North Carolina NP collaboration is documented through a collaborative practice agreement with a primary supervising physician. The agreement should identify the drugs, devices, medical treatments, tests, and procedures the NP may prescribe, order, or perform at each practice site, and it must include a predetermined plan for emergency services.1
The agreement is not just a one-time form. North Carolina requires annual review with a dated signature sheet, ongoing availability for consultation, a written quality-improvement plan, monthly meetings during the first six months, and quality-improvement meetings at least every six months after that.1 Practical examples are available from UNC School of Medicine and the North Carolina Psychiatric Association.
Citations
1. 21 NCAC 36 .0810.
In North Carolina, NP registration alone does not authorize practice. The NP must use the Board of Nursing's Nurse Practitioner applications page or Nurse Portal to submit an Initial Approval to Practice, or the combined Registration & Initial Approval to Practice application, with supervising-physician and practice-site information.
NP practice begins after the Board of Nursing sends final approval. After approval, the Board's Physician Maintenance workflow is used to add or remove a supervising physician, add practice sites, or update approved practice information; the signed collaborative practice agreement is maintained onsite, reviewed annually, and supported by documented QI meetings.

⚠️ Special Note: Structured North Carolina oversight Fees may stay lower than in high-complexity states, but approval-before-practice, monthly first-six-month meetings, six-month QI meetings, and annual CPA review can still add physician oversight work.
