CHAPTER Med 600  PHYSICIAN ASSISTANT

 

Statutory Authority:  RSA 328-D:10, I

 

PART Med 601  CHAPTER DEFINITIONS

 

          Med 601.01  "Alternate registered supervisory physician (ARSP)" means a physician licensed to practice in New Hampshire under RSA 329 who is responsible for the supervision and performance of a physician assistant in lieu of the registered supervisory physician.

 

                                                                      Source.  #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.02  "Applicant" means a physician assistant who has submitted an application for licensure.

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.03  "Approved program" means a program for the education and training of physician assistants that is accredited by the American Medical Association's Committee on Allied Health Education and Accreditation, or the Commission on Accreditation of Allied Health Education Programs or by its successor.

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.04  "National Certification" means to hold a current physician assistant certificate issued by the National Commission on Certification of Physician Assistants (NCCPA).

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.05  "Physician assistant (PA)" means "physician assistant" as defined in RSA 328-D:1, III.

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.06  "Physician assistant advisory committee (PAAC)" means the physician assistant advisory committee to the Board established by RSA 328-D:9.

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.07  "Prescription" means a verbal, or written, or facsimile or electronically transmitted order for drugs, medicines and devices by a licensed practitioner as defined in RSA 318:1 XVI.

 

                                                                      Source.  #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.08  "Registered supervisory physician (RSP)" means a physician, licensed to practice in New Hampshire under RSA 329, who is responsible for the supervision and performance of a physician assistant.

 

                                                                      Source.  #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 601.09  "Supervision" means the opportunity and ability of a specified licensed physician to exercise control and direction over the services of a specified physician assistant.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 602  SUPERVISION OF A PHYSICIAN ASSISTANT

 

          Med 602.01  Responsibility of the Supervisory Physician(s).

 

          (a)  The RSP or ARSP shall be available for consultation with the physician assistant and shall be responsible for assuring that appropriate directions are given to, and understood and executed by, the physician assistant.

 

          (b)  The RSP or ARSP shall not be required to be physically present while the physician assistant is providing care, so long as the RSP or ARSP and the physician assistant are or can easily be in contact with each other by an electronic communication device.

 

          (c)  The RSP shall establish a regular, ongoing evaluation of a representative sample of patient records as part of a review of the physician assistant's performance.

 

          (d)  The RSP shall file a written acceptance of supervisory responsibility with the board.  The RSP shall designate in writing all of the alternate supervising physicians whose scope of practice encompasses the PA's  scope of practice, and such alternates shall assume responsibility for the supervision of the physician assistant when the RSP is unavailable.  Alternates shall sign a written acceptance of supervisory responsibility with the board.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 602.02  Number of PAs Supervised.

 

          (a)  A physician shall not be the RSP for more than 2 physician assistants.

 

          (b)  A physician shall not be an ARSP for more than 6 physician assistants simultaneously and shall not actively supervise more than 2 physician assistants simultaneously.

 

          (c)  Physician assistants employed in 2 or more separate medical jobs shall have a designated registered supervising physician and at least one alternate in each setting.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 602.03  Delegation Agreement.

 

          (a)  The RSP and the PA shall develop a specific written job description which shall conform to the requirements for supervision set forth in Med 602.01, and shall be signed by all parties, including the PA, RSP and all ARSPs.

 

          (b)  The delegation agreement shall constitute the authority for the physician assistant to provide medical care under the supervision of the RSP and ARSP.

 

                                                                      Source.  #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 602.04  Change of Supervisory Relationship.

 

          (a)  If, for any reason, a physician assistant discontinues a supervised relationship with the RSP or ARSP, the PA shall immediately report this fact to the board in writing.

 

          (b)  The PA shall not practice until such time as a new registered supervising physician, who shall comply with the requirements for supervision set forth under Med 602.01, has filed a written acceptance of supervisory responsibility with the board.

 

          (c)  If the RSP designates new or additional ARSPs, who shall comply with the requirements for supervision set forth under Med 602.01, then the RSP shall so inform the board in writing.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 603  SCOPE OF PRACTICE OF PHYSICIAN ASSISTANT

 

          Med 603.01  Scope of Practice.

 

          (a)  The scope of practice of the PA shall be defined by agreement with the RSP.  The scope of practice of the PA shall be limited to and no broader than the scope of practice and privileges of the supervising physician.

 

          (b)  Medical services delegated by a supervising physician may be performed by the physician assistant in any setting authorized by the supervising physician.

 

          (c)  A physician assistant may write orders for patients as delegated by the supervising physician or alternate.  Such orders shall be countersigned by the RSP or ARSP as required by institutional policy, however, such countersignature shall not be required prior to the order being executed.

 

          (d)  Physician assistants shall perform practice-related activities, including but not limited to, the ordering of diagnostic or therapeutic services to be implemented by other health professionals, under the requirements for supervision set forth under Med 602.01.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 8-3-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 604  APPLICATION FOR LICENSURE

 

          Med 604.01  Application Form.

