2023 Tennessee Code › Title 63 - PROFESSIONS OF THE HEALING ARTS (§§ 63-1-NEW — 63-32-119) › Chapter 7 - NURSING (§§ 63-7-101 — 63-7-403) › Part 1 - GENERAL PROVISIONS (§§ 63-7-101 — 63-7-130) › Section 63-7-123 - Certified nurse practitioners - Drug prescriptions - Temporary certificate - Rules and regulations

(a)
The board shall issue a certificate of fitness to nurse practitioners who meet the qualifications, competencies, training, education and experience, pursuant to §
63-7-207(14)
, sufficient to prepare such persons to write and sign prescriptions and/or issue drugs within the limitations and provisions of §
63-1-132
.
(b)
(1)
A nurse who has been issued a certificate of fitness as a nurse practitioner pursuant to §
63-7-207
and this section shall file a notice with the board, containing the name of the nurse practitioner, the name of the licensed physician collaborating with the nurse practitioner who has control and responsibility for prescriptive services rendered by the nurse practitioner, and a copy of the formulary describing the categories of legend drugs to be prescribed and/or issued by the nurse practitioner. The nurse practitioner shall be responsible for updating this information.
(2)
(A)
The nurse practitioner who holds a certificate of fitness shall be authorized to prescribe and/or issue controlled substances listed in Schedules II, III, IV, and V of title 39, chapter 17, part 4, upon joint adoption of physician collaboration rules concerning controlled substances pursuant to subsection (d).
(B)
Notwithstanding subdivision (b)(2)(A), a nurse practitioner shall not prescribe Schedules II, III, and IV controlled substances unless such prescription is specifically authorized by the formulary or expressly approved after consultation with the collaborating physician before the initial issuance of the prescription or dispensing of the medication.
(C)
A nurse practitioner who had been issued a certificate of fitness may only prescribe or issue a Schedule II or III opioid listed on the formulary for a maximum of a non-refillable, thirty-day course of treatment unless specifically approved after consultation with the collaborating physician before the initial issuance of the prescription or dispensing of the medication. This subdivision (b)(2)(C) shall not apply to prescriptions issued in a hospital, a nursing home licensed under title 68, or inpatient facilities licensed under title 33.
(3)
(A)
Any prescription written and signed or drug issued by a nurse practitioner under collaboration with and the control of a collaborating physician shall be deemed to be that of the nurse practitioner. Every prescription issued by a nurse practitioner pursuant to this section shall be entered in the medical records of the patient and shall be written on a preprinted prescription pad bearing the name, address, and telephone number of the collaborating physician and of the nurse practitioner, and the nurse practitioner shall sign each prescription so written. Where the preprinted prescription pad contains the names of more than one (1) physician, the nurse practitioner shall indicate on the prescription which of those physicians is the nurse practitioner's primary collaborating physician by placing a checkmark beside or a circle around the name of that physician.
(B)
Any handwritten prescription order for a drug prepared by a nurse practitioner who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing nurse practitioner, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing nurse practitioner must sign the handwritten prescription order on the day it is issued, unless the prescription order is:
(i)
Issued as a standing order in a hospital, a nursing home or an assisted care living facility as defined in §
68-11-201
; or
(ii)
Prescribed by a nurse practitioner in the department of health or local health departments or dispensed by the department of health or a local health department as stipulated in §
63-10-205
.
(C)
Any typed or computer-generated prescription order for a drug issued by a nurse practitioner who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing nurse practitioner, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing nurse practitioner must sign the typed or computer-generated prescription order on the day it is issued, unless the prescription order is:
(i)
Issued as a standing order in a hospital, nursing home or an assisted care living facility as defined in §
68-11-201
; or
(ii)
Prescribed by a nurse practitioner in the department of health or local health departments or dispensed by the department of health or a local health department as stipulated in §
63-10-205
.
(D)
Nothing in this section shall be construed to prevent a nurse practitioner from issuing a verbal prescription order.
(E)
(i)
All handwritten, typed or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid service guidance to state medicaid directors regarding § 7002(b) of the United States Troop Readiness, Veterans' Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007, P.L. 110-28, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions.
