Who Can Prescribe and Administer Prescriptions in Washington State

Professions that can prescribe drugs

Restriction

Advanced registered nurse practitioner (ARNP) (NP)

Restriction

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

Note: See DOH webpage for opioid prescribing requirements.

Osteopathic physician assistants (OA) if certified by the National Commission on Certification of Physician Assistants, may use PA-C

Restriction

As approved by the Board of Osteopathic Medicine and Surgery

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

Note: See DOH webpage for opioid prescribing requirements.

 

Certified registered nurse anesthetist (CRNA)

Restriction

Legend and Schedule II-IV for anesthesia per facility protocols

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*  

No

RCW/WAC

Comments: prescribing within the providers scope of practice

N/A

Dentist (DMD or DDS)

Restriction

None

Out-of-state Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice

Naturopath (naturopathic doctor or ND)

Restriction

Controlled substance prescription are limited to testosterone and codeine-containing substances in Schedules III-V

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

No

RCW/WAC

Comments: prescribing within the providers scope of practice.

N/A

Optometrist (OD)

Restriction

No oral steroids. Epinephrine by injection for anaphylactic shock. May write controlled substance prescriptions for Scheduled II hydrocodone combination products and Schedule III-V only and are limited to seven days per single condition.

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

No

RCW/WAC

Comments: prescribing within the providers scope of practice.

Practitioners must meet certification requirements to receive prescriptive authority. Prescriptions must be within scope of practice and include notation of purpose.

Osteopathic physicians (DO)

Restriction

None

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

Note: See DOH webpage for opioid prescribing requirements.

Pharmacist (RPh or PharmD)

Restriction

Initiate, modify or continue drug therapy under agreement with authorized prescriber. Agreement must be on file with the Pharmacy Quality Assurance Commission

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

No

RCW/WAC

Comments: prescribing within the providers scope of practice.

May prescribe legend drugs, including controlled substances and vaccines with a collaborative agreement

Certified physician assistant (PA- C)

Restriction

As approved by the Medical Commission (WMC)

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

None. A practice agreement must be on file with the WMC. PA and PA-C have the same prescriptive authority as the sponsoring physician. See
Note: See DOH webpage for opioid prescribing requirements.

Physician assistant (PA)

Restriction

As approved by the Medical Commission

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

May dispense medications from office supplies

Physicians (MD)

Restriction

None

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

N/A

Podiatric physician (DPM)

Restriction

None

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

Podiatry practice only

Veterinarian (DVM)

Restriction

For animal treatment only.

Out-of-State Rx Accepted
(non-controlled drug from practitioner from B.C. Canada)*

Yes

RCW/WAC

Comments: prescribing within the providers scope of practice.

Veterinarians may dispense limited amount of prescriptions prescribed by other veterinarians per RCW 18.92.012.

General Prescribing Limitations

See below
  1. Providers may prescribe non-controlled substances for themselves. Although permitted, it is not recommended that they prescribe controlled or non-controlled substances for family members without a provider/patient relationship.
  2. Prescriptions written by MDs, DOs, DDSs, DPMs, DMDs, DVMs, ARNPs and “physician assistants” from out-of-state may be dispensed. It's not permitted for other out-of-state prescribers per RCW 69.41.030 and RCW 69.50.101(w)(3).
  3. Prescriptions written by MDs, DOs, DDSs, DPMs, DMDs, DVMs, ARNPs and “physician assistants” from British Columbia may be dispensed; except controlled substances because they're not DEA registrants.
  4. Prescriptions must be for a legitimate medical purpose.
  5. There must be a valid “provider, patient, client” relationship.
  6. Drugs must be within the provider's scope of practice.
  7. Prescriptions written in Washington for delivery to the pharmacy must be on Pharmacy Quality Assurance Commission approved tamper-resistant prescription paper per RCW18.64.500.
  8. Prescriptions written in Washington must have two signature lines at opposite ends on the bottom of the form. "DISPENSE AS WRITTEN" on the right and "SUBSTITUTION PERMITTED" on the left.
  9. Health care providers with prescriptive authority may prescribe epinephrine autoinjectors in the name of an authorized entity according to RCW 70.54.440. Pharmacists, ARNPs and physician (MD and DO) may dispense epinephrine autoinjectors for a prescription issued in the name of an authorized entity.
  10. Expands prescribing privileges to NPs, and PAs who have completed training may be eligible for a waiver to prescribe buprenorphine for opioid dependency treatment. Previously restricted to MDs and DOs. Waiver Information.

Professions that may administer drugs ordered by authorized prescribers

See below

Acupuncturist and Eastern medicine practitioners (RCW 18.06.010) – Point injection therapy includes injection of sterile water, minerals and vitamins in liquid form. Point injection therapy does not include injection of controlled substances contained in Schedules I through V of the uniform controlled substances act, chapter 69.50 RCW or steroids as defined in RCW 69.41.300.

Athletic trainer (RCW 18.250.110) – Administer over-the-counter topical medications such as hydrocortisone, fluocinonide, topical anesthetics, silver sulfadiazine, lidocaine, magnesium sulfate, zinc oxide, and other similar medications, as prescribed by an authorized health care practitioner for the practice of athletic training. 

Cardiovascular invasive specialist (chapter18.84 RCW) – Administer diagnostic and therapeutic agents during cardiac or vascular catheterization procedures under the personal supervision of a physician.

Dental anesthesia assistant, certified (RCW 18.350.040)

Dental assistant, registered (RCW 18.260.040)

Dental hygienist (chapter 18.29 RCW) – Local anesthetics, topical fluoride and antimicrobials for dental patients only.

