Nurse Practitioners (NPs), are Registered Nurses in the Extended Class [RN (EC)], who have met additional education, experience and exam requirements set by CNO. These requirements permit them to ground their care in evidence-informed practice and to use critical inquiry in their advanced diagnostic and clinical reasoning.

NPs are autonomous health care practitioners and are accountable to their own nursing practice. They are authorized to diagnose, order, and interpret diagnostic tests and prescribe medications, including controlled substances, and other treatments for clients. NPs also facilitate referrals to specialists and request consultation or referral for procedures. In some settings, an NP can be the most responsible health care provider.

NPs assume sole accountability for their activities, including reflecting on their practice and considering whether they have the knowledge, skill and judgment to perform the activity or procedure safely and competently. They are accountable for managing any adverse outcomes and following up on the care they provide.

NPs are accountable to the Nurse Practitioner practice standard in addition to the other practice standards and guidelines all nurses must follow.

This page provides practice resources for NPs. The information is intended to complement the Nurse Practitioner practice standard. CNO is not responsible for information provided by external organizations.

Diagnostic Tests and Procedures

CNO does not outline an exhaustive list of treatments or diagnostic and/or laboratory tests NPs can provide. NP practice is diverse, and the authorities to order diagnostic tests and procedures are not solely defined by controlled acts in the Registered Health Professionals Act (RHPA) and the Nursing Act, 1991. Diagnostic and laboratory tests are also informed by other legislation (for example, Healing Arts Radiation Protection Act and the Laboratory and Specimen Collection Centre Licensing Act). Access to a broad range of diagnostic tests or procedures is a crucial component of NP practice to establish a diagnosis and provide access to quality client care, such as ordering of:

  • laboratory tests
  • imaging (X-ray, CT, MRI, Ultrasound)
  • miscellaneous services (pulmonary function test, cardiac stress test, ECGs and EEGs)

Ordering laboratory and diagnostic tests

OHIP billing

NPs do not bill OHIP directly for the services they provide. OHIP billing numbers are assigned when NPs order tests or refer patients to specialists. When ordering tests, NPs must include their OHIP billing number on the requisition. This number authorizes the laboratory or diagnostic facility to bill OHIP for the tests. To obtain an OHIP billing number, visit OHIP’s website to submit an Application for OHIP Billing Number for Health Professionals

Prescribing and Ontario support programs

Ontario Drug Benefit (ODB) program

The ODB program provides drug benefits for eligible Ontarians.

Prescriptions written by NPs and dispensed in Ontario are ODB-eligible. NPs must include their CNO registration number on prescriptions.

NPs who prescribe medications to ODB-eligible clients must have an OHIP billing number. This number is not required on the prescription unless you are prescribing a monitored drug. This number is used by the Ministry of Health and Long-Term Care when adjudicating claims. To obtain a billing number, visit OHIP’s website to submit an Application for OHIP Billing Number for Health Professionals.

The ODB formulary is regularly updated and published. Information about ODB and other Ontario public drug programs is available from the Ministry of Health and Long-Term Care .

Therapeutic products listed on the Formulary, such as diabetes testing strips and nutritional products prescribed by NPs, are eligible for the ODB.

Palliative Care Facilitated Access (PCFA)program

NPs who wish to be added to the PCFA Prescriber list must meet all of the following requirements:

  • hold current certification in the Extended Class with the CNO
  • be authorized to prescribe controlled substances
  • have no restrictions on the NP certification that impact their ability to practice
  • provide evidence of continuing education in palliative and end-of-life care

In addition, the NP must meet at least one of the following requirements:

  • provide 20 or more palliative care consults or assessments within a year
  • provide 30-50 or more palliative care visits within a year
  • be identified by the NP’s employer as an a provider of palliative care
  • work in collaboration with a palliative care physician or PCFA-approved NP

All NPs in Ontario can register as PCFA prescribers if they meet the eligibility requirements. To remain on the prescriber list, NPs are required to reapply annually to ensure they continuously meet eligibility criteria.

