HB 52 — Revise the practice of certified registered nurse anesthetists

(L) "Collaboration" or "collaborating" means the following:

(1) In the case of a clinical nurse specialist or a certified nurse practitioner, that one or more podiatrists acting within the scope of practice of podiatry in accordance with section 4731.51 of the Revised Code and with whom the nurse has entered into a standard care arrangement or one or more physicians with whom the nurse has entered into a standard care arrangement are continuously available to communicate with the clinical nurse specialist or certified nurse practitioner either in Sub.

52 Page136th 3G.A. As Passed by the House (F) "The practice of nursing as a licensed practical 44 nurse" means providing to individuals and groups nursing care 45 requiring the application of basic knowledge of the biological, 46 physical, behavioral, social, and nursing sciences at the 47 direction of a registered nurse or any of the following who is 48 authorized to practice in this state:

aperson physician,or physicianby 49electronic assistant,communication; dentist, podiatrist, optometrist, or chiropractor.

50(2) SuchIn nursingthe case of a certified nurse-midwife, that one or more physicians with whom the certified nurse-midwife has entered into a standard care includes:arrangement are continuously available to communicate with the certified nurse-midwife either in person or by electronic communication;

51(3) (1)In Observation,the patientcase teaching,of anda carecertified inregistered nurse anesthetist, that a diversitydentist 52who ofholds healtha careconscious settings;sedation or general anesthesia permit issued under Chapter 4715.

53of (2)the ContributionsRevised Code, physician, or podiatrist requests, either verbally or in writing, the nurse to perform patient care activities authorized by division (D) of section 4723.43 of the planning,Revised implementation,Code and 54the evaluationrequest ofis nursing;made in accordance with policies established by the health care facility where the nurse and the dentist, physician, or podiatrist practice.

55For (3)purposes Administrationof this division, division (D) of medicationssection 4723.43 of the Revised Code, and treatmentssections 564723.433 authorizedand by4723.434 anof individualthe whoRevised isCode, authorized"health tocare practicefacility" inmeans 57an thisambulatory statesurgical andfacility, iscardiovascular actingor withinvascular thecenter, coursefreestanding birthing center, hospital, or office of thea individual'sdentist, 58physician, professionalor practice;podiatrist.

59(M) (4)"Supervision," Administrationas toit anpertains adultto ofa intravenouscertified therapyregistered 60nurse authorizedanesthetist, bymeans anthat individualthe whocertified isregistered authorizednurse toanesthetist practice in 61 this state and is actingunder within the coursedirection of thea individual'spodiatrist 62acting professionalwithin practice, on the conditionpodiatrist's thatscope theof licensedpractice 63in practicalaccordance nursewith is authorized under section 4723.184731.51 or 4723.181 64 of the Revised CodeCode, toa performdentist intravenousacting therapywithin andthe performsdentist's 65scope intravenousof therapypractice only in accordance with thoseChapter sections;4715.

66of (5)the DelegationRevised ofCode, nursingor tasksa asphysician, directedand, bywhen aadministering 67anesthesia, the certified registered nurse;nurse anesthetist is in the immediate presence of the podiatrist, dentist, or physician.

68(N) (6)"Standard Teachingcare nursingarrangement" tasksmeans toa licensedwritten, practicalformal nursesguide 69for planning and individualsevaluating toa whompatient's thehealth licensedcare practicalthat nurse is 70developed authorizedby toone delegateor nursingmore taskscollaborating asphysicians directedor bypodiatrists and a registeredclinical 71nurse nurse.specialist, certified nurse-midwife, or certified nurse practitioner and meets the requirements of section 4723.431 of the Revised Code.

72(O)(N) Sub."Advanced practice registered nurse" means an individual who holds a current, valid license issued under this chapter that authorizes the practice of nursing as an advanced practice registered nurse and is designated as any of the following:

(1) A certified registered nurse anesthetist;

(2) A clinical nurse specialist;

(3) A certified nurse-midwife;

(4) A certified nurse practitioner.

(P)(O) "Practice of nursing as an advanced practice registered nurse" means providing to individuals and groups nursing care that requires knowledge and skill obtained from advanced formal education, training, and clinical experience.

Such nursing care includes the care described in section 4723.43 of the Revised Code.

(Q)(P) "Dialysis care" means the care and procedures that a dialysis technician or dialysis technician intern is authorized to provide and perform, as specified in section 4723.72 of the Revised Code.

Sub.

52 Page136th 4G.A. As Passed by the House (G) "Certified registered nurse anesthetist" means an 73 advanced practice registered nurse who holds a current, valid 74 license issued under this chapter and is designated as a 75 certified registered nurse anesthetist in accordance with 76 section 4723.42 of the Revised Code and rules adopted by the 77 board of nursing.

78(R)(Q) (H)"Dialysis "Clinicaltechnician" nurse specialist" means an advancedindividual practice 79 registered nurse who holds a current, valid licensecertificate issuedto underpractice 80 this chapter and is designated as a clinicaldialysis nursetechnician specialistissued inunder 81 accordance with section 4723.424723.75 of the Revised CodeCode. and rules 82 adopted by the board of nursing.

83(S)(R) (I)"Dialysis "Certifiedtechnician nurse-midwife"intern" means an advancedindividual practicewho 84has registerednot nursepassed whothe holdsdialysis atechnician current,certification validexamination licenserequired issuedby undersection 854723.751 thisof chapterthe andRevised isCode, designatedbut aswho has successfully completed a certifieddialysis nurse-midwifetraining inprogram 86approved accordanceby withthe board of nursing under section 4723.424723.74 of the Revised Code andwithin rules 87 adopted by the boardprevious ofeighteen nursing.months.

88(T)(S) (J) "Certified nursecommunity practitioner"health worker" means an advancedindividual 89 practice registered nurse who holds a current, valid licensecertificate 90 issued under this chapter and is designated as a certifiedcommunity nursehealth 91worker practitionerissued inunder accordance with section 4723.424723.85 of the Revised 92Code. Code and rules adopted by the board of nursing.

93(U)(T) (K)"Medication "Physician"aide" means an individual authorizedwho holds a current, valid certificate issued under 94this Chapterchapter 4731.that authorizes the individual to administer medication in accordance with section 4723.67 of the Revised Code;.

of(V)(U) the"Nursing Revisedspecialty" Codemeans toa specialty in practice medicineas anda 95certified surgeryregistered ornurse osteopathicanesthetist, medicineclinical andnurse surgery.specialist, certified nurse-midwife, or certified nurse practitioner.

96(W)(V) (L)"Physician "Collaboration"assistant" ormeans "collaborating"an meansindividual thewho 97is following:licensed to practice as a physician assistant under Chapter 4730.

98 (1) In the case of a clinical nurse specialist or a 99 certified nurse practitioner, that one or more podiatrists 100 acting within the scope of practice of podiatry in accordance 101 Sub.

H.

B.

No.

52 Page 5 As Passed by the House with section 4731.51 of the Revised Code and with whom the nurse 102 has entered into a standard care arrangement or one or more 103 physicians with whom the nurse has entered into a standard care 104 arrangement are continuously available to communicate with the 105 clinical nurse specialist or certified nurse practitioner either 106 in person or by electronic communication;

107 (2) In the case of a certified nurse-midwife, that one or 108 more physicians with whom the certified nurse-midwife has 109 entered into a standard care arrangement are continuously 110 available to communicate with the certified nurse-midwife either 111 in person or by electronic communication;

112 (3) In the case of a certified registered nurse 113 anesthetist, that a dentist who holds a conscious sedation or 114 general anesthesia permit issued under Chapter 4715.

of the 115 Revised Code, physician, or podiatrist requests, either verbally 116 or in writing, the nurse to perform patient care activities 117 authorized by division (D) of section 4723.43 of the Revised 118 Code and the request is made in accordance with policies 119 established by the health care facility where the nurse and the 120 dentist, physician, or podiatrist practice.