Emergency medical technician (EMT) (RCW 18.73.081) – Administration of prescribed drugs within scope of practice per verbal or written orders of MD or DO also credentialed as a county medical program director (MPD) or MPD delegate.

Expanded function dental auxiliary (EFDA) (RCW 18.260.070)

Home care aides (RCW 18.88B) – May administer in community-based care settings or in-home care settings under nurse delegation.

Intermediate life support technician (ILS) (RCW 18.71.205) – Administration of prescribed drugs within scope of practice per verbal or written orders of MD or DO also credentialed as a county medical program director (MPD) or MPD delegate.

Licensed midwife (RCW 18.50.115, WAC 246-834-250) – Purchase and administer certain drugs. May also administer drugs that have been prescribed by a physician.

Licensed practical nurse (LPN) (chapter 18.79 RCW, WAC 246-840) – Administer prescribed drugs within, scope of practice, under the general direction of an ARNP, MD, DO, DPM, DDS, PA or ND, and under the direction or supervision of a registered nurse.

Standing Orders and Verbal Orders NCAO 6.0 (PDF). Dispensing Mediations/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health by Public Health Nurses NCAO 9.0 (PDF).

 

School personnel (RCW 28A.210.260 thru 280) – Superintendent of Public Instruction – Health Services

Veterinary technician (RCW 18.92.013, WAC 246-935-410 thru 440) – May administer prescribed drugs with indirect supervision of a veterinarian

Respiratory care practitioner chapter (18.89 RCW) – Administer prescribed drugs for the practice of respiratory care as defined by statute.

Medical assistant (MA) - certified, MA-registered and MA-hemodialysis technician (chapter RCW 18.360, WAC 246-827) – Administer prescribed drugs within scope of practice (see RCW 18.360.050) and under the supervision of a healthcare practitioner as defined in RCW 18.360.010(3). MA-hemodialysis technician may administer oxygen and drugs necessary for hemodialysis (see WAC 246-827-0500 and WAC 246-827-0520). MA-registered may administer eye drops, topical ointments and vaccines, including combination or multidose vaccines. See WAC 246-827-0240 for MA-certified.

Nursing assistant (CNA or NAR) (chapter 18.88A RCW) – May administer in community-based care settings or in-home care settings under nurse delegation. CNA may administer in a nursing home setting with a medication assistant endorsement.

Nursing technician (NT) (chapter 18.79 RCW, WAC 246-840 – Must be enrolled in a commission-approved nursing program and meet other requirements may administer medications within the limits of their education, skills and knowledge under the direct supervision of a RN. The NT may not administer chemotherapy drugs, intravenous medications, or scheduled drugs (see chapter RCW 18.79.350 and WAC 246-840-870).

Occupational therapist (RCW 18.59.040, chapter 246-847 WAC) – May purchase, store and administer certain topical drugs as prescribed by an authorized healthcare practitioner.

Paramedic (RCW 18.71.205) – Administration of prescribed drugs within scope of practice per verbal or written orders of MD or DO also credentialed as a county medical program director (MPD) or MPD delegate.

Pharmacist (RPh or PharmD) (chapter 18.64 RCW) – Administer prescribed drugs.

Physical therapists (PT) (chapter 18.74 RCW) – May purchase, store and administer certain drugs as determined by law and may administer such other drugs or medications as prescribed by an authorized healthcare practitioner for the practice of physical therapy.

Radiologic technologist (chapter 18.84 RCW) – Administer diagnostic and therapeutic agents under the direct supervision of a physician.

Radiologist assistant (chapter 18.84 RCW) – Administer imaging and non-imaging agents parenterally, administer oral medications; level of supervision specified
in regulation (WAC 246-926-300).

Registered nurse (RN) (chapter 18.79 RCW, WAC 246-840) – Administer prescribed drugs within, scope of practice, under the general direction of an ARNP, MD, DO, DPM, DDS, PA or ND, and under the direction or supervision of a registered nurse.

Standing Orders and Verbal Orders NCAO 6.0 (PDF). Dispensing Mediations/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health by Public Health Nurses NCAO 9.0 (PDF).

Examples of professions that may not prescribe, administer or dispense drugs

See below

Chiropractor and chiropractic x-ray technician – Chapter 18.25 RCW

Counselor, licensed marriage and family therapist and licensed marriage and family therapist associate – Chapter 18.225 RCW

Counselor, licensed mental health counselor and licensed mental health counselor associate – Chapter 18.225 RCW

Counselor, certified counselor, certified adviser, agency affiliated counselor and hypnotherapist – Chapter 18.19 RCW,

Counselor, licensed social worker advanced, licensed social work associate advanced, Licensed social work independent clinical, and licensed social work associate independent clinical – Chapter 18.225 RCW

Denturist – Chapter 18.30 RCW

Dietitian and nutritionist – Chapter 18.138 RCW

Genetic counselor – Chapter 18.290 RCW

Massage practitioner – Chapter 18.108 RCW

Ocularist – Chapter 18.55 RCW

Optician – Chapter 18.34 RCW

Orthotist and prosthetist – Chapter 18.200 RCW

Pharmacy technician – Chapter 18.64A RCW (may assist pharmacist)

Psychologist – Chapter 18.83 RCW

Sex offender treatment provider and affiliate provider – Chapter 18.155 RCW

Substance use disorder professionals and substance use disorder professional trainee – Chapter 18.205 RCW

Surgical technologist – Chapter 18.215 RCW

Veterinary medication clerk – RCW 18.92.030 and 125 (may assist veterinarian)

X-Ray technician – Chapter 18.84 RCW