 

          (a)  Applicants for licensure as a physician assistant shall file an application supplied by the board which includes the following:

 

(1)  Name, home address and telephone number of the applicant;

 

(2)  Date of birth and sex of the applicant;

 

(3)  Name, address and telephone number of the applicant's proposed place of employment and registered supervising physicians;

 

(4)  Certification from the RSP and all ARSPs that he or she has accepted supervisory responsibility for the physician assistant, including the proposed date on which the relationship will commence;

 

(5)  Documentation of completion of an approved program of education as defined in Med 601.03;

 

(6)  Verification from the licensing authority of any other state license ever held by the applicant which shows such license to be in good standing;

 

(7)  Documentation that the applicant has passed an initial examination administered by the NCCPA and continues to hold a valid national certificate issued by that organization or its successor agency; and

 

(8)  A statement indicating whether the applicant has ever been refused a license or certification by any other licensing or certifying body and if so, the circumstances of the incident;

 

(9)  A statement indicating whether the applicant has ever been or has reason to believe that he or she is the subject of any kind of disciplinary investigation or action by any hospital, healthcare organization or licensing or certifying body and if so, the nature of the allegations and the subsequent disposition of the action;

 

(10)  A statement indicating whether the applicant has ever been convicted of a felony or misdemeanor, and, if so, the name of the court, the details of the offense, the date of conviction and the sentence imposed;

 

(11)  A statement indicating whether the applicant has been treated for drug or alcohol abuse, or has been hospitalized for any mental illness within the year preceding the filing of the application, or whether the applicant has ever had such treatment or hospitalization for a condition which affected his or her ability to perform the functions of a physician assistant and if so, the treatment prescribed and the outcome of that treatment;

 

(12)  A statement that the applicant has arranged for the direct submission of letters of reference from 2 physicians, who have served in an advisory capacity to the applicant;

 

(13)  Signature and 3 x 5 inch full face photograph of the applicant.

 

          (b)  A copy of the applicants curriculum vitae or resume shall accompany the application.

 

          (c)  Letters of reference required in (a)(12) above shall be original, signed documents submitted directly to the board on professional letterhead.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 605  REQUIREMENTS FOR LICENSURE

 

          Med 605.01  Educational Requirements.  The applicant shall be a graduate of an approved physician assistant training program as defined in Med 601.03.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 605.02  Professional Character.

 

          (a)  The applicant shall adhere to the requirements of RSA 328-D and the rules of this chapter, and shall not have previously engaged in activities for which disciplinary sanctions might be imposed under Med 609.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 606 - RESERVED

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

PART Med 607  REINSTATEMENT OF LICENSE

 

          Med 607.01  Reinstatement of Lapsed Licenses.

 

          (a)  A 90 day grace period to apply for renewal shall be allowed, subject to an additional late fee.  If the renewal application is not received by the grace period date, the license shall be considered lapsed.

 

          (b)  If a license expires or lapses as a result of a licensee being ordered to active duty with the armed services, the licensee shall have 90 days from the date of discharge or release from the armed service to apply for renewal and all late fees shall be waived.

 

          (c)  If a physician assistant license lapses, the physician assistant shall be eligible to apply for reinstatement.

 

          (d)  Applicants for reinstatement of a lapsed license shall pay the reinstatement fee set forth in Med 611.01, Table 6.11.1.

 

          (e)  Applicants shall file an application supplied by the board which contains the following:

 

(1)  The same information required in Med 604.01(a)(1-15) excluding Med 604.01(a)(5); and

 

(2)  A chronological history of the applicant's employment since the original license was lapsed.

 

                                                                      Source.  #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 8-3-96

 

                                                                      New.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 608  LICENSE RENEWAL

 

          Med 608.01  Renewal Application.

 

          (a)  On or before October 31, of each year, the board shall forward a license renewal application for the coming year to each licensee.  The applicant shall file the completed renewal application no later than December 31 of the current license year.

 

          (b)  Persons seeking renewal of a physician assistant license shall file an application for renewal which contains, on or as an attachment to the application, the following:

 

(1)  Name and home address of the licensee, including street address and mailing address;

 

(2)  Place(s) of employment, business address and business telephone number;

 

(3)  Name and New Hampshire license number of RSP and ARSP;

 

(4)  Other states where the licensee holds a current license;

 

(5)  Copy of current national certification issued by the NCCPA;

 

(6)  Whether the applicant has, within the past 12 months, been found guilty or pleaded no contest to any felony or misdemeanor;

 

(7)  Whether the applicant has terminated a relationship with a registered supervisory physician or terminated employment for any reason during the past twelve months;

 

(8)  Whether the applicant has been the subject of disciplinary action, or has been denied a license or surrendered a license in any state or jurisdiction within the past 12 months;

 

(9)  Whether the applicant has been treated for misuse of any chemical substance or has been restricted in any manner by the US Drug Enforcement Agency (DEA);

 

(10)  Whether the applicant has been treated for any physical or psychological disturbance within the past 12 months which has impaired his or her ability to practice as a physician assistant;

 

(11)  Whether the applicant has been the subject of any investigation or disciplinary proceeding or has been reported to the National Practitioners Data Bank (NPDB) within the past 12 months;

 

(12)  Whether any malpractice claims have been made against the applicant within the past 12 months;

 

(13)  If responses to questions (7) through (12) above are in the affirmative, a written explanation of the circumstances;

 

(14)  Signature of the applicant; and

 

(15)  Payment of the fee specified in Table 6.11.1, Med 611.01.

