As Re-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 



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, satisfactory315
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, thean343
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 was352
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 either366
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 is373
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 allboth418
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. The459

       (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 established512
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 assistant635
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 was772
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 only1144
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's1419
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