As Reported by the House Health 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 

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A BILL

To amend sections 185.01, 185.03, 185.05, 2133.211,

1

3719.06, 4730.06, 4730.09, 4730.38, 4730.39,

2

4730.40, 4730.41, 4730.42, 4730.44, 4730.45,

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, 4730.093, and

6

4730.411, and to repeal section 4730.401 of the

7

Revised Code to modify the laws governing

8

physician assistants.

9

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

Section 1.  That sections 185.01, 185.03, 185.05, 2133.211,	10
3719.06, 4730.06, 4730.09, 4730.38, 4730.39, 4730.40, 4730.41,	11
4730.42, 4730.44, 4730.45, 4755.48, 4755.481, 4765.01, 4765.35,	12
4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51 be	13
amended and sections 4730.04, 4730.092, 4730.093, and 4730.411 of	14
the Revised Code be enacted to read as follows:	15

Sec. 185.01.  As used in this chapter:

16

(A) "Advanced practice nurse" has the same meaning as in	17
section 4723.01 of the Revised Code.	18

(B) "Collaboration" has the same meaning as in section	19
4723.01 of the Revised Code.	20

(C) "Patient centered medical home education advisory group"	21
means the entity established under section 185.03 of the Revised	22
Code to implement and administer the patient centered medical home	23
education pilot project.	24

(D) "Patient centered medical home education pilot project"	25
means the pilot project established under section 185.02 of the	26
Revised Code.	27

(E) "Physician assistant" means an individual who holds a	28
valid certificate to practice as a physician assistant issued	29
under Chapter 4730. of the Revised Code.	30

Sec. 185.03. (A) The patient centered medical home education	31
advisory group is hereby created for the purpose of implementing	32
and administering the patient centered medical home pilot project.	33
The advisory group shall develop a set of expected outcomes for	34
the pilot project.	35

(B) The advisory group shall consist of the following voting	36
members:	37

(1) One individual with expertise in the training and	38
education of primary care physicians who is appointed by the dean	39
of the university of Toledo college of medicine;	40

(2) One individual with expertise in the training and	41
education of primary care physicians who is appointed by the dean	42
of the Boonshoft school of medicine at Wright state university;	43

(3) One individual with expertise in the training and	44
education of primary care physicians who is appointed by the	45
president and dean of the northeast Ohio medical university;	46

(4) One individual with expertise in the training and	47
education of primary care physicians who is appointed by the dean	48
of the Ohio university college of osteopathic medicine;	49

(5) Two individuals appointed by the governing board of the	50
Ohio academy of family physicians;	51

(6) One individual appointed by the governing board of the	52
Ohio chapter of the American college of physicians;	53

(7) One individual appointed by the governing board of the	54
American academy of pediatrics;	55

(8) One individual appointed by the governing board of the	56
Ohio osteopathic association;	57

(9) One individual with expertise in the training and	58
education of advanced practice nurses who is appointed by the	59
governing board of the Ohio council of deans and directors of	60
baccalaureate and higher degree programs in nursing;	61

(10) One individual appointed by the governing board of the	62
Ohio nurses association;	63

(11) One individual appointed by the governing board of the	64
Ohio association of advanced practice nurses;	65

(12) One individual appointed by the governing board of the	66
Ohio association of physician assistants;	67

(13) One individual appointed by the governing board of the	68
Ohio council for home care and hospice;	69

(13)(14) One individual appointed by the superintendent of	70
insurance.	71

(C) The advisory group shall consist of the following	72
nonvoting, ex officio members:	73

(1) The executive director of the state medical board, or the	74
director's designee;	75

(2) The executive director of the board of nursing or the	76
director's designee;	77

(3) The chancellor of the Ohio board of regents, or the	78
chancellor's designee;	79

(4) The individual within the department of job and family	80
services who serves as the director of medicaid, or the director's	81
designee;	82

(5) The director of health or the director's designee.

83

(D) Advisory group members who are appointed shall serve at	84
the pleasure of their appointing authorities. Terms of office of	85
appointed members shall be three years, except that a member's	86
term ends if the pilot project ceases operation during the	87
member's term.	88

Vacancies shall be filled in the manner provided for original	89
appointments.	90

Members shall serve without compensation, except to the	91
extent that serving on the advisory group is considered part of	92
their regular employment duties.	93

(E) The advisory group shall select from among its members a	94
chairperson and vice-chairperson. The advisory group may select	95
any other officers it considers necessary to conduct its business.	96

A majority of the members of the advisory group constitutes a	97
quorum for the transaction of official business. A majority of a	98
quorum is necessary for the advisory group to take any action,	99
except that when one or more members of a quorum are required to	100
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)	101
of section 185.05 of the Revised Code, the number of members	102
necessary for a majority of a quorum shall be reduced accordingly.	103

The advisory group shall meet as necessary to fulfill its	104
duties. The times and places for the meetings shall be selected by	105
the chairperson.	106

(F) Sections 101.82 to 101.87 of the Revised Code do not	107
apply to the advisory group.	108

Sec. 185.05. (A) The patient centered medical home education	109
advisory group shall accept applications for inclusion in the	110
patient centered medical home education pilot project from primary	111
care practices with educational affiliations, as determined by the	112
advisory group, with one or more of the following:	113

(1) The Boonshoft school of medicine at Wright state	114
university;	115

(2) The university of Toledo college of medicine;

116

(3) The northeast Ohio medical university;

117

(4) The Ohio university college of osteopathic medicine;

118

(5) The college of nursing at the university of Toledo;

119

(6) The Wright state university college of nursing and	120
health;	121

(7) The college of nursing at Kent state university;

122

(8) The university of Akron college of nursing;

123

(9) The school of nursing at Ohio university.

124

(B)(1) Subject to division (C)(1) of this section, the	125
advisory group shall select for inclusion in the pilot project not	126
more than the following number of physician practices:	127

(a) Ten practices affiliated with the Boonshoft school of	128
medicine at Wright state university;	129

(b) Ten practices affiliated with the university of Toledo	130
college of medicine;	131

(c) Ten practices affiliated with the northeast Ohio medical	132
university;	133

(d) Ten practices affiliated with the centers for osteopathic	134
research and education of the Ohio university college of	135
osteopathic medicine.	136

(2) Subject to division (C)(2) of this section, the advisory	137
group shall select for inclusion in the pilot project not less	138
than the following number of advanced practice nurse primary care	139
practices:	140

(a) One practice affiliated with the college of nursing at	141
the university of Toledo;	142

(b) One practice affiliated with the Wright state university	143
college of nursing and health;	144

(c) One practice affiliated with the college of nursing at	145
Kent state university or the university of Akron college of	146
nursing;	147

(d) One practice affiliated with the school of nursing at	148
Ohio university.	149

(C)(1) All of the following apply with respect to the	150
selection of physician practices under division (B) of this	151
section:	152

(a) The advisory group shall strive to select physician	153
practices in such a manner that the pilot project includes aboth	154
of the following:	155

(i) A diverse range of primary care specialties, including	156
practices specializing in pediatrics, geriatrics, general internal	157
medicine, or family medicine;	158

(ii) Practices that utilize physician assistants as part of	159
the health care delivery system.	160

(b) When evaluating an application, the advisory group shall	161
consider the percentage of patients in the physician practice who	162
are part of a medically underserved population, including medicaid	163
recipients and individuals without health insurance.	164

(c) The advisory group shall select not fewer than six	165
practices that serve rural areas of this state, as those areas are	166
determined by the advisory group.	167

(d) A member of the advisory group shall abstain from	168
participating in any vote taken regarding the selection of a	169
physician practice if the member would receive any financial	170
benefit from having the practice included in the pilot project.	171

(2) All of the following apply with respect to the selection	172
of advanced practice nurse primary care practices under division	173
(B) of this section:	174

(a) When evaluating an application, the advisory group shall	175
consider the percentage of patients in the advanced practice nurse	176
primary care practice who are part of a medically underserved	177
population, including medicaid recipients and individuals without	178
health insurance.	179

(b) If the advisory group determines that it has not received	180
an application from a sufficiently qualified advanced practice	181
nurse primary care practice affiliated with a particular	182
institution specified in division (B)(2) of this section, the	183
advisory group shall make the selections required under that	184
division in such a manner that the greatest possible number of	185
those institutions are represented in the pilot project. To be	186
selected in this manner, a practice remains subject to the	187
eligibility requirements specified in division (B) of section	188
185.06 of the Revised Code. As specified in division (B)(2) of	189
this section, the number of practices selected for inclusion in	190
the pilot project shall be at least four.	191

(c) A member of the advisory group shall abstain from	192
participating in any vote taken regarding the selection of an	193
advanced practice nurse primary care practice if the member would	194
receive any financial benefit from having the practice included in	195
the pilot project.	196

