As Reported by the Senate Health, Human Services and Aging Committee

129th General Assembly Regular Session 2011-2012

Sub. H. B. No. 284

Representatives Gonzales, Letson 

Cosponsors: Representatives Stebelton, Wachtmann, Boyd, Slesnick, Gerberry, O'Brien, Murray, Reece, Mallory, Amstutz, Antonio, Boose, Carney, Celeste, Duffey, Fedor, Foley, Gardner, Garland, Hottinger, McClain, Milkovich, Newbold, Pelanda, Phillips, Pillich, Ramos, Schuring, Sears, Sprague, Terhar, Young, Yuko Speaker Batchelder 

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A BILL

To amend sections 2133.211, 3719.06, 4730.06,

1

4730.09, 4730.10, 4730.11, 4730.38, 4730.39,

2

4730.40, 4730.41, 4730.42, 4730.44, 4730.46,

3

4755.48, 4755.481, 4765.01, 4765.35, 4765.36,

4

4765.37, 4765.38, 4765.39, 4765.49, and 4765.51,

5

to enact sections 4723.36, 4730.04, 4730.092, and

6

4730.411, and to repeal section 4730.401 of the

7

Revised Code to modify the laws governing

8

physician assistants and to authorize certain

9

nurses to determine and pronounce death under

10

specified circumstances.

11

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That sections 2133.211, 3719.06, 4730.06,	12
4730.09, 4730.10, 4730.11, 4730.38, 4730.39, 4730.40, 4730.41,	13
4730.42, 4730.44, 4730.46, 4755.48, 4755.481, 4765.01, 4765.35,	14
4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51 be	15
amended and sections 4723.36, 4730.04, 4730.092, and 4730.411 of	16
the Revised Code be enacted to read as follows:	17

Sec. 2133.211.  A person who holds a certificate of authority	18
to practice as a certified nurse practitioner or clinical nurse	19
specialist issued under section 4723.42 of the Revised Code may	20
take any action that may be taken by an attending physician under	21
sections 2133.21 to 2133.26 of the Revised Code and has the	22
immunity provided by section 2133.22 of the Revised Code if the	23
action is taken pursuant to a standard care arrangement with a	24
collaborating physician.	25

A person who holds a certificate to practice as a physician	26
assistant issued under Chapter 4730. of the Revised Code may take	27
any action that may be taken by an attending physician under	28
sections 2133.21 to 2133.26 of the Revised Code and has the	29
immunity provided by section 2133.22 of the Revised Code if the	30
action is taken pursuant to a physician supervisory plan approved	31
pursuant to section 4730.17 of the Revised Code or the policies of	32
a health care facility in which the physician assistant is	33
practicing.	34

Sec. 3719.06.  (A)(1) A licensed health professional	35
authorized to prescribe drugs, if acting in the course of	36
professional practice, in accordance with the laws regulating the	37
professional's practice, and in accordance with rules adopted by	38
the state board of pharmacy, may, except as provided in division	39
(A)(2) or (3) of this section, do the following:	40

(a) Prescribe schedule II, III, IV, and V controlled	41
substances;	42

(b) Administer or personally furnish to patients schedule II,	43
III, IV, and V controlled substances;	44

(c) Cause schedule II, III, IV, and V controlled substances	45
to be administered under the prescriber's direction and	46
supervision.	47

(2) A licensed health professional authorized to prescribe	48
drugs who is a clinical nurse specialist, certified nurse-midwife,	49
or certified nurse practitioner is subject to both of the	50
following:	51

(a) A schedule II controlled substance may be prescribed only	52
in accordance with division (C) of section 4723.481 of the Revised	53
Code.	54

(b) No schedule II controlled substance shall be personally	55
furnished to any patient.	56

(3) A licensed health professional authorized to prescribe	57
drugs who is a physician assistant shall not prescribe or	58
personally furnish to patients anyis subject to all of the	59
following:	60

(a) A controlled substance that is notmay be prescribed or	61
personally furnished only if it is included in the	62
physician-delegated prescriptive authority granted to the	63
physician assistant in accordance with Chapter 4730. of the	64
Revised Code.	65

(b) A schedule II controlled substance may be prescribed only	66
in accordance with division (B)(4) of section 4730.41 and section	67
4730.411 of the Revised Code.	68

(c) No schedule II controlled substance shall be personally	69
furnished to any patient.	70

(B) No licensed health professional authorized to prescribe	71
drugs shall prescribe, administer, or personally furnish a	72
schedule III anabolic steroid for the purpose of human muscle	73
building or enhancing human athletic performance and no pharmacist	74
shall dispense a schedule III anabolic steroid for either purpose,	75
unless it has been approved for that purpose under the "Federal	76
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	77
301, as amended.	78

(C) Each written prescription shall be properly executed,	79
dated, and signed by the prescriber on the day when issued and	80
shall bear the full name and address of the person for whom, or	81
the owner of the animal for which, the controlled substance is	82
prescribed and the full name, address, and registry number under	83
the federal drug abuse control laws of the prescriber. If the	84
prescription is for an animal, it shall state the species of the	85
animal for which the controlled substance is prescribed.	86

Sec. 4723.36.  (A) A certified nurse practitioner or clinical	87
nurse specialist may determine and pronounce an individual's	88
death, but only if the individual's respiratory and circulatory	89
functions are not being artificially sustained and, at the time	90
the determination and pronouncement of death is made, either or	91
both of the following apply:	92

(1) The individual was receiving care in one of the	93
following:	94

(a) A nursing home licensed under section 3721.02 of the	95
Revised Code or by a political subdivision under section 3721.09	96
of the Revised Code;	97

(b) A residential care facility or home for the aging	98
licensed under Chapter 3721. of the Revised Code;	99

(c) A county home or district home operated pursuant to	100
Chapter 5155. of the Revised Code;	101

(d) A residential facility licensed under section 5123.19 of	102
the Revised Code.	103

(2) The certified nurse practitioner or clinical nurse	104
specialist is providing or supervising the individual's care	105
through a hospice care program licensed under Chapter 3712. of the	106
Revised Code or any other entity that provides palliative care.	107

(B) A registered nurse may determine and pronounce an	108
individual's death, but only if the individual's respiratory and	109
circulatory functions are not being artificially sustained and, at	110
the time the determination and pronouncement of death is made, the	111
registered nurse is providing or supervising the individual's care	112
through a hospice care program licensed under Chapter 3712. of the	113
Revised Code or any other entity that provides palliative care.	114

(C) If a certified nurse practitioner, clinical nurse	115
specialist, or registered nurse determines and pronounces an	116
individual's death, the nurse shall comply with both of the	117
following:	118

(1) The nurse shall not complete any portion of the	119
individual's death certificate.	120

(2) The nurse shall notify the individual's attending	121
physician of the determination and pronouncement of death in order	122
for the physician to fulfill the physician's duties under section	123
3705.16 of the Revised Code. The nurse shall provide the	124
notification within a period of time that is reasonable but not	125
later than twenty-four hours following the determination and	126
pronouncement of the individual's death.	127

Sec. 4730.04.  (A) As used in this section:

128

(1) "Disaster" means any imminent threat or actual occurrence	129
of widespread or severe damage to or loss of property, personal	130
hardship or injury, or loss of life that results from any natural	131
phenomenon or act of a human.	132

(2) "Emergency" means an occurrence or event that poses an	133
imminent threat to the health or life of a human.	134

(B) Nothing in this chapter prohibits any of the following	135
individuals from providing medical care, to the extent the	136
individual is able, in response to a need for medical care	137
precipitated by a disaster or emergency:	138

(1) An individual who holds a certificate to practice as a	139
physician assistant issued under this chapter;	140

(2) An individual licensed or authorized to practice as a	141
physician assistant in another state;	142

(3) An individual credentialed or employed as a physician	143
assistant by an agency, office, or other instrumentality of the	144
federal government.	145

(C) For purposes of the medical care provided by a physician	146
assistant pursuant to division (B)(1) of this section, both of the	147
following apply notwithstanding any supervision requirement of	148
this chapter to the contrary:	149

(1) The physician who supervises the physician assistant	150
pursuant to a physician supervisory plan approved by the state	151
medical board under section 4730.17 of the Revised Code is not	152
required to meet the supervision requirements established under	153
this chapter.	154

(2) The physician designated as the medical director of the	155
disaster or emergency may supervise the medical care provided by	156
the physician assistant.	157

Sec. 4730.06.  (A) The physician assistant policy committee	158
of the state medical board shall review, and shall submit to the	159
board recommendations concerning, all of the following:	160

(1) Requirements for issuance of certificates to practice as	161
a physician assistant, including the educational requirements that	162
must be met to receive a certificate to practice;	163

(2) Existing and proposed rules pertaining to the practice of	164
physician assistants, the supervisory relationship between	165
physician assistants and supervising physicians, and the	166
administration and enforcement of this chapter;	167

(3) Physician-delegatedIn accordance with section 4730.38 of	168
the Revised Code, physician-delegated prescriptive authority for	169
physician assistants, in accordance withand proposed changes to	170
the physician assistant formulary the board adopts pursuant to	171
division (A)(1) of section 4730.384730.39 of the Revised Code;	172

(4) Application procedures and forms for certificates to	173
practice as a physician assistant, physician supervisory plans,	174
and supervision agreements;	175

(5) Fees required by this chapter for issuance and renewal of	176
certificates to practice as a physician assistant;	177

(6) Criteria to be included in applications submitted to the	178
board for approval of physician supervisory plans, including	179
criteria to be included in applications for approval to delegate	180
to physician assistants the performance of special services;	181

(7) Criteria to be included in supervision agreements	182
submitted to the board for approval and renewal of the board's	183
approval;	184

(8) Any issue the board asks the committee to consider.

