HB 821 — Health Care Practitioners

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 student athlete;

providing appropriations and Pageauthorizing 13positions; of 154 CODING:

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 authorizing positions;

The name of each school or training program that the applicant has attended, with the months and years of attendance and the month and year of graduation, and a description of all graduate professional education completed by the applicant, excluding any coursework taken to satisfy continuing education Page 14 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 applicant has attended, with the months and years of attendance and the month and year of graduation, and a description of all graduate professional education completed by the applicant, excluding any coursework taken to satisfy continuing education requirements.

A description of any criminal offense of which the applicant has been found guilty, regardless of whether adjudicationPage 15 of guilt155 wasCODING: withheld, or to which the applicant has pled guilty or nolo contendere.

A criminal offense committed in another jurisdiction which would have been a felony or misdemeanor if committed in this state must be reported.

If the Page 15 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 applicantadjudication indicates that a criminal offense is under appeal and submits a copy of theguilt noticewas forwithheld, appealor ofto thatwhich criminal offense, the departmentapplicant musthas statepled thatguilty theor criminalnolo offensecontendere. is under appeal if the criminal offense is reported in the applicant's profile.

A criminal offense committed in another jurisdiction which would have been a felony or misdemeanor if committed in this state must be reported.

If the applicant indicates that a criminal offense is under appeal and submits a copy of the notice for appeal of that criminal offense, the department must state that the criminal offense is under appeal if the criminal offense is reported in the applicant's profile.

If the applicant indicates that the disciplinary action is under appeal and submits a copy of the document initiating an appeal of the disciplinary action, the department must state that the disciplinary action is under appeal if the disciplinary action is reported in the applicant's Page 16 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 disciplinary action is under appeal and submits a copy of the document initiating an appeal of the disciplinary action, the department must state that the disciplinary action is under appeal if the disciplinary action is reported in the applicant's profile.

Failure to comply with the requirements of this subsection to update and submit information constitutes a ground for disciplinary action under the applicable practice act chapterPage 46417 andof s.155 CODING:

456.072(1)(k).

For failure to comply with the requirements of this subsection to update and submit information, the department or board, as appropriate, may:

(a) Refuse to issue a license or registration to any Page 17 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 personchapter applying464 for initial licensure or registration who fails to submit and updates. the required information.

456.072(1)(k).

For failure to comply with the requirements of this subsection to update and submit information, the department or board, as appropriate, may:

(a) Refuse to issue a license or registration to any person applying for initial licensure or registration who fails to submit and update the required information.

464.012 must submit a set of fingerprints to the Department of Health on a form and under procedures specified by the department, along with payment in an amount equal to the costs incurred by the Department of Health for a national criminal history check of Page 18 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 must submit a set of fingerprints to the Department of Health on a form and under procedures specified by the department, along with payment in an amount equal to the costs incurred by the Department of Health for a national criminal history check of the applicant.

The Department of Health shall submit the fingerprints provided by an applicant for initial licensure to the Florida Department of Law Enforcement for a statewide criminal history check, and the Florida Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history check of the applicant.Page 19 of 155 CODING:

2.

The department shall submit the fingerprints provided by an applicant for the initial renewal of licensure to the Florida Department of Law Enforcement for a statewide criminal Page 19 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 historyapplicant. check, and the Florida Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history check for the initial renewal of the applicant's certificate after the effective date of this section.

2.

The department shall submit the fingerprints provided by an applicant for the initial renewal of licensure to the Florida Department of Law Enforcement for a statewide criminal history check, and the Florida Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history check for the initial renewal of the applicant's certificate after the effective date of this section.

(d) Any applicant for initial licensure or renewal of licensure as an advanced practice registered nurse who submits to the Department of Health a set of fingerprints and information required for the criminal history check required under this section shall not be required to provide a subsequent set of fingerprints or other duplicate information required for a criminal history check to the Agency for Health Care Administration, the Department of Juvenile Justice, or the Department of Children and Families for employment or licensure with such agency or department, if the applicant has undergone a criminal history check as a condition of initial licensure or renewal of licensure as an advanced practice registered nurse withPage the20 Department of Health,155 notwithstandingCODING: any other provision of law to the contrary.