(ii)
Subdivision (b)(3)(E)(i) shall not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted care living facility as defined in §
68-11-201
or inpatients or residents of a mental health hospital or residential facility licensed under title 33 or individuals incarcerated in a local, state or federal correctional facility.
(4)
The nurse practitioner shall maintain a copy of the protocol the nurse practitioner is using at the nurse practitioner's practice location and shall make the protocol available upon request by the board of nursing, the board of medical examiners or authorized agents of either board.
(5)
An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter, who provides services in a free clinic as defined in §
63-6-703
or engages in the voluntary provision of healthcare services as defined in §
63-6-703
, may arrange for required personal review of the nurse's charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA-compliant electronic means rather than at the site of the clinic. For purposes of this subdivision (b)(5), "HIPAA-compliant" means that the entity has implemented technical policies and procedures for electronic information systems that meet the requirements of
45 CFR 164.312
.
(6)
An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter, who provides services in a community mental health center as defined in §
33-1-101
or federally qualified health center as defined in §
63-10-601
, may arrange for the required personal review of the advanced practice registered nurse's charts by a collaborating physician, with the same authority to render prescriptive services that the nurse practitioner is authorized to render, in the office or practice site of the physician, or the required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic. For purposes of this subdivision (b)(6), "HIPAA-compliant" means that the entity has implemented technical policies and procedures for electronic information systems that meet the requirements of
45 C.F.R. § 164.312
.
(7)
Except for subdivisions (b)(5) and (6):
(A)
An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter, who provides services at a site remote from the advanced practice registered nurse's collaborating physician's practice site, may arrange for the required personal review of the advanced practice registered nurse's charts by a collaborating physician either via HIPAA-compliant electronic means or in person;
(B)
An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter may arrange for up to ten (10) of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic;
(C)
For purposes of this subdivision (b)(7):
(i)
"Annual" means a rolling twelve-month period; and
(ii)
"HIPAA-compliant" means that the entity has implemented technical policies and procedures for electronic information systems that meet the requirements of
45 C.F.R. § 164.312
.
(c)
(1)
The board may issue a temporary certificate of fitness to a registered nurse who:
(A)
Is licensed to practice in Tennessee;
(B)
Has a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills that includes three (3) quarter hours of pharmacology instruction or its equivalent; and
(C)
Has applied for examination and/or is awaiting examination results for national certification as a first-time examinee in an appropriate nursing specialty area.
(2)
Such temporary certificate shall remain valid until the examination results are obtained. The holder of a temporary certificate issued under this subsection (c) who has not received the results of the examination shall work only under the supervision and control of a certified nurse practitioner or physician.
(d)
Any rules that purport to regulate the collaboration of nurse practitioners with physicians shall be jointly adopted by the board of medical examiners and the board of nursing.
Amended by 2022 Tenn. Acts, ch. 949, Secs.s 1, s 2 eff. 4/29/2022.
Amended by 2019 Tenn. Acts, ch. 183, s 1, eff. 4/23/2019.
Amended by 2018 Tenn. Acts, ch. 883, s 6, eff. 1/1/2019.
Amended by 2017 Tenn. Acts, ch. 334, Secs.s 3, s 4, s 5 eff. 7/1/2017.
Amended by 2017 Tenn. Acts, ch. 334, s 2, eff. 7/1/2017.
Amended by 2016 Tenn. Acts, ch. 980, s 12, eff. 7/1/2016.
Amended by 2016 Tenn. Acts, ch. 769, s 1, eff. 4/19/2016.
Amended by 2013 Tenn. Acts, ch. 396, s 1, eff. 7/1/2013.
Amended by 2013 Tenn. Acts, ch. 74,s 5, eff. 4/1/2013.
Acts 1980, ch. 851, § 4; T.C.A., § 63-760; Acts 1985, ch. 120, § 9; 1992, ch. 822, § 1; 1994, ch. 569, § 2; 1995, ch. 358, § 1; 1996, ch. 659, § 2; 1997 , ch. 507, § 2; 1998, ch. 842, §§ 2, 3; 2003 , ch. 259, § 1; 2004, ch. 678, § 9; 2005, ch. 12, § 4; 2008 , ch. 1035, §§ 5, 9; 2010 , ch. 795, §§ 6, 17.