121 For purposes of this division, division (D) of section 122 4723.43 of the Revised Code, and sections 4723.433 and 4723.434 123 of the Revised Code, "health care facility" means an ambulatory 124 surgical facility, cardiovascular or vascular center, 125 freestanding birthing center, hospital, or office of a dentist, 126 physician, or podiatrist.

127 (M) "Supervision," as it pertains to a certified 128 registered nurse anesthetist, means that the certified 129 registered nurse anesthetist is under the direction of a 130 podiatrist acting within the podiatrist's scope of practice in 131 Sub.

H.

B.

No.

52 Page 6 As Passed by the House accordance with section 4731.51 of the Revised Code, a dentist 132 acting within the dentist's scope of practice in accordance with 133 Chapter 4715.

of the Revised Code, or a physician, and, when 134 administering anesthesia, the certified registered nurse 135 anesthetist is in the immediate presence of the podiatrist, 136 dentist, or physician.

137 (N) "Standard care arrangement" means a written, formal 138 guide for planning and evaluating a patient's health care that 139 is developed by one or more collaborating physicians or 140 podiatrists and a clinical nurse specialist, certified nurse- 141 midwife, or certified nurse practitioner and meets the 142 requirements of section 4723.431 of the Revised Code.

143 (O)(N) "Advanced practice registered nurse" means an 144 individual who holds a current, valid license issued under this 145 chapter that authorizes the practice of nursing as an advanced 146 practice registered nurse and is designated as any of the 147 following:

148 (1) A certified registered nurse anesthetist;

149 (2) A clinical nurse specialist;

150 (3) A certified nurse-midwife;

151 (4) A certified nurse practitioner.

152 (P)(O) "Practice of nursing as an advanced practice 153 registered nurse" means providing to individuals and groups 154 nursing care that requires knowledge and skill obtained from 155 advanced formal education, training, and clinical experience.

156 Such nursing care includes the care described in section 4723.43 157 of the Revised Code.

158 (Q)(P) "Dialysis care" means the care and procedures that 159 Sub.

H.

B.

No.

52 Page 7 As Passed by the House a dialysis technician or dialysis technician intern is 160 authorized to provide and perform, as specified in section 161 4723.72 of the Revised Code.

162 (R)(Q) "Dialysis technician" means an individual who holds 163 a current, valid certificate to practice as a dialysis 164 technician issued under section 4723.75 of the Revised Code.

165 (S)(R) "Dialysis technician intern" means an individual 166 who has not passed the dialysis technician certification 167 examination required by section 4723.751 of the Revised Code, 168 but who has successfully completed a dialysis training program 169 approved by the board of nursing under section 4723.74 of the 170 Revised Code within the previous eighteen months.

171 (T)(S) "Certified community health worker" means an 172 individual who holds a current, valid certificate as a community 173 health worker issued under section 4723.85 of the Revised Code.

174 (U)(T) "Medication aide" means an individual who holds a 175 current, valid certificate issued under this chapter that 176 authorizes the individual to administer medication in accordance 177 with section 4723.67 of the Revised Code;.

178 (V)(U) "Nursing specialty" means a specialty in practice 179 as a certified registered nurse anesthetist, clinical nurse 180 specialist, certified nurse-midwife, or certified nurse 181 practitioner.

182 (W)(V) "Physician assistant" means an individual who is 183 licensed to practice as a physician assistant under Chapter 184 4730.

185 (W) "Podiatrist" means an individual authorized under 186 Chapter 4731.

of the Revised Code to practice podiatric medicine 187 and surgery.

188(X) Sub."Dentist" means an individual who is licensed to practice dentistry under Chapter 4715.

H.

B.

No.

52 Page 8 As Passed by the House (X) "Dentist" means an individual who is licensed to 189 practice dentistry under Chapter 4715.

190 Sec.

A certified registered nurse anesthetist, 191 clinical nurse specialist, certified nurse-midwife, or certified 192 nurse practitioner, clinical nurse specialist, or certified 193 registered nurse anesthetist may provide to individuals and 194 groups nursing care that requires knowledge and skill obtained 195 from advanced formal education and clinical experience.

In this 196 capacity as an advanced practice registered nurse, a certified 197 nurse-midwife is subject to division (A) of this section, a 198 certified registered nurse anesthetist is subject to division 199 (B) of this section, a certified nurse practitioner is subject 200 to division (C) (B) of this section, and a clinical nurse 201 specialist is subject to division (D) (C) of this section, and a 202 certified registered nurse anesthetist is subject to division 203 (D) of this section and section 4723.433 of the Revised Code.

204 (A) A nurse authorized to practice as a certified nurse-nurse-midwife, 205 midwife, in collaboration with one or more physicians, may 206 provide the management of preventive services and those primary 207 care services necessary to provide health care to women 208 antepartally, intrapartally, postpartally, and gynecologically, 209 consistent with the nurse's education and certification, and in 210 accordance with rules adopted by the board of nursing.

211 No certified nurse-midwife may perform version, deliver 212 breech or face presentation, use forceps, do any obstetric 213 operation, or treat any other abnormal condition, except in 214 emergencies.

Division (A) of this section does not prohibit a 215 certified nurse-midwife from performing episiotomies or normal 216 vaginal deliveries, or repairing vaginal tears.

A certified 217 nurse-midwife may, in collaboration with one or more physicians, 218prescribe drugs and therapeutic devices in accordance Sub.

52 Page136th 9G.A. As Passed by the House prescribe drugs and therapeutic devices in accordance with 219 section 4723.481 of the Revised Code.

220 (B) A nurse authorized to practice as a certified 221 registered nurse anesthetist, consistent with thesection nurse's4723.481 222of education and certification and in accordance with rules adopted 223 by the board,Revised mayCode. do the following:

224(B) (1)A Withnurse supervisionauthorized andto inpractice theas immediatea presencecertified ofregistered anurse 225anesthetist, physician,consistent podiatrist,with orthe dentist,nurse's administereducation anesthesiaand certification and 226in performaccordance anesthesiawith induction,rules maintenance,adopted andby emergence;the board, may do the following:

227(1) (2) With supervision,supervision obtainand informedin consentthe forimmediate 228presence anesthesiaof carea andphysician, performpodiatrist, preanestheticor preparationdentist, andadminister 229anesthesia evaluation, postanesthetic preparation and evaluation,perform 230anesthesia postanesthesiainduction, care,maintenance, and,and subjectemergence; to section 4723.433 of the 231 Revised Code, clinical support functions;

232(2) (3) With supervisionsupervision, andobtain ininformed accordanceconsent withfor sectionanesthesia 233care 4723.434and ofperform thepreanesthetic Revisedpreparation Code,and engageevaluation, inpostanesthetic thepreparation activitiesand describedevaluation, 234postanesthesia incare, divisionand, (A)subject to section 4723.433 of thatthe section.Revised Code, clinical support functions;

235(3) TheWith physician,supervision podiatrist,and orin dentistaccordance supervisingwith asection 2364723.434 certifiedof registeredthe nurseRevised anesthetistCode, mustengage bein activelythe engagedactivities 237described in practicedivision in(A) thisof state.that section.

WhenThe physician, podiatrist, or dentist supervising a certified registered nurse 238 anesthetist ismust supervisedbe byactively aengaged podiatrist,in the nurse's scope of 239 practice isin limitedthis tostate. the anesthesia procedures that the 240 podiatrist has the authority under section 4731.51 of the 241 Revised Code to perform.

