As Passed by the House

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 4730.04, 4730.092, and 4730.411,

6

and to repeal section 4730.401 of the Revised Code

7

to modify the laws governing physician assistants.

8

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

Section 1.  That sections 2133.211, 3719.06, 4730.06,	9
4730.09, 4730.10, 4730.11, 4730.38, 4730.39, 4730.40, 4730.41,	10
4730.42, 4730.44, 4730.46, 4755.48, 4755.481, 4765.01, 4765.35,	11
4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51 be	12
amended and sections 4730.04, 4730.092, and 4730.411 of the	13
Revised Code be enacted to read as follows:	14

Sec. 2133.211.  A person who holds a certificate of authority	15
to practice as a certified nurse practitioner or clinical nurse	16
specialist issued under section 4723.42 of the Revised Code may	17
take any action that may be taken by an attending physician under	18
sections 2133.21 to 2133.26 of the Revised Code and has the	19
immunity provided by section 2133.22 of the Revised Code if the	20
action is taken pursuant to a standard care arrangement with a	21
collaborating physician.	22

A person who holds a certificate to practice as a physician	23
assistant issued under Chapter 4730. of the Revised Code may take	24
any action that may be taken by an attending physician under	25
sections 2133.21 to 2133.26 of the Revised Code and has the	26
immunity provided by section 2133.22 of the Revised Code if the	27
action is taken pursuant to a physician supervisory plan approved	28
pursuant to section 4730.17 of the Revised Code or the policies of	29
a health care facility in which the physician assistant is	30
practicing.	31

Sec. 3719.06.  (A)(1) A licensed health professional	32
authorized to prescribe drugs, if acting in the course of	33
professional practice, in accordance with the laws regulating the	34
professional's practice, and in accordance with rules adopted by	35
the state board of pharmacy, may, except as provided in division	36
(A)(2) or (3) of this section, do the following:	37

(a) Prescribe schedule II, III, IV, and V controlled	38
substances;	39

(b) Administer or personally furnish to patients schedule II,	40
III, IV, and V controlled substances;	41

(c) Cause schedule II, III, IV, and V controlled substances	42
to be administered under the prescriber's direction and	43
supervision.	44

(2) A licensed health professional authorized to prescribe	45
drugs who is a clinical nurse specialist, certified nurse-midwife,	46
or certified nurse practitioner is subject to both of the	47
following:	48

(a) A schedule II controlled substance may be prescribed only	49
in accordance with division (C) of section 4723.481 of the Revised	50
Code.	51

(b) No schedule II controlled substance shall be personally	52
furnished to any patient.	53

(3) A licensed health professional authorized to prescribe	54
drugs who is a physician assistant shall not prescribe or	55
personally furnish to patients anyis subject to all of the	56
following:	57

(a) A controlled substance that is notmay be prescribed or	58
personally furnished only if it is included in the	59
physician-delegated prescriptive authority granted to the	60
physician assistant in accordance with Chapter 4730. of the	61
Revised Code.	62

(b) A schedule II controlled substance may be prescribed only	63
in accordance with division (B)(4) of section 4730.41 and section	64
4730.411 of the Revised Code.	65

(c) No schedule II controlled substance shall be personally	66
furnished to any patient.	67

(B) No licensed health professional authorized to prescribe	68
drugs shall prescribe, administer, or personally furnish a	69
schedule III anabolic steroid for the purpose of human muscle	70
building or enhancing human athletic performance and no pharmacist	71
shall dispense a schedule III anabolic steroid for either purpose,	72
unless it has been approved for that purpose under the "Federal	73
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	74
301, as amended.	75

(C) Each written prescription shall be properly executed,	76
dated, and signed by the prescriber on the day when issued and	77
shall bear the full name and address of the person for whom, or	78
the owner of the animal for which, the controlled substance is	79
prescribed and the full name, address, and registry number under	80
the federal drug abuse control laws of the prescriber. If the	81
prescription is for an animal, it shall state the species of the	82
animal for which the controlled substance is prescribed.	83

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

84

(1) "Disaster" means any imminent threat or actual occurrence	85
of widespread or severe damage to or loss of property, personal	86
hardship or injury, or loss of life that results from any natural	87
phenomenon or act of a human.	88

(2) "Emergency" means an occurrence or event that poses an	89
imminent threat to the health or life of a human.	90

(B) Nothing in this chapter prohibits any of the following	91
individuals from providing medical care, to the extent the	92
individual is able, in response to a need for medical care	93
precipitated by a disaster or emergency:	94

(1) An individual who holds a certificate to practice as a	95
physician assistant issued under this chapter;	96

(2) An individual licensed or authorized to practice as a	97
physician assistant in another state;	98

(3) An individual credentialed or employed as a physician	99
assistant by an agency, office, or other instrumentality of the	100
federal government.	101

(C) For purposes of the medical care provided by a physician	102
assistant pursuant to division (B)(1) of this section, both of the	103
following apply notwithstanding any supervision requirement of	104
this chapter to the contrary:	105

(1) The physician who supervises the physician assistant	106
pursuant to a physician supervisory plan approved by the state	107
medical board under section 4730.17 of the Revised Code is not	108
required to meet the supervision requirements established under	109
this chapter.	110

(2) The physician designated as the medical director of the	111
disaster or emergency may supervise the medical care provided by	112
the physician assistant.	113

Sec. 4730.06.  (A) The physician assistant policy committee	114
of the state medical board shall review, and shall submit to the	115
board recommendations concerning, all of the following:	116

(1) Requirements for issuance of certificates to practice as	117
a physician assistant, including the educational requirements that	118
must be met to receive a certificate to practice;	119

(2) Existing and proposed rules pertaining to the practice of	120
physician assistants, the supervisory relationship between	121
physician assistants and supervising physicians, and the	122
administration and enforcement of this chapter;	123

(3) Physician-delegatedIn accordance with section 4730.38 of	124
the Revised Code, physician-delegated prescriptive authority for	125
physician assistants, in accordance withand proposed changes to	126
the physician assistant formulary the board adopts pursuant to	127
division (A)(1) of section 4730.384730.39 of the Revised Code;	128

(4) Application procedures and forms for certificates to	129
practice as a physician assistant, physician supervisory plans,	130
and supervision agreements;	131

(5) Fees required by this chapter for issuance and renewal of	132
certificates to practice as a physician assistant;	133

(6) Criteria to be included in applications submitted to the	134
board for approval of physician supervisory plans, including	135
criteria to be included in applications for approval to delegate	136
to physician assistants the performance of special services;	137

(7) Criteria to be included in supervision agreements	138
submitted to the board for approval and renewal of the board's	139
approval;	140

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

141

(B) In addition to the matters that are required to be	142
reviewed under division (A) of this section, the committee may	143
review, and may submit to the board recommendations concerning,	144
either or both of the following:	145

(1) Quality assurance activities to be performed by a	146
supervising physician and physician assistant under a quality	147
assurance system established pursuant to division (F) of section	148
4730.21 of the Revised Code;	149

(2) The development and approval of one or more model	150
physician supervisory plans and one or more models for a special	151
services portion of the one or more model physician supervisory	152
plans. The committee may submit recommendations for model plans	153
that reflect various medical specialties.	154

(C) The board shall take into consideration all	155
recommendations submitted by the committee. Not later than ninety	156
days after receiving a recommendation from the committee, the	157
board shall approve or disapprove the recommendation and notify	158
the committee of its decision. If a recommendation is disapproved,	159
the board shall inform the committee of its reasons for making	160
that decision. The committee may resubmit the recommendation after	161
addressing the concerns expressed by the board and modifying the	162
disapproved recommendation accordingly. Not later than ninety days	163
after receiving a resubmitted recommendation, the board shall	164
approve or disapprove the recommendation. There is no limit on the	165
number of times the committee may resubmit a recommendation for	166
consideration by the board.	167

(D)(1) Except as provided in division (D)(2) of this section,	168
the board may not take action regarding a matter that is subject	169
to the committee's review under division (A) or (B) of this	170
section unless the committee has made a recommendation to the	171
board concerning the matter.	172

(2) If the board submits to the committee a request for a	173
recommendation regarding a matter that is subject to the	174
committee's review under division (A) or (B) of this section, and	175
the committee does not provide a recommendation before the	176
sixty-first day after the request is submitted, the board may take	177
action regarding the matter without a recommendation.	178

Sec. 4730.09. (A) Under a physician supervisory plan approved	179
under section 4730.17 of the Revised Code, a physician assistant	180
may provide any or all of the following services without approval	181
by the state medical board as special services:	182

(1) Obtaining comprehensive patient histories;

