Updated September 2026
Short answer: IV therapy regulations by state have tightened quickly. Between July 2022 and July 2026, boards in 12 states issued statements saying a licensed prescriber, usually a physician, NP or PA, must evaluate each patient and write an individual order before a nurse starts an elective IV. Nine of them said standing orders cannot replace that exam. Texas put its rules into statute in 2025. Many boards also treat adding vitamins to a bag as compounding, and several address mobile IV directly.
IV therapy regulations by state: the 2022–2026 timeline
- July 2022, Alabama: a Board of Medical Examiners declaratory ruling found that an RN evaluating patients alone under standing orders violates Alabama law.
- August 2023, South Carolina: joint advisory opinion of the medical, pharmacy and nursing boards.
- 2024: Vermont's joint board statement (May–June), Rhode Island's health department guidance (July) and North Dakota's nursing guidance (December).
- 2025: Kentucky (March), Ohio (May), Mississippi (April, updated October) and Wisconsin (October). Texas HB 3749 took effect September 1.
- 2026: Oklahoma (March, revised May), Georgia (May) and West Virginia (July).
Standing orders for IV therapy: what the boards say
The boards describe the same model: a walk-in patient picks a drip from a menu, fills in a questionnaire, and an RN or paramedic starts the IV under a medical director's protocol. Their answers fall into three groups.
- Standing orders cannot replace the exam: Alabama, South Carolina, Vermont, Rhode Island (where it is "unprofessional conduct"), Ohio, Mississippi, Georgia, Oklahoma and West Virginia.
- Standing orders only after an individual assessment: Kentucky lets RNs work from signed standing orders once a prescriber has documented the initial assessment. North Dakota and Wisconsin allow them only within an established relationship.
- Looser rules: Illinois lets physicians delegate IVs to RNs and LPNs by standing orders within a physician-patient relationship. South Dakota lets a written protocol allow the nurse to take the history for clients the provider has not seen.
Ohio's position: protocols are not authorized
Ohio's medical, pharmacy and nursing boards issued a joint regulatory statement on May 15, 2025. Its main points:
- A physician, PA or APRN must personally evaluate and diagnose the patient, keep a record, get informed consent and issue a prescription before any IV. The relationship may be set up by telehealth.
- Protocols for recommending, compounding or administering IV medications are not authorized. Ohio's protocol rule (OAC 4729:5-3-12) covers only emergencies, vaccines and a few other listed uses.
- Nurses and paramedics may not diagnose or recommend IVs. LPNs are not authorized to administer IV solutions at a retail IV clinic.
- Mixing IV cocktails is compounding and requires a terminal distributor of dangerous drugs (TDDD) licence. "Immediate use" mixing is capped at three commercial products and two entries into any one container, given within six hours, with a prescriber on site.
Texas HB 3749: elective IVs and LVNs
Texas HB 3749 (Jenifer's Law) took effect September 1, 2025. It covers elective IV therapy given outside a physician's office or licensed facility. A physician may delegate ordering only to a PA or APRN, and administration only to a PA, APRN or RN, each under adequate physician supervision. LVNs are on neither list, which commentators read to mean LVNs can no longer start elective IVs in those settings.
New York: patient-specific orders only
The State Education Department says RNs generally must carry out regimens ordered for a specific patient by a practitioner who examined that patient. Non-patient-specific orders are allowed only for a short list: immunizations, anaphylaxis and opioid-overdose treatment, certain tests and screenings, and some emergency and newborn services. IV hydration, vitamin and NAD+ drips are not on it.
Mobile IV therapy laws
- Rhode Island: nursing services at a home, workplace or event need a home nursing care provider licence (which requires a certificate of need). A van or trailer needs an organized ambulatory care facility licence.
- Kentucky: RNs, LPNs and EMTs may not possess or store legend drugs, including overnight in a home or vehicle.
- Nevada: nurses may carry only the fluids and drugs ordered for that patient.
- North Dakota, Oklahoma, Georgia, Mississippi, West Virginia and Wyoming: their statements expressly cover mobile or drip-bar services and apply the same exam and order rules.
IV hydration clinic requirements: compounding and supply
Boards in Ohio, Rhode Island, South Carolina, Vermont, West Virginia and Wisconsin treat adding vitamins or drugs to a bag of saline as compounding. Vermont and West Virginia say RNs may not mix additives in these clinics. Kentucky lets nurses add no more than two sterile products, given within four hours. Rhode Island requires an on-site physician or pharmacist for any compounding. Wisconsin's boards say fluids and additives must come from FDA-licensed manufacturers, licensed distributors or 503B outsourcing facilities.