AWhen a certified registered nurse 242 anesthetist mayis notsupervised administerby generala anesthesiapodiatrist, under the 243nurse's supervisionscope of apractice is limited to the anesthesia procedures that the podiatrist inhas athe podiatrist'sauthority office.under section 4731.51 of the Revised Code to perform.

WhenA a 244 certified registered nurse anesthetist ismay supervisednot byadminister ageneral 245anesthesia dentist,under the nurse'ssupervision scope of practicea ispodiatrist limitedin toa thepodiatrist's 246office. anesthesia procedures that the dentist has the authority under 247 Sub.

H.When a certified registered nurse anesthetist is supervised by a dentist, the nurse's scope of practice is limited to the anesthesia procedures that the dentist has the authority under Chapter 4715.

B.

No.

52 Page 10 As Passed by the House Chapter 4715.

248 (C) A nurse authorized to practice as a certified nurse 249 practitioner, in collaboration with one or more physicians or 250 podiatrists, may provide preventive and primary care services, 251 provide services for acute illnesses, and evaluate and promote 252 patient wellness within the nurse's nursing specialty, 253 consistent with the nurse's education and certification, and in 254 accordance with rules adopted by the board of nursing.

A 255 certified nurse practitioner may, in collaboration with one or 256 more physicians or podiatrists, prescribe drugs and therapeutic 257 devices in accordance with section 4723.481 of the Revised Code.

258 When a certified nurse practitioner is collaborating with 259 a podiatrist, the nurse's scope of practice is limited to the 260 procedures that the podiatrist has the authority under section 261 4731.51 of the Revised Code to perform.

262 (D) (C) A nurse authorized to practice as a clinical nurse 263 specialist, in collaboration with one or more physicians or 264 podiatrists, may provide and manage the care of individuals and 265 groups with complex health problems and provide health care 266 services that promote, improve, and manage health care within 267 the nurse's nursing specialty, consistent with the nurse's 268 education and in accordance with rules adopted by the board of 269 nursing.

A clinical nurse specialist may, in collaboration with 270 one or more physicians or podiatrists, prescribe drugs and 271 therapeutic devices in accordance with section 4723.481 of the 272 Revised Code.

273 When a clinical nurse specialist is collaborating with a 274 podiatrist, the nurse's scope of practice is limited to the 275 procedures that the podiatrist has the authority under section 276 4731.51 of the RevisedSub. Code to perform.

277 Sub.

52 Page136th 11G.A. As Passed by the House (D) A certified registered nurse anesthetist, in 278 collaboration with a physician, podiatrist, or dentist actively 279 engaged in practice in this state, and with a verbal or written 280 request consistent with division (L) of section 4723.01 of the 281 Revised Code, may perform the following patient care activities, 282 in accordance with the nurse's education and certification, 283 rules adopted by the board of nursing, and policies established 284 and privileges delineated by the health care facility where the 285 nurse and collaborating physician, podiatrist, or dentist 286 practice:

287Revised (1)Code Obtainingto informedperform. consent for anesthesia care and 288 performing preanesthetic preparation and evaluation;

289(D) (2)A Administeringcertified anesthesia,registered nurse anesthetist, in collaboration with a physician, podiatrist, or dentist actively engaged in practice in this state, and with a verbal or written request consistent with division (L) of section 4723.01 of the Revised Code, may perform the following patient care activities, in accordance with the nurse's education and certification, rules adopted by performingthe anesthesiaboard 290of induction,nursing, maintenance,and policies established and emergence;privileges delineated by the health care facility where the nurse and collaborating physician, podiatrist, or dentist practice:

291(1) (3)Obtaining Performinginformed epiduralconsent orfor spinalanesthesia anestheticcare procedures;and performing preanesthetic preparation and evaluation;

292(2) (4)Administering Performinganesthesia, postanestheticby preparationperforming andanesthesia evaluationinduction, 293maintenance, and providingemergence; postanesthesia care;

294(3) (5) Performing clinicalepidural supportor functions;spinal anesthetic procedures;

295(4) (6)Performing Aspostanesthetic necessarypreparation for patient management and care,evaluation 296 selecting, ordering, and administeringproviding treatments,postanesthesia drugs,care; and 297 intravenous fluids for conditions related to either the 298 administration of anesthesia or the performance of clinical 299 support functions;

300(5) (7) Performing and documenting evaluations and 301 assessments, which may include ordering and evaluating one or 302 more diagnostic tests for conditions related to the 303 administration of anesthesia or the performance of clinical 304 support functions;

305(6) Sub.As necessary for patient management and care, selecting, ordering, and administering treatments, drugs, and intravenous fluids for conditions related to either the administration of anesthesia or the performance of clinical support functions;

H.(7) Performing and documenting evaluations and assessments, which may include ordering and evaluating one or more diagnostic tests for conditions related to the administration of anesthesia or the performance of clinical support functions;

B.(8) Directing a registered nurse, licensed practical nurse, or respiratory therapist to do the following, but only if the nurse or therapist is authorized by law to do so:

No.(a) Provide supportive care, with such care to include monitoring vital signs, conducting electrocardiograms, and administering intravenous fluids;

52(b) PageAdminister 12treatments, Asdrugs, Passedand byintravenous thefluids Housefor (8)conditions Directingrelated a registered nurse, licensed practical 306 nurse, or respiratory therapist to doeither the following,administration butof onlyanesthesia ifor 307 the nurseperformance orof therapistclinical issupport authorizedfunctions. by law to do so:

308When (a)a Providecertified supportiveregistered care,nurse anesthetist collaborates with sucha caredentist, the nurse's scope of practice is limited to includethe 309anesthesia monitoringprocedures vitalthat signs,the conductingdentist electrocardiograms,has andthe 310authority administeringto intravenousperform fluids;under the dentist's conscious sedation or general anesthesia permit issued under Chapter 4715.

311 (b) Administer treatments, drugs, and intravenous fluids 312 for conditions related to either the administration of 313 anesthesia or the performanceRevised ofCode. clinical support functions.

314A When a certified registered nurse anesthetist collaboratesmay 315perform withthe ainduction, dentist,maintenance, theand nurse'semergence scope of practicegeneral isanesthesia limitedonly toif the 316collaborating anesthesiaphysician, procedurespodiatrist, thator the dentist hasis thepresent authorityat to 317 perform under the dentist'shealth consciouscare sedationfacility orduring generalsuch 318induction, anesthesiamaintenance, permitand issuedemergence. under Chapter 4715.

A certified registered nurse anesthetist shall not prescribe a drug for use outside of the Revisedhealth 319care Code.facility where the nurse practices.

320Sec. A certified registered nurse anesthetist may perform the 321 induction, maintenance, and emergence of general anesthesia only 322 if the collaborating physician, podiatrist, or dentist is 323 present at the health care facility during such induction, 324 maintenance, and emergence.

325 A certified registered nurse anesthetist shall not 326 prescribe a drug for use outside of the health care facility 327 where the nurse practices.

328 Sec.

(A) An advanced practice registered nurse 329 who is designated as a clinical nurse specialist, certified 330 nurse-midwife, or certified nurse practitioner shall cooperate 331 with the state medical board in any investigation the board 332 conducts with respect to a physician or podiatrist who 333Sub. collaborates with the nurse.

The nurse shall cooperate with the 334 Sub.

52 Page136th 13G.A. As Passed by the House board in any investigation the board conducts with respect to 335 the unauthorized practice of medicine by the nurse.

336collaborates (B) An advanced practice registered nurse who is 337 designated as a certified registered nurse anesthetist shall 338 cooperate with the statenurse. medical board or state dental board in 339 any investigation either board conducts conducted by such board 340 with respect to a collaborating physician, podiatrist, or 341 dentist who permits requests that the nurse to practice with the 342 supervision of that physician, podiatrist, or dentistperform 343 patient care activities as described in division (D) of section 344 4723.43 of the Revised Code.

