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COLORADO FINAL RULES
DEPARTMENT OF REGULATORY AGENCIES

BOARD OF MEDICAL EXAMINERS
CERTIFICATION OF AND PRACTICE BY PHYSICIAN ASSISTANTS (PAs)

3 CCR 713-7

COLORADO STATE BOARD MEDICAL EXAMINERS RULES AND REGULATIONS FOR CERTIFICATION OF AND PRACTICE BY PHYSICIAN ASSISTANTS(PAs)

INTRODUCTION

A. Basis. The authority for promulgation of these rules and regulations by the State Board of Medical Examiners is set forth in Sections 12-36-104(1)(a) and 12-36106(5), C.R.S.

B. Purpose. The purpose of revising the physician assistant rules, particularly Section 2 of these rules, is to provide the physician assistants and the physicians who supervise them a clearer set of guidelines as to what is required in the supervisory relationship. The previous use of various factors to provide guidance for the level of supervision has been abandoned. Rather, the Board regards supervision as something best left to the particular physician and physician assistant in question. The rules are designed to provide for accountability on the part of the supervising physician by making that physician responsible if inadequate supervision or improper delegation is provided.

These rules are also designed to provide a single rule appropriate for the different types of supervisory relationships that exist in different clinical settings. The Board acknowledges the need for physician assistants to work in specialized settings and to have more than one supervisor. At the same time, the Board wishes to maintain a direct line of authority and responsibility between the physician assistant and physician. The creation of the primary and the secondary physician supervisor position is designed to meet both of these goals. The rules are designed to make the primary physician supervisor responsible for the conduct of the physician assistant unless another physician, the secondary physician supervisor, clearly assumes responsibility. The March 30, 1998, revision provides clarification that the secondary physician supervisor may supervise more than two physician assistants.

SECTION 1. QUALIFICATIONS FOR CERTIFICATION

Applicants shall be certified as physician assistants by the State Board of Medical Examiners upon submission of the following:

I. A completed Board-approved application form and required fee; and

II. Proof of satisfactory passage of the national certifying examination for assistants to the primary care physician administered by the National Commission on Certification of Physician Assistants.

SECTION 2. EXTENT AND MANNER IN WHICH A PHYSICIAN ASSISTANT MAY PERFORM DELEGATED TASKS CONSTITUTING THE PRACTICE OF MEDICINE UNDER PERSONAL AND RESPONSIBLE DIRECTION AND SUPERVISION

I. Responsibilities of the Physician Assistant

A. Registration. A physician assistant shall insure that a form in compliance with Section 4 of this rule shall be on record with the Board.

B. Nameplate. While performing acts defined as the practice of medicine, a physician assistant shall wear a nameplate with the non-abbreviated title "physician assistant" clearly visible.

C. Chart Note. A physician assistant shall make a chart note for every patient for whom the physician assistant performs any act defined as the practice of medicine in Section 12-36-106(1), C.R.S. The physician assistant shall insure that the written record for each patient is reviewed and signed by a physician supervisor no later than seven working days after the physician assistant has performed an act defined as the practice of medicine.

II. Responsibilities of All Physician Supervisors

A. Two Physician Assistant Limit. A physician may not supervise more than two physician assistants at any one particular moment in time.

B. Charts to be Reviewed Every Seven Working Days. A physician supervisor shall review the chart for every patient seen by a supervised physician, assistant no later than seven working days after the physician assistant has performed an act defined as the practice of medicine. The physician supervisor shall document the performance of such review by signing the chart in a legible manner. In lieu of signing the chart, the physician supervisor may document the performance of such review by the use of an electronically generated signature provided that reasonable measures have been taken to prevent the unauthorized use of the electronically generated signature.

Physician assistants performing delegated medical functions in an acute care hospital setting must comply with the requirements of Section 12-36106(5)(b)(II)(A), (B) and (C), C.R.S.

III. Responsibilities of the Primary Physician Supervisor

A. Primary Physician Supervisor. Except as set forth in subsection IV below, a physician licensed to practice medicine by the Board may delegate to a physician assistant certified by the Board the authority to perform acts which constitute the practice of medicine only if a form in compliance with Section 4 of this rule is on record with the Board. The physician whose name appears on the form in compliance with Section 4 of this rule shall be deemed the "primary physician supervisor". The supervisory relationship shall be deemed to be effective for all time periods in which a form in compliance with Section 4 of this rule is on file with the Board.

B. Liability for Actions of a Physician Assistant. A primary physician supervisor may supervise and delegate responsibilities to a physician assistant in the manner the primary physician supervisor deems fit. Except as provided in subsection IV - B below, the primary physician supervisor shall be deemed to have violated this rule if a supervised physician assistant commits unprofessional conduct as defined in Section 12-36-117(1)(p), C.R.S., or if such physician assistant otherwise violates these rules. The primary physician supervisor shall not be responsible for the conduct of a physician assistant where that physician assistant was acting under the supervision of another primary physician supervisor and there is a form in compliance with Section 4 of these rules signed by that other primary physician supervisor.

C. Limitation to Two Supervised Physician Assistants. A primary physician supervisor shall be the primary physician supervisor for no more than two specific, individual physician assistants. The names of such physician assistants shall appear on the form in compliance with Section 4 of this rule. The primary physician supervisor may supervise additional physician assistants other than those who appear on the form in compliance with Section 4 of this rule. In other words, a primary physician supervisor may also be a secondary physician supervisor, as set forth below, for additional physician assistants. However, the primary physician supervisor may do so only in compliance with the limitations set forth in subsection II A above.

