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In Virginia, Botox injections are considered medical practice and must be administered by doctors, private practice nurse practitioners if the treatment falls within their scope of practice, nurse practitioners (NP) under a written practice agreement with a physician, or physician assistants under physician supervision and pursuant to a written practice agreement.Furthermore, if a registered nurse (RN) or a licensed practical nurse (LPN) has the expertise, ability, and training to safely and competently perform Botox injections under physician supervision and guidance, the physician can delegate Botox injections to them. Botox injections can also be delegated to any appropriately qualified individual if the physician (1) offers direct and immediate supervision, (2) remains responsible for the administration, and (3) the administration is not intravenous, intrathecal, or epidural.

Similarly, an individual practice NP can delegate Botox injections to an RN or LPN if [1] the procedure is within the scope of the NP's practice, [2] the RN or LPN has the expertise, skill, and training to safely and competently perform the procedure, and [3] the RN or LPN has the knowledge, skill, and training to safely and competently perform the procedure.