183

(2) Performing physical examinations, including audiometry	184
screening, routine visual screening, and pelvic, rectal, and	185
genital-urinary examinations, when indicated;	186

(3) Ordering, performing, or ordering and performing routine	187
diagnostic procedures, as indicated;	188

(4) Identifying normal and abnormal findings on histories,	189
physical examinations, and commonly performed diagnostic studies;	190

(5) Assessing patients and developing and implementing	191
treatment plans for patients;	192

(6) Monitoring the effectiveness of therapeutic	193
interventions;	194

(7) Exercising physician-delegated prescriptive authority	195
pursuant to a certificate to prescribe issued under this chapter;	196

(8) Carrying out or relaying the supervising physician's	197
orders for the administration of medication, to the extent	198
permitted by law;	199

(9) Providing patient education;

200

(10) Instituting and changing orders on patient charts;

201

(11) Performing developmental screening examinations on	202
children with regard to neurological, motor, and mental functions;	203

(12) Performing wound care management, suturing minor	204
lacerations and removing the sutures, and incision and drainage of	205
uncomplicated superficial abscesses;	206

(13) Removing superficial foreign bodies;

207

(14) Administering intravenous fluids;

208

(15) Inserting a foley or cudae catheter into the urinary	209
bladder and removing the catheter;	210

(16) Removing intrauterine devices;

211

(17) Performing biopsies of superficial lesions;

212

(18)(17) Making appropriate referrals as directed by the	213
supervising physician;	214

(19) Removing norplant capsules;

215

(20)(18) Performing penile duplex ultrasound;

216

(21)(19) Changing of a tracheostomy;

217

(22)(20) Performing bone marrow aspirations from the	218
posterior iliac crest;	219

(23)(21) Performing bone marrow biopsies from the posterior	220
iliac crest;	221

(24)(22) Performing cystograms;

222

(25)(23) Performing nephrostograms after physician placement	223
of nephrostomy tubes;	224

(26)(24) Fitting or, inserting family planning, or removing	225
birth control devices, including intrauterine devices, diaphragms,	226
and cervical caps;	227

(27)(25) Removing cervical polyps;

228

(28)(26) Performing nerve conduction testing;

229

(29)(27) Performing endometrial biopsies;

230

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

231

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

232

(32)(30) Performing knee joint injections;

233

(33)(31) Performing endotracheal intubation with successful	234
completion of an advanced cardiac life support course;	235

(34)(32) Performing lumbar punctures;

236

(35)(33) In accordance with rules adopted by the board, using	237
light-based medical devices for the purpose of hair removal;	238

(36)(34) Administering, monitoring, or maintaining local	239
anesthesia, as defined in section 4730.091 of the Revised Code;	240

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

241

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

242

(37) Prescribing physical therapy or referring a patient to a	243
physical therapist for the purpose of receiving physical therapy;	244

(38) Ordering occupational therapy or referring a patient to	245
an occupational therapist for the purpose of receiving	246
occupational therapy;	247

(39) Taking any action that may be taken by an attending	248
physician under sections 2133.21 to 2133.26 of the Revised Code,	249
as specified in section 2133.211 of the Revised Code;	250

(40) Determining and pronouncing death in accordance with	251
section 4730.092 of the Revised Code;	252

(41) Performing other services that are within the	253
supervising physician's normal course of practice and expertise,	254
if the services are included in any model physician supervisory	255
plan approved under section 4730.06 of the Revised Code or the	256
services are designated by the board by rule or other means as	257
services that are not subject to approval as special services.	258

(B) Under the policies of a health care facility, the	259
services a physician assistant may provide are limited to the	260
services the facility has authorized the physician assistant to	261
provide for the facility. The services a health care facility may	262
authorize a physician assistant to provide for the facility	263
include the following:	264

(1) Any or all of the services specified in division (A) of	265
this section;	266

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

267

(3) Any other services permitted by the policies of the	268
health care facility, except that the facility may not authorize a	269
physician assistant to perform a service that is prohibited by	270
this chapter.	271

Sec. 4730.092.  (A) A physician assistant may determine and	272
pronounce an individual's death, but only if the individual's	273
respiratory and circulatory functions are not being artificially	274
sustained and, at the time the determination and pronouncement of	275
death is made, either or both of the following apply:	276

(1) The individual was receiving care in one of the	277
following:	278

(a) A nursing home licensed under section 3721.02 of the	279
Revised Code or by a political subdivision under section 3721.09	280
of the Revised Code;	281

(b) A residential care facility or home for the aging	282
licensed under Chapter 3721. of the Revised Code;	283

(c) A county home or district home operated pursuant to	284
Chapter 5155. of the Revised Code;	285

(d) A residential facility licensed under section 5123.19 of	286
the Revised Code.	287

(2) The physician assistant is providing or supervising the	288
individual's care through a hospice care program licensed under	289
Chapter 3712. of the Revised Code or any other entity that	290
provides palliative care.	291

(B) If a physician assistant determines and pronounces an	292
individual's death, the physician assistant shall comply with both	293
of the following:	294

(1) The physician assistant shall not complete any portion of	295
the individual's death certificate.	296

(2) The physician assistant shall notify the individual's	297
attending physician of the determination and pronouncement of	298
death in order for the physician to fulfill the physician's duties	299
under section 3705.16 of the Revised Code. The physician assistant	300
shall provide the notification within a period of time that is	301
reasonable but not later than twenty-four hours following the	302
determination and pronouncement of the individual's death.	303

Sec. 4730.10.  (A) An individual seeking a certificate to	304
practice as a physician assistant shall file with the state	305
medical board a written application on a form prescribed and	306
supplied by the board. The application shall include all of the	307
following:	308

(1) The applicant's name, residential address, business	309
address, if any, and social security number;	310

(2) Satisfactory proof that the applicant meets the age and	311
moral character requirements specified in divisions (A)(1) and (2)	312
of section 4730.11 of the Revised Code;	313

(3) Effective January 1, 2008, except as provided in division	314
(B) of section 4730.11 of the Revised Code, satisfactory	315
Satisfactory proof that the applicant meets one ofeither the	316
educational requirements specified in division (A)(4)(B)(1) or	317
(2) of section 4730.11 of the Revised Code or the educational or	318
other applicable requirements specified in division (C)(1), (2),	319
or (3) of that section;	320

(4) Any other information the board requires.

321

(B) At the time of making application for a certificate to	322
practice, the applicant shall pay the board a fee of two hundred	323
dollars, no part of which shall be returned. SuchThe fees shall	324
be deposited in accordance with section 4731.24 of the Revised	325
Code.	326

Sec. 4730.11.  (A) For an individual toTo be eligible to	327
receive a certificate to practice as a physician assistant, all of	328
the following apply to an applicant:	329

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

330

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

331

(3) The applicant shall hold current certification by the	332
national commission on certification of physician assistants or a	333
successor organization that is recognized by the state medical	334
board.	335

(4) The applicant shall meet either of the following	336
requirements:	337

(a) The educational requirements specified in division (B)(1)	338
or (2) of this section;	339

(b) The educational or other applicable requirements	340
specified in division (C)(1), (2), or (3) of this section.	341

(B) Effective January 1, 2008, except as provided infor	342
purposes of division (B)(A)(4)(a) of this section, thean	343
applicant shall meet oneeither of the following educational	344
requirements:	345

(a)(1) The applicant shall hold a master's or higher degree	346
that was obtained from a program accredited by the accreditation	347
review commission on education for the physician assistant or a	348
predecessor or successor organization recognized by the board.	349

(b)(2) The applicant shall hold aboth of the following	350
degrees:	351

(a) A degree other than a master's or higher degree that was	352
obtained from a program accredited by the accreditation review	353
commission on education for the physician assistant or a	354
predecessor or successor organization recognized by the board and	355
shall hold a;	356

(b) A master's or higher degree in a course of study with	357
clinical relevance to the practice of physician assistants that	358
wasand obtained from a program accredited by a regional or	359
specialized and professional accrediting agency recognized by the	360
council for higher education accreditation.	361

(B) It is not necessary for an applicant to hold a master's	362
or higher degree as a condition of receiving a certificate to	363
practice as a physician assistant if the applicant presents(C)	364
For purposes of division (A)(4)(b) of this section, an applicant	365
shall present evidence satisfactory to the board of holding either	366
meeting one of the following requirements in lieu of meeting the	367
educational requirements specified in division (B)(1) or (2) of	368
this section:	369

(1) AThe applicant shall hold a current, valid license or	370
other form of authority to practice as a physician assistant that	371
was issued by another jurisdiction prior to January 1, 2008;.	372

