Tag Archives: 603 CMR 28.03(3)(c)

Nurse Practitioner’s Notes vs. Physician’s Notes

In Massachusetts, when it comes to the provision of educational services for students who cannot attend school for medical reasons, notes from nurse practitioners now hold just as much weight as notes from physicians.  Although the Massachusetts special education regulations have not yet been changed to reflect this new reality, there is a new statute in effect to support this equal weighting.

Under Massachusetts special education regulations, when a School Principal receives a note from a physician verifying that an enrolled student must remain in a hospital or at home for medical reasons for 14 or more school days, that principal must arrange for the provision of educational services in the hospital or home environment.603 CMR 28.03(3)(c). The purpose of the hospital or home educational services is to ensure that the student continues his or her educational program, even though the student is unable to physically be present at school. Although the principal is supposed to coordinate provision of the services with the Administrator of Special Education, such services should not be considered to be special education services, unless the student has already been determined eligible for such services. Id.  The law is very clear that the note must be from a physician (e.g. “Upon receipt of a physician’s written order verifying that any student enrolled in a public school…” Id.).

In 2012, the Massachusetts legislature amended the scope of authority granted to nurse practitioners, clarifying that when a “law or rule requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, when relating to physical or mental health, that requirement may be fulfilled by a nurse practitioner …” MGL c. 112 § 80I.  Thus, even though the special education regulation specifically refers to the need for a physician’s written order, a nurse practitioner’s written order will equally suffice.

This issue recently came up in a due process hearing decision issued by the Massachusetts Bureau of Special Education Appeals (BSEA).  In a 2016 case involving the Lenox Public Schools, the parents of a special education student presented a nurse practitioner’s note to the school district, excusing the student from school for more than two weeks. In Re: Lenox Public Schools and Halsey, 22 MSER 117 (Mass. Bur. of Spec. Educ. App. 2016).  A little more than two weeks later, the parents submitted a second note, this time from a physician.  In response to Lenox’s argument that the nurse practitioner did not have the necessary authority to justify provision of home / hospital services under 603 CMR 28.03(3)(c), BSEA Hearing Officer Lindsay Byrne referred to the new Massachusetts statute when she stated in her decision that “Lenox could not properly decline to accept the nurse practitioner’s medical excuse for Halsey’s absence on the basis of lack of authority.” Lenox, 22 MSER at 119.  Even though the nurse practitioner did have proper authority to request home / hospital services, her note was found to be faulty for other reasons.  For example, the Hearing Officer stated that the note “does not address the regulatory criteria required to support a request for home instruction such as a medical diagnosis and a description of how the student’s health condition affects the delivery of education services in the school and in the home.” Id.  The follow-up note from the physician  had proper authority, and was valid in its content, as well.  Id.

It is also worthwhile to point that even though a note from a physician or nurse practitioner might be completely valid and sufficient to require home / hospital educational services, the school district still has a right, and might even have a responsibility, to make further inquiries of the health care providers and seek additional medical information.  The purpose of such inquiries cannot be to delay or prevent the home / hospital services.  Instead, the school district might need such additional information to ensure that its educational services are appropriate given the student’s diagnosis and medical needs.  Id.

In conclusion, thanks to a Massachusetts law implemented in 2012, a nurse practitioner, through proper notification, can provide the necessary authority for a student to receive home or hospital educational services from a school district.


The Law Office of James M. Baron represents students and parents in special education and other school-related legal matters throughout Massachusetts and New Hampshire.  Please visit http://www.lawbaron.com, or call 781-209-1166 for more information.

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