In lieu of such duplicate submission, the Agency for Health Care Administration, the Department of Juvenile Justice, and the Department of Children Page 20 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 andwith Familiesthe shallDepartment obtainof criminalHealth, historynotwithstanding informationany forother employmentprovision or licensure of personslaw licensedto underthe s.contrary.

In lieu of such duplicate submission, the Agency for Health Care Administration, the Department of Juvenile Justice, and the Department of Children and Families shall obtain criminal history information for employment or licensure of persons licensed under s.

creation.— (6)Page The21 Department of Health155 shallCODING: provide in each practitioner profile for every physician, autonomous physician assistant, or advanced practice registered nurse terminated for cause from participating in the Medicaid program, pursuant to s.

Page 21 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 409.913,(6) orThe sanctionedDepartment byof theHealth Medicaidshall programprovide ain statementeach thatpractitioner theprofile practitionerfor hasevery beenphysician, terminatedautonomous fromphysician participatingassistant, inor theadvanced Floridapractice Medicaidregistered programnurse orterminated sanctionedfor bycause from participating in the Medicaid program.program, pursuant to s.

409.913, or sanctioned by the Medicaid program a statement that the practitioner has been terminated from participating in the Florida Medicaid program or sanctioned by the Medicaid program.

(d)(h) "Continuing medical education" means courses recognizedPage and22 approved by the boards, the American Academy of Physician155 Assistants,CODING: the American Medical Association, the American Osteopathic Association, or the Accreditation Council on Continuing Medical Education.

Page 22 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (e)(c)recognized "Council"and meansapproved by the boards, the American Academy of Physician Assistants, the American Medical Association, the American Osteopathic Association, or the Accreditation Council on PhysicianContinuing Assistants.Medical Education.

(e)(c) "Council" means the Council on Physician Assistants.

(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— (b) This chapter does not prevent third-party payors from reimbursing employers of physician assistants or autonomous physician assistants for covered services rendered by licensed physician assistants or registered autonomous physician Page 23 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (b) This chapter does not prevent third-party payors from reimbursing employers of physician assistants or autonomous physician assistants for covered services rendered by licensed physician assistants or registered autonomous physician assistants.

The physician assistant must complete a minimum of 10 continuingPage medical24 educationof hours155 inCODING: the specialty practice in which the physician assistant has prescriptive privileges with each licensure renewal.

Three of the 10 hours must consist of a continuing education course on the safe and effective Page 24 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 prescribingcontinuing ofmedical controllededucation substancehours medications which is offered by a statewide professional association of physicians in this state accredited to provide educational activities designated for the Americanspecialty Medicalpractice Associationin Physician'swhich Recognition Award Category 1 credit or designated by the Americanphysician Academyassistant ofhas Physicianprescriptive Assistantsprivileges aswith aeach Categorylicensure 1renewal. credit.

Three of the 10 hours must consist of a continuing education course on the safe and effective prescribing of controlled substance medications which is offered by a statewide professional association of physicians in this state accredited to provide educational activities designated for the American Medical Association Physician's Recognition Award Category 1 credit or designated by the American Academy of Physician Assistants as a Category 1 credit.

The inclusion of the prescriber number creates a presumption that thePage physician25 assistantof is155 authorizedCODING: to prescribe the medicinal drug and the prescription is valid.

6.

The physician assistant must note the prescription or dispensing of medication in the appropriate medical record.

Page 25 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (f)1.the physician assistant is authorized to prescribe the medicinal drug and the prescription is valid.

6.

The physician assistant must note the prescription or dispensing of medication in the appropriate medical record.

(f)1.