(2) A degree, other than a master's or higher degree, that is	373
The applicant shall hold a degree obtained as a result of being	374
enrolled on January 1, 2008, in a program in this state that was	375
accredited by the accreditation review commission on education for	376
the physician assistant but did not grant a master's or higher	377
degree to individuals enrolled in the program on that date, and	378
completing the program on or before December 31, 2009.	379

(C)(3) The applicant shall meet both of the following	380
educational and military experience requirements:	381

(a) Hold a degree obtained from a program accredited by the	382
accreditation review commission on education for the physician	383
assistant;	384

(b) Have experience practicing as a physician assistant for	385
at least three consecutive years while on active duty, with	386
evidence of service under honorable conditions, in any of the	387
armed forces of the United States or the national guard of any	388
state, including any experience attained while practicing as a	389
physician assistant at a health care facility or clinic operated	390
by the United States department of veterans affairs.	391

(D) This section does not require an individual to obtain a	392
master's or higher degree as a condition of retaining or renewing	393
a certificate to practice as a physician assistant if anythe	394
individual received the certificate without holding a master's or	395
higher degree as provided in either of the following apply:	396

(1) Prior toBefore the educational requirements specified in	397
division (B)(1) or (2) of this section became effective January 1,	398
2008, the individual received a certificate to practice as a	399
physician assistant under this chapter without holding a master's	400
or higher degree.;	401

(2) On or after January 1, 2008, the individual received a	402
certificate to practice as a physician assistant under this	403
chapter on the basis of holding a license issued in another	404
jurisdiction, as specified in division (B)(1) of this section.	405

(3) On or after January 1, 2008, the individual received a	406
certificate to practice as a physician assistant under this	407
chapter on the basis of obtaining a degree as specified in	408
division (B)(2)By meeting the educational or other applicable	409
requirements specified in division (C)(1), (2), or (3) of this	410
section.	411

Sec. 4730.38.  (A) Not later than six months after the	412
effective dateExcept as provided in division (B) of this section,	413
the physician assistant policy committee of the state medical	414
board shall, at such times the committee determines to be	415
necessary, submit to the board its initial recommendations	416
regarding physician-delegated prescriptive authority for physician	417
assistants. The committee's recommendations shall address allboth	418
of the following:	419

(1) Policy and procedures regarding physician-delegated	420
prescriptive authority, including the issuance of certificates to	421
prescribe under this chapter;	422

(2) Subject to the limitations specified in section 4730.40	423
of the Revised Code, a formulary listing the drugs and therapeutic	424
devices by class and specific nomenclature that a supervising	425
physician may include in the physician-delegated prescriptive	426
authority granted to a physician assistant who holds a certificate	427
to prescribe issued under this chapter;	428

(3) Any issue the committee considers necessary to assist the	429
board in fulfilling its duty to adopt rules governing	430
physician-delegated prescriptive authority, including the issuance	431
of certificates to prescribe.	432

(B) After the board's adoption of initial rules under section	433
4730.39 of the Revised Code, the committee shall conduct an annual	434
review of its recommendations regarding physician-delegated	435
prescriptive authority. Based on its review, the committee shall	436
submit recommendations to the board as the committee considers	437
necessaryNot less than every six months beginning on the first	438
day of June following the effective date of this amendment, the	439
committee shall review the physician assistant formulary the board	440
adopts pursuant to division (A)(1) of section 4730.39 of the	441
Revised Code and, to the extent it determines to be necessary,	442
submit recommendations proposing changes to the formulary.	443

(C) Recommendations submitted under this section are subject	444
to the procedures and time frames specified in division (C) of	445
section 4730.06 of the Revised Code.	446

Sec. 4730.39.  (A) Not later than six months after receiving	447
the initial recommendations of the physician assistant policy	448
committee submitted pursuant to division (A) of section 4730.38 of	449
the Revised Code, theThe state medical board shall adoptdo both	450
of the following:	451

(1) Adopt a formulary listing the drugs and therapeutic	452
devices by class and specific generic nomenclature that a	453
physician may include in the physician-delegated prescriptive	454
authority granted to a physician assistant who holds a certificate	455
to prescribe under this chapter;	456

(2) Adopt rules governing physician-delegated prescriptive	457
authority for physician assistants, including the issuance of	458
certificates to prescribe under this chapter. The	459

(B) The board's rules governing physician-delegated	460
prescriptive authority adopted pursuant to division (A)(2) of this	461
section shall be adopted in accordance with Chapter 119. of the	462
Revised Code and shall establish all of the following:	463

(1) Subject to the limitations specified in section 4730.40	464
of the Revised Code, a formulary listing the drugs and therapeutic	465
devices by class and specific generic nomenclature that a	466
physician may include in the physician-delegated prescriptive	467
authority granted to a physician assistant who holds a certificate	468
to prescribe under this chapter;	469

(2) Requirements regarding the pharmacology courses that a	470
physician assistant is required to complete to receive a	471
certificate to prescribe;	472

(3)(2) Standards and procedures for the issuance and renewal	473
of certificates to prescribe to physician assistants;	474

(4)(3) Standards and procedures for the appropriate conduct	475
of the provisional period that a physician assistant is required	476
to complete pursuant to section 4730.45 of the Revised Code and	477
for determining whether a physician assistant has successfully	478
completed the provisional period;	479

(5)(4) A specific prohibition against prescribing any drug or	480
device to perform or induce an abortion;	481

(6)(5) Standards and procedures to be followed by a physician	482
assistant in personally furnishing samples of drugs or complete or	483
partial supplies of drugs to patients under section 4730.43 of the	484
Revised Code;	485

(7)(6) Any other requirements the board considers necessary	486
to implement the provisions of this chapter regarding	487
physician-delegated prescriptive authority and the issuance of	488
certificates to prescribe.	489

(B)(C)(1) After adopting the initial rulesconsidering	490
recommendations submitted by the physician assistant policy	491
committee pursuant to sections 4730.06 and 4730.38 of the Revised	492
Code, the board shall conduct an annual review either or both of	493
the rules. Basedfollowing, as appropriate according to the	494
submitted recommendations:	495

(a) The formulary the board adopts under division (A)(1) of	496
this section;	497

(b) The rules the board adopts under division (A)(2) of this	498
section regarding physician-delegated prescriptive authority.	499

(2) Based on its review, the board shall make any necessary	500
modifications to the formulary or rules.	501

(C) All rules adopted under this section shall be adopted in	502
accordance with Chapter 119. of the Revised Code. When adopting	503
the initial rules, the board shall consider the recommendations of	504
the physician assistant policy committee submitted pursuant to	505
division (A) of section 4730.38 of the Revised Code. When making	506
any modifications to the rules subsequent to its annual review of	507
the rules, the board shall consider the committee's	508
recommendations submitted pursuant to division (B) of section	509
4730.38 of the Revised Code.	510

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	511
of this section, the physician assistant formulary established	512
adopted by the state medical board in rules adopted under section	513
4730.39 of the Revised Code listing the drugs and therapeutic	514
devices by class and specific nomenclature that a supervising	515
physician may include in the physician-delegated prescriptive	516
authority granted to a physician assistant who holds a certificate	517
to prescribe issued under this chapter may include any or all of	518
the following drugs:	519

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

520

(2) Drugs that under state or federal law may be dispensed	521
only pursuant to a prescription by a licensed health professional	522
authorized to prescribe drugs, as defined in section 4729.01 of	523
the Revised Code;	524

(3) Any drug that is not a dangerous drug, as defined in	525
section 4729.01 of the Revised Code.	526

(B) The formulary established in the board's rulesadopted by	527
the board shall not include, and shall specify that it does not	528
include, the following:	529

(1) Any schedule II controlled substance;

530

(2) Anyany drug or device used to perform or induce an	531
abortion.	532

(C) When adopting rules establishing the initial formulary,	533
the board shall include provisions ensuring that a physician	534
assistant who holds a certificate to prescribe issued under this	535
chapter may be granted physician-delegated prescriptive authority	536
for all drugs and therapeutic devices that may be prescribed on	537
the effective date of the rules by a holder of a certificate to	538
prescribe issued by the board of nursing under Chapter 4723. of	539
the Revised Code, with the exception of schedule II controlled	540
substances. To the extent permitted by division (A) of this	541
section, the initial formulary may include additional drugs or	542
therapeutic devices.	543

Sec. 4730.41.  (A) A certificate to prescribe issued under	544
this chapter authorizes a physician assistant to prescribe and	545
personally furnish drugs and therapeutic devices in the exercise	546
of physician-delegated prescriptive authority.	547

(B) In exercising physician-delegated prescriptive authority,	548
a physician assistant is subject to all of the following:	549