The 345 The nurse also shall cooperate with either the state 346 medical board or state dental board in any investigation itthe 347board conducts with respect to the unauthorized practice of medicine 348 or dentistry by the nurse.

349(B) Sec.An advanced practice registered nurse who is designated as a certified registered nurse anesthetist shall cooperate with the state medical board or state dental board in any investigation either board conducts conducted by such board with respect to a collaborating physician, podiatrist, or dentist who permits requests that the nurse to practice with the supervision of that physician, podiatrist, or dentistperform patient care activities as described in division (D) of section 4723.43 of the Revised Code.

The The nurse also shall cooperate with either the state medical board or state dental board in any investigation it conducts with respect to the unauthorized practice of medicine or dentistry by the nurse.

Sec.

(A) A certified registered nurse 350 anesthetist shall not engage in one or more of the patient care 351 activities described in division (D) of section 4723.43 of the 352 Revised Code if either of the following determines that it is 353 not in the patient's best interest for the nurse to perform such 354 an activity or activities:

355 (1) The nurse's collaborating physician, podiatrist, or 356 dentist;

357 (2) The health care facility where the nurse and 358 physician, podiatrist, or dentist practice.

359 If a collaborating physician, podiatrist, or dentist or 360 health care facility makes such a determination, the patient's 361 medical or electronic health record shall indicate that the 362 nurse is prohibited from performing the activity or activities.

363(B) Sub.If a certified registered nurse anesthetist performs one or more of the activities described in division (D) of section 4723.43 of the Revised Code, the nurse shall so indicate in the patient's medical or electronic health record.

H.(C) This section does not prohibit a certified registered nurse anesthetist from implementing a verbal order issued by a collaborating physician, podiatrist, or dentist.

B.Sec.

No.

52 Page 14 As Passed by the House (B) If a certified registered nurse anesthetist performs 364 one or more of the activities described in division (D) of 365 section 4723.43 of the Revised Code, the nurse shall so indicate 366 in the patient's medical or electronic health record.

367 (C) This section does not prohibit a certified registered 368 nurse anesthetist from implementing a verbal order issued by a 369 collaborating physician, podiatrist, or dentist.

370 Sec.

(A) Prior to administering anesthesia to a 371 patient or performing an epidural or spinal anesthetic procedure 372 for a patient in a health care facility, the health care 373 facility shall notify the patient or patient's representative, 374 both verbally and in writing, that a certified registered nurse 375 anesthetist, physician, podiatrist, or dentist will administer 376 the patient's anesthesia or perform the patient's epidural or 377 spinal anesthetic procedure.

378 (B) Division (A) of this section does not authorize either 379 of the following:

380 (1) A dentist to administer anesthesia in a manner that 381 exceeds the dentist's authority under a conscious sedation or 382 general anesthesia permit issued under Chapter 4715.

of the 383 Revised Code;

384 (2) A podiatrist to administer anesthesia in a manner that 385 exceeds the podiatrist's scope of practice as described in 386 section 4731.51 of the Revised Code.

387 Sec.

388 (A) "Pharmacy," except when used in a context that refers 389 to the practice of pharmacy, means any area, room, rooms, place 390 of business, department, or portion of any of the foregoing 391Sub. where the practice of pharmacy is conducted.

392 Sub.

52 Page136th 15G.A. As Passed by the House (B) "Practice of pharmacy" means providing pharmacist care 393 requiring specialized knowledge, judgment, and skill derived 394 from the principles of biological, chemical, behavioral, social, 395 pharmaceutical, and clinical sciences.

Aswhere usedthe inpractice thisof division,pharmacy 396is "pharmacistconducted. care" includes the following:

397(B) (1)"Practice Interpretingof prescriptions;pharmacy" means providing pharmacist care requiring specialized knowledge, judgment, and skill derived from the principles of biological, chemical, behavioral, social, pharmaceutical, and clinical sciences.

398As (2)used Dispensingin drugsthis anddivision, drug"pharmacist therapycare" relatedincludes devices;the following:

399(1) (3)Interpreting Compoundingprescriptions; drugs;

400(2) (4)Dispensing Counselingdrugs individualsand with regard to their drug 401 therapy, recommending drug therapy related devices,devices; and 402 assisting in the selection of drugs and appliances for treatment 403 of common diseases and injuries and providing instruction in the 404 proper use of the drugs and appliances;

405(3) (5)Compounding Performing drug regimen reviews with individuals by 406 discussing all of the drugs that the individual is taking and 407 explaining the interactions of the drugs;

408(4) (6)Counseling Performingindividuals drugwith utilizationregard reviewsto withtheir licenseddrug 409therapy, healthrecommending professionalsdrug authorizedtherapy torelated prescribedevices, drugsand whenassisting in the 410selection pharmacistof determinesdrugs thatand anappliances individualfor withtreatment aof prescriptioncommon hasdiseases 411and ainjuries drugand regimenproviding thatinstruction warrantsin additionalthe discussionproper withuse of the 412drugs prescriber;and appliances;

413(5) (7)Performing Advisingdrug anregimen individualreviews andwith theindividuals healthby carediscussing 414all professionalsof treatingthe andrugs that the individual withis regardtaking toand explaining the 415interactions individual'sof drugthe therapy;drugs;

416(6) (8)Performing Actingdrug pursuantutilization reviews with licensed health professionals authorized to aprescribe consultdrugs agreement,when ifthe pharmacist determines that an 417individual agreementwith a prescription has beena established;drug regimen that warrants additional discussion with the prescriber;

418(7) (9)Advising Engagingan inindividual and the administrationhealth ofcare immunizationsprofessionals totreating thean 419individual extentwith authorizedregard byto section 4729.41 of the Revisedindividual's Code;drug therapy;

420(8) Sub.Acting pursuant to a consult agreement, if an agreement has been established;

(9) Engaging in the administration of immunizations to the extent authorized by section 4729.41 of the Revised Code;

(10) Engaging in the administration of drugs to the extent authorized by section 4729.45 of the Revised Code.

(C) "Compounding" means the preparation, mixing, assembling, packaging, and labeling of one or more drugs in any of the following circumstances:

(1) Pursuant to a prescription issued by a licensed health professional authorized to prescribe drugs;

(2) Pursuant to the modification of a prescription made in accordance with a consult agreement;

(3) As an incident to research, teaching activities, or chemical analysis;

(4) In anticipation of orders for drugs pursuant to prescriptions, based on routine, regularly observed dispensing patterns;

(5) Pursuant to a request made by a licensed health professional authorized to prescribe drugs for a drug that is to be used by the professional for the purpose of direct administration to patients in the course of the professional's practice, if all of the following apply:

(a) At the time the request is made, the drug is not commercially available regardless of the reason that the drug is not available, including the absence of a manufacturer for the drug or the lack of a readily available supply of the drug from a manufacturer.

Sub.

52 Page136th 16G.A. As Passed by the House (10) Engaging in the administration of drugs to the extent 421 authorized by section 4729.45 of the Revised Code.

422(b) (C)A "Compounding"limited meansquantity of the preparation,drug mixing,is 423compounded assembling, packaging, and labelingprovided ofto one or more drugs in any 424 of the followingprofessional. circumstances:

425(c) (1)The Pursuantdrug is compounded and provided to athe prescriptionprofessional issuedas byan aoccasional licensedexception healthto 426the professionalnormal authorizedpractice of dispensing drugs pursuant to prescribepatient-specific drugs;prescriptions.