Sec. 2133.211.  A person who holds a certificate of authority	197
to practice as a certified nurse practitioner or clinical nurse	198
specialist issued under section 4723.42 of the Revised Code may	199
take any action that may be taken by an attending physician under	200
sections 2133.21 to 2133.26 of the Revised Code and has the	201
immunity provided by section 2133.22 of the Revised Code if the	202
action is taken pursuant to a standard care arrangement with a	203
collaborating physician.	204

A person who holds a certificate to practice as a physician	205
assistant issued under Chapter 4730. of the Revised Code may take	206
any action that may be taken by an attending physician under	207
sections 2133.21 to 2133.26 of the Revised Code and has the	208
immunity provided by section 2133.22 of the Revised Code if the	209
action is taken pursuant to a physician supervisory plan approved	210
pursuant to section 4730.17 of the Revised Code or the policies of	211
a health care facility in which the physician assistant is	212
practicing.	213

Sec. 3719.06.  (A)(1) A licensed health professional	214
authorized to prescribe drugs, if acting in the course of	215
professional practice, in accordance with the laws regulating the	216
professional's practice, and in accordance with rules adopted by	217
the state board of pharmacy, may, except as provided in division	218
(A)(2) or (3) of this section, do the following:	219

(a) Prescribe schedule II, III, IV, and V controlled	220
substances;	221

(b) Administer or personally furnish to patients schedule II,	222
III, IV, and V controlled substances;	223

(c) Cause schedule II, III, IV, and V controlled substances	224
to be administered under the prescriber's direction and	225
supervision.	226

(2) A licensed health professional authorized to prescribe	227
drugs who is a clinical nurse specialist, certified nurse-midwife,	228
or certified nurse practitioner is subject to both of the	229
following:	230

(a) A schedule II controlled substance may be prescribed only	231
for a patient with a terminal condition, as defined in section	232
2133.01 of the Revised Code, only if the nurse's collaborating	233
physician initially prescribed the substance for the patient, and	234
only in an amount that does not exceed the amount necessary for	235
the patient's use in a single, twenty-four-hour period.	236

(b) No schedule II controlled substance shall be personally	237
furnished to any patient.	238

(3) A licensed health professional authorized to prescribe	239
drugs who is a physician assistant shall not prescribe or	240
personally furnish to patients anyis subject to all of the	241
following:	242

(a) A controlled substance that is notmay be prescribed or	243
personally furnished only if it is included in the	244
physician-delegated prescriptive authority granted to the	245
physician assistant in accordance with Chapter 4730. of the	246
Revised Code.	247

(b) A schedule II controlled substance may be prescribed only	248
in accordance with division (B)(4) of section 4730.41 and section	249
4730.411 of the Revised Code.	250

(c) No schedule II controlled substance shall be personally	251
furnished to any patient.	252

(B) No licensed health professional authorized to prescribe	253
drugs shall prescribe, administer, or personally furnish a	254
schedule III anabolic steroid for the purpose of human muscle	255
building or enhancing human athletic performance and no pharmacist	256
shall dispense a schedule III anabolic steroid for either purpose,	257
unless it has been approved for that purpose under the "Federal	258
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	259
301, as amended.	260

(C) Each written prescription shall be properly executed,	261
dated, and signed by the prescriber on the day when issued and	262
shall bear the full name and address of the person for whom, or	263
the owner of the animal for which, the controlled substance is	264
prescribed and the full name, address, and registry number under	265
the federal drug abuse control laws of the prescriber. If the	266
prescription is for an animal, it shall state the species of the	267
animal for which the controlled substance is prescribed.	268

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

269

(1) "Disaster" means any imminent threat or actual occurrence	270
of widespread or severe damage to or loss of property, personal	271
hardship or injury, or loss of life that results from any natural	272
phenomenon or act of a human.	273

(2) "Emergency" means an occurrence or event that poses an	274
imminent threat to the health or life of a human.	275

(B) Nothing in this chapter prohibits any of the following	276
individuals from providing medical care, to the extent the	277
individual is able, in response to a need for medical care	278
precipitated by a disaster or emergency:	279

(1) An individual who holds a certificate to practice as a	280
physician assistant issued under this chapter;	281

(2) An individual licensed or authorized to practice as a	282
physician assistant in another state;	283

(3) An individual credentialed or employed as a physician	284
assistant by an agency, office, or other instrumentality of the	285
federal government.	286

(C) For purposes of the medical care provided by a physician	287
assistant pursuant to division (B)(1) of this section, both of the	288
following apply notwithstanding any supervision requirement of	289
this chapter to the contrary:	290

(1) The physician who supervises the physician assistant	291
pursuant to a physician supervisory plan approved by the state	292
medical board under section 4730.17 of the Revised Code is not	293
required to meet the supervision requirements established under	294
this chapter.	295

(2) The physician designated as the medical director of the	296
disaster or emergency may supervise the medical care provided by	297
the physician assistant.	298

Sec. 4730.06.  (A) The physician assistant policy committee	299
of the state medical board shall review, and shall submit to the	300
board recommendations concerning, all of the following:	301

(1) Requirements for issuance of certificates to practice as	302
a physician assistant, including the educational requirements that	303
must be met to receive a certificate to practice;	304

(2) Existing and proposed rules pertaining to the practice of	305
physician assistants, the supervisory relationship between	306
physician assistants and supervising physicians, and the	307
administration and enforcement of this chapter;	308

(3) Physician-delegatedIn accordance with section 4730.38 of	309
the Revised Code, physician-delegated prescriptive authority for	310
physician assistants, in accordance withand proposed changes to	311
the physician assistant formulary the board adopts pursuant to	312
division (A)(1) of section 4730.384730.39 of the Revised Code;	313

(4) Application procedures and forms for certificates to	314
practice as a physician assistant, physician supervisory plans,	315
and supervision agreements;	316

(5) Fees required by this chapter for issuance and renewal of	317
certificates to practice as a physician assistant;	318

(6) Criteria to be included in applications submitted to the	319
board for approval of physician supervisory plans, including	320
criteria to be included in applications for approval to delegate	321
to physician assistants the performance of special services;	322

(7) Criteria to be included in supervision agreements	323
submitted to the board for approval and renewal of the board's	324
approval;	325

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

326

(B) In addition to the matters that are required to be	327
reviewed under division (A) of this section, the committee may	328
review, and may submit to the board recommendations concerning,	329
either or both of the following:	330

(1) Quality assurance activities to be performed by a	331
supervising physician and physician assistant under a quality	332
assurance system established pursuant to division (F) of section	333
4730.21 of the Revised Code;	334

(2) The development and approval of one or more model	335
physician supervisory plans and one or more models for a special	336
services portion of the one or more model physician supervisory	337
plans. The committee may submit recommendations for model plans	338
that reflect various medical specialties.	339

(C) The board shall take into consideration all	340
recommendations submitted by the committee. Not later than ninety	341
days after receiving a recommendation from the committee, the	342
board shall approve or disapprove the recommendation and notify	343
the committee of its decision. If a recommendation is disapproved,	344
the board shall inform the committee of its reasons for making	345
that decision. The committee may resubmit the recommendation after	346
addressing the concerns expressed by the board and modifying the	347
disapproved recommendation accordingly. Not later than ninety days	348
after receiving a resubmitted recommendation, the board shall	349
approve or disapprove the recommendation. There is no limit on the	350
number of times the committee may resubmit a recommendation for	351
consideration by the board.	352

(D)(1) Except as provided in division (D)(2) of this section,	353
the board may not take action regarding a matter that is subject	354
to the committee's review under division (A) or (B) of this	355
section unless the committee has made a recommendation to the	356
board concerning the matter.	357

(2) If the board submits to the committee a request for a	358
recommendation regarding a matter that is subject to the	359
committee's review under division (A) or (B) of this section, and	360
the committee does not provide a recommendation before the	361
sixty-first day after the request is submitted, the board may take	362
action regarding the matter without a recommendation.	363

Sec. 4730.09. (A) Under a physician supervisory plan approved	364
under section 4730.17 of the Revised Code, a physician assistant	365
may provide any or all of the following services without approval	366
by the state medical board as special services:	367

(1) Obtaining comprehensive patient histories;

368

(2) Performing physical examinations, including audiometry	369
screening, routine visual screening, and pelvic, rectal, and	370
genital-urinary examinations, when indicated;	371

(3) Ordering, performing, or ordering and performing routine	372
diagnostic procedures, as indicated;	373

(4) Identifying normal and abnormal findings on histories,	374
physical examinations, and commonly performed diagnostic studies;	375

(5) Assessing patients and developing and implementing	376
treatment plans for patients;	377

(6) Monitoring the effectiveness of therapeutic	378
interventions;	379

(7) Exercising physician-delegated prescriptive authority	380
pursuant to a certificate to prescribe issued under this chapter;	381