To apply to the PCFA NP prescriber list or to obtain further information, visit:

NPAO – Palliative Care Facilitated Access Program

RNAO – Palliative Care Facilitated Access Program

Limited use drugs

The criteria for limited use drugs may:

  • not specify who can prescribe them,
  • specify that only physicians can prescribe them or
  • specify that both physicians and NPs can prescribe them.

If the criteria includes NPs or does not identify specific prescribers, NPs can prescribe a limited use drug and the drug will be eligible for coverage under the ODB Program. In this case, NPs may prescribe a limited use drug if the client satisfies ODB-listed limited use criteria.

NPs need to write the limited use code on the prescription, and limited use prescriptions must include a limited use or nutrition product form that indicates the reason for use. To determine whether a medication is covered under limited use, visit the Ministry’s Formulary Search .

Exceptional Access Program (EAP)

ODB can accept an NP prescription under the EAP. The EAP provides access to drugs that are not on the ODB list of prescription drugs. It helps to ensure patient safety, manage costs, ensure compliance with progression of therapies and so on. EAP requests are reviewed individually against clinical criteria. To receive coverage for the requested drug, the patient must be receiving benefits under the ODB program.

More information about the EAP is available on the Ministry's website .

Special Authorization Digital Information Exchange (SADIE)

SADIE is the portal for submitting EAP drug requests for ODB recipients. SADIE is available to Ontario Nurse Practitioners, Physicians and their assigned delegates or designates.

To learn more, visit SADIE at www.Ontario.ca/SADIE .

Lost or stolen prescriptions

To prevent prescription fraud, NPs are expected to adopt strategies to reduce the risk of lost or stolen blank prescriptions. In the event of lost or stolen prescriptions, work with your employer to manage risk and determine whether a report to police is appropriate and in keeping with Ontario’s health privacy law.

Inform Ontario Public Drug Programs of lost or stolen prescriptions by sending an email to publicdrugprgrms.moh@ontario.ca or calling 1-866-811-9893. They will notify pharmacies about missing prescriptions to reduce the potential for fraud.

Special Access Program (SAP)

The SAP allows practitioners to request access to drugs that are unavailable for sale in Canada. This access is limited to clients with serious or life-threatening conditions on an emergency basis when conventional therapies have failed, are unsuitable, or are unavailable.

NPs may request special access to medications that they are legally authorized to prescribe. NPs should consider the additional risks associated with prescribing SAP medications, and discuss these risks with the client. NPs may also wish to consult their professional liability protection provider to address any liability concerns.

More information about the SAP, and requirements that practitioners must meet, is available on Health Canada’s website. For information about NPs’ professional accountabilities related to therapeutic management, see the Nurse Practitioner practice standard.

Facilitating access to personal supports

Assistive Devices Program (ADP)

The ADP helps eligible Ontarians with long-term physical disabilities access and pay for personalized assistive devices. The Ministry accepts NP authorization forms for several devices and supplies. For more information on the type of devices and the circumstances in which NPs can complete authorization forms, visit the Ministry’s website.

Ontario Disability Support Program (ODSP)

The ODSP provides income and employment support to eligible Ontarians. When assessing an individual’s eligibility for income support, ODSP accepts an NP’s assessment of a client’s physical or mental impairment and the expected duration of that impairment. NPs can complete an application for a special diet allowance for eligible recipients. For more information about ODSP, visit the Ministry's website .

Workplace Safety and Insurance Board (WSIB)

The WSIB recognizes NPs as service providers. To bill WSIB, NPs must obtain a WSIB provider identification number. To register for electronic billing please complete the provider registration online form. For more information, visit the WSIB website.

Ontario Disability Tax Credit

Federal legislation authorizes NPs in Canada to sign Form T2201, the Disability Tax Credit Certificate. NPs completing this form are accountable to CNO’s standards, including the Documentation and Nurse Practitioner practice standards.

Hospital practice

Hospital privileges

NPs are authorized to prescribe for and provide care to hospitalized patients. NPs who wish to work within a specific hospital must obtain hospital privileges. Each hospital sets its own process for granting privileges.