427(D) (2)"Consult Pursuantagreement" tomeans thean modificationagreement ofthat ahas prescriptionbeen madeentered ininto 428under accordancesection with4729.39 aof consultthe agreement;Revised Code.

429(E) (3)"Drug" Asmeans: an incident to research, teaching activities, or 430 chemical analysis;

431(1) (4)Any Inarticle anticipationrecognized ofin ordersthe forUnited drugsStates pursuantpharmacopoeia and national formulary, or any supplement to 432them, prescriptions,intended basedfor onuse routine,in regularlythe observeddiagnosis, dispensingcure, 433mitigation, patterns;treatment, or prevention of disease in humans or animals;

434(2) (5)Any Pursuantother toarticle aintended request made by a licensed health 435 professional authorized to prescribe drugs for ause drugin thatthe isdiagnosis, tocure, 436mitigation, betreatment, usedor byprevention the professional for the purpose of directdisease 437 administration to patients in thehumans courseor ofanimals; the professional's 438 practice, if all of the following apply:

439(3) (a)Any Atarticle, theother timethan thefood, requestintended isto made,affect the drugstructure isor notany 440function commercially available regardless of the reasonbody that the drug is 441 not available, including the absence of ahumans manufacturer for the 442 drug or theanimals; lack of a readily available supply of the drug from 443 a manufacturer.

444(4) (b)Any Aarticle limitedintended quantityfor use as a component of theany drugarticle isspecified compoundedin anddivision 445(E)(1), provided(2), toor the(3) professional.of this section;

446but (c)does Thenot druginclude isdevices compoundedor andtheir providedcomponents, toparts, theor 447accessories. professional as an occasional exception to the normal practice 448 Sub.

H."Drug" does not include "hemp" or a "hemp product" as those terms are defined in section 928.01 of the Revised Code.

B.(F) "Dangerous drug" means any of the following:

No.(1) Any drug to which either of the following applies:

52(a) PageUnder 17 As Passed by the House"Federal ofFood, dispensingDrug, drugsand pursuantCosmetic toAct," patient-specific52 prescriptions.Stat.

449 (D) "Consult agreement" means an agreement that has been 450 entered into under section 4729.39 of the Revised Code.

451 (E) "Drug" means:

452 (1) Any article recognized in the United States 453 pharmacopoeia and national formulary, or any supplement to them, 454 intended for use in the diagnosis, cure, mitigation, treatment, 455 or prevention of disease in humans or animals;

456 (2) Any other article intended for use in the diagnosis, 457 cure, mitigation, treatment, or prevention of disease in humans 458 or animals;

459 (3) Any article, other than food, intended to affect the 460 structure or any function of the body of humans or animals;

461 (4) Any article intended for use as a component of any 462 article specified in division (E)(1), (2), or (3) of this 463 section;

but does not include devices or their components, 464 parts, or accessories.

465 "Drug" does not include "hemp" or a "hemp product" as 466 those terms are defined in section 928.01 of the Revised Code.

467 (F) "Dangerous drug" means any of the following:

468 (1) Any drug to which either of the following applies:

469 (a) Under the "Federal Food, Drug, and Cosmetic Act," 52 470 Stat.

301, as amended, the drug is 471 required to bear a label containing the legend "Caution:

Federal 472 law prohibits dispensing without prescription" or "Caution:

473 Federal law restricts this drug to use by or on the order of a 474 licensed veterinarian" or any similar restrictive statement, or 475the Sub.drug may be dispensed only upon a prescription;

H.(b) Under Chapter 3715.

B.

No.

52 Page 18 As Passed by the House the drug may be dispensed only upon a prescription;

476 (b) Under Chapter 3715.

of the Revised Code, the 477 drug may be dispensed only upon a prescription.

478 (2) Any drug that contains a schedule V controlled 479 substance and that is exempt from Chapter 3719.

of the Revised 480 Code or to which that chapter does not apply;

481 (3) Any drug intended for administration by injection into 482 the human body other than through a natural orifice of the human 483 body;

484 (4) Any drug that is a biological product, as defined in 485 section 3715.01 of the Revised Code.

486 (G) "Federal drug abuse control laws" has the same meaning 487 as in section 3719.01 of the Revised Code.

488 (H) "Prescription" means all of the following:

489 (1) A written, electronic, or oral order for drugs or 490 combinations or mixtures of drugs to be used by a particular 491 individual or for treating a particular animal, issued by a 492 licensed health professional authorized to prescribe drugs;

493 (2) For purposes of sections 4723.4810, 4729.282, 494 4730.432, and 4731.93 of the Revised Code,Sub. a written, 495 electronic, or oral order for a drug to treat chlamydia, 496 gonorrhea, or trichomoniasis issued to and in the name of a 497 patient who is not the intended user of the drug but is the 498 sexual partner of the intended user;

499 (3) For purposes of sections 3313.7110, 3313.7111, 500 3314.143, 3326.28, 3328.29, 4723.483, 4729.88, 4730.433, 501 4731.96, and 5101.76 of the Revised Code, a written, electronic, 502 or oral order for an epinephrine autoinjector issued to and in 503 Sub.

52 Page136th 19G.A. As Passed by the House the name of a school, school district, or camp;

504Code, (4)a Forwritten, purposeselectronic, or oral order for a drug to treat chlamydia, gonorrhea, or trichomoniasis issued to and in the name of Chaptera 3728.patient who is not the intended user of the drug but is the sexual partner of the intended user;

and(3) For purposes of sections 4723.483,3313.7110, 5053313.7111, 3314.143, 3326.28, 3328.29, 4723.483, 4729.88, 4730.433, 4731.96, and 4731.965101.76 of the Revised Code, a written, 506 electronic, or oral order for an epinephrine autoinjector issued 507 to and in the name of a qualifiedschool, entity,school asdistrict, definedor incamp; section 508 3728.01 of the Revised Code;

509(4) (5) For purposes of sectionsChapter 3313.7115,3728. 3313.7116, 510 3314.147, 3326.60, 3328.38, 4723.4811, 4730.437, 4731.92, and 511 5101.78 of the Revised Code, a written, electronic, or oral 512 order for injectable or nasally administered glucagon in the 513 name of a school, school district, or camp.

514and (I)sections "Licensed4723.483, health4729.88, professional4730.433, authorizedand to4731.96 prescribeof 515the drugs"Revised orCode, "prescriber"a meanswritten, anelectronic, individualor whooral isorder authorizedfor byan 516epinephrine lawautoinjector issued to prescribeand drugsin orthe dangerousname drugsof ora drugqualified therapyentity, 517as relateddefined devices in thesection course3728.01 of the individual'sRevised professionalCode; 518 practice, including only the following:

519(5) (1)For Apurposes dentistof licensedsections under3313.7115, Chapter3313.7116, 4715.3314.147, 3326.60, 3328.38, 4723.4811, 4730.437, 4731.92, and 5101.78 of the Revised Code, a written, electronic, or oral order for injectable or nasally administered glucagon in the name of a school, school district, or camp.