(1) The physician assistant shall exercise	550
physician-delegated prescriptive authority only to the extent that	551
the physician supervising the physician assistant has granted that	552
authority.	553

(2) The physician assistant shall comply with all conditions	554
placed on the physician-delegated prescriptive authority, as	555
specified by the supervising physician who is supervising the	556
physician assistant in the exercise of physician-delegated	557
prescriptive authority.	558

(3) If the physician assistant possesses physician-delegated	559
prescriptive authority for controlled substances, the physician	560
assistant shall register with the federal drug enforcement	561
administration.	562

(4) If the physician assistant possesses physician-delegated	563
prescriptive authority for schedule II controlled substances, the	564
physician assistant shall comply with section 4730.411 of the	565
Revised Code.	566

Sec. 4730.411. (A) Except as provided in division (B) or (C)	567
of this section, a physician assistant may prescribe to a patient	568
a schedule II controlled substance only if all of the following	569
are the case:	570

(1) The patient is in a terminal condition, as defined in	571
section 2133.01 of the Revised Code.	572

(2) The physician assistant's supervising physician initially	573
prescribed the substance for the patient.	574

(3) The prescription is for an amount that does not exceed	575
the amount necessary for the patient's use in a single,	576
twenty-four-hour period.	577

(B) The restrictions on prescriptive authority in division	578
(A) of this section do not apply if a physician assistant issues	579
the prescription to the patient from any of the following	580
locations:	581

(1) A hospital registered under section 3701.07 of the	582
Revised Code;	583

(2) An entity owned or controlled, in whole or in part, by a	584
hospital or by an entity that owns or controls, in whole or in	585
part, one or more hospitals;	586

(3) A health care facility operated by the department of	587
mental health or the department of developmental disabilities;	588

(4) A nursing home licensed under section 3721.02 of the	589
Revised Code or by a political subdivision certified under section	590
3721.09 of the Revised Code;	591

(5) A county home or district home operated under Chapter	592
5155. of the Revised Code that is certified under the medicare or	593
medicaid program;	594

(6) A hospice care program, as defined in section 3712.01 of	595
the Revised Code;	596

(7) A community mental health agency, as defined in section	597
5122.01 of the Revised Code;	598

(8) An ambulatory surgical facility, as defined in section	599
3702.30 of the Revised Code;	600

(9) A freestanding birthing center, as defined in section	601
3702.51 of the Revised Code;	602

(10) A federally qualified health center, as defined in	603
section 3701.047 of the Revised Code;	604

(11) A federally qualified health center look-alike, as	605
defined in section 3701.047 of the Revised Code;	606

(12) A health care office or facility operated by the board	607
of health of a city or general health district or the authority	608
having the duties of a board of health under section 3709.05 of	609
the Revised Code;	610

(13) A site where a medical practice is operated, but only if	611
the practice is comprised of one or more physicians who also are	612
owners of the practice; the practice is organized to provide	613
direct patient care; and the physician assistant has entered into	614
a supervisory agreement with at least one of the physician owners	615
who practices primarily at that site.	616

(C) A physician assistant shall not issue to a patient a	617
prescription for a schedule II controlled substance from a	618
convenience care clinic even if the convenience care clinic is	619
owned or operated by an entity specified in division (B) of this	620
section.	621

(D) A pharmacist who acts in good faith reliance on a	622
prescription issued by a physician assistant under division (B) of	623
this section is not liable for or subject to any of the following	624
for relying on the prescription: damages in any civil action,	625
prosecution in any criminal proceeding, or professional	626
disciplinary action by the state board of pharmacy under Chapter	627
4729. of the Revised Code.	628

Sec. 4730.42.  (A) In granting physician-delegated	629
prescriptive authority to a particular physician assistant who	630
holds a certificate to prescribe issued under this chapter, the	631
supervising physician is subject to all of the following:	632

(1) The supervising physician shall not grant	633
physician-delegated prescriptive authority for any drug or	634
therapeutic device that is not listed on the physician assistant	635
formulary established in rules adopted under section 4730.39 of	636
the Revised Code as a drug or therapeutic device that may be	637
included in the physician-delegated prescriptive authority granted	638
to a physician assistant.	639

(2) The supervising physician shall not grant	640
physician-delegated prescriptive authority for any drug or device	641
that may be used to perform or induce an abortion.	642

(3) The supervising physician shall not grant	643
physician-delegated prescriptive authority in a manner that	644
exceeds the supervising physician's prescriptive authority,	645
including the physician's authority to treat chronic pain with	646
controlled substances and products containing tramadol as	647
described in section 4731.052 of the Revised Code.	648

(4) The supervising physician shall supervise the physician	649
assistant in accordance with all of the following:	650

(a) The supervision requirements specified in section 4730.21	651
of the Revised Code and, in the case of supervision provided	652
during a provisional period of physician-delegated prescriptive	653
authority, the supervision requirements specified in section	654
4730.45 of the Revised Code;	655

(b) The physician supervisory plan approved for the	656
supervising physician or the policies of the health care facility	657
in which the physician and physician assistant are practicing;	658

(c) The supervision agreement approved under section 4730.19	659
of the Revised Code that applies to the supervising physician and	660
the physician assistant.	661

(B)(1) The supervising physician of a physician assistant may	662
place conditions on the physician-delegated prescriptive authority	663
granted to the physician assistant. If conditions are placed on	664
that authority, the supervising physician shall maintain a written	665
record of the conditions and make the record available to the	666
state medical board on request.	667

(2) The conditions that a supervising physician may place on	668
the physician-delegated prescriptive authority granted to a	669
physician assistant include the following:	670

(a) Identification by class and specific generic nomenclature	671
of drugs and therapeutic devices that the physician chooses not to	672
permit the physician assistant to prescribe;	673

(b) Limitations on the dosage units or refills that the	674
physician assistant is authorized to prescribe;	675

(c) Specification of circumstances under which the physician	676
assistant is required to refer patients to the supervising	677
physician or another physician when exercising physician-delegated	678
prescriptive authority;	679

(d) Responsibilities to be fulfilled by the physician in	680
supervising the physician assistant that are not otherwise	681
specified in the physician supervisory plan or otherwise required	682
by this chapter.	683

Sec. 4730.44. (A) A physician assistant seeking a certificate	684
to prescribe shall submit to the state medical board a written	685
application on a form prescribed and supplied by the board. The	686
application shall include all of the following information:	687

(1) The applicant's name, residential address, business	688
address, if any, and social security number;	689

(2) Evidence of holding a valid certificate to practice as a	690
physician assistant issued under this chapter;	691

(3) Satisfactory proof that the applicant meets the	692
requirements specified in section 4730.46 of the Revised Code to	693
participate in a provisional period of physician-delegated	694
prescriptive authority or satisfactory proof of successful	695
completion of the provisional period, evidenced by a letter or	696
copy of a letter attesting to the successful completion written by	697
a supervising physician of the physician assistant at the time of	698
completionof eligibility to receive a certificate to prescribe by	699
meeting one of the requirements specified in division (B) of this	700
section;	701

(4) Any other information the board requires.

702

(B) To be eligible to receive a certificate to prescribe, an	703
applicant shall meet one of the following requirements:	704

(1) In the case of an applicant seeking to participate in a	705
provisional period of physician-delegated prescriptive authority	706
under section 4730.45 of the Revised Code, the applicant must meet	707
the requirements to participate in the provisional period, as	708
specified in section 4730.46 of the Revised Code.	709

(2) In the case of an applicant seeking a certificate to	710
prescribe after participating in a provisional period of	711
physician-delegated prescriptive authority, the applicant must	712
have successfully completed the provisional period, evidenced by a	713
letter or copy of a letter attesting to the successful completion	714
written by a physician who supervised the applicant at the time of	715
completion.	716

(3) In the case of an applicant who received a certificate to	717
practice by meeting the educational and military experience	718
requirements specified in division (C)(3) of section 4730.11 of	719
the Revised Code, the applicant must have been authorized to	720
prescribe drugs and therapeutic devices while practicing as a	721
physician assistant.	722

(4) In the case of an applicant who is not seeking a	723
certificate to prescribe by meeting the requirements of division	724
(B)(1), (2), or (3) of this section and has practiced as a	725
physician assistant in another state or was credentialed or	726
employed as a physician assistant by the United States government,	727
the applicant must meet both of the following requirements:	728

(a) Hold a master's or higher degree obtained from a program	729
accredited by the accreditation review commission on education for	730
the physician assistant or a predecessor or successor organization	731
recognized by the board;	732

(b) Have held valid authority issued by the other state or	733
the United States government to prescribe therapeutic devices and	734
drugs, including at least some controlled substances, evidenced by	735
an affidavit issued by an appropriate agency or office of the	736
other state or the United States government attesting to that	737
prescriptive authority.	738

