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In West Virginia, Botox injections are considered medical practice and must be administered by physicians; private practice nurse practitioners (NPs) if the treatment falls within their scope of practice and they have received prescriptive authority from the Board of Nursing; or physician assistants (PAs) under physician supervision and under the terms of a formal practice agreement.If [1] the physician or NP is physically on the premises where the patient is receiving care; [2] the physician or NP conducts the initial review of the patient and authorizes the treatment plan; and [3] the physician or NP conducts the initial review of the patient and authorizes the treatment plan, registered nurses (RN) may delegate this procedure to themand[3] The RN is trained, has the necessary education and training to conduct the procedure competently and safely, and these skills are checked and recorded prior to the procedure. An NP must have worked for three years in a documented working partnership with a physician in order to gain prescriptive authority from the Board of Nursing.