185

(B) In addition to the matters that are required to be	186
reviewed under division (A) of this section, the committee may	187
review, and may submit to the board recommendations concerning,	188
either or both of the following:	189

(1) Quality assurance activities to be performed by a	190
supervising physician and physician assistant under a quality	191
assurance system established pursuant to division (F) of section	192
4730.21 of the Revised Code;	193

(2) The development and approval of one or more model	194
physician supervisory plans and one or more models for a special	195
services portion of the one or more model physician supervisory	196
plans. The committee may submit recommendations for model plans	197
that reflect various medical specialties.	198

(C) The board shall take into consideration all	199
recommendations submitted by the committee. Not later than ninety	200
days after receiving a recommendation from the committee, the	201
board shall approve or disapprove the recommendation and notify	202
the committee of its decision. If a recommendation is disapproved,	203
the board shall inform the committee of its reasons for making	204
that decision. The committee may resubmit the recommendation after	205
addressing the concerns expressed by the board and modifying the	206
disapproved recommendation accordingly. Not later than ninety days	207
after receiving a resubmitted recommendation, the board shall	208
approve or disapprove the recommendation. There is no limit on the	209
number of times the committee may resubmit a recommendation for	210
consideration by the board.	211

(D)(1) Except as provided in division (D)(2) of this section,	212
the board may not take action regarding a matter that is subject	213
to the committee's review under division (A) or (B) of this	214
section unless the committee has made a recommendation to the	215
board concerning the matter.	216

(2) If the board submits to the committee a request for a	217
recommendation regarding a matter that is subject to the	218
committee's review under division (A) or (B) of this section, and	219
the committee does not provide a recommendation before the	220
sixty-first day after the request is submitted, the board may take	221
action regarding the matter without a recommendation.	222

Sec. 4730.09. (A) Under a physician supervisory plan approved	223
under section 4730.17 of the Revised Code, a physician assistant	224
may provide any or all of the following services without approval	225
by the state medical board as special services:	226

(1) Obtaining comprehensive patient histories;

227

(2) Performing physical examinations, including audiometry	228
screening, routine visual screening, and pelvic, rectal, and	229
genital-urinary examinations, when indicated;	230

(3) Ordering, performing, or ordering and performing routine	231
diagnostic procedures, as indicated;	232

(4) Identifying normal and abnormal findings on histories,	233
physical examinations, and commonly performed diagnostic studies;	234

(5) Assessing patients and developing and implementing	235
treatment plans for patients;	236

(6) Monitoring the effectiveness of therapeutic	237
interventions;	238

(7) Exercising physician-delegated prescriptive authority	239
pursuant to a certificate to prescribe issued under this chapter;	240

(8) Carrying out or relaying the supervising physician's	241
orders for the administration of medication, to the extent	242
permitted by law;	243

(9) Providing patient education;

244

(10) Instituting and changing orders on patient charts;

245

(11) Performing developmental screening examinations on	246
children with regard to neurological, motor, and mental functions;	247

(12) Performing wound care management, suturing minor	248
lacerations and removing the sutures, and incision and drainage of	249
uncomplicated superficial abscesses;	250

(13) Removing superficial foreign bodies;

251

(14) Administering intravenous fluids;

252

(15) Inserting a foley or cudae catheter into the urinary	253
bladder and removing the catheter;	254

(16) Removing intrauterine devices;

255

(17) Performing biopsies of superficial lesions;

256

(18)(17) Making appropriate referrals as directed by the	257
supervising physician;	258

(19) Removing norplant capsules;

259

(20)(18) Performing penile duplex ultrasound;

260

(21)(19) Changing of a tracheostomy;

261

(22)(20) Performing bone marrow aspirations from the	262
posterior iliac crest;	263

(23)(21) Performing bone marrow biopsies from the posterior	264
iliac crest;	265

(24)(22) Performing cystograms;

266

(25)(23) Performing nephrostograms after physician placement	267
of nephrostomy tubes;	268

(26)(24) Fitting or, inserting family planning, or removing	269
birth control devices, including intrauterine devices, diaphragms,	270
and cervical caps;	271

(27)(25) Removing cervical polyps;

272

(28)(26) Performing nerve conduction testing;

273

(29)(27) Performing endometrial biopsies;

274

(30)(28) Inserting filiform and follower catheters;

275

(31)(29) Performing arthrocentesis of the knee;

276

(32)(30) Performing knee joint injections;

277

(33)(31) Performing endotracheal intubation with successful	278
completion of an advanced cardiac life support course;	279

(34)(32) Performing lumbar punctures;

280

(35)(33) In accordance with rules adopted by the board, using	281
light-based medical devices for the purpose of hair removal;	282

(36)(34) Administering, monitoring, or maintaining local	283
anesthesia, as defined in section 4730.091 of the Revised Code;	284

(37)(35) Applying or removing a cast or splint;

285

(38)(36) Inserting or removing chest tubes;

286

(37) Prescribing physical therapy or referring a patient to a	287
physical therapist for the purpose of receiving physical therapy;	288

(38) Ordering occupational therapy or referring a patient to	289
an occupational therapist for the purpose of receiving	290
occupational therapy;	291

(39) Taking any action that may be taken by an attending	292
physician under sections 2133.21 to 2133.26 of the Revised Code,	293
as specified in section 2133.211 of the Revised Code;	294

(40) Determining and pronouncing death in accordance with	295
section 4730.092 of the Revised Code;	296

(41) Performing other services that are within the	297
supervising physician's normal course of practice and expertise,	298
if the services are included in any model physician supervisory	299
plan approved under section 4730.06 of the Revised Code or the	300
services are designated by the board by rule or other means as	301
services that are not subject to approval as special services.	302

(B) Under the policies of a health care facility, the	303
services a physician assistant may provide are limited to the	304
services the facility has authorized the physician assistant to	305
provide for the facility. The services a health care facility may	306
authorize a physician assistant to provide for the facility	307
include the following:	308

(1) Any or all of the services specified in division (A) of	309
this section;	310

(2) Assisting in surgery in the health care facility;

311

(3) Any other services permitted by the policies of the	312
health care facility, except that the facility may not authorize a	313
physician assistant to perform a service that is prohibited by	314
this chapter.	315

Sec. 4730.092.  (A) A physician assistant may determine and	316
pronounce an individual's death, but only if the individual's	317
respiratory and circulatory functions are not being artificially	318
sustained and, at the time the determination and pronouncement of	319
death is made, either or both of the following apply:	320

(1) The individual was receiving care in one of the	321
following:	322

(a) A nursing home licensed under section 3721.02 of the	323
Revised Code or by a political subdivision under section 3721.09	324
of the Revised Code;	325

(b) A residential care facility or home for the aging	326
licensed under Chapter 3721. of the Revised Code;	327

(c) A county home or district home operated pursuant to	328
Chapter 5155. of the Revised Code;	329

(d) A residential facility licensed under section 5123.19 of	330
the Revised Code.	331

(2) The physician assistant is providing or supervising the	332
individual's care through a hospice care program licensed under	333
Chapter 3712. of the Revised Code or any other entity that	334
provides palliative care.	335

(B) If a physician assistant determines and pronounces an	336
individual's death, the physician assistant shall comply with both	337
of the following:	338

(1) The physician assistant shall not complete any portion of	339
the individual's death certificate.	340

(2) The physician assistant shall notify the individual's	341
attending physician of the determination and pronouncement of	342
death in order for the physician to fulfill the physician's duties	343
under section 3705.16 of the Revised Code. The physician assistant	344
shall provide the notification within a period of time that is	345
reasonable but not later than twenty-four hours following the	346
determination and pronouncement of the individual's death.	347

Sec. 4730.10.  (A) An individual seeking a certificate to	348
practice as a physician assistant shall file with the state	349
medical board a written application on a form prescribed and	350
supplied by the board. The application shall include all of the	351
following:	352

(1) The applicant's name, residential address, business	353
address, if any, and social security number;	354

(2) Satisfactory proof that the applicant meets the age and	355
moral character requirements specified in divisions (A)(1) and (2)	356
of section 4730.11 of the Revised Code;	357

(3) Effective January 1, 2008, except as provided in division	358
(B) of section 4730.11 of the Revised Code, satisfactory	359
Satisfactory proof that the applicant meets one ofeither the	360
educational requirements specified in division (A)(4)(B)(1) or	361
(2) of section 4730.11 of the Revised Code or the educational or	362
other applicable requirements specified in division (C)(1), (2),	363
or (3) of that section;	364

(4) Any other information the board requires.