The boards shall adopt the formulary required by this paragraph, and each addition, deletion, or modification to the formulary,Page by26 rule.of 155 CODING:

Notwithstanding any provision of chapter 120 to the contrary, the formulary rule shall be effective 60 days after the date it is filed with the Secretary of State.

Upon adoption of the formulary, the department shall mail a copy of Page 26 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 suchformulary, formularyby torule. each registered autonomous physician assistant or fully licensed physician assistant having prescribing authority under this section or s.

Notwithstanding any provision of chapter 120 to the contrary, the formulary rule shall be effective 60 days after the date it is filed with the Secretary of State.

Upon adoption of the formulary, the department shall mail a copy of such formulary to each registered autonomous physician assistant or fully licensed physician assistant having prescribing authority under this section or s.

The department shall issuePage a27 licenseof to155 anyCODING: person certified by the council as having met the following requirements:

Words stricken are deletions;

words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 issue a license to any person certified by the council as having met the following requirements:

Has satisfactorily passed a proficiency examination by Pagean 27acceptable score established by the National Commission on Certification of 154Physician CODING:Assistants.

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 an acceptable score established by the National Commission on Certification of Physician Assistants.

A copy of course transcripts and a copy of the course description from a physician assistant training program describingPage course28 contentof in155 pharmacotherapy,CODING: if the applicant wishes to apply for prescribing authority.

These documents must meet the evidence requirements for prescribing authority.

(f) The Board of Medicine may impose any of the penalties Page 28 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 authorizeddescribing undercourse ss.content in pharmacotherapy, if the applicant wishes to apply for prescribing authority.

These documents must meet the evidence requirements for prescribing authority.

(f) The Board of Medicine may impose any of the penalties authorized under ss.

Has completed, in any jurisdiction of the United States, at least 2,000 clinical practice hours within the 3 years immediately preceding the submission of the registration request while practicing as a physician assistant under the supervisionPage of29 an allopathic or osteopathic physician who held an active, unencumbered license issued by any state, the District of Columbia,155 orCODING: a possession or territory of the United States during the period of such supervision.

Page 29 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 4.supervision of an allopathic or osteopathic physician who held an active, unencumbered license issued by any state, the District of Columbia, or a possession or territory of the United States during the period of such supervision.

4.

If such person initiates or resumes any practicePage as30 an autonomous physician assistant, he or she must notify the department of such155 activityCODING: and fulfill the professional liability coverage requirements of this subparagraph.

Page 30 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (b)practice Theas department shall conspicuously distinguish an autonomous physician assistantassistant, license if he or she ismust registerednotify underthe department of such activity and fulfill the professional liability coverage requirements of this subsection.subparagraph.

(b) The department shall conspicuously distinguish an autonomous physician assistant license if he or she is registered under this subsection.

(d)Page An31 autonomousof physician155 assistantCODING: must biennially renew his or her registration under this subsection.

The biennial renewal shall coincide with the autonomous physician assistant's biennial renewal period for physician assistant Page 31 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 licensure.(d) An autonomous physician assistant must biennially renew his or her registration under this subsection.

The biennial renewal shall coincide with the autonomous physician assistant's biennial renewal period for physician assistant licensure.

(b)Page Two32 of the155 membersCODING: appointed to the council must be physicians who supervise physician assistants in their practice.

Members shall be appointed to terms of 4 years, except that of the initial appointments, two members shall be appointed to Page 32 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 terms(b) Two of 2the years, two members shall be appointed to termsthe ofcouncil 3must years, and one member shall be appointedphysicians towho asupervise termphysician ofassistants 4in years,their aspractice. established by rule of the boards.

Members shall be appointed to terms of 4 years, except that of the initial appointments, two members shall be appointed to terms of 2 years, two members shall be appointed to terms of 3 years, and one member shall be appointed to a term of 4 years, as established by rule of the boards.

