The Signing Physician · 2026-W37
Illinois drops the written agreement for pharmacists; Missouri now names a Written Protocol
One signature obligation comes off your desk in Illinois, and the instrument you would sign for a pharmacist gains a name in Missouri, Michigan and Wisconsin. Plus the practice type where 41 states expect a physician to be medical director.
Moved in our research
Changes we recorded this week, framed as the duty they put on you or take off you.
Illinois: no written agreement required for pharmacists
Our research for Illinois pharmacists changed from requiring a written agreement to not requiring one. For a physician asked to sign on with a pharmacist in Illinois, that is a signature obligation — and the review and oversight terms that ride with it — no longer on file as required.
/physician-agreement/illinois/pharmacist
Source: Our research
Missouri: pharmacist collaboration now recorded as a Written Protocol, delegation type
Missouri pharmacists previously had no collaborative practice instrument listed in our research; the instrument is now recorded under the statutory name Written Protocol, with the agreement type on file as delegation. If you are the collaborating physician, the arrangement you sign there is documented as a delegation instrument rather than absent.
/physician-agreement/missouri/pharmacist
Sources: Our research, Our research, Our research, Our research, Our research, Our research
Michigan: delegation is the named instrument for nurse practitioners and pharmacists
Our research now records Delegation Agreement as the statutory name of the instrument for both nurse practitioners and pharmacists in Michigan, and standardizes the physician assistant instrument as Written Practice Agreement. The naming tells you which of your Michigan arrangements are framed as delegation of your own authority and which as a practice agreement.
Sources: Our research, Our research, Our research
Wisconsin: pharmacist arrangement named a Delegation Agreement
Wisconsin pharmacists now carry Delegation Agreement as the instrument's statutory name in our research, while the nurse practitioner and physician assistant instruments are recorded as Collaborative Arrangement and Written Collaborative Agreement. Collaboration and delegation carry different postures for the signing physician, and Wisconsin now shows all three side by side.
/physician-agreement/wisconsin
Sources: Our research, Our research, Our research
Utah: physician assistant independence tiers pointed to the written agreement note
The condition for Utah physician assistant independence remains 10,000 or more hours of post-graduate clinical experience; below that threshold, our research now directs you to the note under Written agreement for the two lower tiers. That note is where the agreement you would be asked to sign for a less experienced PA is described.
/physician-agreement/utah/physician-assistant
Source: Our research
Missouri: nurse practitioner instrument recorded as Collaborative Practice Arrangement
The statutory name for the Missouri nurse practitioner instrument is now recorded without the abbreviation, as Collaborative Practice Arrangement. The arrangement itself is unchanged in our research.
/physician-agreement/missouri/nurse-practitioner
Source: Our research
Practice type spotlight: Addiction Medicine
41 states require a medical director for an addiction medicine; 0 researched states do not
Grey states on the map are not yet researched.
Medical director requirements for Addiction Medicines by state
Alabama: required (Medical Director)
Alaska: required (Medical Director)
Arizona: required (Medical Director)
California: required (Medical Director)
Connecticut: required (Medical or Dental Director)
Delaware: required (Medical Director)
Every outside claim carries the source it was read from this week. Our own research dates are on each state page. Published 2026-09-07.