365

(B) At the time of making application for a certificate to	366
practice, the applicant shall pay the board a fee of two hundred	367
dollars, no part of which shall be returned. SuchThe fees shall	368
be deposited in accordance with section 4731.24 of the Revised	369
Code.	370

Sec. 4730.11.  (A) For an individual toTo be eligible to	371
receive a certificate to practice as a physician assistant, all of	372
the following apply to an applicant:	373

(1) The applicant shall be at least eighteen years of age.

374

(2) The applicant shall be of good moral character.

375

(3) The applicant shall hold current certification by the	376
national commission on certification of physician assistants or a	377
successor organization that is recognized by the state medical	378
board.	379

(4) The applicant shall meet either of the following	380
requirements:	381

(a) The educational requirements specified in division (B)(1)	382
or (2) of this section;	383

(b) The educational or other applicable requirements	384
specified in division (C)(1), (2), or (3) of this section.	385

(B) Effective January 1, 2008, except as provided infor	386
purposes of division (B)(A)(4)(a) of this section, thean	387
applicant shall meet oneeither of the following educational	388
requirements:	389

(a)(1) The applicant shall hold a master's or higher degree	390
that was obtained from a program accredited by the accreditation	391
review commission on education for the physician assistant or a	392
predecessor or successor organization recognized by the board.	393

(b)(2) The applicant shall hold aboth of the following	394
degrees:	395

(a) A degree other than a master's or higher degree that was	396
obtained from a program accredited by the accreditation review	397
commission on education for the physician assistant or a	398
predecessor or successor organization recognized by the board and	399
shall hold a;	400

(b) A master's or higher degree in a course of study with	401
clinical relevance to the practice of physician assistants that	402
wasand obtained from a program accredited by a regional or	403
specialized and professional accrediting agency recognized by the	404
council for higher education accreditation.	405

(B) It is not necessary for an applicant to hold a master's	406
or higher degree as a condition of receiving a certificate to	407
practice as a physician assistant if the applicant presents(C)	408
For purposes of division (A)(4)(b) of this section, an applicant	409
shall present evidence satisfactory to the board of holding either	410
meeting one of the following requirements in lieu of meeting the	411
educational requirements specified in division (B)(1) or (2) of	412
this section:	413

(1) AThe applicant shall hold a current, valid license or	414
other form of authority to practice as a physician assistant that	415
was issued by another jurisdiction prior to January 1, 2008;.	416

(2) A degree, other than a master's or higher degree, that is	417
The applicant shall hold a degree obtained as a result of being	418
enrolled on January 1, 2008, in a program in this state that was	419
accredited by the accreditation review commission on education for	420
the physician assistant but did not grant a master's or higher	421
degree to individuals enrolled in the program on that date, and	422
completing the program on or before December 31, 2009.	423

(C)(3) The applicant shall meet both of the following	424
educational and military experience requirements:	425

(a) Hold a degree obtained from a program accredited by the	426
accreditation review commission on education for the physician	427
assistant;	428

(b) Have experience practicing as a physician assistant for	429
at least three consecutive years while on active duty, with	430
evidence of service under honorable conditions, in any of the	431
armed forces of the United States or the national guard of any	432
state, including any experience attained while practicing as a	433
physician assistant at a health care facility or clinic operated	434
by the United States department of veterans affairs.	435

(D) This section does not require an individual to obtain a	436
master's or higher degree as a condition of retaining or renewing	437
a certificate to practice as a physician assistant if anythe	438
individual received the certificate without holding a master's or	439
higher degree as provided in either of the following apply:	440

(1) Prior toBefore the educational requirements specified in	441
division (B)(1) or (2) of this section became effective January 1,	442
2008, the individual received a certificate to practice as a	443
physician assistant under this chapter without holding a master's	444
or higher degree.;	445

(2) On or after January 1, 2008, the individual received a	446
certificate to practice as a physician assistant under this	447
chapter on the basis of holding a license issued in another	448
jurisdiction, as specified in division (B)(1) of this section.	449

(3) On or after January 1, 2008, the individual received a	450
certificate to practice as a physician assistant under this	451
chapter on the basis of obtaining a degree as specified in	452
division (B)(2)By meeting the educational or other applicable	453
requirements specified in division (C)(1), (2), or (3) of this	454
section.	455

Sec. 4730.38.  (A) Not later than six months after the	456
effective dateExcept as provided in division (B) of this section,	457
the physician assistant policy committee of the state medical	458
board shall, at such times the committee determines to be	459
necessary, submit to the board its initial recommendations	460
regarding physician-delegated prescriptive authority for physician	461
assistants. The committee's recommendations shall address allboth	462
of the following:	463

(1) Policy and procedures regarding physician-delegated	464
prescriptive authority, including the issuance of certificates to	465
prescribe under this chapter;	466

(2) Subject to the limitations specified in section 4730.40	467
of the Revised Code, a formulary listing the drugs and therapeutic	468
devices by class and specific nomenclature that a supervising	469
physician may include in the physician-delegated prescriptive	470
authority granted to a physician assistant who holds a certificate	471
to prescribe issued under this chapter;	472

(3) Any issue the committee considers necessary to assist the	473
board in fulfilling its duty to adopt rules governing	474
physician-delegated prescriptive authority, including the issuance	475
of certificates to prescribe.	476

(B) After the board's adoption of initial rules under section	477
4730.39 of the Revised Code, the committee shall conduct an annual	478
review of its recommendations regarding physician-delegated	479
prescriptive authority. Based on its review, the committee shall	480
submit recommendations to the board as the committee considers	481
necessaryNot less than every six months beginning on the first	482
day of June following the effective date of this amendment, the	483
committee shall review the physician assistant formulary the board	484
adopts pursuant to division (A)(1) of section 4730.39 of the	485
Revised Code and, to the extent it determines to be necessary,	486
submit recommendations proposing changes to the formulary.	487

(C) Recommendations submitted under this section are subject	488
to the procedures and time frames specified in division (C) of	489
section 4730.06 of the Revised Code.	490

Sec. 4730.39.  (A) Not later than six months after receiving	491
the initial recommendations of the physician assistant policy	492
committee submitted pursuant to division (A) of section 4730.38 of	493
the Revised Code, theThe state medical board shall adoptdo both	494
of the following:	495

(1) Adopt a formulary listing the drugs and therapeutic	496
devices by class and specific generic nomenclature that a	497
physician may include in the physician-delegated prescriptive	498
authority granted to a physician assistant who holds a certificate	499
to prescribe under this chapter;	500

(2) Adopt rules governing physician-delegated prescriptive	501
authority for physician assistants, including the issuance of	502
certificates to prescribe under this chapter. The	503

(B) The board's rules governing physician-delegated	504
prescriptive authority adopted pursuant to division (A)(2) of this	505
section shall be adopted in accordance with Chapter 119. of the	506
Revised Code and shall establish all of the following:	507

(1) Subject to the limitations specified in section 4730.40	508
of the Revised Code, a formulary listing the drugs and therapeutic	509
devices by class and specific generic nomenclature that a	510
physician may include in the physician-delegated prescriptive	511
authority granted to a physician assistant who holds a certificate	512
to prescribe under this chapter;	513

(2) Requirements regarding the pharmacology courses that a	514
physician assistant is required to complete to receive a	515
certificate to prescribe;	516

(3)(2) Standards and procedures for the issuance and renewal	517
of certificates to prescribe to physician assistants;	518

(4)(3) Standards and procedures for the appropriate conduct	519
of the provisional period that a physician assistant is required	520
to complete pursuant to section 4730.45 of the Revised Code and	521
for determining whether a physician assistant has successfully	522
completed the provisional period;	523

(5)(4) A specific prohibition against prescribing any drug or	524
device to perform or induce an abortion;	525

(6)(5) Standards and procedures to be followed by a physician	526
assistant in personally furnishing samples of drugs or complete or	527
partial supplies of drugs to patients under section 4730.43 of the	528
Revised Code;	529

(7)(6) Any other requirements the board considers necessary	530
to implement the provisions of this chapter regarding	531
physician-delegated prescriptive authority and the issuance of	532
certificates to prescribe.	533

(B)(C)(1) After adopting the initial rulesconsidering	534
recommendations submitted by the physician assistant policy	535
committee pursuant to sections 4730.06 and 4730.38 of the Revised	536
Code, the board shall conduct an annual review either or both of	537
the rules. Basedfollowing, as appropriate according to the	538
submitted recommendations:	539

(a) The formulary the board adopts under division (A)(1) of	540
this section;	541

(b) The rules the board adopts under division (A)(2) of this	542
section regarding physician-delegated prescriptive authority.	543

(2) Based on its review, the board shall make any necessary	544
modifications to the formulary or rules.	545

(C) All rules adopted under this section shall be adopted in	546
accordance with Chapter 119. of the Revised Code. When adopting	547
the initial rules, the board shall consider the recommendations of	548
the physician assistant policy committee submitted pursuant to	549
division (A) of section 4730.38 of the Revised Code. When making	550
any modifications to the rules subsequent to its annual review of	551
the rules, the board shall consider the committee's	552
recommendations submitted pursuant to division (B) of section	553
4730.38 of the Revised Code.	554

