Disclaimer: This material is for educational and informational purposes only and does not constitute legal or medical advice. Always verify current rules with the Georgia Composite Medical Board (GCMB), Georgia Board of Nursing, and Georgia Board of Pharmacy, and seek qualified legal counsel before making decisions or taking action.
Executive Summary
- Physician Ownership & Control: Georgia restricts lay control of medical practices. Only physicians may make clinical decisions. MSOs may handle non-clinical operations but cannot influence patient care.
- Medical Director Requirements: The medical director must be a Georgia-licensed MD or DO in good standing, with active oversight of staff, protocols, and delegated services.
- Delegation & Prescriptive Authority: APRNs require written Nurse Protocol Agreements (NPAs) under O.C.G.A. §43-34-25, and PAs require Delegation Agreements per O.C.G.A. §43-34-103. Both must define duties, prescribing limits, and be reviewed annually.
- Controlled Substance Compliance: All prescribers must query and document Georgia PDMP checks before issuing controlled substances, following GCMB Rule 360-38 and DPH PDMP requirements.
- Scope of Practice & QA Oversight: Every procedure (injectables, IV therapy, lasers) must link to a protocol specifying supervision, training, and competency renewal. Clinics must keep chart reviews, QA meeting logs, and remediation records.
- Laser & Aesthetic Services: Governed by the Georgia Cosmetic Laser Services Act (O.C.G.A. §§43-34-240–248). Only licensed or certified practitioners may operate devices under physician supervision.
- Telehealth & Weight-Loss Services: Telemedicine must meet GCMB Rule 360-3-.07 standards with proper documentation, consent, and PDMP checks. GLP-1s and phentermine require valid prescriptive authority and QA oversight.
- Marketing & Advertising: Titles and claims must match credentials. Misleading statements like “Guaranteed Results” or “Physician Supervised” violate O.C.G.A. §43-34-8 and GCMB Rule 360-3-.02 on unprofessional conduct.
- Documentation & Audit Readiness: Maintain a compliance binder with NPAs, DAs, licenses, PDMP logs, QA records, and safety protocols. Documents must be accessible within three business days upon inspection.
90-Day Compliance Setup:
- (Days 1–30) Establish structure, NPAs, and protocols.
- (Days 31–60) Launch QA and PDMP compliance; perform mock audit.
- (Days 61–90) Verify competencies, ensure record accessibility, and confirm all signage and marketing compliance.
Georgia Quick Compliance Checklist (2025)
Entity & Ownership Structure
Deliver medical care through a physician-owned or physician-controlled professional entity in compliance with Georgia’s prohibition on the corporate practice of medicine.
Non-physician entities (MSOs) may manage nonclinical operations—such as billing, HR, and marketing—but must not control or influence medical judgment or patient care.
Medical Director Credentials
Must hold an active, unrestricted Georgia medical license (MD or DO) issued by the Georgia Composite Medical Board (GCMB).
A DEA registration is required to prescribe or supervise the prescribing of controlled substances.
The physician medical director must be readily available for consultation, chart review, and emergency response—either on-site or via telecommunication per GCMB supervision standards.
Delegation & Prescriptive Authority
Advanced Practice Registered Nurses (APRNs)
Must operate under a written Nurse Protocol Agreement (NPA) with a delegating physician as required by O.C.G.A. §43-34-25.
The NPA must define authorized medical acts, prescriptive limits, communication and consultation procedures, and QA protocols.
Both parties must review and sign the agreement annually, and it must be available for inspection.
Physician Assistants (PAs)
Must practice under a Delegation Agreement approved by the supervising physician in accordance with O.C.G.A. §43-34-103.
The agreement must specify scope of duties, prescribing authority, chart review frequency, and physician availability.
Agreements must be filed and accessible for review by the GCMB upon request.
Prescription Drug Monitoring Program (PDMP)
All prescribers must check the Georgia PDMP before prescribing controlled substances and document compliance in the patient record.
The Georgia Department of Public Health enforces PDMP participation and training requirements.
Scope of Practice Mapping
Maintain a scope-of-practice matrix covering every clinical service offered (e.g., injectables, lasers, IV therapy, diagnostics).
For each procedure, record:
- Practitioner(s) authorized to perform it
- Supervision level (direct, indirect, tele-supervision)
- Training and competency renewal dates
- Governing statute or rule reference
Quality Assurance & Supervision
Implement a structured Quality Assurance (QA) program that includes:
- Periodic chart reviews signed by the supervising physician
- Documented monthly or quarterly QA meetings
- Competency and skills checklists tied to specific procedures
- Incident logs and remediation or retraining documentation
Laser and Energy Device Compliance
Regulated under the Georgia Cosmetic Laser Services Act (O.C.G.A. §§43-34-240 through 43-34-248).