(8) Carrying out or relaying the supervising physician's	382
orders for the administration of medication, to the extent	383
permitted by law;	384

(9) Providing patient education;

385

(10) Instituting and changing orders on patient charts;

386

(11) Performing developmental screening examinations on	387
children with regard to neurological, motor, and mental functions;	388

(12) Performing wound care management, suturing minor	389
lacerations and removing the sutures, and incision and drainage of	390
uncomplicated superficial abscesses;	391

(13) Removing superficial foreign bodies;

392

(14) Administering intravenous fluids;

393

(15) Inserting a foley or cudae catheter into the urinary	394
bladder and removing the catheter;	395

(16) Removing intrauterine devices;

396

(17) Performing biopsies of superficial lesions;

397

(18)(17) Making appropriate referrals as directed by the	398
supervising physician;	399

(19) Removing norplant capsules;

400

(20)(18) Performing penile duplex ultrasound;

401

(21)(19) Changing of a tracheostomy;

402

(22)(20) Performing bone marrow aspirations from the	403
posterior iliac crest;	404

(23)(21) Performing bone marrow biopsies from the posterior	405
iliac crest;	406

(24)(22) Performing cystograms;

407

(25)(23) Performing nephrostograms after physician placement	408
of nephrostomy tubes;	409

(26)(24) Fitting or, inserting family planning, or removing	410
birth control devices, including intrauterine devices, diaphragms,	411
and cervical capssubject to section 4730.093 of the Revised Code;	412

(27)(25) Removing cervical polyps;

413

(28)(26) Performing nerve conduction testing;

414

(29)(27) Performing endometrial biopsies;

415

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

416

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

417

(32)(30) Performing knee joint injections;

418

(33)(31) Performing endotracheal intubation with successful	419
completion of an advanced cardiac life support course;	420

(34)(32) Performing lumbar punctures;

421

(35)(33) In accordance with rules adopted by the board, using	422
light-based medical devices for the purpose of hair removal;	423

(36)(34) Administering, monitoring, or maintaining local	424
anesthesia, as defined in section 4730.091 of the Revised Code;	425

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

426

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

427

(37) Prescribing physical therapy or referring a patient to a	428
physical therapist for the purpose of receiving physical therapy;	429

(38) Ordering occupational therapy or referring a patient to	430
an occupational therapist for the purpose of receiving	431
occupational therapy;	432

(39) Taking any action that may be taken by an attending	433
physician under sections 2133.21 to 2133.26 of the Revised Code,	434
as specified in section 2133.211 of the Revised Code;	435

(40) Determining and pronouncing death in accordance with	436
section 4730.092 of the Revised Code;	437

(41) Performing other services that are within the	438
supervising physician's normal course of practice and expertise,	439
if the services are included in any model physician supervisory	440
plan approved under section 4730.06 of the Revised Code or the	441
services are designated by the board by rule or other means as	442
services that are not subject to approval as special services.	443

(B) Under the policies of a health care facility, the	444
services a physician assistant may provide are limited to the	445
services the facility has authorized the physician assistant to	446
provide for the facility. The services a health care facility may	447
authorize a physician assistant to provide for the facility	448
include the following:	449

(1) Any or all of the services specified in division (A) of	450
this section;	451

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

452

(3) Any other services permitted by the policies of the	453
health care facility, except that the facility may not authorize a	454
physician assistant to perform a service that is prohibited by	455
this chapter.	456

Sec. 4730.092.  (A) A physician assistant may determine and	457
pronounce an individual's death, but only if the individual's	458
respiratory and circulatory functions are not being artificially	459
sustained and, at the time the determination and pronouncement of	460
death is made, either or both of the following apply:	461

(1) The individual was receiving care in one of the	462
following:	463

(a) A nursing home licensed under section 3721.02 of the	464
Revised Code or by a political subdivision under section 3721.09	465
of the Revised Code;	466

(b) A residential care facility or home for the aging	467
licensed under Chapter 3721. of the Revised Code;	468

(c) A county home or district home operated pursuant to	469
Chapter 5155. of the Revised Code;	470

(d) A residential facility licensed under section 5123.19 of	471
the Revised Code.	472

(2) The physician assistant is providing or supervising the	473
individual's care through a hospice care program licensed under	474
Chapter 3712. of the Revised Code or any other entity that	475
provides palliative care.	476

(B) If a physician assistant determines and pronounces an	477
individual's death, the physician assistant shall comply with both	478
of the following:	479

(1) The physician assistant shall not complete any portion of	480
the individual's death certificate.	481

(2) The physician assistant shall notify the individual's	482
attending physician of the determination and pronouncement of	483
death in order for the physician to fulfill the physician's duties	484
under section 3705.16 of the Revised Code. The physician assistant	485
shall provide the notification within a period of time that is	486
reasonable but not later than twenty-four hours following the	487
determination and pronouncement of the individual's death.	488

Sec. 4730.093.  Under either a physician supervisory plan or	489
the policies of a health care facility, both of the following	490
apply with respect to a physician assistant's authority to fit,	491
insert, or remove a birth control device:	492

(A) A physician assistant may fit, insert, or remove a birth	493
control device that is designed in such a manner that it functions	494
solely by preventing fertilization, including such devices as	495
diaphragms, cervical caps, and, except as provided in division (B)	496
of this section, intrauterine devices.	497

(B) A physician assistant shall not fit, insert, or remove a	498
birth control device, including an intrauterine device, that is	499
designed in such a manner that it functions either solely or in	500
combination with other functions by preventing or hindering an	501
embryo from implanting within the uterus or from growing if	502
implantation occurs.	503

Sec. 4730.38.  (A) Not later than six months after the	504
effective dateExcept as provided in division (B) of this section,	505
the physician assistant policy committee of the state medical	506
board shall, at such times the committee determines to be	507
necessary, submit to the board its initial recommendations	508
regarding physician-delegated prescriptive authority for physician	509
assistants. The committee's recommendations shall address allboth	510
of the following:	511

(1) Policy and procedures regarding physician-delegated	512
prescriptive authority, including the issuance of certificates to	513
prescribe under this chapter;	514

(2) Subject to the limitations specified in section 4730.40	515
of the Revised Code, a formulary listing the drugs and therapeutic	516
devices by class and specific nomenclature that a supervising	517
physician may include in the physician-delegated prescriptive	518
authority granted to a physician assistant who holds a certificate	519
to prescribe issued under this chapter;	520

(3) Any issue the committee considers necessary to assist the	521
board in fulfilling its duty to adopt rules governing	522
physician-delegated prescriptive authority, including the issuance	523
of certificates to prescribe.	524

(B) After the board's adoption of initial rules under section	525
4730.39 of the Revised Code, the committee shall conduct an annual	526
review of its recommendations regarding physician-delegated	527
prescriptive authority. Based on its review, the committee shall	528
submit recommendations to the board as the committee considers	529
necessaryNot less than every six months beginning on the first	530
day of June following the effective date of this amendment, the	531
committee shall review the physician assistant formulary the board	532
adopts pursuant to division (A)(1) of section 4730.39 of the	533
Revised Code and, to the extent it determines to be necessary,	534
submit recommendations proposing changes to the formulary.	535

(C) Recommendations submitted under this section are subject	536
to the procedures and time frames specified in division (C) of	537
section 4730.06 of the Revised Code.	538

Sec. 4730.39.  (A) Not later than six months after receiving	539
the initial recommendations of the physician assistant policy	540
committee submitted pursuant to division (A) of section 4730.38 of	541
the Revised Code, theThe state medical board shall adoptdo both	542
of the following:	543

(1) Adopt a formulary listing the drugs and therapeutic	544
devices by class and specific generic nomenclature that a	545
physician may include in the physician-delegated prescriptive	546
authority granted to a physician assistant who holds a certificate	547
to prescribe under this chapter;	548

(2) Adopt rules governing physician-delegated prescriptive	549
authority for physician assistants, including the issuance of	550
certificates to prescribe under this chapter. The	551

(B) The board's rules governing physician-delegated	552
prescriptive authority adopted pursuant to division (A)(2) of this	553
section shall be adopted in accordance with Chapter 119. of the	554
Revised Code and shall establish all of the following:	555

(1) Subject to the limitations specified in section 4730.40	556
of the Revised Code, a formulary listing the drugs and therapeutic	557
devices by class and specific generic nomenclature that a	558
physician may include in the physician-delegated prescriptive	559
authority granted to a physician assistant who holds a certificate	560
to prescribe under this chapter;	561

(2) Requirements regarding the pharmacology courses that a	562
physician assistant is required to complete to receive a	563
certificate to prescribe;	564

(3)(2) Standards and procedures for the issuance and renewal	565
of certificates to prescribe to physician assistants;	566