(C) At the time of making application for a certificate to	739
prescribe, the applicant shall pay the board a fee of one hundred	740
dollars, no part of which shall be returned. The fees shall be	741
deposited in accordance with section 4731.24 of the Revised Code.	742

(C)(D) The board shall review all applications received. If	743
an application is complete and the board determines that the	744
applicant meets the requirements for a certificate to prescribe,	745
the board shall issue the certificate to the applicant. The	746
initial certificate to prescribe issued to an applicant seeking to	747
participate in a provisional period of physician-delegated	748
prescriptive authority shall be issued as a provisional	749
certificate to prescribe.	750

Sec. 4730.46.  (A) To be eligible to participate in the	751
provisional period of physician-delegated prescriptive authority	752
required by section 4730.45 of the Revised Code, both of the	753
following apply to a physician assistant:	754

(1) The physician assistant shall meet the educational	755
requirements specified in division (B)(1) or (2) of this section	756
or the educational and clinical experience requirements specified	757
in division (B)(2) of this section.	758

(2) The physician assistant shall successfully complete the	759
pharmacology instruction specified in division (C) of this	760
section.	761

(B)(1) For purposes of division (A)(1) of this section, a	762
physician assistant shall meet either of the following educational	763
requirements unless division (B)(2) of this section applies:	764

(a)(1) The physician assistant shall hold a master's or	765
higher degree that was obtained from a program accredited by the	766
accreditation review commission on education for the physician	767
assistant or a predecessor or successor organization recognized by	768
the state medical board.	769

(b)(2) The physician assistant shall hold aboth of the	770
following degrees:	771

(a) A degree other than a master's or higher degree that was	772
obtained from a school or program accredited by the accreditation	773
review commission on education for the physician assistant or a	774
predecessor or successor organization recognized by the board and	775
shall hold a;	776

(b) A master's or higher degree in a course of study with	777
clinical relevance to the practice of physician assistants that	778
was obtained from a program accredited by a regional or	779
specialized and professional accrediting agency recognized by the	780
council for higher education accreditation.	781

(2) Until two years after the effective date of the initial	782
rules adopted under section 4730.39 of the Revised Code, a	783
physician assistant who does not hold a master's or higher degree	784
as specified in division (B)(1) of this section is eligible to	785
participate in a provisional period if both of the following	786
apply:	787

(a) The physician assistant holds a degree other than a	788
master's or higher degree that was obtained from a program	789
accredited by the accreditation review commission on education for	790
the physician assistant or a predecessor or successor organization	791
recognized by the board.	792

(b) The physician assistant has obtained not less than ten	793
years of clinical experience as a physician assistant in this	794
state or another jurisdiction, three years of which were obtained	795
in the five-year period immediately preceding the date the	796
evidence is submitted to the supervising physician.	797

(C) For purposes of division (A)(2) of this section, all of	798
the following conditions shall be met:	799

(1) The pharmacology instruction shall be completed not	800
longer than three years prior to applying for the certificate to	801
prescribe.	802

(2) The instruction shall be obtained through a course of	803
study consisting of planned classroom or continued education and	804
clinical study that meets either of the following conditions:	805

(a) It is accredited by the accreditation review commission	806
on education for the physician assistant or a predecessor or	807
successor organization recognized by the board.	808

(b) It is approved by the board in accordance with standards	809
established in rules adopted under section 4730.39 of the Revised	810
Code.	811

(3) The content of the instruction shall include all of the	812
following:	813

(a) A minimum of thirty contact hours of training in	814
pharmacology that includes pharmacokinetic principles and clinical	815
application and the use of drugs and therapeutic devices in the	816
prevention of illness and maintenance of health;	817

(b) A minimum of twenty contact hours of clinical training in	818
pharmacology;	819

(c) A minimum of fifteen contact hours including training in	820
the fiscal and ethical implications of prescribing drugs and	821
therapeutic devices and training in the state and federal laws	822
that apply to the authority to prescribe;	823

(d) Any additional training required pursuant to rules	824
adopted under section 4730.39 of the Revised Code.	825

Sec. 4755.48.  (A) No person shall employ fraud or deception	826
in applying for or securing a license to practice physical therapy	827
or to be a physical therapist assistant.	828

(B) No person shall practice or in any way imply or claim to	829
the public by words, actions, or the use of letters as described	830
in division (C) of this section to be able to practice physical	831
therapy or to provide physical therapy services, including	832
practice as a physical therapist assistant, unless the person	833
holds a valid license under sections 4755.40 to 4755.56 of the	834
Revised Code or except for submission of claims as provided in	835
section 4755.56 of the Revised Code.	836

(C) No person shall use the words or letters, physical	837
therapist, physical therapy, physical therapy services,	838
physiotherapist, physiotherapy, physiotherapy services, licensed	839
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	840
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	841
therapist assistant, physical therapy technician, licensed	842
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	843
letters, words, abbreviations, or insignia, indicating or implying	844
that the person is a physical therapist or physical therapist	845
assistant without a valid license under sections 4755.40 to	846
4755.56 of the Revised Code.	847

(D) No person who practices physical therapy or assists in	848
the provision of physical therapy treatments under the supervision	849
of a physical therapist shall fail to display the person's current	850
license granted under sections 4755.40 to 4755.56 of the Revised	851
Code in a conspicuous location in the place where the person	852
spends the major part of the person's time so engaged.	853

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	854
Code shall affect or interfere with the performance of the duties	855
of any physical therapist or physical therapist assistant in	856
active service in the army, navy, coast guard, marine corps, air	857
force, public health service, or marine hospital service of the	858
United States, while so serving.	859

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	860
Code shall prevent or restrict the activities or services of a	861
person pursingpursuing a course of study leading to a degree in	862
physical therapy in an accredited or approved educational program	863
if the activities or services constitute a part of a supervised	864
course of study and the person is designated by a title that	865
clearly indicates the person's status as a student.	866

(G) No(1) Except as provided in division (G)(2) of this	867
section and subject to division (H) of this section, no person	868
shall practice physical therapy other than on the prescription of,	869
or the referral of a patient by, a person who is licensed in this	870
or another state to practicedo at least one of the following:	871

(a) Practice medicine and surgery, chiropractic, dentistry,	872
osteopathic medicine and surgery, podiatric medicine and surgery,	873
or to practice;	874

(b) Practice as a physician assistant;

875

(c) Practice nursing as a certified registered nurse	876
anesthetist, clinical nurse specialist, certified nurse-midwife,	877
or certified nurse practitioner, within the scope of such	878
practices, and whose license is in good standing, unless either of	879
the following conditions is met:.	880

(1)(2) The prohibition in division (G)(1) of this section on	881
practicing physical therapy other than on the prescription of, or	882
the referral of a patient by, any of the persons described in that	883
division does not apply if either of the following applies to the	884
person:	885

(a) The person holds a master's or doctorate degree from a	886
professional physical therapy program that is accredited by a	887
national physical therapy accreditation agency recognized by the	888
United States department of education.	889

(2)(b) On or before December 31, 2004, the person has	890
completed at least two years of practical experience as a licensed	891
physical therapist.	892

(H) To be authorized to prescribe physical therapy or refer	893
a patient to a physical therapist for physical therapy, a person	894
described in division (G)(1) of this section must be in good	895
standing with the relevant licensing board in this state or the	896
state in which the person is licensed and must act only within the	897
person's scope of practice.	898

(I) In the prosecution of any person for violation of	899
division (B) or (C) of this section, it is not necessary to allege	900
or prove want of a valid license to practice physical therapy or	901
to practice as a physical therapist assistant, but such matters	902
shall be a matter of defense to be established by the accused.	903

Sec. 4755.481. (A) If a physical therapist evaluates and	904
treats a patient without the prescription of, or the referral of	905
the patient by, a person who is licensed to practice medicine and	906
surgery, chiropractic, dentistry, osteopathic medicine and	907
surgery, podiatric medicine and surgery, or nursing as a certified	908
registered nurse anesthetist, clinical nurse specialist, certified	909
nurse-midwife, or certified nurse practitionerdescribed in	910
division (G)(1) of section 4755.48 of the Revised Code, all of the	911
following apply:	912

(1) The physical therapist shall, upon consent of the	913
patient, inform the patient's physician, chiropractor, dentist,	914
podiatrist, certified registered nurse anesthetist, clinical nurse	915
specialist, certified nurse-midwife, or certified nurse	916
practitionerrelevant person described in division (G)(1) of	917
section 4755.48 of the Revised Code of the evaluation not later	918
than five business days after the evaluation is made.	919