- Only licensed physicians or certified laser practitioners (Level 1 or 2) may perform cosmetic laser services.
- A physician must supervise all laser operations and maintain written policies for patient safety and emergency response.
- Maintain proof of laser safety training, device maintenance logs, and PPE compliance (eyewear, signage, etc.).
Marketing & Advertising Guardrails
Marketing and representations must comply with Georgia’s unprofessional conduct and advertising standards:
- Professional titles must reflect actual licensure (e.g., “RN,” “PA,” “APRN”)—avoid using “Doctor” unless a physician.
- Do not claim “Guaranteed Results,” “Permanent Weight Loss,” or “Physician Supervised” unless verifiable and supported by documentation.
- Marketing materials must not imply non-physician ownership or medical control.
- Misleading or deceptive advertising constitutes professional misconduct under O.C.G.A. §43-34-8 and GCMB Rule 360-3-.02.
Documentation & Inspection Readiness
Maintain a compliance binder (digital or hard copy) with:
- Current entity formation documents and any MSO agreements
- Active GCMB licenses and DEA certificates
- Current NPAs, Delegation Agreements, and PDMP access documentation
- QA meeting minutes and competency logs
- Laser certification and safety documentation
- Approved marketing language and version control records
These materials must be readily available for inspection by the GCMB, DPH, or other state agencies.
The Legal Frame: CPOM & Medical Director Authority
Corporate Practice of Medicine & Medical Director Authority
Who May Serve as Medical Director
Delegation & Prescriptive Authority (APRNs & PAs): Required Documents
Nurse Protocol Agreements (NPAs) – For APRNs
- Required for all Advanced Practice Registered Nurses (APRNs) who diagnose, treat, or prescribe under delegated authority.
- Must be a written agreement between the delegating physician and APRN that defines:
- Authorized medical acts and prescriptive limits.
- Consultation and communication procedures.
- Record-review frequency and quality assurance requirements.
- Authorized medical acts and prescriptive limits.
- Must be signed by both parties, kept onsite or filed electronically with the Georgia Composite Medical Board (GCMB), and reviewed at least annually or when practice scope changes.
- Delegated prescribing authority may include Schedule III–V controlled substances, provided the APRN holds DEA registration and complies with the restrictions in O.C.G.A. §43-34-25.
- Supervising physicians must conduct regular chart reviews and maintain documentation for inspection.
Delegation Agreements (Job Descriptions) – For PAs
- Each Physician Assistant (PA) must practice under a written job description or delegation agreement with a supervising physician per O.C.G.A. §43-34-103.
- The document must clearly define:
- All delegated medical tasks and procedures.
- Prescribing parameters, including any restrictions on controlled substances.
- Supervision structure, alternate supervising physicians, and chart-review intervals.
- All delegated medical tasks and procedures.
- Must be reviewed regularly (at least annually) and retained for inspection by the GCMB.
- PAs may prescribe Schedule III–V controlled substances under supervision, and Schedule II only in limited emergency or inpatient scenarios as allowed by Georgia law.
- The supervising physician is legally responsible for all delegated acts and must ensure compliance with board rules and QA requirements.
Practical Tips That Survive Georgia Audits
- Maintain a chart-review log with each review date, supervising physician signature, and corrective actions taken, so you can show inspection-ready documentation of oversight.
- Create and update a master index of all Nurse Protocol Agreements (NPAs) and PA delegation/job description documents, with renewal dates, scope of practice changes, and responsible physician or APRN noted.
- For each clinical service (e.g., injectables, IV therapy, energy-devices), link it to a written protocol or scope document that states who performs it, under what supervision or physician availability, and training/renewal dates.
- For controlled substances, log each PDMP query (including date, patient, prescriber, and delegate if used) and retain proof of registration and query compliance under Rule 360-38 or Rule 511-7-2 (PDMP) standards. Via Georgia Department of Public Health – PDMP.
Medspas
- Injectables, fillers, and aesthetic services are considered medical procedures under Georgia law.
- Must be performed only by licensed practitioners (MD, DO, PA, or APRN) or delegated personnel under active physician supervision.
- The supervising physician retains responsibility for clinical oversight, patient safety, and delegation limits.
- Maintain product tracking logs, patient consent forms, and emergency response protocols (e.g., for vascular occlusion or allergic reactions).