Ingredient quality is a live issue too. On August 27, 2026, FDA reported at least 30 patients with reactions after IV glutathione and told compounders not to use dietary-supplement-grade glutathione. FDA status for NAD+, glutathione and vitamin injectables is under NAD+ and vitamin rules.
IV hydration clinic requirements by state: 51 jurisdictions
"Standard rules" means ordinary medical and nursing rules apply with no IV-specific requirement found. "Extra requirements" means an IV-specific exam, order, staffing or compounding rule. † marks a row based on a law-firm summary rather than a board source. The full IV therapy map has citations and dates.
| State | Status | What the state requires |
|---|---|---|
| Alabama | Extra requirements | Prescriber evaluates and diagnoses each patient (telemedicine allowed) and prescribes; standing orders do not satisfy this (2022). |
| Alaska | Not confirmed — check with the board | — |
| Arizona | Not confirmed — check with the board | Board advisory opinion (rev. May 2024) could not be reviewed. |
| Arkansas | Extra requirements | Individual order from a prescriber with an established relationship; licensed nurses start the IV. |
| California | Extra requirements † | Physician, NP or PA exam before an RN gives the IV; a generic standing order does not replace it. |
| Colorado | Standard rules | RNs and LPNs administer on a Colorado prescriber's order. |
| Connecticut | Not confirmed — check with the board | — |
| Delaware | Not confirmed — check with the board | — |
| District of Columbia | Not confirmed — check with the board | — |
| Florida | Standard rules | No IV-specific rule found; RNs administer as prescribed. |
| Georgia | Extra requirements | Individualized order after a prescriber history and physical; no standing orders or menus (2026). |
| Hawaii | Not confirmed — check with the board | — |
| Idaho | Not confirmed — check with the board | — |
| Illinois | Standard rules | Delegation to RNs and LPNs, including by standing orders, within a physician-patient relationship. |
| Indiana | Not confirmed — check with the board | — |
| Iowa | Not confirmed — check with the board | — |
| Kansas | Not confirmed — check with the board | — |
| Kentucky | Extra requirements | Prescriber assessment first, then RN standing orders; nurses may not store legend drugs; two additives maximum. |
| Louisiana | Not confirmed — check with the board | — |
| Maine | Not confirmed — check with the board | — |
| Maryland | Not confirmed — check with the board | Nursing board site could not be reviewed. |
| Massachusetts | Not confirmed — check with the board | Nursing advisory rulings could not be reviewed. |
| Michigan | Standard rules | General delegation and supervision rules. |
| Minnesota | Not confirmed — check with the board | — |
| Mississippi | Extra requirements | Prescriber history and physical and individualized order; no standing orders; nurses may not compound. |
| Missouri | Not confirmed — check with the board | — |
| Montana | Not confirmed — check with the board | — |
| Nebraska | Standard rules | RNs and LPNs on a prescriber order after a documented assessment; no unlicensed staff. |
| Nevada | Extra requirements | Order from a practitioner who assessed the patient; nurses carry only what was ordered. |
| New Hampshire | Not confirmed — check with the board | — |
| New Jersey | Standard rules † | RNs and IV-certified LPNs may administer; medical assistants may not. |
| New Mexico | Not confirmed — check with the board | — |
| New York | Extra requirements | Patient-specific order after a prescriber exam; IV hydration is not on the standing-order list. |
| North Carolina | Extra requirements | Individualized order and client evaluation; RNs need no on-site prescriber. |
| North Dakota | Extra requirements | Prescriber history and physical and client-specific plan (telehealth allowed); covers mobile IV. |
| Ohio | Extra requirements | Prescriber evaluates each patient; protocols not authorized; mixing needs a TDDD licence. |
| Oklahoma | Extra requirements | Individualized order after a prescriber history and physical; no standing orders, including mobile. |
| Oregon | Standard rules | Only licensed prescribers order IVs; patients may not self-select from a menu. |
| Pennsylvania | Standard rules † | General delegation; trained LPNs may give IVs with a prescriber available. |
| Rhode Island | Extra requirements | Prescriber history and physical; standing orders and menus are unprofessional conduct; no LPNs. |
| South Carolina | Extra requirements | Prescriber history and physical (telemedicine allowed); no standing orders; mixing brings pharmacy rules. |
| South Dakota | Standard rules | RNs on a provider's order or protocol; the protocol may let the nurse take the history. |
| Tennessee | Not confirmed — check with the board | — |
| Texas | Extra requirements | HB 3749: ordering by physician, PA or APRN; administration by PA, APRN or RN only (since Sept. 2025). |
| Utah | Not confirmed — check with the board | — |
| Vermont | Extra requirements | Individual prescription; medical-director standing orders invalid; RNs may not mix additives. |
| Virginia | Standard rules | RNs and trained personnel give infusions on physician, APRN or PA orders. |
| Washington | Standard rules | RNs under prescriber direction, following Board advisory opinions. |
| West Virginia | Extra requirements | Prescriber evaluates each patient (telehealth allowed); no standing orders; RNs may not mix (July 2026). |
| Wisconsin | Extra requirements | Prescriber assesses first; standing orders only after that; RN monitors the infusion. |
| Wyoming | Extra requirements | Relationship by audio-video, order within a plan including a personal exam; RNs may not choose or compound. |
For how supervision, good faith exams and chart review fit together, see our guide to med spa medical director responsibilities.