(I) "Licensed health professional authorized to prescribe drugs" or "prescriber" means an individual who is authorized by law to prescribe drugs or dangerous drugs or drug therapy related devices in the course of the Revisedindividual's 520professional Code;practice, including only the following:

521(1) (2) A clinicaldentist nurselicensed specialist, certified nurse-midwife, 522 or certified nurse practitioner who holds a current, valid 523 license issued under Chapter 4723.4715.

of the Revised CodeCode; to 524 practice nursing as an advanced practice registered nurse;

525(2) (3) A clinical nurse specialist, certified registerednurse-midwife, or certified nurse anesthetistpractitioner who holds a 526 current, valid license issued under Chapter 4723.

of the Revised 527 Code to practice nursing as an advanced practice registered 528nurse; nurse, but only to the extent of the nurse's authority under 529 sections section 4723.43 and 4723.434 of the Revised Code;

530(3) (4)A Ancertified optometristregistered licensednurse anesthetist who holds a current, valid license issued under Chapter 4725.4723.

of the 531 Revised Code to practice optometry;nursing as an advanced practice registered nurse, but only to the extent of the nurse's authority under sections section 4723.43 and 4723.434 of the Revised Code;

532(4) Sub.An optometrist licensed under Chapter 4725.

of the Revised Code to practice optometry;

(5) A physician authorized under Chapter 4731.

of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery;

(6) A physician assistant who holds a license to practice as a physician assistant issued under Chapter 4730.

of the Revised Code, holds a valid prescriber number issued by the state medical board, and has been granted physician-delegated prescriptive authority;

(7) A veterinarian licensed under Chapter 4741.

of the Revised Code;

(8) A certified mental health assistant licensed under Chapter 4772.

of the Revised Code who has been granted physician-delegated prescriptive authority by the physician supervising the certified mental health assistant.

(J) "Sale" or "sell" includes any transaction made by any person, whether as principal proprietor, agent, or employee, to do or offer to do any of the following:

deliver, distribute, broker, exchange, gift or otherwise give away, or transfer, whether the transfer is by passage of title, physical movement, or both.

(K) "Wholesale sale" and "sale at wholesale" mean any sale in which the purpose of the Sub.

52 Page136th 20G.A. As Passed by the House (5) A physician authorized under Chapter 4731.

ofpurchaser theis 533 Revised Code to practiceresell medicinethe andarticle surgery,purchased osteopathic 534 medicine and surgery, or podiatricreceived medicineby andthe surgery;purchaser.

535(L) (6)"Retail Asale" physicianand assistant"sale whoat holdsretail" amean licenseany tosale practiceother 536than as a physicianwholesale assistantsale issuedor undersale Chapterat 4730.wholesale.

of(M) the"Retail 537seller" Revisedmeans Code,any holdsperson athat validsells prescriberany numberdangerous issueddrug byto theconsumers 538without stateassuming medicalcontrol board,over and hasresponsibility beenfor grantedits physician-delegatedadministration. 539 prescriptive authority;

540Mere (7)advice Aor veterinarianinstructions licensedregarding underadministration Chapterdo 4741.not constitute control or establish responsibility.

of(N) "Price information" means the 541price Revisedcharged Code;for a prescription for a particular drug product and, in an easily understandable manner, all of the following:

542(1) (8)The Aproprietary certifiedname mentalof healththe assistantdrug licensedproduct; under 543 Chapter 4772.

of(2) theThe Revisedestablished Code(generic) whoname hasof been granted 544 physician-delegated prescriptive authority by the physiciandrug 545product; supervising the certified mental health assistant.

546(3) (J)The "Sale"strength orof "sell"the includesdrug anyproduct transactionif madethe byproduct anycontains 547a person,single whetheractive asingredient principalor proprietor,if agent,the ordrug employee,product tocontains 548more dothan orone offeractive toingredient doand anya ofrelevant strength can be associated with the following:product without indicating each active ingredient.

deliver,The distribute,established 549name broker,and exchange,quantity giftof oreach otherwiseactive giveingredient away,are orrequired transfer,if 550such whethera therelevant transferstrength iscannot bybe passageso ofassociated title,with physicala movement,drug 551product orcontaining both.more than one ingredient.

552(4) (K)The "Wholesaledosage sale"form; and "sale at wholesale" mean any sale 553 in which the purpose of the purchaser is to resell the article 554 purchased or received by the purchaser.

555(5) (L)The "Retailprice sale"charged andfor "sale at retail" mean any sale other 556 than a wholesalespecific salequantity orof salethe atdrug wholesale.product.

557The (M)stated "Retailprice seller"shall meansinclude anyall personcharges thatto sellsthe anyconsumer, 558including, dangerousbut not limited to, the cost of the drug toproduct, consumersprofessional withoutfees, assuminghandling controlfees, overif any, and 559a responsibilitystatement foridentifying itsprofessional administration.services routinely furnished by the pharmacy.

MereAny advicemailing orfees 560and instructionsdelivery regardingfees administrationmay dobe notstated constituteseparately controlwithout 561repetition. Sub.

The information shall not be false or misleading.

(O) "Wholesale distributor of dangerous drugs" or "wholesale distributor" means a person engaged in the sale of dangerous drugs at wholesale and includes any agent or employee of such a person authorized by the person to engage in the sale of dangerous drugs at wholesale.

(P) "Manufacturer of dangerous drugs" or "manufacturer" means a person, other than a pharmacist or prescriber, who manufactures dangerous drugs and who is engaged in the sale of those dangerous drugs.

(Q) "Terminal distributor of dangerous drugs" or "terminal distributor" means a person who is engaged in the sale of dangerous drugs at retail, or any person, other than a manufacturer, repackager, outsourcing facility, third-party logistics provider, wholesale distributor, or pharmacist, who has possession, custody, or control of dangerous drugs for any purpose other than for that person's own use and consumption.

"Terminal distributor" includes pharmacies, hospitals, nursing homes, and laboratories and all other persons who procure dangerous drugs for sale or other distribution by or under the supervision of a pharmacist, licensed health professional authorized to prescribe drugs, or other person authorized by the state board of pharmacy.

(R) "Promote to the public" means disseminating a representation to the public in any manner or by any means, other than by labeling, for the purpose of inducing, or that is likely to induce, directly or indirectly, the purchase of a dangerous drug at retail.

Sub.

52 Page136th 21G.A. As Passed by the House or establish responsibility.

562(S) (N)"Person" "Priceincludes information"any meansindividual, thepartnership, priceassociation, chargedlimited forliability acompany, 563or prescriptioncorporation, forthe astate, particularany drugpolitical productsubdivision and,of inthe anstate, easilyand 564any understandabledistrict, manner,department, allor agency of the following:state or its political subdivisions.

565(T)(1) (1)"Animal Theshelter" proprietarymeans namea offacility theoperated drugby product;a humane society or any society organized under Chapter 1717.

566of (2)the TheRevised establishedCode (generic)or namea ofdog thepound drugoperated product;pursuant to Chapter 955.

567 (3) The strength of the drug product if the product 568 contains a single active ingredient or if the drug product 569 contains more than one active ingredient and a relevant strength 570 can be associated with the product without indicating each 571 active ingredient.

The established name and quantity of each 572 active ingredient are required if such a relevant strength 573 cannot be so associated with a drug product containing more than 574 one ingredient.

575 (4) The dosage form;

576 (5) The price charged for a specific quantity of the drug 577 product.

The stated price shall include all charges to the 578 consumer, including, but not limited to, the cost of the drug 579 product, professional fees, handling fees, if any, and a 580 statement identifying professional services routinely furnished 581 by the pharmacy.

Any mailing fees and delivery fees may be 582 stated separately without repetition.

The information shall not 583 be false or misleading.

584 (O) "Wholesale distributor of dangerous drugs" or 585 "wholesale distributor" means a person engaged in the sale of 586 dangerous drugs at wholesale and includes any agent or employee 587 of such a person authorized by the person to engage in the sale 588 of dangerous drugs at wholesale.

589 Sub.

H.

B.

No.

52 Page 22 As Passed by the House (P) "Manufacturer of dangerous drugs" or "manufacturer" 590 means a person, other than a pharmacist or prescriber, who 591 manufactures dangerous drugs and who is engaged in the sale of 592 those dangerous drugs.

