Medical clearance for NRT – 4/27/10

Q: The Alabama Tobacco Prevention & Control Branch would like to know who has the authority to sign your state quitline's medical clearance forms for NRT? Are nurse practitioners allowed to sign, or is a physician's signature required?

A:

1. Iowa: In Iowa, anyone with prescription authority can sign the fax referral form for nicotine replacement therapy for patients with medical contraindications. Those with prescription authority include MDs, DOs, Psychiatrists, Nurse Practitioners, Physician Assistants, and Dentists. Those without medical contradictions do not need a health care provider signature.
    
2. Indiana: This is handled directly by our quitline.
    
3. New Hampshire: We have a clinical supervisor on staff (on site at the quitline) that provides that QA for the three states, RI, NH, MA.
    
4. South Dakota: In SD, the only NRT users who need medical clearance for this over-the-counter tobacco cessation medication are those who have a contra-indication for use as indicated in the PHS Clinical Practice Guidelines for Treating Tobacco Use and Dependence. For example: those under age 18, pregnant or nursing, or with certain medical conditions. For those individuals they must have medical clearance from their medical provider, and in SD we do accept medical clearance from both physicians and mid-level providers.
    
5. Utah: In Utah, nurse practitioners have authority to write prescriptions, therefore, either a physician or nurse practitioner could sign medical clearance for NRT.

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