- Laser and energy-based procedures are regulated under the Georgia Cosmetic Laser Services Act and Georgia Rules Chapter 360-35, which require physician supervision and certified laser practitioner credentials.
Psychiatry & Behavioral Health
- Nurse Practitioners (NPs) with Full Practice Authority (FPA) may independently evaluate, diagnose, and prescribe within their certification scope under AANP – NY FPA Update.
- Physician Assistants (PAs) must practice under continuous physician supervision with duties and prescribing authority defined in writing per 10 NYCRR §94.2.
For controlled medications, maintain DEA registration, iSTOP documentation, and structured follow-up protocols as required by Public Health Law §3371.
Telehealth
- Telemedicine is permitted in Georgia if it complies with GCMB Rule 360-3-.07 (Practice Through Electronic or Other Means).
- A valid physician–patient relationship must be established before providing treatment or prescribing medications.
- All documentation, informed consent, and QA procedures must meet the same standards as in-person visits.
- Controlled substance prescribing via telehealth is restricted; providers must perform PDMP and federal DEA requirements.
- Physicians must ensure secure transmission, patient identification, and continuity of care for telehealth encounters.
Weight Loss & Wellness
- Prescription weight-loss medications (including phentermine and GLP-1 drugs such as semaglutide or tirzepatide) may only be prescribed by a Georgia-licensed physician or a delegated APRN/PA with a valid Nurse Protocol or Delegation Agreement.
- All prescribers must maintain PDMP documentation for controlled substances and follow DEA and Georgia Board of Pharmacy rules for storage and dispensing.
- IV therapy and wellness infusions are considered medical treatments; they require written protocols, signed physician approval, and on-site emergency procedures (e.g., adverse reaction management, crash-kit readiness).
- Clinics must maintain drug inventory logs, lot-number tracking, and scope-specific competency documentation for all staff performing IV or injectable procedures.
The Paperwork Georgia Regulators Actually Ask to See
Entity Formation and Governance Documents
- Articles of incorporation, operating agreements, or professional corporation filings showing physician ownership or physician control of clinical decision-making.
- Management Service Organization (MSO) contracts that clearly separate non-clinical services (billing, marketing, HR) from medical practice oversight.
- Any governance documents or meeting minutes confirming that physicians retain authority over medical policies and staff credentialing.
- Business license or facility registration (if applicable), consistent with professional entity status.
Licenses and DEA Registrations
- Current Georgia Composite Medical Board (GCMB) licenses for all physicians, PAs, and APRNs practicing at the site.
- DEA registrations for any prescriber authorized to handle controlled substances.
- Documentation of renewal dates, good standing, and disciplinary history (if any).
- Copies of professional liability insurance and Board correspondence related to licensure.
Nurse Protocol Agreements (NPAs) and Physician Assistant Delegation Documents
- Signed and current NPAs (for APRNs) and job descriptions/delegation agreements (for PAs), as required by O.C.G.A. §§ 43-34-25 and 43-34-103.
- Clearly define each practitioner’s scope of delegated duties, prescribing parameters, and chart-review frequency.
- Must be accessible within three business days of a GCMB request (on-site or electronically).
- Annual reviews or revisions documented and signed by both supervising physician and delegate.
Quality Assurance (QA) and Supervision Records
- Chart-review logs signed and dated by supervising physicians.
- QA meeting minutes documenting clinical performance, training updates, and any corrective actions.
- Competency checklists for each procedure or device, tied to training or certification records.
- Incident and remediation reports demonstrating timely follow-up and retraining when issues arise.
- Retention schedule ensuring QA files are stored for the duration required by GCMB or payer policy.
PDMP and Prescribing Documentation
- Proof of PDMP registration for all prescribers and delegates.
- PDMP query logs or attestations showing compliance before issuing controlled-substance prescriptions.
- Medication and controlled-substance inventory records, including ordering, dispensing, and waste logs.
- Prescribing protocols linked to NPAs or PA delegation agreements for controlled substances and weight-loss drugs.
Avoid These Common Georgia Mistakes
- Listing a “medical director” with no clinical control
Physicians must retain clinical authority; non-physicians cannot direct care or medical decisions under Georgia’s corporate practice of medicine principles. - Using outdated NPAs or Delegation Agreements
APRNs and PAs must have current, signed, and annually reviewed protocols defining duties, prescribing limits, and supervision under O.C.G.A. §§ 43-34-25 and 43-34-103. - Failing to log PDMP checks
Prescribers must query Georgia’s PDMP before prescribing controlled substances and document compliance at least every 90 days per Rule 360-38-.04. - Allowing unlicensed staff to perform injectables or lasers
Only licensed or delegated practitioners under physician supervision may perform medical aesthetic or laser services per the Cosmetic Laser Services Act. - Missing QA documentation during inspections
Clinics must keep chart-review logs, QA meeting notes, and competency records showing active physician oversight and corrective actions when required.