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	555
of this section, the physician assistant formulary established	556
adopted by the state medical board in rules adopted under section	557
4730.39 of the Revised Code listing the drugs and therapeutic	558
devices by class and specific nomenclature that a supervising	559
physician may include in the physician-delegated prescriptive	560
authority granted to a physician assistant who holds a certificate	561
to prescribe issued under this chapter may include any or all of	562
the following drugs:	563

(1) Schedule II, III, IV, and V controlled substances;

564

(2) Drugs that under state or federal law may be dispensed	565
only pursuant to a prescription by a licensed health professional	566
authorized to prescribe drugs, as defined in section 4729.01 of	567
the Revised Code;	568

(3) Any drug that is not a dangerous drug, as defined in	569
section 4729.01 of the Revised Code.	570

(B) The formulary established in the board's rulesadopted by	571
the board shall not include, and shall specify that it does not	572
include, the following:	573

(1) Any schedule II controlled substance;

574

(2) Anyany drug or device used to perform or induce an	575
abortion.	576

(C) When adopting rules establishing the initial formulary,	577
the board shall include provisions ensuring that a physician	578
assistant who holds a certificate to prescribe issued under this	579
chapter may be granted physician-delegated prescriptive authority	580
for all drugs and therapeutic devices that may be prescribed on	581
the effective date of the rules by a holder of a certificate to	582
prescribe issued by the board of nursing under Chapter 4723. of	583
the Revised Code, with the exception of schedule II controlled	584
substances. To the extent permitted by division (A) of this	585
section, the initial formulary may include additional drugs or	586
therapeutic devices.	587

Sec. 4730.41.  (A) A certificate to prescribe issued under	588
this chapter authorizes a physician assistant to prescribe and	589
personally furnish drugs and therapeutic devices in the exercise	590
of physician-delegated prescriptive authority.	591

(B) In exercising physician-delegated prescriptive authority,	592
a physician assistant is subject to all of the following:	593

(1) The physician assistant shall exercise	594
physician-delegated prescriptive authority only to the extent that	595
the physician supervising the physician assistant has granted that	596
authority.	597

(2) The physician assistant shall comply with all conditions	598
placed on the physician-delegated prescriptive authority, as	599
specified by the supervising physician who is supervising the	600
physician assistant in the exercise of physician-delegated	601
prescriptive authority.	602

(3) If the physician assistant possesses physician-delegated	603
prescriptive authority for controlled substances, the physician	604
assistant shall register with the federal drug enforcement	605
administration.	606

(4) If the physician assistant possesses physician-delegated	607
prescriptive authority for schedule II controlled substances, the	608
physician assistant shall comply with section 4730.411 of the	609
Revised Code.	610

Sec. 4730.411. (A) Except as provided in division (B) or (C)	611
of this section, a physician assistant may prescribe to a patient	612
a schedule II controlled substance only if all of the following	613
are the case:	614

(1) The patient is in a terminal condition, as defined in	615
section 2133.01 of the Revised Code.	616

(2) The physician assistant's supervising physician initially	617
prescribed the substance for the patient.	618

(3) The prescription is for an amount that does not exceed	619
the amount necessary for the patient's use in a single,	620
twenty-four-hour period.	621

(B) The restrictions on prescriptive authority in division	622
(A) of this section do not apply if a physician assistant issues	623
the prescription to the patient from any of the following	624
locations:	625

(1) A hospital registered under section 3701.07 of the	626
Revised Code;	627

(2) An entity owned or controlled, in whole or in part, by a	628
hospital or by an entity that owns or controls, in whole or in	629
part, one or more hospitals;	630

(3) A health care facility operated by the department of	631
mental health or the department of developmental disabilities;	632

(4) A nursing home licensed under section 3721.02 of the	633
Revised Code or by a political subdivision certified under section	634
3721.09 of the Revised Code;	635

(5) A county home or district home operated under Chapter	636
5155. of the Revised Code that is certified under the medicare or	637
medicaid program;	638

(6) A hospice care program, as defined in section 3712.01 of	639
the Revised Code;	640

(7) A community mental health agency, as defined in section	641
5122.01 of the Revised Code;	642

(8) An ambulatory surgical facility, as defined in section	643
3702.30 of the Revised Code;	644

(9) A freestanding birthing center, as defined in section	645
3702.51 of the Revised Code;	646

(10) A federally qualified health center, as defined in	647
section 3701.047 of the Revised Code;	648

(11) A federally qualified health center look-alike, as	649
defined in section 3701.047 of the Revised Code;	650

(12) A health care office or facility operated by the board	651
of health of a city or general health district or the authority	652
having the duties of a board of health under section 3709.05 of	653
the Revised Code;	654

(13) A site where a medical practice is operated, but only if	655
the practice is comprised of one or more physicians who also are	656
owners of the practice; the practice is organized to provide	657
direct patient care; and the physician assistant has entered into	658
a supervisory agreement with at least one of the physician owners	659
who practices primarily at that site.	660

(C) A physician assistant shall not issue to a patient a	661
prescription for a schedule II controlled substance from a	662
convenience care clinic even if the convenience care clinic is	663
owned or operated by an entity specified in division (B) of this	664
section.	665

(D) A pharmacist who acts in good faith reliance on a	666
prescription issued by a physician assistant under division (B) of	667
this section is not liable for or subject to any of the following	668
for relying on the prescription: damages in any civil action,	669
prosecution in any criminal proceeding, or professional	670
disciplinary action by the state board of pharmacy under Chapter	671
4729. of the Revised Code.	672

Sec. 4730.42.  (A) In granting physician-delegated	673
prescriptive authority to a particular physician assistant who	674
holds a certificate to prescribe issued under this chapter, the	675
supervising physician is subject to all of the following:	676

(1) The supervising physician shall not grant	677
physician-delegated prescriptive authority for any drug or	678
therapeutic device that is not listed on the physician assistant	679
formulary established in rules adopted under section 4730.39 of	680
the Revised Code as a drug or therapeutic device that may be	681
included in the physician-delegated prescriptive authority granted	682
to a physician assistant.	683

(2) The supervising physician shall not grant	684
physician-delegated prescriptive authority for any drug or device	685
that may be used to perform or induce an abortion.	686

(3) The supervising physician shall not grant	687
physician-delegated prescriptive authority in a manner that	688
exceeds the supervising physician's prescriptive authority,	689
including the physician's authority to treat chronic pain with	690
controlled substances and products containing tramadol as	691
described in section 4731.052 of the Revised Code.	692

(4) The supervising physician shall supervise the physician	693
assistant in accordance with all of the following:	694

(a) The supervision requirements specified in section 4730.21	695
of the Revised Code and, in the case of supervision provided	696
during a provisional period of physician-delegated prescriptive	697
authority, the supervision requirements specified in section	698
4730.45 of the Revised Code;	699

(b) The physician supervisory plan approved for the	700
supervising physician or the policies of the health care facility	701
in which the physician and physician assistant are practicing;	702

(c) The supervision agreement approved under section 4730.19	703
of the Revised Code that applies to the supervising physician and	704
the physician assistant.	705

(B)(1) The supervising physician of a physician assistant may	706
place conditions on the physician-delegated prescriptive authority	707
granted to the physician assistant. If conditions are placed on	708
that authority, the supervising physician shall maintain a written	709
record of the conditions and make the record available to the	710
state medical board on request.	711

(2) The conditions that a supervising physician may place on	712
the physician-delegated prescriptive authority granted to a	713
physician assistant include the following:	714

(a) Identification by class and specific generic nomenclature	715
of drugs and therapeutic devices that the physician chooses not to	716
permit the physician assistant to prescribe;	717

(b) Limitations on the dosage units or refills that the	718
physician assistant is authorized to prescribe;	719

(c) Specification of circumstances under which the physician	720
assistant is required to refer patients to the supervising	721
physician or another physician when exercising physician-delegated	722
prescriptive authority;	723

(d) Responsibilities to be fulfilled by the physician in	724
supervising the physician assistant that are not otherwise	725
specified in the physician supervisory plan or otherwise required	726
by this chapter.	727

Sec. 4730.44. (A) A physician assistant seeking a certificate	728
to prescribe shall submit to the state medical board a written	729
application on a form prescribed and supplied by the board. The	730
application shall include all of the following information:	731

(1) The applicant's name, residential address, business	732
address, if any, and social security number;	733

(2) Evidence of holding a valid certificate to practice as a	734
physician assistant issued under this chapter;	735

(3) Satisfactory proof that the applicant meets the	736
requirements specified in section 4730.46 of the Revised Code to	737
participate in a provisional period of physician-delegated	738
prescriptive authority or satisfactory proof of successful	739
completion of the provisional period, evidenced by a letter or	740
copy of a letter attesting to the successful completion written by	741
a supervising physician of the physician assistant at the time of	742
completionof eligibility to receive a certificate to prescribe by	743
meeting one of the requirements specified in division (B) of this	744
section;	745

(4) Any other information the board requires.

