within the geographic boundaries of this State. This is a geographic in-state active practice requirement, not a proximity requirement relative to the APRN’s clinic. A physician must be actively practicing medicine within South Carolina to serve as a qualifying collaborating physician under a practice agreement.
A physician who holds a South Carolina license but has relocated their primary practice to another state does not satisfy this requirement.
The 72-Hour Board Production Rule
South Carolina’s 72-hour practice agreement production requirement is one of the most operationally specific obligations in the state’s framework. Under SC Code § 40-33-34(3) and confirmed in the 2018 joint board FAQ, there is no prior approval requirement for practice agreements. Either board may request a copy of the practice agreement at any time, and it must be submitted within 72 hours of the request.
What This Requires in Practice
The practice agreement must be immediately accessible at all times. Both the APRN and the physician should maintain readily retrievable copies of all current and recently amended versions of the agreement. A request from either board that cannot be satisfied within 72 hours creates a disciplinary exposure regardless of whether the agreement itself is compliant in content.
The 72-hour window applies to the original agreement and to all amendments. An amendment that has been executed but not retained in an accessible location effectively does not exist from a compliance standpoint when a board request arrives.
The Annual Review Requirement
South Carolina requires the original practice agreement and any amendments to be reviewed at least annually and to be dated and signed by both the APRN and the physician following each review.
What Counts as a Valid Review
The annual review must result in a dated signature by both parties. A practice agreement that has passed the one-year mark without a new dated co-signature is not current. Both the board of nursing and the board of medical examiners expect to see evidence of the annual review when the agreement is produced on request.
Amendments made during the year also reset the review obligation. Any amendment must be dated, signed by both parties, and retained with the original agreement. The total package must be producible within 72 hours of either board’s request.
The Underserved Area Practice Obligation
One of South Carolina’s most distinctive collaboration requirements is the statutory obligation for APRNs practicing under a practice agreement to serve underserved populations.
What the Law Requires
Under SC Code § 40-33-34(C), a licensed NP, CNM, or CNS who does not have full practice authority must spend a portion of their time practicing in an underserved or rural area or serving an underserved population as defined in Section 40-33-20.
This is a requirement placed on the APRN, not directly on the physician. However, it shapes the practice context of collaboration arrangements in South Carolina and distinguishes the state from all others covered in this series. The practice agreement should reflect the APRN’s commitment to this requirement and should not create a scope that contradicts the APRN’s obligation to serve underserved populations.
Prescriptive Authority and Controlled Substances in South Carolina
South Carolina APRNs practicing under a practice agreement may prescribe medications and controlled substances within the scope described in the agreement.
Prescription Requirements
Every prescription written by an APRN must be signed or electronically submitted by the APRN with the prescriber’s identification number assigned by the board and all prescribing numbers required by law. Written prescription forms must include the name, address, and phone number of both the APRN and the physician. A specific number of refills must be designated on every prescription. Nonspecific refill indications are not permitted.
Controlled Substances
APRNs practicing under a practice agreement may prescribe Schedule II through V controlled substances within the scope described in the agreement and consistent with applicable state and federal law. South Carolina does not impose a blanket prohibition on Schedule II prescribing for APRNs, which distinguishes it from states like Georgia and Missouri.
DEA Registration
APRNs prescribing controlled substances must hold a current DEA registration. Prescriptions for controlled substances must comply with all applicable state and federal requirements.
The 15 Business Day Notification Window
South Carolina requires the APRN to notify the Board of Nursing within 15 business days of initiating, changing, or terminating a practice agreement. This notification obligation applies to every material change in the arrangement.
What Triggers the Notification
The 15 business day window applies when:
- A new practice agreement is initiated
- An existing agreement is amended in any material way
- A practice agreement is terminated
The notification is the APRN’s responsibility. Physicians should confirm with the APRN that the notification has been submitted following any change and maintain their own record of the change date.
The Legislative Landscape: Team-Based Health Care Act and Full Practice Authority Bills
South Carolina’s APRN practice framework is under active legislative review in the 2025 to 2026 session.
Senate Bill 669: Team-Based Health Care Act
SB 669 was introduced in 2025 and proposes to create a Team-Based Health Care Committee composed of representatives of both boards to oversee collaboration standards, review practice agreements for NP-owned practices, and address fee reasonableness in collaboration arrangements. If enacted, it would require practice agreements for practices owned in whole or in part by the NP to be reviewed by the committee. It would also prohibit APRNs employed by health systems from being charged a fee for physician collaboration. As of the publication date of this guide, SB 669 has not been enacted.