 

          (c)  Applications which do not contain all of the information required in section (b) above shall not be accepted for filing and shall be returned, unprocessed, to the applicant.

 

                                                                      Source.  #4745, eff 1-25-90, EXPIRED 1-25-96

 

                                                                      New.  #6472, eff 3-25-97; ss by #6828, eff 8-11-98; ss by #8678, eff 7-11-06

 

PART Med 609  ETHICAL STANDARDS

 

          Med 609.01  Disciplinary Action.

 

          (a)  Professional misconduct by physician assistants shall include the following:

 

(1)  Holding oneself out as or permitting another to represent one as a licensed physician;

 

(2)  Performing activities which are not authorized by the licensee's training or supervising physician's practice or which are outside the direction and supervision of the RSP or ARSP;

 

(3)  Habitual use of controlled drugs or intoxicants;

 

(4)  Conviction of a felony under the laws of the United States or any state;

 

(5) Engaging in dishonest, unprofessional or immoral conduct related to the performance of physician assistant activities;

 

(6)  Failing to meet reasonable standards of medical care;

 

(7)  Failing to report changes in RSP or ARSP;

 

(8)  Violating the guidelines for ethical conduct for the physician assistant profession of the American Academy of Physician Assistants adopted in 2000 and amended in 2004;

 

(9)  Practicing as a physician assistant while being mentally or physically impaired in a manner which precludes safe and dependable performance;

 

(10)  Engaging in conduct inconsistent with the basic knowledge and competency expected of any physician assistant; or

 

(11)  Intentionally injuring or exploiting any patient or person entrusted to licensee's care as a physician assistant.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 609.02  Allegations of Professional Misconduct.  Allegations of professional misconduct shall be investigated and disciplinary action shall be taken in accordance with Med 200 or, if applicable, Jus 800, and Med 400 and RSA 328-D:7.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 609.03  Change of Address.  Licensees shall report any change in business or home address within 30 days of such change.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 610  METHOD OF PERFORMANCE

 

          Med 610.01  Identification.

 

          (a)  A physician assistant shall keep his or her license available for inspection at the primary place of business and shall, when engaged in his or her professional activities, wear a name tag identifying themselves as a "physician assistant".

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

          Med 610.02  Proximity.  The physician assistant shall ensure that the RSP or ARSP is available for continuous consultation with the physician assistant in person or by electronic device.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

PART Med 611  FEES

 

          Med 611.01  Fees.

 

          (a)  The fees set by the board under RSA 328-D shall be as set forth in table 6.11.1 below:

 

Table 6.11.1

 

                    License Fee

$100.00

                    Renewal Fee

$50.00

                    Reinstatement Fee

$100.00

                    Late Fee

$50.00

 

                                                                      Source.  #6472, eff 3-25-97; ss by #6828, eff 8-11-98; ss by #8678, eff 7-11-06

 

PART Med 612  PRESCRIPTIVE PRACTICE

 

          Med 612.01  Scope of Prescriptive Practice.

 

          (a)  Physician assistants shall transmit prescriptions for any patient only in accordance with a delegation agreement, or a patient specific order of the RSP or ARSP, and in compliance with all requirements of RSA 318 and RSA 318-B.

 

          (b)  Physician assistants, acting in accordance with a delegation agreement as the agent of the RSP or ARSP, may dispense samples of prescription drugs as necessary and appropriate for patient care.

 

          (c)  Physician assistants shall not engage in the act of prescribing controlled substances unless they have obtained the proper registration from the US Drug Enforcement Administration.

 

          (d)  A licensed physician assistant may prescribe, dispense and administer drugs and medical devices to the extent delegated by the supervising physician in compliance with RSA 318 and RSA 318-B.

 

          (e)  Physician assistants may request, receive, and sign for professional samples and may distribute professional samples to patients.

 

                                                                      Source.  #6472, eff 3-25-97, EXPIRED: 3-25-05

 

                                                                      New.  #8678, eff 7-11-06

 

APPENDIX

 

RULE NUMBER

STATUTE IMPLEMENTED

 

 

Med 601

RSA 328-D:1

Med 602

RSA 328-D:10, I(f)

Med 603

RSA 328-D:10, I(a)

Med 604

RSA 328-D:10, I(b) and (c)

Med 605

RSA 328-D:3, RSA 328-D:10, I(e)

Med 606

RESERVED

Med 607

RSA 328-D:5-a, I, RSA 328-D:10, I(c)

Med 608

RSA 328-D:5, RSA 328-D:10, I(c)

Med 609

RSA 328-D:6, RSA 328-D:7, RSA 328-D:10, I(d) and (g)

Med 610

RSA 328-D:10, I(j)

Med 611

RSA 328-D:2, III, RSA 328-D:5, RSA 328-D:5-a, I

Med 612

RSA 328-D:10, I(a)