746

(B) To be eligible to receive a certificate to prescribe, an	747
applicant shall meet one of the following requirements:	748

(1) In the case of an applicant seeking to participate in a	749
provisional period of physician-delegated prescriptive authority	750
under section 4730.45 of the Revised Code, the applicant must meet	751
the requirements to participate in the provisional period, as	752
specified in section 4730.46 of the Revised Code.	753

(2) In the case of an applicant seeking a certificate to	754
prescribe after participating in a provisional period of	755
physician-delegated prescriptive authority, the applicant must	756
have successfully completed the provisional period, evidenced by a	757
letter or copy of a letter attesting to the successful completion	758
written by a physician who supervised the applicant at the time of	759
completion.	760

(3) In the case of an applicant who received a certificate to	761
practice by meeting the educational and military experience	762
requirements specified in division (C)(3) of section 4730.11 of	763
the Revised Code, the applicant must have been authorized to	764
prescribe drugs and therapeutic devices while practicing as a	765
physician assistant.	766

(4) In the case of an applicant who is not seeking a	767
certificate to prescribe by meeting the requirements of division	768
(B)(1), (2), or (3) of this section and has practiced as a	769
physician assistant in another state or was credentialed or	770
employed as a physician assistant by the United States government,	771
the applicant must meet both of the following requirements:	772

(a) Hold a master's or higher degree obtained from a program	773
accredited by the accreditation review commission on education for	774
the physician assistant or a predecessor or successor organization	775
recognized by the board;	776

(b) Have held valid authority issued by the other state or	777
the United States government to prescribe therapeutic devices and	778
drugs, including at least some controlled substances, evidenced by	779
an affidavit issued by an appropriate agency or office of the	780
other state or the United States government attesting to that	781
prescriptive authority.	782

(C) At the time of making application for a certificate to	783
prescribe, the applicant shall pay the board a fee of one hundred	784
dollars, no part of which shall be returned. The fees shall be	785
deposited in accordance with section 4731.24 of the Revised Code.	786

(C)(D) The board shall review all applications received. If	787
an application is complete and the board determines that the	788
applicant meets the requirements for a certificate to prescribe,	789
the board shall issue the certificate to the applicant. The	790
initial certificate to prescribe issued to an applicant seeking to	791
participate in a provisional period of physician-delegated	792
prescriptive authority shall be issued as a provisional	793
certificate to prescribe.	794

Sec. 4730.46.  (A) To be eligible to participate in the	795
provisional period of physician-delegated prescriptive authority	796
required by section 4730.45 of the Revised Code, both of the	797
following apply to a physician assistant:	798

(1) The physician assistant shall meet the educational	799
requirements specified in division (B)(1) or (2) of this section	800
or the educational and clinical experience requirements specified	801
in division (B)(2) of this section.	802

(2) The physician assistant shall successfully complete the	803
pharmacology instruction specified in division (C) of this	804
section.	805

(B)(1) For purposes of division (A)(1) of this section, a	806
physician assistant shall meet either of the following educational	807
requirements unless division (B)(2) of this section applies:	808

(a)(1) The physician assistant shall hold a master's or	809
higher degree that was obtained from a program accredited by the	810
accreditation review commission on education for the physician	811
assistant or a predecessor or successor organization recognized by	812
the state medical board.	813

(b)(2) The physician assistant shall hold aboth of the	814
following degrees:	815

(a) A degree other than a master's or higher degree that was	816
obtained from a school or program accredited by the accreditation	817
review commission on education for the physician assistant or a	818
predecessor or successor organization recognized by the board and	819
shall hold a;	820

(b) A master's or higher degree in a course of study with	821
clinical relevance to the practice of physician assistants that	822
was obtained from a program accredited by a regional or	823
specialized and professional accrediting agency recognized by the	824
council for higher education accreditation.	825

(2) Until two years after the effective date of the initial	826
rules adopted under section 4730.39 of the Revised Code, a	827
physician assistant who does not hold a master's or higher degree	828
as specified in division (B)(1) of this section is eligible to	829
participate in a provisional period if both of the following	830
apply:	831

(a) The physician assistant holds a degree other than a	832
master's or higher degree that was obtained from a program	833
accredited by the accreditation review commission on education for	834
the physician assistant or a predecessor or successor organization	835
recognized by the board.	836

(b) The physician assistant has obtained not less than ten	837
years of clinical experience as a physician assistant in this	838
state or another jurisdiction, three years of which were obtained	839
in the five-year period immediately preceding the date the	840
evidence is submitted to the supervising physician.	841

(C) For purposes of division (A)(2) of this section, all of	842
the following conditions shall be met:	843

(1) The pharmacology instruction shall be completed not	844
longer than three years prior to applying for the certificate to	845
prescribe.	846

(2) The instruction shall be obtained through a course of	847
study consisting of planned classroom or continued education and	848
clinical study that meets either of the following conditions:	849

(a) It is accredited by the accreditation review commission	850
on education for the physician assistant or a predecessor or	851
successor organization recognized by the board.	852

(b) It is approved by the board in accordance with standards	853
established in rules adopted under section 4730.39 of the Revised	854
Code.	855

(3) The content of the instruction shall include all of the	856
following:	857

(a) A minimum of thirty contact hours of training in	858
pharmacology that includes pharmacokinetic principles and clinical	859
application and the use of drugs and therapeutic devices in the	860
prevention of illness and maintenance of health;	861

(b) A minimum of twenty contact hours of clinical training in	862
pharmacology;	863

(c) A minimum of fifteen contact hours including training in	864
the fiscal and ethical implications of prescribing drugs and	865
therapeutic devices and training in the state and federal laws	866
that apply to the authority to prescribe;	867

(d) Any additional training required pursuant to rules	868
adopted under section 4730.39 of the Revised Code.	869

Sec. 4755.48.  (A) No person shall employ fraud or deception	870
in applying for or securing a license to practice physical therapy	871
or to be a physical therapist assistant.	872

(B) No person shall practice or in any way imply or claim to	873
the public by words, actions, or the use of letters as described	874
in division (C) of this section to be able to practice physical	875
therapy or to provide physical therapy services, including	876
practice as a physical therapist assistant, unless the person	877
holds a valid license under sections 4755.40 to 4755.56 of the	878
Revised Code or except for submission of claims as provided in	879
section 4755.56 of the Revised Code.	880

(C) No person shall use the words or letters, physical	881
therapist, physical therapy, physical therapy services,	882
physiotherapist, physiotherapy, physiotherapy services, licensed	883
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	884
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	885
therapist assistant, physical therapy technician, licensed	886
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	887
letters, words, abbreviations, or insignia, indicating or implying	888
that the person is a physical therapist or physical therapist	889
assistant without a valid license under sections 4755.40 to	890
4755.56 of the Revised Code.	891

(D) No person who practices physical therapy or assists in	892
the provision of physical therapy treatments under the supervision	893
of a physical therapist shall fail to display the person's current	894
license granted under sections 4755.40 to 4755.56 of the Revised	895
Code in a conspicuous location in the place where the person	896
spends the major part of the person's time so engaged.	897

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	898
Code shall affect or interfere with the performance of the duties	899
of any physical therapist or physical therapist assistant in	900
active service in the army, navy, coast guard, marine corps, air	901
force, public health service, or marine hospital service of the	902
United States, while so serving.	903

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	904
Code shall prevent or restrict the activities or services of a	905
person pursingpursuing a course of study leading to a degree in	906
physical therapy in an accredited or approved educational program	907
if the activities or services constitute a part of a supervised	908
course of study and the person is designated by a title that	909
clearly indicates the person's status as a student.	910

(G) No(1) Except as provided in division (G)(2) of this	911
section and subject to division (H) of this section, no person	912
shall practice physical therapy other than on the prescription of,	913
or the referral of a patient by, a person who is licensed in this	914
or another state to practicedo at least one of the following:	915

(a) Practice medicine and surgery, chiropractic, dentistry,	916
osteopathic medicine and surgery, podiatric medicine and surgery,	917
or to practice;	918

(b) Practice as a physician assistant;

919

(c) Practice nursing as a certified registered nurse	920
anesthetist, clinical nurse specialist, certified nurse-midwife,	921
or certified nurse practitioner, within the scope of such	922
practices, and whose license is in good standing, unless either of	923
the following conditions is met:.	924

(1)(2) The prohibition in division (G)(1) of this section on	925
practicing physical therapy other than on the prescription of, or	926
the referral of a patient by, any of the persons described in that	927
division does not apply if either of the following applies to the	928
person:	929

(a) The person holds a master's or doctorate degree from a	930
professional physical therapy program that is accredited by a	931
national physical therapy accreditation agency recognized by the	932
United States department of education.	933

(2)(b) On or before December 31, 2004, the person has	934
completed at least two years of practical experience as a licensed	935
physical therapist.	936

(H) To be authorized to prescribe physical therapy or refer	937
a patient to a physical therapist for physical therapy, a person	938
described in division (G)(1) of this section must be in good	939
standing with the relevant licensing board in this state or the	940
state in which the person is licensed and must act only within the	941
person's scope of practice.	942