(2) If the physical therapist determines, based on reasonable	920
evidence, that no substantial progress has been made with respect	921
to that patient during the thirty-day period immediately following	922
the date of the patient's initial visit with the physical	923
therapist, the physical therapist shall consult with or refer the	924
patient to a licensed physician, chiropractor, dentist,	925
podiatrist, certified registered nurse anesthetist, clinical nurse	926
specialist, certified nurse-midwife, or certified nurse	927
practitionerperson described in division (G)(1) of section	928
4755.48 of the Revised Code, unless either of the following	929
applies:	930

(a) The evaluation, treatment, or services are being provided	931
for fitness, wellness, or prevention purposes.	932

(b) The patient previously was diagnosed with chronic,	933
neuromuscular, or developmental conditions and the evaluation,	934
treatment, or services are being provided for problems or symptoms	935
associated with one or more of those previously diagnosed	936
conditions.	937

(3) If the physical therapist determines that orthotic	938
devices are necessary to treat the patient, the physical therapist	939
shall be limited to the application of the following orthotic	940
devices:	941

(a) Upper extremity adaptive equipment used to facilitate the	942
activities of daily living;	943

(b) Finger splints;

944

(c) Wrist splints;

945

(d) Prefabricated elastic or fabric abdominal supports with	946
or without metal or plastic reinforcing stays and other	947
prefabricated soft goods requiring minimal fitting;	948

(e) Nontherapeutic accommodative inlays;

949

(f) Shoes that are not manufactured or modified for a	950
particular individual;	951

(g) Prefabricated foot care products;

952

(h) Custom foot orthotics;

953

(i) Durable medical equipment.

954

(4) If, at any time, the physical therapist has reason to	955
believe that the patient has symptoms or conditions that require	956
treatment or services beyond the scope of practice of a physical	957
therapist, the physical therapist shall refer the patient to a	958
licensed health care practitioner acting within the practitioner's	959
scope of practice.	960

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	961
Code shall be construed to require reimbursement under any health	962
insuring corporation policy, contract, or agreement, any sickness	963
and accident insurance policy, the medical assistance program as	964
defined in section 5111.01 of the Revised Code, or the health	965
partnership program or qualified health plans established pursuant	966
to sections 4121.44 to 4121.442 of the Revised Code, for any	967
physical therapy service rendered without the prescription of, or	968
the referral of the patient by, a licensed physician,	969
chiropractor, dentist, podiatrist, certified registered nurse	970
anesthetist, clinical nurse specialist, certified nurse-midwife,	971
or certified nurse practitionerperson described in division	972
(G)(1) of section 4755.48 of the Revised Code.	973

(C) For purposes of this section, "business day" means any	974
calendar day that is not a Saturday, Sunday, or legal holiday.	975
"Legal holiday" has the same meaning as in section 1.14 of the	976
Revised Code.	977

Sec. 4765.01.  As used in this chapter:

978

(A) "First responder" means an individual who holds a	979
current, valid certificate issued under section 4765.30 of the	980
Revised Code to practice as a first responder.	981

(B) "Emergency medical technician-basic" or "EMT-basic" means	982
an individual who holds a current, valid certificate issued under	983
section 4765.30 of the Revised Code to practice as an emergency	984
medical technician-basic.	985

(C) "Emergency medical technician-intermediate" or "EMT-I"	986
means an individual who holds a current, valid certificate issued	987
under section 4765.30 of the Revised Code to practice as an	988
emergency medical technician-intermediate.	989

(D) "Emergency medical technician-paramedic" or "paramedic"	990
means an individual who holds a current, valid certificate issued	991
under section 4765.30 of the Revised Code to practice as an	992
emergency medical technician-paramedic.	993

(E) "Ambulance" means any motor vehicle that is used, or is	994
intended to be used, for the purpose of responding to emergency	995
medical situations, transporting emergency patients, and	996
administering emergency medical service to patients before,	997
during, or after transportation.	998

(F) "Cardiac monitoring" means a procedure used for the	999
purpose of observing and documenting the rate and rhythm of a	1000
patient's heart by attaching electrical leads from an	1001
electrocardiograph monitor to certain points on the patient's body	1002
surface.	1003

(G) "Emergency medical service" means any of the services	1004
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	1005
the Revised Code that are performed by first responders, emergency	1006
medical technicians-basic, emergency medical	1007
technicians-intermediate, and paramedics. "Emergency medical	1008
service" includes such services performed before or during any	1009
transport of a patient, including transports between hospitals and	1010
transports to and from helicopters.	1011

(H) "Emergency medical service organization" means a public	1012
or private organization using first responders, EMTs-basic,	1013
EMTs-I, or paramedics, or a combination of first responders,	1014
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	1015
services.	1016

(I) "Physician" means an individual who holds a current,	1017
valid certificate issued under Chapter 4731. of the Revised Code	1018
authorizing the practice of medicine and surgery or osteopathic	1019
medicine and surgery.	1020

(J) "Registered nurse" means an individual who holds a	1021
current, valid license issued under Chapter 4723. of the Revised	1022
Code authorizing the practice of nursing as a registered nurse.	1023

(K) "Volunteer" means a person who provides services either	1024
for no compensation or for compensation that does not exceed the	1025
actual expenses incurred in providing the services or in training	1026
to provide the services.	1027

(L) "Emergency medical service personnel" means first	1028
responders, emergency medical service technicians-basic, emergency	1029
medical service technicians-intermediate, emergency medical	1030
service technicians-paramedic, and persons who provide medical	1031
direction to such persons.	1032

(M) "Hospital" has the same meaning as in section 3727.01 of	1033
the Revised Code.	1034

(N) "Trauma" or "traumatic injury" means severe damage to or	1035
destruction of tissue that satisfies both of the following	1036
conditions:	1037

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

1038

(a) Loss of life;

1039

(b) Loss of a limb;

1040

(c) Significant, permanent disfigurement;

1041

(d) Significant, permanent disability.

1042

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

1043

(a) Blunt or penetrating injury;

1044

(b) Exposure to electromagnetic, chemical, or radioactive	1045
energy;	1046

(c) Drowning, suffocation, or strangulation;

1047

(d) A deficit or excess of heat.

1048

(O) "Trauma victim" or "trauma patient" means a person who	1049
has sustained a traumatic injury.	1050

(P) "Trauma care" means the assessment, diagnosis,	1051
transportation, treatment, or rehabilitation of a trauma victim by	1052
emergency medical service personnel or by a physician, nurse,	1053
physician assistant, respiratory therapist, physical therapist,	1054
chiropractor, occupational therapist, speech-language pathologist,	1055
audiologist, or psychologist licensed to practice as such in this	1056
state or another jurisdiction.	1057

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

1058

(1) Any hospital that is verified by the American college of	1059
surgeons as an adult or pediatric trauma center;	1060

(2) Any hospital that is operating as an adult or pediatric	1061
trauma center under provisional status pursuant to section	1062
3727.101 of the Revised Code;	1063

(3) Until December 31, 2004, any hospital in this state that	1064
is designated by the director of health as a level II pediatric	1065
trauma center under section 3727.081 of the Revised Code;	1066

(4) Any hospital in another state that is licensed or	1067
designated under the laws of that state as capable of providing	1068
specialized trauma care appropriate to the medical needs of the	1069
trauma patient.	1070

(R) "Pediatric" means involving a patient who is less than	1071
sixteen years of age.	1072

(S) "Adult" means involving a patient who is not a pediatric	1073
patient.	1074

(T) "Geriatric" means involving a patient who is at least	1075
seventy years old or exhibits significant anatomical or	1076
physiological characteristics associated with advanced aging.	1077

(U) "Air medical organization" means an organization that	1078
provides emergency medical services, or transports emergency	1079
victims, by means of fixed or rotary wing aircraft.	1080

(V) "Emergency care" and "emergency facility" have the same	1081
meanings as in section 3727.01 of the Revised Code.	1082

(W) "Stabilize," except as it is used in division (B) of	1083
section 4765.35 of the Revised Code with respect to the manual	1084
stabilization of fractures, has the same meaning as in section	1085
1753.28 of the Revised Code.	1086

(X) "Transfer" has the same meaning as in section 1753.28 of	1087
the Revised Code.	1088

(Y) "Firefighter" means any member of a fire department as	1089
defined in section 742.01 of the Revised Code.	1090

(Z) "Volunteer firefighter" has the same meaning as in	1091
section 146.01 of the Revised Code.	1092

(AA) "Part-time paid firefighter" means a person who provides	1093
firefighting services on less than a full-time basis, is routinely	1094
scheduled to be present on site at a fire station or other	1095
designated location for purposes of responding to a fire or other	1096
emergency, and receives more than nominal compensation for the	1097
provision of firefighting services.	1098