593 (Q) "Terminal distributor of dangerous drugs" or "terminal 594 distributor" means a person who is engaged in the sale of 595 dangerous drugs at retail, or any person, other than a 596 manufacturer, repackager, outsourcing facility, third-party 597 logistics provider, wholesale distributor, or pharmacist, who 598 has possession, custody, or control of dangerous drugs for any 599 purpose other than for that person's own use and consumption.

600 "Terminal distributor" includes pharmacies, hospitals, nursing 601 homes, and laboratories and all other persons who procure 602 dangerous drugs for sale or other distribution by or under the 603 supervision of a pharmacist, licensed health professional 604 authorized to prescribe drugs, or other person authorized by the 605 state board of pharmacy.

606 (R) "Promote to the public" means disseminating a 607 representation to the public in any manner or by any means, 608 other than by labeling, for the purpose of inducing, or that is 609 likely to induce, directly or indirectly, the purchase of a 610 dangerous drug at retail.

611 (S) "Person" includes any individual, partnership, 612 association, limited liability company, or corporation, the 613 state, any political subdivision of the state, and any district, 614 department, or agency of the state or its political 615 subdivisions.

616 (T)(1) "Animal shelter" means a facility operated by a 617 humane society or any society organized under Chapter 1717.

of 618 the Revised Code or a dog pound operated pursuant to Chapter 619 Sub.

H.

B.

No.

52 Page 23 As Passed by the House 955.

620 (2) "County dog warden" means a dog warden or deputy dog 621 warden appointed or employed under section 955.12 of the Revised 622 Code.

623 (U) "Food" has the same meaning as in section 3715.01 of 624 the Revised Code.

625 (V) "Pain management clinic" has the same meaning as in 626 section 4731.054 of the Revised Code.

627 (W) "Investigational drug or product" means a drug or 628 product that has successfully completed phase one of the United 629 States food and drug administration clinical trials and remains 630 under clinical trial, but has not been approved for general use 631 by the United States food and drug administration.

632 "Investigational drug or product" does not include controlled 633 substances in schedule I, as defined in section 3719.01 of the 634 Revised Code.

635 (X) "Product," when used in reference to an 636 investigational drug or product, means a biological product, 637 other than a drug, that is made from a natural human, animal, or 638 microorganism source and is intended to treat a disease or 639 medical condition.

640 (Y) "Third-party logistics provider" means a person that 641 provides or coordinates warehousing or other logistics services 642 pertaining to dangerous drugs including distribution, on behalf 643 of a manufacturer, wholesale distributor, or terminal 644 distributor of dangerous drugs, but does not take ownership of 645 the drugs or have responsibility to direct the sale or 646 disposition of the drugs.

647 (Z) "Repackager of dangerous drugs" or "repackager" means 648a Sub.person that repacks and relabels dangerous drugs for sale or distribution.

(AA) "Outsourcing facility" means a facility that is engaged in the compounding and sale of sterile drugs and is registered as an outsourcing facility with the United States food and drug administration.

(BB) "Laboratory" means a laboratory licensed under this chapter as a terminal distributor of dangerous drugs and entrusted to have custody of any of the following drugs and to use the drugs for scientific and clinical purposes and for purposes of instruction:

dangerous drugs that are not controlled substances, as defined in section 3719.01 of the Revised Code;

dangerous drugs that are controlled substances, as defined in that section;

and controlled substances in schedule I, as defined in that section.

(CC) "Overdose reversal drug" means both of the following:

(1) Naloxone;

(2) Any other drug that the state board of pharmacy, through rules adopted in accordance with Chapter 119.

of the Revised Code, designates as a drug that is approved by the federal food and Sub.

52 Page136th 24G.A. As Passed by the House a person that repacks and relabels dangerous drugs for sale or 649 distribution.

650drug (AA)administration "Outsourcingfor facility" means a facility that is 651 engaged in the compoundingreversal and sale of sterilea drugsknown andor issuspected 652opioid-related registeredoverdose. as an outsourcing facility with the United States 653 food and drug administration.

654Sec. (BB) "Laboratory" means a laboratory licensed under this 655 chapter as a terminal distributor of dangerous drugs and 656 entrusted to have custody of any of the following drugs and to 657 use the drugs for scientific and clinical purposes and for 658 purposes of instruction:

dangerous drugs that are not controlled 659 substances, as defined in section 3719.01 of the Revised Code;

660 dangerous drugs that are controlled substances, as defined in 661 that section;

and controlled substances in schedule I, as 662 defined in that section.

663 (CC) "Overdose reversal drug" means both of the following:

664 (1) Naloxone;

665 (2) Any other drug that the state board of pharmacy, 666 through rules adopted in accordance with Chapter 119.

of the 667 Revised Code, designates as a drug that is approved by the 668 federal food and drug administration for the reversal of a known 669 or suspected opioid-related overdose.

670 Sec.

(A) As used in this section, 671 "collaboration," "physician," and "standard care arrangement," 672 and "supervision" have the same meanings as in section 4723.01 673 of the Revised Code.

674 (B) A physician or podiatrist shall enter into a standard 675 care arrangement with each clinical nurse specialist, certified 676 nurse-midwife, or certified nurse practitioner with whom the 677physician Sub.or podiatrist is in collaboration.

The collaborating physician or podiatrist shall fulfill the responsibilities of collaboration, as specified in the arrangement and in accordance with division (A) of section 4723.431 of the Revised Code.

A copy of the standard care arrangement shall be retained on file by the nurse's employer.

Prior approval of the standard care arrangement by the state medical board is not required, but the board may periodically review it.

A physician or podiatrist who terminates collaboration with a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist before their standard care arrangement expires shall give the nurse the written or electronic notice of termination required by division (D)(1) of section 4723.431 of the Revised Code.

Nothing in this division prohibits a hospital from hiring a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner as an employee and negotiating standard care arrangements on behalf of the employee as necessary to meet the requirements of this section.

A standard care arrangement between the hospital's employee and the employee's collaborating physician is subject to approval by the medical staff and governing body of the hospital prior to implementation of the arrangement at the hospital.

(C) A physician or podiatrist shall cooperate with the board of nursing in any investigation the board conducts with respect to a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner who collaborates with the physician or podiatrist or with respect to a certified registered nurse anesthetist who practices in collaboration with the supervision of the physician or podiatrist.

Sec.

4731.35.

(A) This chapter does not apply to or prohibit in any way the administration of anesthesia by a certified registered nurse anesthetist under the direction of and in the immediate presence of an individual authorized by this chapter to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgeryan individual from practicing as a certified registered nurse anesthetist in accordance with Chapter 4723.

of the Revised Code.

(B) This chapter does not prohibit an individual from practicing as an anesthesiologist assistant in accordance with Chapter 4760.

of the Revised Code.

Sec.

4731.513.

In administering and enforcing sections 4731.51 to 4731.61 of the Revised Code and in adopting rules under section 4731.05 of the Revised Code, the state medical board shall not prohibit a podiatrist who practices other than in a hospital or college of podiatric medicine and surgery as described in section 4731.51 of the Revised Code from collaborating with a certified registered nurse anesthetist.

Sub.

52 Page136th 25G.A. As Passed by the House physician or podiatrist is in collaboration.

678For Thepurposes collaboratingof physicianthis orsection, podiatrist"certified shallregistered fulfillnurse 679anesthetist" theand responsibilities"collaborating" ofhave collaboration, as specified in the 680same arrangementmeanings andas in accordance with division (A) of section 6814723.01 4723.431 of the Revised Code.

ASec. copy of the standard care 682 arrangement shall be retained on file by the nurse's employer.

6834761.17. Prior approval of the standard care arrangement by the state 684 medical board is not required, but the board may periodically 685 review it.