Frequently asked questions
Is a good faith exam required before IV hydration?
In most states with an IV-specific rule, yes: a physician, NP or PA must assess the patient before the first IV. Alabama, Georgia, Mississippi, Ohio, Oklahoma, Rhode Island, South Carolina and West Virginia say so expressly. Nebraska and South Dakota are looser, allowing a nurse assessment under a provider order or protocol.
Are standing orders allowed for IV therapy?
Nine states in our research say standing orders cannot replace the prescriber exam, including Ohio, which says protocols are not authorized in retail IV clinics. Kentucky, North Dakota and Wisconsin allow standing orders only after an individual assessment. Illinois and South Dakota are looser.
Can LPNs or LVNs start IVs at an IV hydration clinic?
Often not. Texas's HB 3749 lists only PAs, APRNs and RNs for elective IV administration, Ohio says LPNs may not administer IV solutions at retail IV clinics, and Rhode Island bars LPNs from these businesses. Nevada allows IV-certified LPNs, and a law-firm review says New Jersey does too.
Can the IV exam be done by telehealth?
Several states allow it, including Alabama, Ohio, Oklahoma, North Dakota, South Carolina and West Virginia. Wyoming requires an audio-video interaction, not a form. Rhode Island says the exam should ideally be in person.
What licences does a mobile IV business need?
Beyond the state's exam and order rules, some states license the setting. Rhode Island requires a home nursing care provider licence for off-site services and a facility licence for mobile units, and Kentucky bars nurses from storing legend drugs in a vehicle. Check with your state health department and boards.
Is adding vitamins to an IV bag compounding?
Boards in Ohio, Rhode Island, South Carolina, Vermont, West Virginia and Wisconsin say it is. That can bring pharmacy licensing (Ohio requires a TDDD licence), USP 797 standards and limits on who may mix.
This article is general information, not legal advice. Board positions change; confirm with your state medical, nursing and pharmacy boards or a healthcare attorney before relying on it.
Check your state's IV rules before you open or expand. See the sourced IV therapy map on MedGrid, or verify your NPI and see wholesale pricing from diligence-cleared vendors.
Sources
- Joint Regulatory Statement of the State Medical Board of Ohio, Ohio Board of Pharmacy, and Ohio Board of Nursing Regarding Retail IV Therapy Clinics, State Medical Board of Ohio, Ohio Board of Pharmacy, Ohio Board of Nursing (2025-05-15)
- HB 3749 enrolled text (89th Legislature), Texas Legislature (2025-09-01)
- Non Patient Specific Orders and Protocols (RNs, LPNs, CNSs & NPs), New York State Education Department, Office of the Professions (2026-09-01)
- Declaratory Ruling: Wellness clinics offering IV medications for a fee, Alabama State Board of Medical Examiners (2022-07-21)
- Guidance Document Regarding the Operation of Medical Spas and Intravenous (IV) Therapy Businesses, Rhode Island Department of Health (2024-07-01)
- Joint Statement Regarding Retail IV Therapy, Kentucky Boards of Medical Licensure, Nursing and Pharmacy (2025-03-28)
- Joint Advisory Opinion Regarding Retail IV Therapy, West Virginia Board of Medicine, Board of Osteopathic Medicine and Board of Pharmacy (2026-07-27)
- Joint Advisory Opinion Regarding IV Hydration Therapy Business, Wisconsin Department of Safety and Professional Services (2025-10-22)
- FDA reminds compounders not to use dietary supplement grade glutathione for injectables, FDA (2026-08-27)