D. One Primary Physician Supervisor Per Employer. A physician assistant shall not have more than one primary physician supervisor for each employer. For purposes of this rule, any hospital system or health maintenance organization shall constitute a single employer.

IV. Responsibilities of the Secondary Physician Supervisor

A. Secondary Physician Supervisor. A physician licensed to practice medicine by the Board other than the supervisor whose name appears on the form in compliance with Section 4 of this rule, may delegate to a physician assistant certified by the Board, the authority to perform acts which constitute the practice of medicine only as permitted by this subsection IV. Such physician shall be termed the "secondary physician supervisor".

B. Liability on the Part of a Secondary Physician Supervisor for the Actions of a Physician Assistant. If a physician signs the chart for a patient seen by a physician assistant as a secondary physician supervisor, such physician shall be deemed to be responsible for any act defined as the practice of medicine performed by such physician assistant while supervised by the secondary physician supervisor. If, from the signature on the chart and all the surrounding facts and circumstances, a physician has assumed the role of secondary physician supervisor, that physician shall have assumed the responsibility for supervision of the physician assistant and shall be deemed to have relieved the primary physician supervisor of the supervisory responsibilities set forth in subsection III - B above. Such assumption of responsibility shall relate only to those particular actions of the physician assistant supervised by the secondary physician supervisor. The secondary physician supervisor shall be deemed to have violated this rule if such supervised physician assistant commits unprofessional conduct as defined in Section 12-36-117(1)(p), C.R.S., or if such physician assistant otherwise violates these rules.

C. Other Responsibilities of the Secondary Physician Supervisor. In the event that a physician undertakes the supervision of a physician assistant who does not have a primary physician supervisor, or who does not have a form in compliance Section 4 of this rule on file with the Board, such physician shall be deemed to the primary physician supervisor and shall be subject to all responsibilities of the any physician supervisor including the two physician assistant limit. The Board commends but does not require that any physician acting as a secondary physician supervisor sign every chart with the words "secondary physician supervisor" and notify the primary physician supervisor.

D. Effect of the Failure of the Secondary Physician Supervisor to supervise. Absent a review and signing of the chart by the secondary physician supervisor, the primary physician supervisor for that employer shall be deemed to e been the supervisor rather than the secondary supervisor. In such event, the any physician supervisor shall be responsible for the practice of medicine of the physician assistant as set forth above.

V. Waiver of Provisions of these Rules

A. Criteria for Obtaining Waivers. Upon a showing of good cause, the and may permit waivers of the above rules. It is anticipated that waivers may be granted to permit a physician supervisor to supervise more than two physician assistants, to permit a physician supervisor to review charts less frequently than seven working days. Other waivers may be granted. Factors to be considered in granting such waivers include, but are not limited to: whether the physician assistant is located in an undeserved or rural area distant form the physician supervisor; the quality of protocols setting out the responsibilities of a physician assistant in the particular practice; any disciplinary history on the part of the physician supervisor or the physician assistant; and whether the physician assistants question work less than a full schedule. All such waivers shall be in the sole discretion of the Board. All waivers shall be strictly limited to the terms provided by e Board.

B. Procedure for Obtaining Waivers. Applicants for waivers must submit a to the Board detailing the basis for the waiver request and addressing the pertinent factors listed in subsection V - A. The applicant should also submit a copy any written protocols in place for the supervision of physician assistants. Upon receipt of the Waiver request and documentation, the matter will be considered at the available Board meeting. If a waiver to the two physician assistant limit is anted, the primary supervising physician must submit a revised form in compliance Section 4 of this rule containing the names of all physician assistants to be supervised before the waiver shall become effective.

3. PRESCRIPTION AND DISPENSING OF DRUGS.

I. A certified physician assistant may issue a prescription order for any drug or controlled substance provided that:

A. Each and every prescription and refill order is entered on the patient's chart.

B. Each written prescription order shall be on either the primary or secondary supervising physician's prescription order form and signed by the physician assistant and shall contain in preprinted form the name, address and telephone number of the supervising physician and the name of the physician assistant.

C. Nothing in this Section 3 shall prohibit a physician supervisor from restricting the ability of a supervised physician assistant to prescribe drugs or controlled substances.

D. A physician assistant may not issue a prescription order for any controlled substance unless the physician assistant has received a registration from the United States Drug Enforcement Administration.

II. Physician assistants shall not write or sign prescriptions or perform any services which the supervising physician for that particular patient is not qualified or authorized to prescribe or perform.

III. No drug which a physician assistant is authorized to prescribe, dispense, administer or deliver shall be obtained by said physician assistant from a source other than a supervising physician, pharmacist or pharmaceutical representative.

IV. No device which a physician assistant is authorized to prescribe, dispense, administer or deliver shall be obtained by said physician assistant from a source other than a supervising physician, pharmacist or pharmaceutical representative.

SECTION 4. REPORTING REQUIREMENTS

Any person wishing to form a supervisory relationship in conformance with these rules shall file with the Board a form as required by the Board. The form shall be signed by the primary physician supervisor and the physician assistant or assistants for whom the physician intends to be the primary physician supervisor. Except as provided by Board waiver, no primary physician supervisor shall be a primary physician supervisor for more than two specific, individual physician assistants. Except as provided by Board waiver, the names of no more than two individual physician assistants shall appear on the form in compliance with this Section. The supervisory relationship acknowledged in the form shall be deemed to continue for purposes of these rules until specifically rescinded by either the physician assistant or the primary physician supervisor in writing.

Revised December, 1984; Revised August, 1992; Revised December 1, 1994;

Revised December 1, 1995; Revised March 31, 1996; Revised August 1, 1997;

Revised September 30, 1997; Revised March 30, 1998


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