(4)(3) Standards and procedures for the appropriate conduct	567
of the provisional period that a physician assistant is required	568
to complete pursuant to section 4730.45 of the Revised Code and	569
for determining whether a physician assistant has successfully	570
completed the provisional period;	571

(5)(4) A specific prohibition against prescribing any drug or	572
device to perform or induce an abortion;	573

(6)(5) Standards and procedures to be followed by a physician	574
assistant in personally furnishing samples of drugs or complete or	575
partial supplies of drugs to patients under section 4730.43 of the	576
Revised Code;	577

(7)(6) Any other requirements the board considers necessary	578
to implement the provisions of this chapter regarding	579
physician-delegated prescriptive authority and the issuance of	580
certificates to prescribe.	581

(B)(C)(1) After adopting the initial rulesconsidering	582
recommendations submitted by the physician assistant policy	583
committee pursuant to sections 4730.06 and 4730.38 of the Revised	584
Code, the board shall conduct an annual review either or both of	585
the rules. Basedfollowing, as appropriate according to the	586
submitted recommendations:	587

(a) The formulary the board adopts under division (A)(1) of	588
this section;	589

(b) The rules the board adopts under division (A)(2) of this	590
section regarding physician-delegated prescriptive authority.	591

(2) Based on its review, the board shall make any necessary	592
modifications to the formulary or rules.	593

(C) All rules adopted under this section shall be adopted in	594
accordance with Chapter 119. of the Revised Code. When adopting	595
the initial rules, the board shall consider the recommendations of	596
the physician assistant policy committee submitted pursuant to	597
division (A) of section 4730.38 of the Revised Code. When making	598
any modifications to the rules subsequent to its annual review of	599
the rules, the board shall consider the committee's	600
recommendations submitted pursuant to division (B) of section	601
4730.38 of the Revised Code.	602

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	603
of this section, the physician assistant formulary established	604
adopted by the state medical board in rules adopted under section	605
4730.39 of the Revised Code listing the drugs and therapeutic	606
devices by class and specific nomenclature that a supervising	607
physician may include in the physician-delegated prescriptive	608
authority granted to a physician assistant who holds a certificate	609
to prescribe issued under this chapter may include any or all of	610
the following drugs:	611

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

612

(2) Drugs that under state or federal law may be dispensed	613
only pursuant to a prescription by a licensed health professional	614
authorized to prescribe drugs, as defined in section 4729.01 of	615
the Revised Code;	616

(3) Any drug that is not a dangerous drug, as defined in	617
section 4729.01 of the Revised Code.	618

(B) The formulary established in the board's rulesadopted by	619
the board shall not include, and shall specify that it does not	620
include, the following:	621

(1) Any schedule II controlled substance;

622

(2) Anyany drug or device used to perform or induce an	623
abortion.	624

(C) When adopting rules establishing the initial formulary,	625
the board shall include provisions ensuring that a physician	626
assistant who holds a certificate to prescribe issued under this	627
chapter may be granted physician-delegated prescriptive authority	628
for all drugs and therapeutic devices that may be prescribed on	629
the effective date of the rules by a holder of a certificate to	630
prescribe issued by the board of nursing under Chapter 4723. of	631
the Revised Code, with the exception of schedule II controlled	632
substances. To the extent permitted by division (A) of this	633
section, the initial formulary may include additional drugs or	634
therapeutic devices.	635

Sec. 4730.41.  (A) A certificate to prescribe issued under	636
this chapter authorizes a physician assistant to prescribe and	637
personally furnish drugs and therapeutic devices in the exercise	638
of physician-delegated prescriptive authority.	639

(B) In exercising physician-delegated prescriptive authority,	640
a physician assistant is subject to all of the following:	641

(1) The physician assistant shall exercise	642
physician-delegated prescriptive authority only to the extent that	643
the physician supervising the physician assistant has granted that	644
authority.	645

(2) The physician assistant shall comply with all conditions	646
placed on the physician-delegated prescriptive authority, as	647
specified by the supervising physician who is supervising the	648
physician assistant in the exercise of physician-delegated	649
prescriptive authority.	650

(3) If the physician assistant possesses physician-delegated	651
prescriptive authority for controlled substances, the physician	652
assistant shall register with the federal drug enforcement	653
administration.	654

(4) If the physician assistant possesses physician-delegated	655
prescriptive authority for schedule II controlled substances, the	656
physician assistant shall comply with section 4730.411 of the	657
Revised Code.	658

Sec. 4730.411. (A) Except as provided in division (B) or (C)	659
of this section, a physician assistant may prescribe to a patient	660
a schedule II controlled substance only if all of the following	661
are the case:	662

(1) The patient is in a terminal condition, as defined in	663
section 2133.01 of the Revised Code.	664

(2) The physician assistant's supervising physician initially	665
prescribed the substance for the patient.	666

(3) The prescription is for an amount that does not exceed	667
the amount necessary for the patient's use in a single,	668
twenty-four-hour period.	669

(B) The restrictions on prescriptive authority in division	670
(A) of this section do not apply if a physician assistant issues	671
the prescription to the patient from any of the following	672
locations:	673

(1) A hospital registered under section 3701.07 of the	674
Revised Code;	675

(2) An entity owned or controlled, in whole or in part, by a	676
hospital or by an entity that owns or controls, in whole or in	677
part, one or more hospitals;	678

(3) A health care facility operated by the department of	679
mental health or the department of developmental disabilities;	680

(4) A nursing home licensed under section 3721.02 of the	681
Revised Code or by a political subdivision certified under section	682
3721.09 of the Revised Code;	683

(5) A county home or district home operated under Chapter	684
5155. of the Revised Code that is certified under the medicare or	685
medicaid program;	686

(6) A hospice care program, as defined in section 3712.01 of	687
the Revised Code;	688

(7) A community mental health agency, as defined in section	689
5122.01 of the Revised Code;	690

(8) An ambulatory surgical facility, as defined in section	691
3702.30 of the Revised Code;	692

(9) A freestanding birthing center, as defined in section	693
3702.51 of the Revised Code;	694

(10) A federally qualified health center, as defined in	695
section 3701.047 of the Revised Code;	696

(11) A federally qualified health center look-alike, as	697
defined in section 3701.047 of the Revised Code;	698

(12) A health care office or facility operated by the board	699
of health of a city or general health district or the authority	700
having the duties of a board of health under section 3709.05 of	701
the Revised Code;	702

(13) A site where a medical practice is operated, but only if	703
the practice is comprised of one or more physicians who also are	704
owners of the practice; the practice is organized to provide	705
direct patient care; and the physician assistant has entered into	706
a supervisory agreement with at least one of the physician owners	707
who practices primarily at that site.	708

(C) A physician assistant shall not issue to a patient a	709
prescription for a schedule II controlled substance from a	710
convenience care clinic even if the convenience care clinic is	711
owned or operated by an entity specified in division (B) of this	712
section.	713

(D) A pharmacist who acts in good faith reliance on a	714
prescription issued by a physician assistant under division (B) of	715
this section is not liable for or subject to any of the following	716
for relying on the prescription: damages in any civil action,	717
prosecution in any criminal proceeding, or professional	718
disciplinary action by the state board of pharmacy under Chapter	719
4729. of the Revised Code.	720

Sec. 4730.42.  (A) In granting physician-delegated	721
prescriptive authority to a particular physician assistant who	722
holds a certificate to prescribe issued under this chapter, the	723
supervising physician is subject to all of the following:	724

(1) The supervising physician shall not grant	725
physician-delegated prescriptive authority for any drug or	726
therapeutic device that is not listed on the physician assistant	727
formulary established in rules adopted under section 4730.39 of	728
the Revised Code as a drug or therapeutic device that may be	729
included in the physician-delegated prescriptive authority granted	730
to a physician assistant.	731

(2) The supervising physician shall not grant	732
physician-delegated prescriptive authority for any drug or device	733
that may be used to perform or induce an abortion.	734

(3) The supervising physician shall not grant	735
physician-delegated prescriptive authority in a manner that	736
exceeds the supervising physician's prescriptive authority.	737

(4) The supervising physician shall supervise the physician	738
assistant in accordance with all of the following:	739

(a) The supervision requirements specified in section 4730.21	740
of the Revised Code and, in the case of supervision provided	741
during a provisional period of physician-delegated prescriptive	742
authority, the supervision requirements specified in section	743
4730.45 of the Revised Code;	744

(b) The physician supervisory plan approved for the	745
supervising physician or the policies of the health care facility	746
in which the physician and physician assistant are practicing;	747

(c) The supervision agreement approved under section 4730.19	748
of the Revised Code that applies to the supervising physician and	749
the physician assistant.	750

(B)(1) The supervising physician of a physician assistant may	751
place conditions on the physician-delegated prescriptive authority	752
granted to the physician assistant. If conditions are placed on	753
that authority, the supervising physician shall maintain a written	754
record of the conditions and make the record available to the	755
state medical board on request.	756