NPs who are not employees of a hospital may still order tests for outpatients that are performed at the hospital, even if they do not hold hospital privileges.

Under Regulation 965 of the Public Hospitals Act, a hospital’s Medical Advisory Committee (MAC) may recommend to the hospital board whether hospital privileges should be granted to NPs who are not hospital employees. The MAC is also responsible for the overall supervision and quality of practice of NPs who have been granted hospital privileges.

To apply for hospital privileges, contact the individual hospital.

Admitting, transferring and discharging clients

NPs are authorized to admit, transfer and discharge hospital patients. The process for an NP to admit, transfer and discharge clients is up to the discretion of the hospital. An NP should always consult with the hospital for further information on its policies.

Public health reporting

Under the Health Protection and Promotion Act, NPs have a duty to report certain diseases to the medical officer of health in their local public health unit, if they suspect or know that a person is or may be infected with a communicable disease.

The Ministry of Health has a list of the local public health units in Ontario and their locations.

For a list of reportable diseases and infectious agents, as well as instructions on reporting, contact your local public health unit.

Reporting to the local public health unit

In facilities (such as hospitals and long-term care homes), it is the employer’s responsibility to report diseases or infectious agents. If you work in a facility, consult the applicable facility policies and procedures on how reporting will take place.

In addition, NPs have a duty to report when a client refuses or neglects treatment for a communicable disease. NPs should submit a report containing the client’s name and address to the medical officer of health in their local public health unit.

If an NP certifies death where a communicable disease was a cause or contributing factor of the client’s death, this information must be reported to the local public health unit. For information about the circumstances in which NPs are authorized to certify death, see Certifying Death.

An NP who has information about any animal bite or other animal to human contact that may result in rabies must report the information to the local medical officer of health as soon as possible.

Providing immunizations

Immunization of school pupils

Under the Immunization of School Pupils Act, NPs are authorized to complete a statement that exempts a child from a childhood immunization required for school attendance in Ontario. The conditions under which an exemption may be provided are:

  • the immunization may be detrimental to the health of the client (that is, the child is known to be allergic to a substance in the vaccine) or
  • the immunization is unnecessary because the client is already immune (that is, there is laboratory evidence of immunity).

Immunization reactions

Under the Health Protection and Promotion Act, NPs have a duty to report to the medical officer of health in their local public health unit any of the following immunization reactions:

  1. persistent crying or screaming, anaphylaxis or anaphylactic shock within 48 hours after immunization
  2. shock-like collapse, high fever or convulsions within three days after immunization
  3. arthritis within 42 days of immunization
  4. generalized urticaria, residual seizure disorder, encephalopathy or any other significant occurrence within 15 days of immunization
  5. death occurring at any time or death following any of the above

NPs must make the report within seven days of determining that a client has, or may have, experienced any of these reactions.

In addition, when health care workers are obtaining consent for immunizations, they must provide education to clients about the importance of immediately reporting any reaction that might be a reportable event to a physician or NP.

Parking and driving-related forms

Parking Permits

NPs can complete the Application for Accessible Parking Permit form (SRLV-129 07-08) for clients. The form is available on the Ministry of Transportation website and at any Service Ontario driver and vehicle licence issuing office.

Commercial Licence Medical Report

NPs can complete the Commercial Licence Medical Report form (drivers’ physical). For further information, visit the Medical Review Section (Commercial Drivers) of the Ministry of Transportation website.

Fitness to Drive Medical Reports

It is mandatory for NPs to report certain high risk medical conditions, functional impairments and visual impairments in clients 16 years of age or older. Details of the prescribed conditions NPs must report can be found in Ontario Regulation 340/94, s. 14.1 (3).

NPs also have discretion to report any person who, in the opinion of the NP, has or appears to have any medical condition that may impair safe driving.

A medical reporting form for both mandatory and discretionary reports is available through the Ministry of Transportation website.

NPs are not required to report an individual if no nurse-client relationship exists.