The language of all proposed rules submitted by the council must bePage approved33 by both boards pursuant to each respective board's guidelines and standards regarding the adoption of proposed155 rules.CODING:

If either board rejects the council's proposed rule, that board must specify its objection to the council with Page 33 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 particularitybe andapproved includeby anyboth recommendationsboards itpursuant mayto haveeach forrespective theboard's modificationguidelines ofand standards regarding the adoption of proposed rule.rules.

If either board rejects the council's proposed rule, that board must specify its objection to the council with particularity and include any recommendations it may have for the modification of the proposed rule.

Such conditions may include placement of the licensee on probation for a period of time and subject to such conditions as the council may specify, including but not limited to, requiring the licenseePage to34 undergo treatment, to attend continuing education courses, to work under the direct supervision of a155 physicianCODING: licensed in this state, or to take corrective action.

(12)(11) PENALTY.—Any person who has not been licensed by Page 34 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 thelicensee councilto andundergo approvedtreatment, byto theattend departmentcontinuing andeducation whocourses, holdsto himselfwork orunder herselfthe outdirect assupervision anof autonomous physician assistant or a physician assistantlicensed or who uses any other term in indicatingthis orstate, implying that he or sheto istake ancorrective autonomousaction. physician assistant or a physician assistant commits a felony of the third degree, punishable as provided in s.

(12)(11) PENALTY.—Any person who has not been licensed by the council and approved by the department and who holds himself or herself out as an autonomous physician assistant or a physician assistant or who uses any other term in indicating or implying that he or she is an autonomous physician assistant or a physician assistant commits a felony of the third degree, punishable as provided in s.

(19)Page ADVERSE35 INCIDENTS.—Anof autonomous155 physicianCODING: assistant must report adverse incidents to the department in the manner required under s.

458.351.

Section 4.

Subsections (8) through (17) of section Page 35 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 459.022,(19) FloridaADVERSE Statutes,INCIDENTS.—An areautonomous renumberedphysician asassistant subsectionsmust (9)report throughadverse (18),incidents respectively, subsection (2), paragraphs (b) and (e) of subsection (4), paragraph (a) of subsection (6), paragraphs (a) and (f) of subsection (7), present subsection (9), and present subsections (11) through (13) are amended, paragraph (b) is added to subsectionthe (2),department andin newthe subsectionsmanner (8)required andunder (19)s. are added to that section, to read:

458.351.

Section 4.

Subsections (8) through (17) of section 459.022, Florida Statutes, are renumbered as subsections (9) through (18), respectively, subsection (2), paragraphs (b) and (e) of subsection (4), paragraph (a) of subsection (6), paragraphs (a) and (f) of subsection (7), present subsection (9), and present subsections (11) through (13) are amended, paragraph (b) is added to subsection (2), and new subsections (8) and (19) are added to that section, to read:

(e)(c)Page "Council"36 meansof the155 CouncilCODING: on Physician Assistants.

(f)(e) "Physician assistant" means a person who is a graduate of an approved program or its equivalent or meets Page 36 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 standards(e)(c) approved"Council" bymeans the boardsCouncil andon isPhysician licensedAssistants. to perform medical services delegated by the supervising physician.

(f)(e) "Physician assistant" means a person who is a graduate of an approved program or its equivalent or meets standards approved by the boards and is licensed to perform medical services delegated by the supervising physician.

(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.— (b) This chapter does not prevent third-party payors from reimbursing employers of autonomous physician assistants or physician assistants for covered services rendered by registered autonomous physician assistants or licensed physician assistants.Page 37 of 155 CODING:

(e) A supervising physician may delegate to a fully licensed physician assistant the authority to prescribe or dispense any medication used in the supervising physician's Page 37 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 practiceassistants. unless such medication is listed on the formulary created pursuant to s.

(e) A supervising physician may delegate to a fully licensed physician assistant the authority to prescribe or dispense any medication used in the supervising physician's practice unless such medication is listed on the formulary created pursuant to s.