Step-by-Step: Building a Defensible Georgia Setup
Days 1–30: Establish Governance and Clinical Authority
- Confirm that the practice operates as a physician-owned or physician-controlled entity, preserving medical decision-making authority.
- Draft or update all Nurse Protocol Agreements (NPAs) and Physician Assistant Delegation Agreements (DAs) in compliance with O.C.G.A. §§ 43-34-25 and 43-34-103.
- Develop or revise clinical protocols covering injectables, IV therapy, and device-based procedures, ensuring physician approval and alignment with GCMB supervision rules.
Days 31–60: Implement Oversight and Quality Systems
- Launch the Quality Assurance (QA) program with documented chart reviews, supervision logs, and monthly QA meetings led by the medical director.
- Verify all prescribers’ PDMP access and compliance, documenting initial and follow-up checks for controlled substances.
- Conduct a mock compliance audit using GCMB and DPH standards to identify gaps in protocols, supervision, or documentation.
Days 61–90: Validate Competency and Inspection Readiness
- Complete and sign all staff competency and training verifications for delegated procedures under the supervising physician’s review.
- Ensure QA, NPA/DA, PDMP, and licensure documents can be retrieved within a reasonable timeframe (ideally three business days) upon GCMB request.
- Review and confirm that all clinical signage, marketing, and staff titles comply with GCMB and Georgia advertising standards.
FAQs
Can a non-physician own a clinic in Georgia?
Yes, but they cannot make medical decisions. Physicians must retain authority over care.
Do APRNs and PAs need written agreements?
Yes—APRNs require NPAs, PAs require DAs.
Are lasers and injectables medical procedures?
Yes. Both require physician oversight.
Is telehealth prescribing allowed?
Yes, under GCMB Rule 360-3-.07 and PDMP compliance.
How Medical Director Co. Fits into Georgia Compliance
- Georgia-Licensed Physicians:
Our medical directors are Georgia-licensed MDs and DOs with extensive experience in medspas, telehealth, weight-loss clinics, and IV therapy, ensuring every delegated act complies with O.C.G.A. Title 43, Chapter 34 and GCMB supervision standards. - Turnkey Delegation Frameworks:
We build compliant Nurse Protocol Agreements (NPAs) and Physician Assistant Delegation Agreements (DAs) tailored to your services — fully aligned with O.C.G.A. §§ 43-34-25 and 43-34-103, including prescribing, supervision, and QA documentation requirements. - Sustainable QA Cadence:
Our team implements risk-tiered chart reviews, structured QA meeting templates, and incident tracking that satisfy GCMB’s expectations for physician oversight, training verification, and documentation readiness. - Device & Procedural Compliance:
We prepare written protocols, training ladders, and safety documentation for injectables, lasers, and IV therapy, ensuring compliance with the Georgia Cosmetic Laser Services Act (O.C.G.A. §§ 43-34-240–248) and GCMB Rule 360-35 on supervision and certification. - Entity Structure Alignment:
We review your Professional Corporation (PC) or Professional LLC (PLLC) and MSO agreements to confirm physician control over clinical decisions and prevent Corporate Practice of Medicine (CPOM) violations under Georgia’s regulatory framework. - Controlled Substance & PDMP Compliance:
Our systems integrate Georgia PDMP (Prescription Drug Monitoring Program) checks, DEA documentation, and prescribing logs to meet Rule 360-38 and DPH PDMP participation standards. - Regulatory Monitoring & Updates:
We continuously track updates from the Georgia Composite Medical Board (GCMB), Department of Public Health, and Board of Pharmacy — keeping your clinic current with evolving rules on telehealth, delegation, and controlled substances.
Areas We Serve
Medical Director Co. supports clinics, medspas, and wellness practices across Georgia with physician-led compliance, delegation, and QA oversight. Our network includes both metro and regional markets to ensure full-state coverage.
Georgia Resources & References (2025)
Georgia Composite Medical Board (GCMB):
https://medicalboard.georgia.gov
Georgia Department of Public Health:
https://dph.georgia.gov/pdmp
Find Law:
https://www.findlaw.com/
Rules and Regulations of the State of Georgia:
https://rules.sos.ga.gov/
Legal Information Institute:
https://www.law.cornell.edu/
Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