(2) The conditions that a supervising physician may place on	757
the physician-delegated prescriptive authority granted to a	758
physician assistant include the following:	759

(a) Identification by class and specific generic nomenclature	760
of drugs and therapeutic devices that the physician chooses not to	761
permit the physician assistant to prescribe;	762

(b) Limitations on the dosage units or refills that the	763
physician assistant is authorized to prescribe;	764

(c) Specification of circumstances under which the physician	765
assistant is required to refer patients to the supervising	766
physician or another physician when exercising physician-delegated	767
prescriptive authority;	768

(d) Responsibilities to be fulfilled by the physician in	769
supervising the physician assistant that are not otherwise	770
specified in the physician supervisory plan or otherwise required	771
by this chapter.	772

Sec. 4730.44. (A) A physician assistant seeking a certificate	773
to prescribe shall submit to the state medical board a written	774
application on a form prescribed and supplied by the board. The	775
application shall include all of the following information:	776

(1) The applicant's name, residential address, business	777
address, if any, and social security number;	778

(2) Evidence of holding a valid certificate to practice as a	779
physician assistant issued under this chapter;	780

(3) One of the following:

781

(a) Satisfactory proof that the applicant meets the	782
requirements specified in section 4730.46 of the Revised Code to	783
participate in a provisional period of physician-delegated	784
prescriptive authority or satisfactory;	785

(b) Satisfactory proof of successful completion of the	786
provisional period, evidenced by a letter or copy of a letter	787
attesting to the successful completion written by a supervising	788
physician of the physician assistant at the time of completion;	789

(c) Satisfactory proof that the applicant has practiced as a	790
physician assistant in another state or was credentialed or	791
employed as a physician assistant by the United States government,	792
holds a master's or higher degree that was obtained from a program	793
accredited by the accreditation review commission on education for	794
the physician assistant or a predecessor or successor organization	795
recognized by the board, and held valid authority issued by the	796
other state or the United States government to prescribe	797
therapeutic devices and drugs, including at least some controlled	798
substances, evidenced by an affidavit issued by an appropriate	799
agency or office of the other state or the United States	800
government attesting to the prescriptive authority described in	801
division (A)(3)(c) of this section.	802

(4) Any other information the board requires.

803

(B) At the time of making application for a certificate to	804
prescribe, the applicant shall pay the board a fee of one hundred	805
dollars, no part of which shall be returned. The fees shall be	806
deposited in accordance with section 4731.24 of the Revised Code.	807

(C)(1) The board shall review all applications received. If	808
an application is complete and the board determines that the	809
applicant meets the requirements for a certificate to prescribe,	810
the board shall, subject to division (C)(2) of this section, issue	811
the certificate to the applicant. The	812

(2) The initial certificate to prescribe issued to an	813
applicant who meets the requirements of division (A)(3)(a) of this	814
section shall be issued as a provisional certificate to prescribe.	815

Sec. 4730.45.  (A) A provisional certificate to prescribe	816
issued under division (C)(2) of section 4730.44 of the Revised	817
Code authorizes the physician assistant holding the certificate to	818
participate in a provisional period of physician-delegated	819
prescriptive authority. The physician assistant shall successfully	820
complete the provisional period as a condition of receiving a new	821
certificate to prescribe.	822

(B) The provisional period shall be conducted by one or more	823
supervising physicians in accordance with rules adopted under	824
section 4730.39 of the Revised Code. When supervising a physician	825
assistant who is completing the first five hundred hours of a	826
provisional period, the supervising physician shall provide	827
on-site supervision of the physician assistant's exercise of	828
physician-delegated prescriptive authority.	829

The provisional period shall last not longer than one year,	830
unless it is extended for not longer than one additional year at	831
the direction of a supervising physician. The physician assistant	832
shall not be required to participate in the provisional period for	833
more than one-thousand-eight-hundredone thousand eight hundred	834
hours, except when a supervising physician has extended the	835
physician assistant's provisional period.	836

(C) If a physician assistant does not successfully complete	837
the provisional period, each supervising physician shall cease	838
granting physician-delegated prescriptive authority to the	839
physician assistant. The supervising physician with primary	840
responsibility for conducting the provisional period shall	841
promptly notify the state medical board that the physician	842
assistant did not successfully complete the provisional period and	843
the board shall revoke the certificate.	844

(D) A physician assistant who successfully completes a	845
provisional period shall not be required to complete another	846
provisional period as a condition of being eligible to be granted	847
physician-delegated prescriptive authority by a supervising	848
physician who was not involved in the conduct of the provisional	849
period.	850

Sec. 4755.48.  (A) No person shall employ fraud or deception	851
in applying for or securing a license to practice physical therapy	852
or to be a physical therapist assistant.	853

(B) No person shall practice or in any way imply or claim to	854
the public by words, actions, or the use of letters as described	855
in division (C) of this section to be able to practice physical	856
therapy or to provide physical therapy services, including	857
practice as a physical therapist assistant, unless the person	858
holds a valid license under sections 4755.40 to 4755.56 of the	859
Revised Code or except for submission of claims as provided in	860
section 4755.56 of the Revised Code.	861

(C) No person shall use the words or letters, physical	862
therapist, physical therapy, physical therapy services,	863
physiotherapist, physiotherapy, physiotherapy services, licensed	864
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	865
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	866
therapist assistant, physical therapy technician, licensed	867
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	868
letters, words, abbreviations, or insignia, indicating or implying	869
that the person is a physical therapist or physical therapist	870
assistant without a valid license under sections 4755.40 to	871
4755.56 of the Revised Code.	872

(D) No person who practices physical therapy or assists in	873
the provision of physical therapy treatments under the supervision	874
of a physical therapist shall fail to display the person's current	875
license granted under sections 4755.40 to 4755.56 of the Revised	876
Code in a conspicuous location in the place where the person	877
spends the major part of the person's time so engaged.	878

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	879
Code shall affect or interfere with the performance of the duties	880
of any physical therapist or physical therapist assistant in	881
active service in the army, navy, coast guard, marine corps, air	882
force, public health service, or marine hospital service of the	883
United States, while so serving.	884

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	885
Code shall prevent or restrict the activities or services of a	886
person pursingpursuing a course of study leading to a degree in	887
physical therapy in an accredited or approved educational program	888
if the activities or services constitute a part of a supervised	889
course of study and the person is designated by a title that	890
clearly indicates the person's status as a student.	891

(G) No(1) Except as provided in division (G)(2) of this	892
section and subject to division (H) of this section, no person	893
shall practice physical therapy other than on the prescription of,	894
or the referral of a patient by, a person who is licensed in this	895
or another state to practicedo at least one of the following:	896

(a) Practice medicine and surgery, chiropractic, dentistry,	897
osteopathic medicine and surgery, podiatric medicine and surgery,	898
or to practice;	899

(b) Practice as a physician assistant;

900

(c) Practice nursing as a certified registered nurse	901
anesthetist, clinical nurse specialist, certified nurse-midwife,	902
or certified nurse practitioner, within the scope of such	903
practices, and whose license is in good standing, unless either of	904
the following conditions is met:.	905

(1)(2) The prohibition in division (G)(1) of this section on	906
practicing physical therapy other than on the prescription of, or	907
the referral of a patient by, any of the persons described in that	908
division does not apply if either of the following applies to the	909
person:	910

(a) The person holds a master's or doctorate degree from a	911
professional physical therapy program that is accredited by a	912
national physical therapy accreditation agency recognized by the	913
United States department of education.	914

(2)(b) On or before December 31, 2004, the person has	915
completed at least two years of practical experience as a licensed	916
physical therapist.	917

(H) To be authorized to prescribe physical therapy or refer	918
a patient to a physical therapist for physical therapy, a person	919
described in division (G)(1) of this section must be in good	920
standing with the relevant licensing board in this state or the	921
state in which the person is licensed and must act only within the	922
person's scope of practice.	923

(I) In the prosecution of any person for violation of	924
division (B) or (C) of this section, it is not necessary to allege	925
or prove want of a valid license to practice physical therapy or	926
to practice as a physical therapist assistant, but such matters	927
shall be a matter of defense to be established by the accused.	928

Sec. 4755.481. (A) If a physical therapist evaluates and	929
treats a patient without the prescription of, or the referral of	930
the patient by, a person who is licensed to practice medicine and	931
surgery, chiropractic, dentistry, osteopathic medicine and	932
surgery, podiatric medicine and surgery, or nursing as a certified	933
registered nurse anesthetist, clinical nurse specialist, certified	934
nurse-midwife, or certified nurse practitionerdescribed in	935
division (G)(1) of section 4755.48 of the Revised Code, all of the	936
following apply:	937