(I) In the prosecution of any person for violation of	943
division (B) or (C) of this section, it is not necessary to allege	944
or prove want of a valid license to practice physical therapy or	945
to practice as a physical therapist assistant, but such matters	946
shall be a matter of defense to be established by the accused.	947

Sec. 4755.481. (A) If a physical therapist evaluates and	948
treats a patient without the prescription of, or the referral of	949
the patient by, a person who is licensed to practice medicine and	950
surgery, chiropractic, dentistry, osteopathic medicine and	951
surgery, podiatric medicine and surgery, or nursing as a certified	952
registered nurse anesthetist, clinical nurse specialist, certified	953
nurse-midwife, or certified nurse practitionerdescribed in	954
division (G)(1) of section 4755.48 of the Revised Code, all of the	955
following apply:	956

(1) The physical therapist shall, upon consent of the	957
patient, inform the patient's physician, chiropractor, dentist,	958
podiatrist, certified registered nurse anesthetist, clinical nurse	959
specialist, certified nurse-midwife, or certified nurse	960
practitionerrelevant person described in division (G)(1) of	961
section 4755.48 of the Revised Code of the evaluation not later	962
than five business days after the evaluation is made.	963

(2) If the physical therapist determines, based on reasonable	964
evidence, that no substantial progress has been made with respect	965
to that patient during the thirty-day period immediately following	966
the date of the patient's initial visit with the physical	967
therapist, the physical therapist shall consult with or refer the	968
patient to a licensed physician, chiropractor, dentist,	969
podiatrist, certified registered nurse anesthetist, clinical nurse	970
specialist, certified nurse-midwife, or certified nurse	971
practitionerperson described in division (G)(1) of section	972
4755.48 of the Revised Code, unless either of the following	973
applies:	974

(a) The evaluation, treatment, or services are being provided	975
for fitness, wellness, or prevention purposes.	976

(b) The patient previously was diagnosed with chronic,	977
neuromuscular, or developmental conditions and the evaluation,	978
treatment, or services are being provided for problems or symptoms	979
associated with one or more of those previously diagnosed	980
conditions.	981

(3) If the physical therapist determines that orthotic	982
devices are necessary to treat the patient, the physical therapist	983
shall be limited to the application of the following orthotic	984
devices:	985

(a) Upper extremity adaptive equipment used to facilitate the	986
activities of daily living;	987

(b) Finger splints;

988

(c) Wrist splints;

989

(d) Prefabricated elastic or fabric abdominal supports with	990
or without metal or plastic reinforcing stays and other	991
prefabricated soft goods requiring minimal fitting;	992

(e) Nontherapeutic accommodative inlays;

993

(f) Shoes that are not manufactured or modified for a	994
particular individual;	995

(g) Prefabricated foot care products;

996

(h) Custom foot orthotics;

997

(i) Durable medical equipment.

998

(4) If, at any time, the physical therapist has reason to	999
believe that the patient has symptoms or conditions that require	1000
treatment or services beyond the scope of practice of a physical	1001
therapist, the physical therapist shall refer the patient to a	1002
licensed health care practitioner acting within the practitioner's	1003
scope of practice.	1004

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	1005
Code shall be construed to require reimbursement under any health	1006
insuring corporation policy, contract, or agreement, any sickness	1007
and accident insurance policy, the medical assistance program as	1008
defined in section 5111.01 of the Revised Code, or the health	1009
partnership program or qualified health plans established pursuant	1010
to sections 4121.44 to 4121.442 of the Revised Code, for any	1011
physical therapy service rendered without the prescription of, or	1012
the referral of the patient by, a licensed physician,	1013
chiropractor, dentist, podiatrist, certified registered nurse	1014
anesthetist, clinical nurse specialist, certified nurse-midwife,	1015
or certified nurse practitionerperson described in division	1016
(G)(1) of section 4755.48 of the Revised Code.	1017

(C) For purposes of this section, "business day" means any	1018
calendar day that is not a Saturday, Sunday, or legal holiday.	1019
"Legal holiday" has the same meaning as in section 1.14 of the	1020
Revised Code.	1021

Sec. 4765.01.  As used in this chapter:

1022

(A) "First responder" means an individual who holds a	1023
current, valid certificate issued under section 4765.30 of the	1024
Revised Code to practice as a first responder.	1025

(B) "Emergency medical technician-basic" or "EMT-basic" means	1026
an individual who holds a current, valid certificate issued under	1027
section 4765.30 of the Revised Code to practice as an emergency	1028
medical technician-basic.	1029

(C) "Emergency medical technician-intermediate" or "EMT-I"	1030
means an individual who holds a current, valid certificate issued	1031
under section 4765.30 of the Revised Code to practice as an	1032
emergency medical technician-intermediate.	1033

(D) "Emergency medical technician-paramedic" or "paramedic"	1034
means an individual who holds a current, valid certificate issued	1035
under section 4765.30 of the Revised Code to practice as an	1036
emergency medical technician-paramedic.	1037

(E) "Ambulance" means any motor vehicle that is used, or is	1038
intended to be used, for the purpose of responding to emergency	1039
medical situations, transporting emergency patients, and	1040
administering emergency medical service to patients before,	1041
during, or after transportation.	1042

(F) "Cardiac monitoring" means a procedure used for the	1043
purpose of observing and documenting the rate and rhythm of a	1044
patient's heart by attaching electrical leads from an	1045
electrocardiograph monitor to certain points on the patient's body	1046
surface.	1047

(G) "Emergency medical service" means any of the services	1048
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	1049
the Revised Code that are performed by first responders, emergency	1050
medical technicians-basic, emergency medical	1051
technicians-intermediate, and paramedics. "Emergency medical	1052
service" includes such services performed before or during any	1053
transport of a patient, including transports between hospitals and	1054
transports to and from helicopters.	1055

(H) "Emergency medical service organization" means a public	1056
or private organization using first responders, EMTs-basic,	1057
EMTs-I, or paramedics, or a combination of first responders,	1058
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	1059
services.	1060

(I) "Physician" means an individual who holds a current,	1061
valid certificate issued under Chapter 4731. of the Revised Code	1062
authorizing the practice of medicine and surgery or osteopathic	1063
medicine and surgery.	1064

(J) "Registered nurse" means an individual who holds a	1065
current, valid license issued under Chapter 4723. of the Revised	1066
Code authorizing the practice of nursing as a registered nurse.	1067

(K) "Volunteer" means a person who provides services either	1068
for no compensation or for compensation that does not exceed the	1069
actual expenses incurred in providing the services or in training	1070
to provide the services.	1071

(L) "Emergency medical service personnel" means first	1072
responders, emergency medical service technicians-basic, emergency	1073
medical service technicians-intermediate, emergency medical	1074
service technicians-paramedic, and persons who provide medical	1075
direction to such persons.	1076

(M) "Hospital" has the same meaning as in section 3727.01 of	1077
the Revised Code.	1078

(N) "Trauma" or "traumatic injury" means severe damage to or	1079
destruction of tissue that satisfies both of the following	1080
conditions:	1081

(1) It creates a significant risk of any of the following:

1082

(a) Loss of life;

1083

(b) Loss of a limb;

1084

(c) Significant, permanent disfigurement;

1085

(d) Significant, permanent disability.

1086

(2) It is caused by any of the following:

1087

(a) Blunt or penetrating injury;

1088

(b) Exposure to electromagnetic, chemical, or radioactive	1089
energy;	1090

(c) Drowning, suffocation, or strangulation;

1091

(d) A deficit or excess of heat.

1092

(O) "Trauma victim" or "trauma patient" means a person who	1093
has sustained a traumatic injury.	1094

(P) "Trauma care" means the assessment, diagnosis,	1095
transportation, treatment, or rehabilitation of a trauma victim by	1096
emergency medical service personnel or by a physician, nurse,	1097
physician assistant, respiratory therapist, physical therapist,	1098
chiropractor, occupational therapist, speech-language pathologist,	1099
audiologist, or psychologist licensed to practice as such in this	1100
state or another jurisdiction.	1101

(Q) "Trauma center" means all of the following:

1102

(1) Any hospital that is verified by the American college of	1103
surgeons as an adult or pediatric trauma center;	1104

(2) Any hospital that is operating as an adult or pediatric	1105
trauma center under provisional status pursuant to section	1106
3727.101 of the Revised Code;	1107

(3) Until December 31, 2004, any hospital in this state that	1108
is designated by the director of health as a level II pediatric	1109
trauma center under section 3727.081 of the Revised Code;	1110

(4) Any hospital in another state that is licensed or	1111
designated under the laws of that state as capable of providing	1112
specialized trauma care appropriate to the medical needs of the	1113
trauma patient.	1114

(R) "Pediatric" means involving a patient who is less than	1115
sixteen years of age.	1116

(S) "Adult" means involving a patient who is not a pediatric	1117
patient.	1118

(T) "Geriatric" means involving a patient who is at least	1119
seventy years old or exhibits significant anatomical or	1120
physiological characteristics associated with advanced aging.	1121

(U) "Air medical organization" means an organization that	1122
provides emergency medical services, or transports emergency	1123
victims, by means of fixed or rotary wing aircraft.	1124

