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Starting a medical business in Las Vegas can be confusing, especially if you are not starting a traditional medical practice where a physician sees every patient.  

A midlevel is a Nurse Practitioner or Physician Assistant.  Abbreviations for these are PA, NP, or APRN.  These professionals have generally done at least two years of additional training to get a "masters degree."  These professionals have the ability to make the first consult with a patient, so prescriptions can be written.

An RN cannot give a patient a medication without a midlevel or MD having seen the patient first.

A medical assistant may take orders from a physician (MD or DO) or  PA, but a Nurse Practitioner cannot use a medical assistant for anything other than basic tasks, such as taking vital signs, cleaning rooms, etc.  An NP may not supervise a medical assistant.

A midlevel or physician must be the first consult with a patient for medications to be prescribed.  This must be in person.  Not over the phone or telemedicine.  The patient must be seen at least every six months to be able to continue to write prescriptions for them.

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