(1) The physical therapist shall, upon consent of the	938
patient, inform the patient's physician, chiropractor, dentist,	939
podiatrist, certified registered nurse anesthetist, clinical nurse	940
specialist, certified nurse-midwife, or certified nurse	941
practitionerrelevant person described in division (G)(1) of	942
section 4755.48 of the Revised Code of the evaluation not later	943
than five business days after the evaluation is made.	944

(2) If the physical therapist determines, based on reasonable	945
evidence, that no substantial progress has been made with respect	946
to that patient during the thirty-day period immediately following	947
the date of the patient's initial visit with the physical	948
therapist, the physical therapist shall consult with or refer the	949
patient to a licensed physician, chiropractor, dentist,	950
podiatrist, certified registered nurse anesthetist, clinical nurse	951
specialist, certified nurse-midwife, or certified nurse	952
practitionerperson described in division (G)(1) of section	953
4755.48 of the Revised Code, unless either of the following	954
applies:	955

(a) The evaluation, treatment, or services are being provided	956
for fitness, wellness, or prevention purposes.	957

(b) The patient previously was diagnosed with chronic,	958
neuromuscular, or developmental conditions and the evaluation,	959
treatment, or services are being provided for problems or symptoms	960
associated with one or more of those previously diagnosed	961
conditions.	962

(3) If the physical therapist determines that orthotic	963
devices are necessary to treat the patient, the physical therapist	964
shall be limited to the application of the following orthotic	965
devices:	966

(a) Upper extremity adaptive equipment used to facilitate the	967
activities of daily living;	968

(b) Finger splints;

969

(c) Wrist splints;

970

(d) Prefabricated elastic or fabric abdominal supports with	971
or without metal or plastic reinforcing stays and other	972
prefabricated soft goods requiring minimal fitting;	973

(e) Nontherapeutic accommodative inlays;

974

(f) Shoes that are not manufactured or modified for a	975
particular individual;	976

(g) Prefabricated foot care products;

977

(h) Custom foot orthotics;

978

(i) Durable medical equipment.

979

(4) If, at any time, the physical therapist has reason to	980
believe that the patient has symptoms or conditions that require	981
treatment or services beyond the scope of practice of a physical	982
therapist, the physical therapist shall refer the patient to a	983
licensed health care practitioner acting within the practitioner's	984
scope of practice.	985

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	986
Code shall be construed to require reimbursement under any health	987
insuring corporation policy, contract, or agreement, any sickness	988
and accident insurance policy, the medical assistance program as	989
defined in section 5111.01 of the Revised Code, or the health	990
partnership program or qualified health plans established pursuant	991
to sections 4121.44 to 4121.442 of the Revised Code, for any	992
physical therapy service rendered without the prescription of, or	993
the referral of the patient by, a licensed physician,	994
chiropractor, dentist, podiatrist, certified registered nurse	995
anesthetist, clinical nurse specialist, certified nurse-midwife,	996
or certified nurse practitionerperson described in division	997
(G)(1) of section 4755.48 of the Revised Code.	998

(C) For purposes of this section, "business day" means any	999
calendar day that is not a Saturday, Sunday, or legal holiday.	1000
"Legal holiday" has the same meaning as in section 1.14 of the	1001
Revised Code.	1002

Sec. 4765.01.  As used in this chapter:

1003

(A) "First responder" means an individual who holds a	1004
current, valid certificate issued under section 4765.30 of the	1005
Revised Code to practice as a first responder.	1006

(B) "Emergency medical technician-basic" or "EMT-basic" means	1007
an individual who holds a current, valid certificate issued under	1008
section 4765.30 of the Revised Code to practice as an emergency	1009
medical technician-basic.	1010

(C) "Emergency medical technician-intermediate" or "EMT-I"	1011
means an individual who holds a current, valid certificate issued	1012
under section 4765.30 of the Revised Code to practice as an	1013
emergency medical technician-intermediate.	1014

(D) "Emergency medical technician-paramedic" or "paramedic"	1015
means an individual who holds a current, valid certificate issued	1016
under section 4765.30 of the Revised Code to practice as an	1017
emergency medical technician-paramedic.	1018

(E) "Ambulance" means any motor vehicle that is used, or is	1019
intended to be used, for the purpose of responding to emergency	1020
medical situations, transporting emergency patients, and	1021
administering emergency medical service to patients before,	1022
during, or after transportation.	1023

(F) "Cardiac monitoring" means a procedure used for the	1024
purpose of observing and documenting the rate and rhythm of a	1025
patient's heart by attaching electrical leads from an	1026
electrocardiograph monitor to certain points on the patient's body	1027
surface.	1028

(G) "Emergency medical service" means any of the services	1029
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	1030
the Revised Code that are performed by first responders, emergency	1031
medical technicians-basic, emergency medical	1032
technicians-intermediate, and paramedics. "Emergency medical	1033
service" includes such services performed before or during any	1034
transport of a patient, including transports between hospitals and	1035
transports to and from helicopters.	1036

(H) "Emergency medical service organization" means a public	1037
or private organization using first responders, EMTs-basic,	1038
EMTs-I, or paramedics, or a combination of first responders,	1039
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	1040
services.	1041

(I) "Physician" means an individual who holds a current,	1042
valid certificate issued under Chapter 4731. of the Revised Code	1043
authorizing the practice of medicine and surgery or osteopathic	1044
medicine and surgery.	1045

(J) "Registered nurse" means an individual who holds a	1046
current, valid license issued under Chapter 4723. of the Revised	1047
Code authorizing the practice of nursing as a registered nurse.	1048

(K) "Volunteer" means a person who provides services either	1049
for no compensation or for compensation that does not exceed the	1050
actual expenses incurred in providing the services or in training	1051
to provide the services.	1052

(L) "Emergency medical service personnel" means first	1053
responders, emergency medical service technicians-basic, emergency	1054
medical service technicians-intermediate, emergency medical	1055
service technicians-paramedic, and persons who provide medical	1056
direction to such persons.	1057

(M) "Hospital" has the same meaning as in section 3727.01 of	1058
the Revised Code.	1059

(N) "Trauma" or "traumatic injury" means severe damage to or	1060
destruction of tissue that satisfies both of the following	1061
conditions:	1062

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

1063

(a) Loss of life;

1064

(b) Loss of a limb;

1065

(c) Significant, permanent disfigurement;

1066

(d) Significant, permanent disability.

1067

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

1068

(a) Blunt or penetrating injury;

1069

(b) Exposure to electromagnetic, chemical, or radioactive	1070
energy;	1071

(c) Drowning, suffocation, or strangulation;

1072

(d) A deficit or excess of heat.

1073

(O) "Trauma victim" or "trauma patient" means a person who	1074
has sustained a traumatic injury.	1075

(P) "Trauma care" means the assessment, diagnosis,	1076
transportation, treatment, or rehabilitation of a trauma victim by	1077
emergency medical service personnel or by a physician, nurse,	1078
physician assistant, respiratory therapist, physical therapist,	1079
chiropractor, occupational therapist, speech-language pathologist,	1080
audiologist, or psychologist licensed to practice as such in this	1081
state or another jurisdiction.	1082

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

1083

(1) Any hospital that is verified by the American college of	1084
surgeons as an adult or pediatric trauma center;	1085

(2) Any hospital that is operating as an adult or pediatric	1086
trauma center under provisional status pursuant to section	1087
3727.101 of the Revised Code;	1088

(3) Until December 31, 2004, any hospital in this state that	1089
is designated by the director of health as a level II pediatric	1090
trauma center under section 3727.081 of the Revised Code;	1091

(4) Any hospital in another state that is licensed or	1092
designated under the laws of that state as capable of providing	1093
specialized trauma care appropriate to the medical needs of the	1094
trauma patient.	1095

(R) "Pediatric" means involving a patient who is less than	1096
sixteen years of age.	1097

(S) "Adult" means involving a patient who is not a pediatric	1098
patient.	1099

(T) "Geriatric" means involving a patient who is at least	1100
seventy years old or exhibits significant anatomical or	1101
physiological characteristics associated with advanced aging.	1102

(U) "Air medical organization" means an organization that	1103
provides emergency medical services, or transports emergency	1104
victims, by means of fixed or rotary wing aircraft.	1105

(V) "Emergency care" and "emergency facility" have the same	1106
meanings as in section 3727.01 of the Revised Code.	1107

(W) "Stabilize," except as it is used in division (B) of	1108
section 4765.35 of the Revised Code with respect to the manual	1109
stabilization of fractures, has the same meaning as in section	1110
1753.28 of the Revised Code.	1111

(X) "Transfer" has the same meaning as in section 1753.28 of	1112
the Revised Code.	1113

(Y) "Firefighter" means any member of a fire department as	1114
defined in section 742.01 of the Revised Code.	1115