The department may issue a prescriber number to the physicianPage assistant38 granting authority for the prescribing of medicinal155 drugsCODING: authorized within this paragraph upon completion of the requirements of this paragraph.

The physician assistant is not required to independently register pursuant to s.

Page 38 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 465.0276.physician assistant granting authority for the prescribing of medicinal drugs authorized within this paragraph upon completion of the requirements of this paragraph.

The physician assistant is not required to independently register pursuant to s.

465.0276.

The council may recommend only those physician assistant programs that hold full accreditation or provisional accreditation from the Commission on Accreditation of Allied HealthPage Programs39 orof its155 successorCODING: organization.

(7) PHYSICIAN ASSISTANT LICENSURE.— (a) Any person desiring to be licensed as a physician assistant must apply to the department.

The department shall Page 39 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 issueHealth aPrograms licenseor toits anysuccessor personorganization. certified by the council as having met the following requirements:

(7) PHYSICIAN ASSISTANT LICENSURE.— (a) Any person desiring to be licensed as a physician assistant must apply to the department.

The department shall issue a license to any person certified by the council as having met the following requirements:

c.Page 40 of 155 CODING:

Acknowledgment of any previous revocation or denial of licensure or certification in any state.

d.

A copy of course transcripts and a copy of the course description from a physician assistant training program Page 40 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 describingc. course content in pharmacotherapy, if the applicant wishes to apply for prescribing authority.

Acknowledgment of any previous revocation or denial of licensure or certification in any state.

d.

A copy of course transcripts and a copy of the course description from a physician assistant training program describing course content in pharmacotherapy, if the applicant wishes to apply for prescribing authority.

3.Page 41 of 155 CODING:

Has completed, in any jurisdiction of the United States, at least 2,000 clinical practice hours within the 3 years immediately preceding the submission of the registration request while practicing as a physician assistant under the Page 41 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 supervision3. of an allopathic or osteopathic physician who held an active, unencumbered license issued by any state, the District of Columbia, or a possession or territory of the United States during the period of such supervision.

Has completed, in any jurisdiction of the United States, at least 2,000 clinical practice hours within the 3 years immediately preceding the submission of the registration request while practicing as a physician assistant under the supervision of an allopathic or osteopathic physician who held an active, unencumbered license issued by any state, the District of Columbia, or a possession or territory of the United States during the period of such supervision.

Such practice is limited to that which is incidental to and a necessary part of duties in connection with the teaching position.Page 42 of 155 CODING:

d.

Any person who holds an active license under this subsection who is not practicing as an autonomous physician assistant in this state.

If such person initiates or resumes any Page 42 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 practiceposition. as an autonomous physician assistant, he or she must notify the department of such activity and fulfill the professional liability coverage requirements of this subparagraph.

d.

Any person who holds an active license under this subsection who is not practicing as an autonomous physician assistant in this state.

If such person initiates or resumes any practice as an autonomous physician assistant, he or she must notify the department of such activity and fulfill the professional liability coverage requirements of this subparagraph.

6.Page 43 of 155 CODING:

Provide any service that is within the scope of the autonomous physician assistant's education and experience and provided in accordance with rules adopted by the board.

(d) An autonomous physician assistant must biennially Page 43 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 renew6. his or her registration under this subsection.

Provide any service that is within the scope of the autonomous physician assistant's education and experience and provided in accordance with rules adopted by the board.

(d) An autonomous physician assistant must biennially renew his or her registration under this subsection.

3.Page 44 of 155 CODING:

The State Surgeon General or her or his designee shall appoint three a fully licensed physician assistants assistant licensed under chapter 458 or this chapter.

(b) Two of the members appointed to the council must be Page 44 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 physicians3. who supervise physician assistants in their practice.

The State Surgeon General or her or his designee shall appoint three a fully licensed physician assistants assistant licensed under chapter 458 or this chapter.

(b) Two of the members appointed to the council must be physicians who supervise physician assistants in their practice.

