For example, before a child is cleared to attend a child care center, Maryland requires a parent to have him or her undergo a complete medical evaluation. Advanced practice nurses are qualified and capable to perform that task, and it would lessen the burden on the individuals seeking these approvals. But state regulations require that the exam be administered and certified by a physician. Similarly, only a physician can authorize a student to be home or hospital schooled. Therefore, if a child has Crohn's disease (an inflammatory bowel disease), even if the child has been seen regularly by a pediatric nurse practitioner, the parent must find a physician to authorize this accommodation.