(Z) "Volunteer firefighter" has the same meaning as in	1116
section 146.01 of the Revised Code.	1117

(AA) "Part-time paid firefighter" means a person who provides	1118
firefighting services on less than a full-time basis, is routinely	1119
scheduled to be present on site at a fire station or other	1120
designated location for purposes of responding to a fire or other	1121
emergency, and receives more than nominal compensation for the	1122
provision of firefighting services.	1123

(BB) "Physician assistant" means an individual who holds a	1124
valid certificate to practice as a physician assistant issued	1125
under Chapter 4730. of the Revised Code.	1126

Sec. 4765.35.  (A) A first responder shall perform the	1127
emergency medical services described in this section in accordance	1128
with this chapter and any rules adopted under it.	1129

(B) A first responder may provide limited emergency medical	1130
services to patients until the arrival of an emergency medical	1131
technician-basic, emergency medical technician-intermediate, or	1132
emergency medical technician-paramedic. In an emergency, a first	1133
responder may render emergency medical services such as opening	1134
and maintaining an airway, giving mouth to barrier ventilation,	1135
chest compressions, electrical interventions with automated	1136
defibrillators to support or correct the cardiac function and	1137
other methods determined by the board, controlling of hemorrhage,	1138
manual stabilization of fractures, bandaging, assisting in	1139
childbirth, and determining triage of trauma victims.	1140

(C) A first responder may perform any other emergency medical	1141
services approved pursuant to rules adopted under section 4765.11	1142
of the Revised Code. The board shall determine whether the nature	1143
of any such service requires that a first responder receive	1144
authorization prior to performing the service.	1145

(D)(1) Except as provided in division (D)(2) of this section,	1146
if the board determines under division (C) of this section that a	1147
service requires prior authorization, the service shall be	1148
performed only pursuant to the written or verbal authorization of	1149
a physician or of the cooperating physician advisory board, or	1150
pursuant to an authorization transmitted through a direct	1151
communication device by a physician, physician assistant	1152
designated by a physician, or registered nurse designated by a	1153
physician.	1154

(2) If communications fail during an emergency situation or	1155
the required response time prohibits communication, a first	1156
responder may perform services subject to this division, if, in	1157
the judgment of the first responder, the life of the patient is in	1158
immediate danger. Services performed under these circumstances	1159
shall be performed in accordance with the written protocols for	1160
triage of adult and pediatric trauma victims established in rules	1161
adopted under sections 4765.11 and 4765.40 of the Revised Code and	1162
any applicable protocols adopted by the emergency medical service	1163
organization with which the first responder is affiliated.	1164

Sec. 4765.36.  In a hospital, an emergency medical	1165
technician-basic, emergency medical technician-intermediate, or	1166
emergency medical technician-paramedic may perform emergency	1167
medical services only under the direction and supervision of a	1168
physician or registered nurse designated by a physician and only	1169
if the services are performed in accordance with both of the	1170
following conditions:	1171

(A) Only in the hospital's emergency department or while	1172
moving a patient between the emergency department and another part	1173
of the hospital;	1174

(B) Only under the direction and supervision of one of the	1175
following:	1176

(1) A physician;

1177

(2) A physician assistant designated by a physician;

1178

(3) A registered nurse designated by a physician.

1179

Sec. 4765.37.  (A) An emergency medical technician-basic	1180
shall perform the emergency medical services described in this	1181
section in accordance with this chapter and any rules adopted	1182
under it by the state board of emergency medical services.	1183

(B) An emergency medical technician-basic may operate, or be	1184
responsible for operation of, an ambulance and may provide	1185
emergency medical services to patients. In an emergency, an	1186
EMT-basic may determine the nature and extent of illness or injury	1187
and establish priority for required emergency medical services. An	1188
EMT-basic may render emergency medical services such as opening	1189
and maintaining an airway, giving positive pressure ventilation,	1190
cardiac resuscitation, electrical interventions with automated	1191
defibrillators to support or correct the cardiac function and	1192
other methods determined by the board, controlling of hemorrhage,	1193
treatment of shock, immobilization of fractures, bandaging,	1194
assisting in childbirth, management of mentally disturbed	1195
patients, initial care of poison and burn patients, and	1196
determining triage of adult and pediatric trauma victims. Where	1197
patients must in an emergency be extricated from entrapment, an	1198
EMT-basic may assess the extent of injury and render all possible	1199
emergency medical services and protection to the entrapped	1200
patient; provide light rescue services if an ambulance has not	1201
been accompanied by a specialized unit; and after extrication,	1202
provide additional care in sorting of the injured in accordance	1203
with standard emergency procedures.	1204

(C) An EMT-basic may perform any other emergency medical	1205
services approved pursuant to rules adopted under section 4765.11	1206
of the Revised Code. The board shall determine whether the nature	1207
of any such service requires that an EMT-basic receive	1208
authorization prior to performing the service.	1209

(D)(1) Except as provided in division (D)(2) of this section,	1210
if the board determines under division (C) of this section that a	1211
service requires prior authorization, the service shall be	1212
performed only pursuant to the written or verbal authorization of	1213
a physician or of the cooperating physician advisory board, or	1214
pursuant to an authorization transmitted through a direct	1215
communication device by a physician, physician assistant	1216
designated by a physician, or registered nurse designated by a	1217
physician.	1218

(2) If communications fail during an emergency situation or	1219
the required response time prohibits communication, an EMT-basic	1220
may perform services subject to this division, if, in the judgment	1221
of the EMT-basic, the life of the patient is in immediate danger.	1222
Services performed under these circumstances shall be performed in	1223
accordance with the protocols for triage of adult and pediatric	1224
trauma victims established in rules adopted under sections 4765.11	1225
and 4765.40 of the Revised Code and any applicable protocols	1226
adopted by the emergency medical service organization with which	1227
the EMT-basic is affiliated.	1228

Sec. 4765.38.  (A) An emergency medical	1229
technician-intermediate shall perform the emergency medical	1230
services described in this section in accordance with this chapter	1231
and any rules adopted under it.	1232

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

1233

(1) Establish and maintain an intravenous lifeline that has	1234
been approved by a cooperating physician or physician advisory	1235
board;	1236

(2) Perform cardiac monitoring;

1237

(3) Perform electrical interventions to support or correct	1238
the cardiac function;	1239

(4) Administer epinephrine;

1240

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

1241

(6) Perform any other emergency medical services approved	1242
pursuant to rules adopted under section 4765.11 of the Revised	1243
Code.	1244

(C)(1) Except as provided in division (C)(2) of this section,	1245
the services described in division (B) of this section shall be	1246
performed by an EMT-I only pursuant to the written or verbal	1247
authorization of a physician or of the cooperating physician	1248
advisory board, or pursuant to an authorization transmitted	1249
through a direct communication device by a physician, physician	1250
assistant designated by a physician, or registered nurse	1251
designated by a physician.	1252

(2) If communications fail during an emergency situation or	1253
the required response time prohibits communication, an EMT-I may	1254
perform any of the services described in division (B) of this	1255
section, if, in the judgment of the EMT-I, the life of the patient	1256
is in immediate danger. Services performed under these	1257
circumstances shall be performed in accordance with the protocols	1258
for triage of adult and pediatric trauma victims established in	1259
rules adopted under sections 4765.11 and 4765.40 of the Revised	1260
Code and any applicable protocols adopted by the emergency medical	1261
service organization with which the EMT-I is affiliated.	1262

(D) In addition to, and in the course of, providing emergency	1263
medical treatment, an emergency medical technician-intermediate	1264
may withdraw blood as provided under sections 1547.11, 4506.17,	1265
and 4511.19 of the Revised Code. An emergency medical	1266
technician-intermediate shall withdraw blood in accordance with	1267
this chapter and any rules adopted under it by the state board of	1268
emergency medical services.	1269

Sec. 4765.39.  (A) An emergency medical technician-paramedic	1270
shall perform the emergency medical services described in this	1271
section in accordance with this chapter and any rules adopted	1272
under it.	1273

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

1274

(1) Perform cardiac monitoring;

1275

(2) Perform electrical interventions to support or correct	1276
the cardiac function;	1277

(3) Perform airway procedures;

1278

(4) Perform relief of pneumothorax;

1279

(5) Administer appropriate drugs and intravenous fluids;

1280

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

1281

(7) Perform any other emergency medical services, including	1282
life support or intensive care techniques, approved pursuant to	1283
rules adopted under section 4765.11 of the Revised Code.	1284

(C)(1) Except as provided in division (C)(2) of this section,	1285
the services described in division (B) of this section shall be	1286
performed by a paramedic only pursuant to the written or verbal	1287
authorization of a physician or of the cooperating physician	1288
advisory board, or pursuant to an authorization transmitted	1289
through a direct communication device by a physician, physician	1290
assistant designated by a physician, or registered nurse	1291
designated by a physician.	1292

