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Physicians, PAs, and NPs are licensed to inject Botox and other dermal fillers in Ohio.

When the job falls within their supervising physician's scope of practice and is assigned according to the supervision agreement, PAs can inject Botox. PAs are not permitted to prescribe Botox, but they are allowed to administer it after the supervising physician has personally examined the patient or the PA has consulted with the supervising physician through direct, real-time contact prior to starting the drug.

Not as delegates, but through their legislative scope of operation, NPs are permitted to inject Botox. Since NPs are excluded from the legislation prohibiting nurses from practicing medicine, the Board of Nursing has ruled that they are permitted to provide services deemed to be part of the practice of medicine as long as certain requirements are met. This means that the NP may inject Botox if (1) the task is permissible within the general NP scope of practice, which means that the task must be preventative, primary care, or include the evaluation and promotion of patient wellness; (2) the NP has the necessary education, training, and certifications; and (3) the NP has a standard of care. Furthermore, since Botox is a prescription drug, the NP must have a valid prescription certificate and the NP's standard care agreement must authorize the NP to prescribe and administer Botox.

Injecting Botox and other dermal fillers is also within the scope of practice for RNs and LPNs, but certain requirements must be met. First, a valid order from a physician licensed to practice in Ohio who is working within the scope of their practice must guide the RN or LPN to conduct the procedure. RNs and LPNs must never choose their own drug or dose. Second, the RN or LPN must keep documentation of his or her education, training, and experience that shows their practice adheres to safe nursing practice standards. This training should cover age-specific physiologic criteria that apply to the patients' anatomy and physiology, as well as signs, contraindications, and possible risks related to the administration of cosmetic/aesthetic injectable medications, as well as infection management requirements. Third, a physician whose scope of practice includes Botox and other dermal fillers should confirm the RNs' or LPNs' competence of experience and expertise in performing the treatment through a physician preceptor return demonstration by the nurse.