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In Washington, Botox injection is considered medical procedure and must be done by a licensed physician or a nurse practitioner (NP) if it falls within their area of practice. However, under physician supervision, the physician may delegate this procedure to a physician assistant (PA) working under a written delegation agreement; registered nurses (RN); or licensed practical nurses (LPN) if certain requirements are met, including but not limited to: [1] the physician, NP, or PA must conduct the initial patient examination, [2] the physician must maintain a written delegation agreement, and [3] the physician must maintain a written delegation agreement.

Similarly, an NP may delegate this procedure to an RN or LPN if [1] it falls within the scope of the NP's practice, [2] it is done in accordance with nursing delegation laws, and [3] the RN and LPN have the necessary education, ability, and training to conduct the procedure safely and competently.