A proposed rule submitted by the council may not be adoptedPage by45 eitherof board155 unlessCODING: both boards have accepted and approved the identical language contained in the proposed rule.

The language of all proposed rules submitted by the council must be approved by both boards pursuant to each respective board's Page 45 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 guidelinesadopted andby standardseither regardingboard unless both boards have accepted and approved the adoptionidentical oflanguage contained in the proposed rules.rule.

The language of all proposed rules submitted by the council must be approved by both boards pursuant to each respective board's guidelines and standards regarding the adoption of proposed rules.

Such conditions may include placement of the licensee on probation for a period of time and subject to such conditions as the council may specify, including but not limited to, requiring the licensee to undergo treatment, to attend continuing education Page 46 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 conditions may include placement of the licensee on probation for a period of time and subject to such conditions as the council may specify, including but not limited to, requiring the licensee to undergo treatment, to attend continuing education courses, to work under the direct supervision of a physician licensed in this state, or to take corrective action.

(14)(13) RULES.—The boards shall adopt rules to implement this section, including rules detailing the contents of the application for licensure and notification pursuant to subsection (7), rules relating to the registration of autonomous physician assistants pursuant to subsection (8), and rules to ensurePage both47 the continued competency of autonomous155 physicianCODING: assistants and physician assistants and the proper utilization of them by physicians or groups of physicians.

(19) ADVERSE INCIDENTS.—An autonomous physician assistant Page 47 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 mustensure reportboth adversethe incidentscontinued tocompetency theof departmentautonomous inphysician assistants and physician assistants and the sameproper mannerutilization asof requiredthem underby s.physicians or groups of physicians.

(19) ADVERSE INCIDENTS.—An autonomous physician assistant must report adverse incidents to the department in the same manner as required under s.

The board may by rule provide for provisional state licensure of certified registered nurse anesthetists, clinical nurse specialists, certified nurse practitioners, psychiatric nurses, and certified nurse midwives forPage a48 period of time155 determinedCODING: to be appropriate for preparing for and passing the national certification examination.

(b) Graduation from a program leading to a master's degree program in a nursing clinical specialty area with preparation in Page 48 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 specializedfor practitionera skills.period of time determined to be appropriate for preparing for and passing the national certification examination.

(b) Graduation from a program leading to a master's degree program in a nursing clinical specialty area with preparation in specialized practitioner skills.

(3) An advanced practice registered nurse shall perform those functions authorized in this section within the framework of an established protocol that must be maintained on site at the location or locations at which an advanced practice registered nurse practices, unless the advanced practice registeredPage nurse49 isof registered155 toCODING: engage in autonomous practice pursuant to s.

464.0123.

In the case of multiple supervising physicians in the same group, an advanced practice registered nurse must enter into a supervisory protocol with at least one Page 49 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 physicianregistered withinnurse theis physicianregistered groupto practice.engage in autonomous practice pursuant to s.

464.0123.

In the case of multiple supervising physicians in the same group, an advanced practice registered nurse must enter into a supervisory protocol with at least one physician within the physician group practice.

(f)Page Sign,50 certify, stamp, verify, or endorse a document that requires the signature, certification, stamp, verification, affidavit, or endorsement of a155 physician.CODING:

However, a supervisory physician may not delegate the authority to issue a documented Page 50 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 approval(f) toSign, releasecertify, astamp, patientverify, fromor endorse a receivingdocument facilitythat requires the signature, certification, stamp, verification, affidavit, or itsendorsement contractorof undera s.physician.

However, a supervisory physician may not delegate the authority to issue a documented approval to release a patient from a receiving facility or its contractor under s.

(c) Has completed, in any jurisdiction of the United States, at least 2,000 clinical practice hours or clinical instructional hours within the 5 years immediately preceding the registration request while practicing as an advanced practice Page 51 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (c) Has completed, in any jurisdiction of the United States, at least 2,000 clinical practice hours or clinical instructional hours within the 5 years immediately preceding the registration request while practicing as an advanced practice registered nurse under the supervision of an allopathic or osteopathic physician who held an active, unencumbered license issued by another state, the District of Columbia, or a possession or territory of the United States during the period of such supervision.