(BB) "Physician assistant" means an individual who holds a	1099
valid certificate to practice as a physician assistant issued	1100
under Chapter 4730. of the Revised Code.	1101

Sec. 4765.35.  (A) A first responder shall perform the	1102
emergency medical services described in this section in accordance	1103
with this chapter and any rules adopted under it.	1104

(B) A first responder may provide limited emergency medical	1105
services to patients until the arrival of an emergency medical	1106
technician-basic, emergency medical technician-intermediate, or	1107
emergency medical technician-paramedic. In an emergency, a first	1108
responder may render emergency medical services such as opening	1109
and maintaining an airway, giving mouth to barrier ventilation,	1110
chest compressions, electrical interventions with automated	1111
defibrillators to support or correct the cardiac function and	1112
other methods determined by the board, controlling of hemorrhage,	1113
manual stabilization of fractures, bandaging, assisting in	1114
childbirth, and determining triage of trauma victims.	1115

(C) A first responder may perform any other emergency medical	1116
services approved pursuant to rules adopted under section 4765.11	1117
of the Revised Code. The board shall determine whether the nature	1118
of any such service requires that a first responder receive	1119
authorization prior to performing the service.	1120

(D)(1) Except as provided in division (D)(2) of this section,	1121
if the board determines under division (C) of this section that a	1122
service requires prior authorization, the service shall be	1123
performed only pursuant to the written or verbal authorization of	1124
a physician or of the cooperating physician advisory board, or	1125
pursuant to an authorization transmitted through a direct	1126
communication device by a physician, physician assistant	1127
designated by a physician, or registered nurse designated by a	1128
physician.	1129

(2) If communications fail during an emergency situation or	1130
the required response time prohibits communication, a first	1131
responder may perform services subject to this division, if, in	1132
the judgment of the first responder, the life of the patient is in	1133
immediate danger. Services performed under these circumstances	1134
shall be performed in accordance with the written protocols for	1135
triage of adult and pediatric trauma victims established in rules	1136
adopted under sections 4765.11 and 4765.40 of the Revised Code and	1137
any applicable protocols adopted by the emergency medical service	1138
organization with which the first responder is affiliated.	1139

Sec. 4765.36.  In a hospital, an emergency medical	1140
technician-basic, emergency medical technician-intermediate, or	1141
emergency medical technician-paramedic may perform emergency	1142
medical services only under the direction and supervision of a	1143
physician or registered nurse designated by a physician and only	1144
if the services are performed in accordance with both of the	1145
following conditions:	1146

(A) Only in the hospital's emergency department or while	1147
moving a patient between the emergency department and another part	1148
of the hospital;	1149

(B) Only under the direction and supervision of one of the	1150
following:	1151

(1) A physician;

1152

(2) A physician assistant designated by a physician;

1153

(3) A registered nurse designated by a physician.

1154

Sec. 4765.37.  (A) An emergency medical technician-basic	1155
shall perform the emergency medical services described in this	1156
section in accordance with this chapter and any rules adopted	1157
under it by the state board of emergency medical services.	1158

(B) An emergency medical technician-basic may operate, or be	1159
responsible for operation of, an ambulance and may provide	1160
emergency medical services to patients. In an emergency, an	1161
EMT-basic may determine the nature and extent of illness or injury	1162
and establish priority for required emergency medical services. An	1163
EMT-basic may render emergency medical services such as opening	1164
and maintaining an airway, giving positive pressure ventilation,	1165
cardiac resuscitation, electrical interventions with automated	1166
defibrillators to support or correct the cardiac function and	1167
other methods determined by the board, controlling of hemorrhage,	1168
treatment of shock, immobilization of fractures, bandaging,	1169
assisting in childbirth, management of mentally disturbed	1170
patients, initial care of poison and burn patients, and	1171
determining triage of adult and pediatric trauma victims. Where	1172
patients must in an emergency be extricated from entrapment, an	1173
EMT-basic may assess the extent of injury and render all possible	1174
emergency medical services and protection to the entrapped	1175
patient; provide light rescue services if an ambulance has not	1176
been accompanied by a specialized unit; and after extrication,	1177
provide additional care in sorting of the injured in accordance	1178
with standard emergency procedures.	1179

(C) An EMT-basic may perform any other emergency medical	1180
services approved pursuant to rules adopted under section 4765.11	1181
of the Revised Code. The board shall determine whether the nature	1182
of any such service requires that an EMT-basic receive	1183
authorization prior to performing the service.	1184

(D)(1) Except as provided in division (D)(2) of this section,	1185
if the board determines under division (C) of this section that a	1186
service requires prior authorization, the service shall be	1187
performed only pursuant to the written or verbal authorization of	1188
a physician or of the cooperating physician advisory board, or	1189
pursuant to an authorization transmitted through a direct	1190
communication device by a physician, physician assistant	1191
designated by a physician, or registered nurse designated by a	1192
physician.	1193

(2) If communications fail during an emergency situation or	1194
the required response time prohibits communication, an EMT-basic	1195
may perform services subject to this division, if, in the judgment	1196
of the EMT-basic, the life of the patient is in immediate danger.	1197
Services performed under these circumstances shall be performed in	1198
accordance with the protocols for triage of adult and pediatric	1199
trauma victims established in rules adopted under sections 4765.11	1200
and 4765.40 of the Revised Code and any applicable protocols	1201
adopted by the emergency medical service organization with which	1202
the EMT-basic is affiliated.	1203

Sec. 4765.38.  (A) An emergency medical	1204
technician-intermediate shall perform the emergency medical	1205
services described in this section in accordance with this chapter	1206
and any rules adopted under it.	1207

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

1208

(1) Establish and maintain an intravenous lifeline that has	1209
been approved by a cooperating physician or physician advisory	1210
board;	1211

(2) Perform cardiac monitoring;

1212

(3) Perform electrical interventions to support or correct	1213
the cardiac function;	1214

(4) Administer epinephrine;

1215

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

1216

(6) Perform any other emergency medical services approved	1217
pursuant to rules adopted under section 4765.11 of the Revised	1218
Code.	1219

(C)(1) Except as provided in division (C)(2) of this section,	1220
the services described in division (B) of this section shall be	1221
performed by an EMT-I only pursuant to the written or verbal	1222
authorization of a physician or of the cooperating physician	1223
advisory board, or pursuant to an authorization transmitted	1224
through a direct communication device by a physician, physician	1225
assistant designated by a physician, or registered nurse	1226
designated by a physician.	1227

(2) If communications fail during an emergency situation or	1228
the required response time prohibits communication, an EMT-I may	1229
perform any of the services described in division (B) of this	1230
section, if, in the judgment of the EMT-I, the life of the patient	1231
is in immediate danger. Services performed under these	1232
circumstances shall be performed in accordance with the protocols	1233
for triage of adult and pediatric trauma victims established in	1234
rules adopted under sections 4765.11 and 4765.40 of the Revised	1235
Code and any applicable protocols adopted by the emergency medical	1236
service organization with which the EMT-I is affiliated.	1237

(D) In addition to, and in the course of, providing emergency	1238
medical treatment, an emergency medical technician-intermediate	1239
may withdraw blood as provided under sections 1547.11, 4506.17,	1240
and 4511.19 of the Revised Code. An emergency medical	1241
technician-intermediate shall withdraw blood in accordance with	1242
this chapter and any rules adopted under it by the state board of	1243
emergency medical services.	1244

Sec. 4765.39.  (A) An emergency medical technician-paramedic	1245
shall perform the emergency medical services described in this	1246
section in accordance with this chapter and any rules adopted	1247
under it.	1248

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

1249

(1) Perform cardiac monitoring;

1250

(2) Perform electrical interventions to support or correct	1251
the cardiac function;	1252

(3) Perform airway procedures;

1253

(4) Perform relief of pneumothorax;

1254

(5) Administer appropriate drugs and intravenous fluids;

1255

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

1256

(7) Perform any other emergency medical services, including	1257
life support or intensive care techniques, approved pursuant to	1258
rules adopted under section 4765.11 of the Revised Code.	1259

(C)(1) Except as provided in division (C)(2) of this section,	1260
the services described in division (B) of this section shall be	1261
performed by a paramedic only pursuant to the written or verbal	1262
authorization of a physician or of the cooperating physician	1263
advisory board, or pursuant to an authorization transmitted	1264
through a direct communication device by a physician, physician	1265
assistant designated by a physician, or registered nurse	1266
designated by a physician.	1267