Full Practice Authority Expansion Bills
Multiple full practice authority expansion bills have been introduced in the 2025 to 2026 session, including SB 45 and HB 3580. These bills propose to expand the criteria for APRNs to qualify for full practice authority and reduce the dependence on practice agreements. None of these bills had been enacted as of the publication date of this guide. Physicians planning long-term collaboration arrangements in South Carolina should monitor the legislative status of these bills, as passage would reduce the market for new physician collaboration agreements.
Common Compliance Mistakes South Carolina Collaborating Physicians Make
Most South Carolina practice agreement compliance problems involve the usual practice standard, the annual review, and failure to respond to board production requests within 72 hours.
- Delegating acts outside the physician’s usual practice. The practice agreement cannot authorize the APRN to perform medical acts outside the physician’s own daily practice and training. A physician who signs an agreement covering clinical services they do not personally provide is not meeting the eligibility standard and creates exposure for both parties. Board of Medical Examiner approval is required for exceptions.
- Agreement not reviewed and co-signed annually. The agreement must be dated and signed by both parties at least once a year. An agreement without a current dated review signature is not compliant, regardless of how well-drafted the original was.
- Unable to produce the agreement within 72 hours. The practice agreement must be immediately accessible and producible within 72 hours of either board’s request. Agreements stored in inaccessible locations or maintained only by one party create a compliance risk every day.
- Physician not actively practicing within South Carolina. The physician must be actively practicing medicine within the geographic boundaries of South Carolina. A physician who has moved their primary practice out of the state does not meet the active in-state practice requirement.
- Prescription forms missing required information. Every prescription must include the name, address, and phone number of both the APRN and the physician. Missing physician information on written prescription forms is a common compliance gap in multi-clinic arrangements.
- 15 business day notification not submitted after changes. The APRN must notify the Board of Nursing within 15 business days of any change to a practice agreement. Physicians should confirm the notification has been submitted following any material change to the arrangement.
South Carolina Collaborating Physician Requirements: Quick Reference
Physician Eligibility
- Active, permanent, unrestricted South Carolina MD or DO license
- Must be actively practicing within the geographic boundaries of South Carolina
- Cannot enter into a practice agreement covering acts outside the physician’s usual practice and training
- Board of Medical Examiners may approve exceptions to the usual practice standard
Core Compliance Document
- Written practice agreement meeting requirements of SC Code § 40-33-34
- Not filed with either board prior to practice
- Must include: medical aspects of care, quality oversight mechanisms, physician availability, annual review provision, prescriptive authority scope, prescription requirements
- Must be produced to either board within 72 hours of request
Annual Review
- Original agreement and all amendments reviewed and co-signed annually
- Dated signatures from both APRN and physician required
- Amendments also dated, signed, and retained with original
72-Hour Production Rule
- Practice agreement must be produced to either board within 72 hours of a request
- Failure to produce may result in disciplinary action
Notification
- APRN notifies Board of Nursing within 15 business days of initiating, changing, or terminating any practice agreement
Prescriptive Authority
- Schedule II through V controlled substances permitted within the agreement scope
- No blanket Schedule II prohibition
- Every prescription must include specific refill count and identifying information for both APRN and physician
Underserved Area Obligation
- APRN without full practice authority must spend a portion of time in underserved or rural areas or serving underserved populations
Geographic Requirement
- None; 45-mile rule removed in 2018; remote collaboration fully permitted
Physician-to-APRN Ratio
- No statutory cap
Clinics Also Need to Understand South Carolina Collaboration Requirements
While this guide primarily covers the responsibilities and compliance requirements placed on collaborating physicians in South Carolina, these regulations directly affect NP-owned clinics, medspas, and healthcare practices that depend on physician collaboration to operate. In many cases, clinic owners researching South Carolina collaboration rules are also trying to understand how to find a qualified physician who is actively practicing within South Carolina, whose clinical background aligns with the APRN’s usual practice, and who understands the 72-hour board production obligation that requires the agreement to be immediately accessible at all times.
Need Help Finding a South Carolina Collaborating Physician?
For clinics, understanding the legal requirements is only one part of the process. The next challenge is finding a qualified physician who meets the active in-state practice standard, does not exceed the usual practice standard by delegating acts outside their own clinical scope, and is prepared to fulfill the annual co-signature review obligation. Whether you are launching a new NP-operated clinic, replacing a physician whose agreement has been terminated, or monitoring the pending full practice authority legislation and need a reliable physician arrangement in the meantime, having the right physician in place is essential.