(V) "Emergency care" and "emergency facility" have the same	1125
meanings as in section 3727.01 of the Revised Code.	1126

(W) "Stabilize," except as it is used in division (B) of	1127
section 4765.35 of the Revised Code with respect to the manual	1128
stabilization of fractures, has the same meaning as in section	1129
1753.28 of the Revised Code.	1130

(X) "Transfer" has the same meaning as in section 1753.28 of	1131
the Revised Code.	1132

(Y) "Firefighter" means any member of a fire department as	1133
defined in section 742.01 of the Revised Code.	1134

(Z) "Volunteer firefighter" has the same meaning as in	1135
section 146.01 of the Revised Code.	1136

(AA) "Part-time paid firefighter" means a person who provides	1137
firefighting services on less than a full-time basis, is routinely	1138
scheduled to be present on site at a fire station or other	1139
designated location for purposes of responding to a fire or other	1140
emergency, and receives more than nominal compensation for the	1141
provision of firefighting services.	1142

(BB) "Physician assistant" means an individual who holds a	1143
valid certificate to practice as a physician assistant issued	1144
under Chapter 4730. of the Revised Code.	1145

Sec. 4765.35.  (A) A first responder shall perform the	1146
emergency medical services described in this section in accordance	1147
with this chapter and any rules adopted under it.	1148

(B) A first responder may provide limited emergency medical	1149
services to patients until the arrival of an emergency medical	1150
technician-basic, emergency medical technician-intermediate, or	1151
emergency medical technician-paramedic. In an emergency, a first	1152
responder may render emergency medical services such as opening	1153
and maintaining an airway, giving mouth to barrier ventilation,	1154
chest compressions, electrical interventions with automated	1155
defibrillators to support or correct the cardiac function and	1156
other methods determined by the board, controlling of hemorrhage,	1157
manual stabilization of fractures, bandaging, assisting in	1158
childbirth, and determining triage of trauma victims.	1159

(C) A first responder may perform any other emergency medical	1160
services approved pursuant to rules adopted under section 4765.11	1161
of the Revised Code. The board shall determine whether the nature	1162
of any such service requires that a first responder receive	1163
authorization prior to performing the service.	1164

(D)(1) Except as provided in division (D)(2) of this section,	1165
if the board determines under division (C) of this section that a	1166
service requires prior authorization, the service shall be	1167
performed only pursuant to the written or verbal authorization of	1168
a physician or of the cooperating physician advisory board, or	1169
pursuant to an authorization transmitted through a direct	1170
communication device by a physician, physician assistant	1171
designated by a physician, or registered nurse designated by a	1172
physician.	1173

(2) If communications fail during an emergency situation or	1174
the required response time prohibits communication, a first	1175
responder may perform services subject to this division, if, in	1176
the judgment of the first responder, the life of the patient is in	1177
immediate danger. Services performed under these circumstances	1178
shall be performed in accordance with the written protocols for	1179
triage of adult and pediatric trauma victims established in rules	1180
adopted under sections 4765.11 and 4765.40 of the Revised Code and	1181
any applicable protocols adopted by the emergency medical service	1182
organization with which the first responder is affiliated.	1183

Sec. 4765.36.  In a hospital, an emergency medical	1184
technician-basic, emergency medical technician-intermediate, or	1185
emergency medical technician-paramedic may perform emergency	1186
medical services only under the direction and supervision of a	1187
physician or registered nurse designated by a physician and only	1188
if the services are performed in accordance with both of the	1189
following conditions:	1190

(A) Only in the hospital's emergency department or while	1191
moving a patient between the emergency department and another part	1192
of the hospital;	1193

(B) Only under the direction and supervision of one of the	1194
following:	1195

(1) A physician;

1196

(2) A physician assistant designated by a physician;

1197

(3) A registered nurse designated by a physician.

1198

Sec. 4765.37.  (A) An emergency medical technician-basic	1199
shall perform the emergency medical services described in this	1200
section in accordance with this chapter and any rules adopted	1201
under it by the state board of emergency medical services.	1202

(B) An emergency medical technician-basic may operate, or be	1203
responsible for operation of, an ambulance and may provide	1204
emergency medical services to patients. In an emergency, an	1205
EMT-basic may determine the nature and extent of illness or injury	1206
and establish priority for required emergency medical services. An	1207
EMT-basic may render emergency medical services such as opening	1208
and maintaining an airway, giving positive pressure ventilation,	1209
cardiac resuscitation, electrical interventions with automated	1210
defibrillators to support or correct the cardiac function and	1211
other methods determined by the board, controlling of hemorrhage,	1212
treatment of shock, immobilization of fractures, bandaging,	1213
assisting in childbirth, management of mentally disturbed	1214
patients, initial care of poison and burn patients, and	1215
determining triage of adult and pediatric trauma victims. Where	1216
patients must in an emergency be extricated from entrapment, an	1217
EMT-basic may assess the extent of injury and render all possible	1218
emergency medical services and protection to the entrapped	1219
patient; provide light rescue services if an ambulance has not	1220
been accompanied by a specialized unit; and after extrication,	1221
provide additional care in sorting of the injured in accordance	1222
with standard emergency procedures.	1223

(C) An EMT-basic may perform any other emergency medical	1224
services approved pursuant to rules adopted under section 4765.11	1225
of the Revised Code. The board shall determine whether the nature	1226
of any such service requires that an EMT-basic receive	1227
authorization prior to performing the service.	1228

(D)(1) Except as provided in division (D)(2) of this section,	1229
if the board determines under division (C) of this section that a	1230
service requires prior authorization, the service shall be	1231
performed only pursuant to the written or verbal authorization of	1232
a physician or of the cooperating physician advisory board, or	1233
pursuant to an authorization transmitted through a direct	1234
communication device by a physician, physician assistant	1235
designated by a physician, or registered nurse designated by a	1236
physician.	1237

(2) If communications fail during an emergency situation or	1238
the required response time prohibits communication, an EMT-basic	1239
may perform services subject to this division, if, in the judgment	1240
of the EMT-basic, the life of the patient is in immediate danger.	1241
Services performed under these circumstances shall be performed in	1242
accordance with the protocols for triage of adult and pediatric	1243
trauma victims established in rules adopted under sections 4765.11	1244
and 4765.40 of the Revised Code and any applicable protocols	1245
adopted by the emergency medical service organization with which	1246
the EMT-basic is affiliated.	1247

Sec. 4765.38.  (A) An emergency medical	1248
technician-intermediate shall perform the emergency medical	1249
services described in this section in accordance with this chapter	1250
and any rules adopted under it.	1251

(B) An EMT-I may do any of the following:

1252

(1) Establish and maintain an intravenous lifeline that has	1253
been approved by a cooperating physician or physician advisory	1254
board;	1255

(2) Perform cardiac monitoring;

1256

(3) Perform electrical interventions to support or correct	1257
the cardiac function;	1258

(4) Administer epinephrine;

1259

(5) Determine triage of adult and pediatric trauma victims;

1260

(6) Perform any other emergency medical services approved	1261
pursuant to rules adopted under section 4765.11 of the Revised	1262
Code.	1263

(C)(1) Except as provided in division (C)(2) of this section,	1264
the services described in division (B) of this section shall be	1265
performed by an EMT-I only pursuant to the written or verbal	1266
authorization of a physician or of the cooperating physician	1267
advisory board, or pursuant to an authorization transmitted	1268
through a direct communication device by a physician, physician	1269
assistant designated by a physician, or registered nurse	1270
designated by a physician.	1271

(2) If communications fail during an emergency situation or	1272
the required response time prohibits communication, an EMT-I may	1273
perform any of the services described in division (B) of this	1274
section, if, in the judgment of the EMT-I, the life of the patient	1275
is in immediate danger. Services performed under these	1276
circumstances shall be performed in accordance with the protocols	1277
for triage of adult and pediatric trauma victims established in	1278
rules adopted under sections 4765.11 and 4765.40 of the Revised	1279
Code and any applicable protocols adopted by the emergency medical	1280
service organization with which the EMT-I is affiliated.	1281

(D) In addition to, and in the course of, providing emergency	1282
medical treatment, an emergency medical technician-intermediate	1283
may withdraw blood as provided under sections 1547.11, 4506.17,	1284
and 4511.19 of the Revised Code. An emergency medical	1285
technician-intermediate shall withdraw blood in accordance with	1286
this chapter and any rules adopted under it by the state board of	1287
emergency medical services.	1288

Sec. 4765.39.  (A) An emergency medical technician-paramedic	1289
shall perform the emergency medical services described in this	1290
section in accordance with this chapter and any rules adopted	1291
under it.	1292

(B) A paramedic may do any of the following:

1293

(1) Perform cardiac monitoring;

1294

(2) Perform electrical interventions to support or correct	1295
the cardiac function;	1296

(3) Perform airway procedures;

1297

(4) Perform relief of pneumothorax;

1298

(5) Administer appropriate drugs and intravenous fluids;

1299

(6) Determine triage of adult and pediatric trauma victims;

1300

(7) Perform any other emergency medical services, including	1301
life support or intensive care techniques, approved pursuant to	1302
rules adopted under section 4765.11 of the Revised Code.	1303