686All Aof physicianthe orfollowing podiatristapply whoto terminatesthe collaborationpractice 687of withrespiratory a certified nurse-midwife, certified nurse practitioner, or 688 clinical nurse specialist before their standard care arrangementby 689a expiresperson shallwho giveholds thea nurselicense the written or electroniclimited noticepermit ofissued 690under terminationthis requiredchapter: by division (D)(1) of section 4723.431 of 691 the Revised Code.

692(A) NothingThe inperson thisshall divisionpractice prohibitsonly apursuant hospitalto from hiring 693 a clinicalprescription nurse specialist, certified nurse-midwife, or 694other certifiedorder nursefor practitionerrespiratory as an employee and negotiating 695 standard care arrangementsissued onby behalfany of the employeefollowing: as 696 necessary to meet the requirements of this section.

(1) A standardphysician; 697 care arrangement between the hospital's employee and the 698 employee's collaborating physician is subject to approval by the 699 medical staff and governing body of the hospital prior to 700 implementation of the arrangement at the hospital.

701(2) (C) A physician or podiatrist shall cooperate with the 702 board of nursing in any investigation the board conducts with 703 respect to a clinical nurse specialist, certified nurse-midwife, 704 or certified nurse practitioner who collaboratesholds with the 705 physician or podiatrist or with respect to a certifiedcurrent, 706valid registeredlicense nurseissued anesthetistunder whoChapter practices4723. in collaboration with 707 Sub.

of the Revised Code to practice nursing as an advanced practice registered nurse and has entered into a standard care arrangement with a physician;

(3) A certified registered nurse anesthetist who holds a current, valid license issued under Chapter 4723.

of the Revised Code to practice nursing as an advanced practice registered nurse and acts in compliance with sections section 4723.43, 4723.433, and 4723.434 of the Revised Code;

(4) A physician assistant who holds a valid prescriber number issued by the state medical board, has been granted physician-delegated prescriptive authority, and has entered into a supervision agreement that allows the physician assistant to prescribe or order respiratory care services.

(B) The person shall practice only under the supervision of any of the following:

(1) A physician;

(2) A certified nurse practitioner, certified nurse-midwife, or clinical nurse specialist;

(3) A physician assistant who is authorized to prescribe or order respiratory care services as provided in division (A)(4) of this section.

(C)(1) When practicing under the prescription or order of a certified nurse practitioner, certified nurse midwife, or clinical nurse specialist or under the supervision of such a nurse, the person's administration of medication that requires a prescription is limited to the drugs that the nurse is authorized to prescribe pursuant to section 4723.481 of the Revised Code.

(2) When practicing under the order of a certified registered nurse anesthetist, the person's administration of medication is limited to the drugs that the nurse is authorized to order or direct the person to administer, as provided in sections section 4723.43, 4723.433, and 4723.434 of the Revised Code.

(3) When practicing under the prescription or order of a physician assistant or under the supervision of a physician assistant, the person's administration of medication that requires a prescription is limited to the drugs that the physician assistant is authorized to prescribe pursuant to the physician assistant's physician-delegated prescriptive authority.

SECTION 2.

That existing sections 4723.01, 4723.43, 4723.432, 4729.01, 4731.27, 4731.35, and 4761.17 of the Revised Code are hereby repealed.

Sub.

52 Page136th 26G.A. As Passed by the House the supervision of the physician or podiatrist.

708S Sec.ECTION3.

4731.35.That sections 4723.433, 4723.434, and 4723.435 of the Revised Code are hereby repealed.

(A)Sub. This chapter does not apply to or 709 prohibit in any way the administration of anesthesia by a 710 certified registered nurse anesthetist under the direction of 711 and in the immediate presence of an individual authorized by 712 this chapter to practice medicine and surgery, osteopathic 713 medicine and surgery, or podiatric medicine and surgeryan 714 individual from practicing as a certified registered nurse 715 anesthetist in accordance with Chapter 4723.

of the Revised 716 Code.

717 (B) This chapter does not prohibit an individual from 718 practicing as an anesthesiologist assistant in accordance with 719 Chapter 4760.

of the Revised Code.

720 Sec.

4731.513.

In administering and enforcing sections 721 4731.51 to 4731.61 of the Revised Code and in adopting rules 722 under section 4731.05 of the Revised Code, the state medical 723 board shall not prohibit a podiatrist who practices other than 724 in a hospital or college of podiatric medicine and surgery as 725 described in section 4731.51 of the Revised Code from 726 collaborating with a certified registered nurse anesthetist.

727 For purposes of this section, "certified registered nurse 728 anesthetist" and "collaborating" have the same meanings as in 729 section 4723.01 of the Revised Code.

730 Sec.

4761.17.

All of the following apply to the practice 731 of respiratory care by a person who holds a license or limited 732 permit issued under this chapter:

733 (A) The person shall practice only pursuant to a 734 prescription or other order for respiratory care issued by any 735 of the following:

736 Sub.

52 Page136th 27G.A. As Passed by the House (1) A physician;

737Speaker (2)___________________ Aof clinicalthe nurseHouse specialist,of certifiedRepresentatives. nurse-midwife, 738 or certified nurse practitioner who holds a current, valid 739 license issued under Chapter 4723.

President ___________________ of the RevisedSenate. Code to 740 practice nursing as an advanced practice registered nurse and 741 has entered into a standard care arrangement with a physician;

742Passed (3)________________________, A20____ certifiedApproved registered________________________, nurse20____ anesthetistGovernor. who holds a 743 current, valid license issued under Chapter 4723.

ofSub. the Revised 744 Code to practice nursing as an advanced practice registered 745 nurse and acts in compliance with sections section 4723.43, 746 4723.433, and 4723.434 of the Revised Code;

747 (4) A physician assistant who holds a valid prescriber 748 number issued by the state medical board, has been granted 749 physician-delegated prescriptive authority, and has entered into 750 a supervision agreement that allows the physician assistant to 751 prescribe or order respiratory care services.

752 (B) The person shall practice only under the supervision 753 of any of the following:

754 (1) A physician;

755 (2) A certified nurse practitioner, certified nurse- 756 midwife, or clinical nurse specialist;

757 (3) A physician assistant who is authorized to prescribe 758 or order respiratory care services as provided in division (A) 759 (4) of this section.

760 (C)(1) When practicing under the prescription or order of 761 a certified nurse practitioner, certified nurse midwife, or 762 clinical nurse specialist or under the supervision of such a 763 nurse, the person's administration of medication that requires a 764 Sub.

52 Page136th 28G.A. As Passed by the House prescription is limited to the drugs that the nurse is 765 authorized to prescribe pursuant to section 4723.481 of the 766 Revised Code.

767The (2)section Whennumbering practicingof underlaw the order of a certifiedgeneral 768and registeredpermanent nursenature anesthetist, the person's administration of 769 medication is limitedcomplete toand the drugs that the nurse is authorized 770 to order or direct the person to administer, as provided in 771conformity sectionswith section 4723.43, 4723.433, and 4723.434 of the Revised 772 Code.

773Director, (3)Legislative WhenService practicingCommission. under the prescription or order of a 774 physician assistant or under the supervision of a physician 775 assistant, the person's administration of medication that 776 requires a prescription is limited to the drugs that the 777 physician assistant is authorized to prescribe pursuant to the 778 physician assistant's physician-delegated prescriptive 779 authority.

780Filed Sectionin 2.the office of the Secretary of State at Columbus, Ohio, on the ____ day of ___________,A.

ThatD. existing sections 4723.01, 4723.43, 781 4723.432, 4729.01, 4731.27, 4731.35, and 4761.17 of the Revised 782 Code are hereby repealed.

78320____. Section 3.

ThatSecretary sections 4723.433, 4723.434, and 4723.435 784 of theState. Revised Code are hereby repealed.

785File No.

_________ Effective Date ___________________