If your clinic is actively looking for a South Carolina collaborating physician, our team can match you with a qualified physician, often within 24 to 48 hours. We work with clinics across South Carolina to simplify the physician matching process while supporting practice agreement drafting, annual review tracking, and long-term collaboration needs.
Final Thoughts
South Carolina collaborating physician requirements are built around a practice agreement that is not pre-approved by either board but must be producible within 72 hours of either board’s request at any time. The usual practice standard, the active in-state practice requirement, and the annual review co-signature obligation create a framework that demands both a well-drafted initial agreement and consistent attention throughout the collaboration.
For physicians entering the South Carolina market, the most important steps are confirming that the clinical scope described in the practice agreement falls within the physician’s actual daily practice, maintaining the agreement in an immediately accessible location, completing the annual co-signature review on schedule, and tracking the 2025 to 2026 legislative developments that could materially change the collaboration landscape in this state.
Build a Compliant South Carolina Collaboration With Collaborating Physician
Are you looking for a collaborating physician role in South Carolina? If you are a licensed South Carolina physician interested in a structured, compliant practice arrangement with an NP-operated clinic, Collaborating Physician handles the infrastructure so you do not have to figure it out alone. The platform connects licensed physicians with vetted clinics across South Carolina and 50-plus other states. Every arrangement is built to meet state-specific requirements, including South Carolina’s usual practice standard under SC Code § 40-33-34, the active in-state practice requirement, the 72-hour board production rule, the annual co-signature review cycle, and the 15 business day notification window. Physicians receive compliance support throughout the collaboration, not just at the start. Applications take under ten minutes. Clinic matches typically happen within 24 to 48 hours. There is no cost to physicians at any stage.
If you are a clinic owner who found this page, we have something for you as well. Collaborating Physician also matches South Carolina clinics with qualified, vetted collaborating physicians who are actively practicing in South Carolina, whose clinical backgrounds align with the APRN’s usual practice scope, and who understand the 72-hour production obligation and the annual review requirements. Whether you are launching a new clinic, replacing a physician mid-arrangement, or planning ahead as full practice authority legislation moves through the state legislature, the network is active and placements happen within 24 to 48 hours. For clinics looking for a collaborating physician, get matched fast.
Disclaimer: This content is for educational and informational purposes only. It does not constitute legal or medical advice. South Carolina healthcare regulations are under active legislative review in 2025 and 2026. Always verify current requirements directly with the South Carolina Board of Nursing, the South Carolina Board of Medical Examiners, and a qualified healthcare attorney before making any practice decisions.
Frequently Asked Questions
Does a South Carolina collaborating physician need to be physically present at the APRN’s clinic?
No. South Carolina removed the prior 45-mile geographic proximity restriction in 2018. Remote collaboration is fully permitted. The physician must be readily available for consultation, meaning reachable in person or by telecommunications or electronic means. The physician does not need to be co-located with the APRN.
What is the usual practice standard in South Carolina?
A physician cannot enter into a practice agreement with an APRN performing a medical act, task, or function that is outside the usual practice of the physician or outside the physician’s training or experience. The delegated acts must be consistent with what the physician actually does in their own clinical practice. The Board of Medical Examiners may approve exceptions to this requirement.
Does a South Carolina practice agreement need to be filed with either board before practice begins?
No. There is no prior approval requirement. The practice agreement must be available for review and must be produced to either board within 72 hours of a request. Failure to produce the agreement within that window may result in disciplinary action.
How often does a South Carolina practice agreement need to be reviewed?
The original practice agreement and any amendments must be reviewed at least annually. After each annual review, both the APRN and the physician must sign and date the agreement to acknowledge the review. An agreement without a current annual co-signature is not compliant.
How long does an APRN have to notify the Board of Nursing when a practice agreement changes?
The APRN must notify the South Carolina Board of Nursing within 15 business days of initiating, changing, or terminating a practice agreement. This window applies to every material change, including new agreements, amendments, and terminations.
Can a South Carolina APRN prescribe Schedule II controlled substances?
Yes. South Carolina does not impose a blanket prohibition on Schedule II prescribing for APRNs practicing under a practice agreement. APRNs may prescribe Schedule II through V controlled substances within the scope described in the practice agreement and consistent with applicable state and federal law. Every controlled substance prescription must comply with SC Code § 39-24-40.