(2) If communications fail during an emergency situation or	1293
the required response time prohibits communication, a paramedic	1294
may perform any of the services described in division (B) of this	1295
section, if, in the paramedic's judgment, the life of the patient	1296
is in immediate danger. Services performed under these	1297
circumstances shall be performed in accordance with the protocols	1298
for triage of adult and pediatric trauma victims established in	1299
rules adopted under sections 4765.11 and 4765.40 of the Revised	1300
Code and any applicable protocols adopted by the emergency medical	1301
service organization with which the paramedic is affiliated.	1302

(D) In addition to, and in the course of, providing emergency	1303
medical treatment, an emergency medical technician-paramedic may	1304
withdraw blood as provided under sections 1547.11, 4506.17, and	1305
4511.19 of the Revised Code. An emergency medical	1306
technician-paramedic shall withdraw blood in accordance with this	1307
chapter and any rules adopted under it by the state board of	1308
emergency medical services.	1309

Sec. 4765.49.  (A) A first responder, emergency medical	1310
technician-basic, emergency medical technician-intermediate, or	1311
emergency medical technician-paramedic is not liable in damages in	1312
a civil action for injury, death, or loss to person or property	1313
resulting from the individual's administration of emergency	1314
medical services, unless the services are administered in a manner	1315
that constitutes willful or wanton misconduct. A physician,	1316
physician assistant designated by a physician, or registered nurse	1317
designated by a physician, whoany of whom is advising or	1318
assisting in the emergency medical services by means of any	1319
communication device or telemetering system, is not liable in	1320
damages in a civil action for injury, death, or loss to person or	1321
property resulting from the individual's advisory communication or	1322
assistance, unless the advisory communication or assistance is	1323
provided in a manner that constitutes willful or wanton	1324
misconduct. Medical directors and members of cooperating physician	1325
advisory boards of emergency medical service organizations are not	1326
liable in damages in a civil action for injury, death, or loss to	1327
person or property resulting from their acts or omissions in the	1328
performance of their duties, unless the act or omission	1329
constitutes willful or wanton misconduct.	1330

(B) A political subdivision, joint ambulance district, joint	1331
emergency medical services district, or other public agency, and	1332
any officer or employee of a public agency or of a private	1333
organization operating under contract or in joint agreement with	1334
one or more political subdivisions, that provides emergency	1335
medical services, or that enters into a joint agreement or a	1336
contract with the state, any political subdivision, joint	1337
ambulance district, or joint emergency medical services district	1338
for the provision of emergency medical services, is not liable in	1339
damages in a civil action for injury, death, or loss to person or	1340
property arising out of any actions taken by a first responder,	1341
EMT-basic, EMT-I, or paramedic working under the officer's or	1342
employee's jurisdiction, or for injury, death, or loss to person	1343
or property arising out of any actions of licensed medical	1344
personnel advising or assisting the first responder, EMT-basic,	1345
EMT-I, or paramedic, unless the services are provided in a manner	1346
that constitutes willful or wanton misconduct.	1347

(C) A student who is enrolled in an emergency medical	1348
services training program accredited under section 4765.17 of the	1349
Revised Code or an emergency medical services continuing education	1350
program approved under that section is not liable in damages in a	1351
civil action for injury, death, or loss to person or property	1352
resulting from either of the following:	1353

(1) The student's administration of emergency medical	1354
services or patient care or treatment, if the services, care, or	1355
treatment is administered while the student is under the direct	1356
supervision and in the immediate presence of an EMT-basic, EMT-I,	1357
paramedic, registered nurse, physician assistant, or physician and	1358
while the student is receiving clinical training that is required	1359
by the program, unless the services, care, or treatment is	1360
provided in a manner that constitutes willful or wanton	1361
misconduct;	1362

(2) The student's training as an ambulance driver, unless the	1363
driving is done in a manner that constitutes willful or wanton	1364
misconduct.	1365

(D) An EMT-basic, EMT-I, paramedic, or other operator, who	1366
holds a valid commercial driver's license issued pursuant to	1367
Chapter 4506. of the Revised Code or driver's license issued	1368
pursuant to Chapter 4507. of the Revised Code and who is employed	1369
by an emergency medical service organization that is not owned or	1370
operated by a political subdivision as defined in section 2744.01	1371
of the Revised Code, is not liable in damages in a civil action	1372
for injury, death, or loss to person or property that is caused by	1373
the operation of an ambulance by the EMT-basic, EMT-I, paramedic,	1374
or other operator while responding to or completing a call for	1375
emergency medical services, unless the operation constitutes	1376
willful or wanton misconduct or does not comply with the	1377
precautions of section 4511.03 of the Revised Code. An emergency	1378
medical service organization is not liable in damages in a civil	1379
action for any injury, death, or loss to person or property that	1380
is caused by the operation of an ambulance by its employee or	1381
agent, if this division grants the employee or agent immunity from	1382
civil liability for the injury, death, or loss.	1383

(E) An employee or agent of an emergency medical service	1384
organization who receives requests for emergency medical services	1385
that are directed to the organization, dispatches first	1386
responders, EMTs-basic, EMTs-I, or paramedics in response to those	1387
requests, communicates those requests to those employees or agents	1388
of the organization who are authorized to dispatch first	1389
responders, EMTs-basic, EMTs-I, or paramedics, or performs any	1390
combination of these functions for the organization, is not liable	1391
in damages in a civil action for injury, death, or loss to person	1392
or property resulting from the individual's acts or omissions in	1393
the performance of those duties for the organization, unless an	1394
act or omission constitutes willful or wanton misconduct.	1395

(F) A person who is performing the functions of a first	1396
responder, EMT-basic, EMT-I, or paramedic under the authority of	1397
the laws of a state that borders this state and who provides	1398
emergency medical services to or transportation of a patient in	1399
this state is not liable in damages in a civil action for injury,	1400
death, or loss to person or property resulting from the person's	1401
administration of emergency medical services, unless the services	1402
are administered in a manner that constitutes willful or wanton	1403
misconduct. A physician, physician assistant designated by a	1404
physician, or registered nurse designated by a physician, whoany	1405
of whom is licensed to practice in the adjoining state and who is	1406
advising or assisting in the emergency medical services by means	1407
of any communication device or telemetering system, is not liable	1408
in damages in a civil action for injury, death, or loss to person	1409
or property resulting from the person's advisory communication or	1410
assistance, unless the advisory communication or assistance is	1411
provided in a manner that constitutes willful or wanton	1412
misconduct.	1413

(G) A person certified under section 4765.23 of the Revised	1414
Code to teach in an emergency medical services training program or	1415
emergency medical services continuing education program, and a	1416
person who teaches at the Ohio fire academy established under	1417
section 3737.33 of the Revised Code or in a fire service training	1418
program described in division (A) of section 4765.55 of the	1419
Revised Code, is not liable in damages in a civil action for	1420
injury, death, or loss to person or property resulting from the	1421
person's acts or omissions in the performance of the person's	1422
duties, unless an act or omission constitutes willful or wanton	1423
misconduct.	1424

(H) In the accreditation of emergency medical services	1425
training programs or approval of emergency medical services	1426
continuing education programs, the state board of emergency	1427
medical services and any person or entity authorized by the board	1428
to evaluate applications for accreditation or approval are not	1429
liable in damages in a civil action for injury, death, or loss to	1430
person or property resulting from their acts or omissions in the	1431
performance of their duties, unless an act or omission constitutes	1432
willful or wanton misconduct.	1433

(I) A person authorized by an emergency medical service	1434
organization to review the performance of first responders,	1435
EMTs-basic, EMTs-I, and paramedics or to administer quality	1436
assurance programs is not liable in damages in a civil action for	1437
injury, death, or loss to person or property resulting from the	1438
person's acts or omissions in the performance of the person's	1439
duties, unless an act or omission constitutes willful or wanton	1440
misconduct.	1441

Sec. 4765.51.  Nothing in this chapter prevents or restricts	1442
the practice, services, or activities of any registered nurse	1443
practicing within the scope of histhe registered nurse's	1444
practice.	1445

Nothing in this chapter prevents or restricts the practice,	1446
services, or activities of any physician assistant practicing in	1447
accordance with a physician supervisory plan approved under	1448
section 4730.17 of the Revised Code or the policies of the health	1449
care facility in which the physician assistant is practicing.	1450

Section 2.  That existing sections 185.01, 185.03, 185.05,	1451
2133.211, 3719.06, 4730.06, 4730.09, 4730.38, 4730.39, 4730.40,	1452
4730.41, 4730.42, 4730.44, 4730.45, 4755.48, 4755.481, 4765.01,	1453
4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51	1454
and section 4730.401 of the Revised Code are hereby repealed.	1455