(C)(1) Except as provided in division (C)(2) of this section,	1304
the services described in division (B) of this section shall be	1305
performed by a paramedic only pursuant to the written or verbal	1306
authorization of a physician or of the cooperating physician	1307
advisory board, or pursuant to an authorization transmitted	1308
through a direct communication device by a physician, physician	1309
assistant designated by a physician, or registered nurse	1310
designated by a physician.	1311

(2) If communications fail during an emergency situation or	1312
the required response time prohibits communication, a paramedic	1313
may perform any of the services described in division (B) of this	1314
section, if, in the paramedic's judgment, the life of the patient	1315
is in immediate danger. Services performed under these	1316
circumstances shall be performed in accordance with the protocols	1317
for triage of adult and pediatric trauma victims established in	1318
rules adopted under sections 4765.11 and 4765.40 of the Revised	1319
Code and any applicable protocols adopted by the emergency medical	1320
service organization with which the paramedic is affiliated.	1321

(D) In addition to, and in the course of, providing emergency	1322
medical treatment, an emergency medical technician-paramedic may	1323
withdraw blood as provided under sections 1547.11, 4506.17, and	1324
4511.19 of the Revised Code. An emergency medical	1325
technician-paramedic shall withdraw blood in accordance with this	1326
chapter and any rules adopted under it by the state board of	1327
emergency medical services.	1328

Sec. 4765.49.  (A) A first responder, emergency medical	1329
technician-basic, emergency medical technician-intermediate, or	1330
emergency medical technician-paramedic is not liable in damages in	1331
a civil action for injury, death, or loss to person or property	1332
resulting from the individual's administration of emergency	1333
medical services, unless the services are administered in a manner	1334
that constitutes willful or wanton misconduct. A physician,	1335
physician assistant designated by a physician, or registered nurse	1336
designated by a physician, whoany of whom is advising or	1337
assisting in the emergency medical services by means of any	1338
communication device or telemetering system, is not liable in	1339
damages in a civil action for injury, death, or loss to person or	1340
property resulting from the individual's advisory communication or	1341
assistance, unless the advisory communication or assistance is	1342
provided in a manner that constitutes willful or wanton	1343
misconduct. Medical directors and members of cooperating physician	1344
advisory boards of emergency medical service organizations are not	1345
liable in damages in a civil action for injury, death, or loss to	1346
person or property resulting from their acts or omissions in the	1347
performance of their duties, unless the act or omission	1348
constitutes willful or wanton misconduct.	1349

(B) A political subdivision, joint ambulance district, joint	1350
emergency medical services district, or other public agency, and	1351
any officer or employee of a public agency or of a private	1352
organization operating under contract or in joint agreement with	1353
one or more political subdivisions, that provides emergency	1354
medical services, or that enters into a joint agreement or a	1355
contract with the state, any political subdivision, joint	1356
ambulance district, or joint emergency medical services district	1357
for the provision of emergency medical services, is not liable in	1358
damages in a civil action for injury, death, or loss to person or	1359
property arising out of any actions taken by a first responder,	1360
EMT-basic, EMT-I, or paramedic working under the officer's or	1361
employee's jurisdiction, or for injury, death, or loss to person	1362
or property arising out of any actions of licensed medical	1363
personnel advising or assisting the first responder, EMT-basic,	1364
EMT-I, or paramedic, unless the services are provided in a manner	1365
that constitutes willful or wanton misconduct.	1366

(C) A student who is enrolled in an emergency medical	1367
services training program accredited under section 4765.17 of the	1368
Revised Code or an emergency medical services continuing education	1369
program approved under that section is not liable in damages in a	1370
civil action for injury, death, or loss to person or property	1371
resulting from either of the following:	1372

(1) The student's administration of emergency medical	1373
services or patient care or treatment, if the services, care, or	1374
treatment is administered while the student is under the direct	1375
supervision and in the immediate presence of an EMT-basic, EMT-I,	1376
paramedic, registered nurse, physician assistant, or physician and	1377
while the student is receiving clinical training that is required	1378
by the program, unless the services, care, or treatment is	1379
provided in a manner that constitutes willful or wanton	1380
misconduct;	1381

(2) The student's training as an ambulance driver, unless the	1382
driving is done in a manner that constitutes willful or wanton	1383
misconduct.	1384

(D) An EMT-basic, EMT-I, paramedic, or other operator, who	1385
holds a valid commercial driver's license issued pursuant to	1386
Chapter 4506. of the Revised Code or driver's license issued	1387
pursuant to Chapter 4507. of the Revised Code and who is employed	1388
by an emergency medical service organization that is not owned or	1389
operated by a political subdivision as defined in section 2744.01	1390
of the Revised Code, is not liable in damages in a civil action	1391
for injury, death, or loss to person or property that is caused by	1392
the operation of an ambulance by the EMT-basic, EMT-I, paramedic,	1393
or other operator while responding to or completing a call for	1394
emergency medical services, unless the operation constitutes	1395
willful or wanton misconduct or does not comply with the	1396
precautions of section 4511.03 of the Revised Code. An emergency	1397
medical service organization is not liable in damages in a civil	1398
action for any injury, death, or loss to person or property that	1399
is caused by the operation of an ambulance by its employee or	1400
agent, if this division grants the employee or agent immunity from	1401
civil liability for the injury, death, or loss.	1402

(E) An employee or agent of an emergency medical service	1403
organization who receives requests for emergency medical services	1404
that are directed to the organization, dispatches first	1405
responders, EMTs-basic, EMTs-I, or paramedics in response to those	1406
requests, communicates those requests to those employees or agents	1407
of the organization who are authorized to dispatch first	1408
responders, EMTs-basic, EMTs-I, or paramedics, or performs any	1409
combination of these functions for the organization, is not liable	1410
in damages in a civil action for injury, death, or loss to person	1411
or property resulting from the individual's acts or omissions in	1412
the performance of those duties for the organization, unless an	1413
act or omission constitutes willful or wanton misconduct.	1414

(F) A person who is performing the functions of a first	1415
responder, EMT-basic, EMT-I, or paramedic under the authority of	1416
the laws of a state that borders this state and who provides	1417
emergency medical services to or transportation of a patient in	1418
this state is not liable in damages in a civil action for injury,	1419
death, or loss to person or property resulting from the person's	1420
administration of emergency medical services, unless the services	1421
are administered in a manner that constitutes willful or wanton	1422
misconduct. A physician, physician assistant designated by a	1423
physician, or registered nurse designated by a physician, whoany	1424
of whom is licensed to practice in the adjoining state and who is	1425
advising or assisting in the emergency medical services by means	1426
of any communication device or telemetering system, is not liable	1427
in damages in a civil action for injury, death, or loss to person	1428
or property resulting from the person's advisory communication or	1429
assistance, unless the advisory communication or assistance is	1430
provided in a manner that constitutes willful or wanton	1431
misconduct.	1432

(G) A person certified under section 4765.23 of the Revised	1433
Code to teach in an emergency medical services training program or	1434
emergency medical services continuing education program, and a	1435
person who teaches at the Ohio fire academy established under	1436
section 3737.33 of the Revised Code or in a fire service training	1437
program described in division (A) of section 4765.55 of the	1438
Revised Code, is not liable in damages in a civil action for	1439
injury, death, or loss to person or property resulting from the	1440
person's acts or omissions in the performance of the person's	1441
duties, unless an act or omission constitutes willful or wanton	1442
misconduct.	1443

(H) In the accreditation of emergency medical services	1444
training programs or approval of emergency medical services	1445
continuing education programs, the state board of emergency	1446
medical services and any person or entity authorized by the board	1447
to evaluate applications for accreditation or approval are not	1448
liable in damages in a civil action for injury, death, or loss to	1449
person or property resulting from their acts or omissions in the	1450
performance of their duties, unless an act or omission constitutes	1451
willful or wanton misconduct.	1452

(I) A person authorized by an emergency medical service	1453
organization to review the performance of first responders,	1454
EMTs-basic, EMTs-I, and paramedics or to administer quality	1455
assurance programs is not liable in damages in a civil action for	1456
injury, death, or loss to person or property resulting from the	1457
person's acts or omissions in the performance of the person's	1458
duties, unless an act or omission constitutes willful or wanton	1459
misconduct.	1460

Sec. 4765.51.  Nothing in this chapter prevents or restricts	1461
the practice, services, or activities of any registered nurse	1462
practicing within the scope of histhe registered nurse's	1463
practice.	1464

Nothing in this chapter prevents or restricts the practice,	1465
services, or activities of any physician assistant practicing in	1466
accordance with a physician supervisory plan approved under	1467
section 4730.17 of the Revised Code or the policies of the health	1468
care facility in which the physician assistant is practicing.	1469

Section 2.  That existing sections 2133.211, 3719.06,	1470
4730.06, 4730.09, 4730.10, 4730.11, 4730.38, 4730.39, 4730.40,	1471
4730.41, 4730.42, 4730.44, 4730.46, 4755.48, 4755.481, 4765.01,	1472
4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51	1473
and section 4730.401 of the Revised Code are hereby repealed.	1474