(2) If communications fail during an emergency situation or	1268
the required response time prohibits communication, a paramedic	1269
may perform any of the services described in division (B) of this	1270
section, if, in the paramedic's judgment, the life of the patient	1271
is in immediate danger. Services performed under these	1272
circumstances shall be performed in accordance with the protocols	1273
for triage of adult and pediatric trauma victims established in	1274
rules adopted under sections 4765.11 and 4765.40 of the Revised	1275
Code and any applicable protocols adopted by the emergency medical	1276
service organization with which the paramedic is affiliated.	1277

(D) In addition to, and in the course of, providing emergency	1278
medical treatment, an emergency medical technician-paramedic may	1279
withdraw blood as provided under sections 1547.11, 4506.17, and	1280
4511.19 of the Revised Code. An emergency medical	1281
technician-paramedic shall withdraw blood in accordance with this	1282
chapter and any rules adopted under it by the state board of	1283
emergency medical services.	1284

Sec. 4765.49.  (A) A first responder, emergency medical	1285
technician-basic, emergency medical technician-intermediate, or	1286
emergency medical technician-paramedic is not liable in damages in	1287
a civil action for injury, death, or loss to person or property	1288
resulting from the individual's administration of emergency	1289
medical services, unless the services are administered in a manner	1290
that constitutes willful or wanton misconduct. A physician,	1291
physician assistant designated by a physician, or registered nurse	1292
designated by a physician, whoany of whom is advising or	1293
assisting in the emergency medical services by means of any	1294
communication device or telemetering system, is not liable in	1295
damages in a civil action for injury, death, or loss to person or	1296
property resulting from the individual's advisory communication or	1297
assistance, unless the advisory communication or assistance is	1298
provided in a manner that constitutes willful or wanton	1299
misconduct. Medical directors and members of cooperating physician	1300
advisory boards of emergency medical service organizations are not	1301
liable in damages in a civil action for injury, death, or loss to	1302
person or property resulting from their acts or omissions in the	1303
performance of their duties, unless the act or omission	1304
constitutes willful or wanton misconduct.	1305

(B) A political subdivision, joint ambulance district, joint	1306
emergency medical services district, or other public agency, and	1307
any officer or employee of a public agency or of a private	1308
organization operating under contract or in joint agreement with	1309
one or more political subdivisions, that provides emergency	1310
medical services, or that enters into a joint agreement or a	1311
contract with the state, any political subdivision, joint	1312
ambulance district, or joint emergency medical services district	1313
for the provision of emergency medical services, is not liable in	1314
damages in a civil action for injury, death, or loss to person or	1315
property arising out of any actions taken by a first responder,	1316
EMT-basic, EMT-I, or paramedic working under the officer's or	1317
employee's jurisdiction, or for injury, death, or loss to person	1318
or property arising out of any actions of licensed medical	1319
personnel advising or assisting the first responder, EMT-basic,	1320
EMT-I, or paramedic, unless the services are provided in a manner	1321
that constitutes willful or wanton misconduct.	1322

(C) A student who is enrolled in an emergency medical	1323
services training program accredited under section 4765.17 of the	1324
Revised Code or an emergency medical services continuing education	1325
program approved under that section is not liable in damages in a	1326
civil action for injury, death, or loss to person or property	1327
resulting from either of the following:	1328

(1) The student's administration of emergency medical	1329
services or patient care or treatment, if the services, care, or	1330
treatment is administered while the student is under the direct	1331
supervision and in the immediate presence of an EMT-basic, EMT-I,	1332
paramedic, registered nurse, physician assistant, or physician and	1333
while the student is receiving clinical training that is required	1334
by the program, unless the services, care, or treatment is	1335
provided in a manner that constitutes willful or wanton	1336
misconduct;	1337

(2) The student's training as an ambulance driver, unless the	1338
driving is done in a manner that constitutes willful or wanton	1339
misconduct.	1340

(D) An EMT-basic, EMT-I, paramedic, or other operator, who	1341
holds a valid commercial driver's license issued pursuant to	1342
Chapter 4506. of the Revised Code or driver's license issued	1343
pursuant to Chapter 4507. of the Revised Code and who is employed	1344
by an emergency medical service organization that is not owned or	1345
operated by a political subdivision as defined in section 2744.01	1346
of the Revised Code, is not liable in damages in a civil action	1347
for injury, death, or loss to person or property that is caused by	1348
the operation of an ambulance by the EMT-basic, EMT-I, paramedic,	1349
or other operator while responding to or completing a call for	1350
emergency medical services, unless the operation constitutes	1351
willful or wanton misconduct or does not comply with the	1352
precautions of section 4511.03 of the Revised Code. An emergency	1353
medical service organization is not liable in damages in a civil	1354
action for any injury, death, or loss to person or property that	1355
is caused by the operation of an ambulance by its employee or	1356
agent, if this division grants the employee or agent immunity from	1357
civil liability for the injury, death, or loss.	1358

(E) An employee or agent of an emergency medical service	1359
organization who receives requests for emergency medical services	1360
that are directed to the organization, dispatches first	1361
responders, EMTs-basic, EMTs-I, or paramedics in response to those	1362
requests, communicates those requests to those employees or agents	1363
of the organization who are authorized to dispatch first	1364
responders, EMTs-basic, EMTs-I, or paramedics, or performs any	1365
combination of these functions for the organization, is not liable	1366
in damages in a civil action for injury, death, or loss to person	1367
or property resulting from the individual's acts or omissions in	1368
the performance of those duties for the organization, unless an	1369
act or omission constitutes willful or wanton misconduct.	1370

(F) A person who is performing the functions of a first	1371
responder, EMT-basic, EMT-I, or paramedic under the authority of	1372
the laws of a state that borders this state and who provides	1373
emergency medical services to or transportation of a patient in	1374
this state is not liable in damages in a civil action for injury,	1375
death, or loss to person or property resulting from the person's	1376
administration of emergency medical services, unless the services	1377
are administered in a manner that constitutes willful or wanton	1378
misconduct. A physician, physician assistant designated by a	1379
physician, or registered nurse designated by a physician, whoany	1380
of whom is licensed to practice in the adjoining state and who is	1381
advising or assisting in the emergency medical services by means	1382
of any communication device or telemetering system, is not liable	1383
in damages in a civil action for injury, death, or loss to person	1384
or property resulting from the person's advisory communication or	1385
assistance, unless the advisory communication or assistance is	1386
provided in a manner that constitutes willful or wanton	1387
misconduct.	1388

(G) A person certified under section 4765.23 of the Revised	1389
Code to teach in an emergency medical services training program or	1390
emergency medical services continuing education program, and a	1391
person who teaches at the Ohio fire academy established under	1392
section 3737.33 of the Revised Code or in a fire service training	1393
program described in division (A) of section 4765.55 of the	1394
Revised Code, is not liable in damages in a civil action for	1395
injury, death, or loss to person or property resulting from the	1396
person's acts or omissions in the performance of the person's	1397
duties, unless an act or omission constitutes willful or wanton	1398
misconduct.	1399

(H) In the accreditation of emergency medical services	1400
training programs or approval of emergency medical services	1401
continuing education programs, the state board of emergency	1402
medical services and any person or entity authorized by the board	1403
to evaluate applications for accreditation or approval are not	1404
liable in damages in a civil action for injury, death, or loss to	1405
person or property resulting from their acts or omissions in the	1406
performance of their duties, unless an act or omission constitutes	1407
willful or wanton misconduct.	1408

(I) A person authorized by an emergency medical service	1409
organization to review the performance of first responders,	1410
EMTs-basic, EMTs-I, and paramedics or to administer quality	1411
assurance programs is not liable in damages in a civil action for	1412
injury, death, or loss to person or property resulting from the	1413
person's acts or omissions in the performance of the person's	1414
duties, unless an act or omission constitutes willful or wanton	1415
misconduct.	1416

Sec. 4765.51.  Nothing in this chapter prevents or restricts	1417
the practice, services, or activities of any registered nurse	1418
practicing within the scope of histhe registered nurse's	1419
practice.	1420

Nothing in this chapter prevents or restricts the practice,	1421
services, or activities of any physician assistant practicing in	1422
accordance with a physician supervisory plan approved under	1423
section 4730.17 of the Revised Code or the policies of the health	1424
care facility in which the physician assistant is practicing.	1425

Section 2.  That existing sections 2133.211, 3719.06,	1426
4730.06, 4730.09, 4730.10, 4730.11, 4730.38, 4730.39, 4730.40,	1427
4730.41, 4730.42, 4730.44, 4730.46, 4755.48, 4755.481, 4765.01,	1428
4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51	1429
and section 4730.401 of the Revised Code are hereby repealed.	1430