626.914(2), from a risk retentionPage group52 asof defined155 underCODING: s.

Words stricken are deletions;

words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 retention group as defined under s.

Obtaining and maintaining an unexpired, irrevocable Pageletter 52of credit, established pursuant to chapter 675, in an amount of 154not CODING:less than $100,000 per claim, with a minimum aggregate availability of credit of not less than $300,000.

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 letter of credit, established pursuant to chapter 675, in an amount of not less than $100,000 per claim, with a minimum aggregate availability of credit of not less than $300,000.

Any person who practices as an advanced practice registered nurse registered under this section only in conjunctionPage with53 hisof or155 herCODING: teaching duties at an accredited school or its main teaching hospitals.

Such practice is limited to that which is incidental to and a necessary part of duties in connection with the teaching position.

Page 53 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 4.conjunction with his or her teaching duties at an accredited school or its main teaching hospitals.

Such practice is limited to that which is incidental to and a necessary part of duties in connection with the teaching position.

4.

1.Page 54 of 155 CODING:

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words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 1.

Discharge the patient from the facility, unless Pageprohibited 54by offederal 154law CODING:or rule.

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 prohibited by federal law or rule.

(9) The board may establish an advisory committee to make evidence-based recommendations about medical acts that an advanced practice registered nurse who is registered under this sectionPage may55 perform.of 155 CODING:

The committee must consist of four advanced practice registered nurses licensed under this chapter, appointed by the board;

two physicians licensed under chapter 458 or chapter 459 who have professional experience with Page 55 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 advancedsection practicemay registeredperform. nurses, appointed by the Board of Medicine;

The committee must consist of four advanced practice registered nurses licensed under this chapter, appointed by the board;

two physicians licensed under chapter 458 or chapter 459 who have professional experience with advanced practice registered nurses, appointed by the Board of Medicine;

(2) The report must be in writing, sent to the department by certified mail, and postmarked within 15 days after the occurrence of the adverse incident if the adverse incident occurs when the patient is at the office of the advanced practicePage registered56 nurse.of 155 CODING:

If the adverse incident occurs when the patient is not at the office of the advanced practice registered nurse, the report must be postmarked within 15 days after the advanced practice registered nurse discovers, or Page 56 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 reasonablypractice shouldregistered havenurse. discovered, the occurrence of the adverse incident.

If the adverse incident occurs when the patient is not at the office of the advanced practice registered nurse, the report must be postmarked within 15 days after the advanced practice registered nurse discovers, or reasonably should have discovered, the occurrence of the adverse incident.

464.018 Disciplinary actions.— (1) The following acts constitute grounds for denial of a licensePage or57 disciplinaryof action,155 asCODING: specified in ss.

456.072(2) and 464.0095:

(r) For an advanced practice registered nurse who is registered to engage in autonomous practice pursuant to s.

Page 57 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 464.0123:license or disciplinary action, as specified in ss.

456.072(2) and 464.0095:

(r) For an advanced practice registered nurse who is registered to engage in autonomous practice pursuant to s.

464.0123:

Soliciting patients, either personally or through an agent, by the use of fraud, intimidation, undue influence, or a formPage 58 of overreaching155 orCODING: vexatious conduct.

As used in this subparagraph, the term "soliciting" means directly or implicitly requesting an immediate oral response from the recipient.

5.

Failing to keep legible, as defined by department rule Page 58 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 inform consultationof withoverreaching the board, medical records that identify the advanced practice registered nurse by name and professional title who is responsible for rendering, ordering, supervising, or billingvexatious forconduct. each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories;

As used in this subparagraph, the term "soliciting" means directly or implicitly requesting an immediate oral response from the recipient.

5.

Failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the advanced practice registered nurse by name and professional title who is responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories;

9.Page 59 of 155 CODING:

Delegating professional responsibilities to a person when the advanced practice registered nurse delegating such responsibilities knows or has reason to believe that such person is not qualified by training, experience, or licensure to Page 59 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 perform9. such responsibilities.

Delegating professional responsibilities to a person when the advanced practice registered nurse delegating such responsibilities knows or has reason to believe that such person is not qualified by training, experience, or licensure to perform such responsibilities.

(43) "Licensed health care professional" means a physician licensed under chapter 458, an osteopathic physician licensed under chapter 459, a nurse licensed under part I of chapter 464, an autonomous physician assistant or a physician assistant registeredPage or60 licensedof under155 chapterCODING: 458 or chapter 459, or a dentist licensed under chapter 466.

Section 10.

Paragraphs (d) and (e) of subsection (5) of section 39.303, Florida Statutes, are redesignated as paragraphs Page 60 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (e)registered andor (f),licensed respectively,under achapter new458 paragraphor (d)chapter is459, addedor toa thatdentist subsection,licensed andunder paragraphchapter (a)466. of subsection (6) of that section is amended, to read:

Section 10.

Paragraphs (d) and (e) of subsection (5) of section 39.303, Florida Statutes, are redesignated as paragraphs (e) and (f), respectively, a new paragraph (d) is added to that subsection, and paragraph (a) of subsection (6) of that section is amended, to read:

(a) The child was examined for the alleged abuse or neglect by a physician who is not a member of the child protection team, and a consultation between the child protection team medical director or a child protection team board-certified pediatrician, advanced practice registered nurse, autonomous physician assistant, or physician assistant working under the supervision of a child protection team medical director or a child protection team board-certified pediatrician, or Page 61 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 pediatrician, advanced practice registered nurse, autonomous physician assistant, or physician assistant working under the supervision of a child protection team medical director or a child protection team board-certified pediatrician, or registered nurse working under the direct supervision of a child protection team medical director or a child protection team board-certified pediatrician, and the examining physician concludes that a further medical evaluation is unnecessary;

39.304 Photographs, medical examinations, X rays, and medical treatment of abused, abandoned, or neglected child.— (1) (b) If the areas of trauma visible on a child indicate a need for a medical examination, or if the child verbally complains or otherwise exhibits distress as a result of injury through suspected child abuse, abandonment, or neglect, or is alleged to have been sexually abused, the person required to investigate may cause the child to be referred for diagnosis to a licensed physician or an emergency department in a hospital withoutPage the62 consent of the155 child'sCODING: parents or legal custodian.

Such examination may be performed by any licensed physician, registered autonomous physician assistant, licensed physician assistant, or an advanced practice registered nurse licensed Page 62 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 pursuantwithout tothe partconsent I of chapterthe 464.child's parents or legal custodian.

Such examination may be performed by any licensed physician, registered autonomous physician assistant, licensed physician assistant, or an advanced practice registered nurse licensed pursuant to part I of chapter 464.

(d) The department shall establish the reimbursement schedulePage for63 prescriptionof drugs155 andCODING: supplies dispensed under the program.

Reimbursement rates for a prescription drug or supply must be based on the cost of the generic equivalent drug or supply if a generic equivalent exists, unless the physician, Page 63 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 advancedschedule practicefor registered nurse, autonomous physician assistant, or physician assistant prescribing the drug or supply clearly states on the prescription that the brand name drug or supply is medically necessary or that the drug or supply is included on the formulary of drugs and supplies thatdispensed mayunder not be interchanged as provided in chapter 465, in which case reimbursement must be based on the costprogram. of the brand name drug or supply as specified in the reimbursement schedule adopted by the department.

Reimbursement rates for a prescription drug or supply must be based on the cost of the generic equivalent drug or supply if a generic equivalent exists, unless the physician, advanced practice registered nurse, autonomous physician assistant, or physician assistant prescribing the drug or supply clearly states on the prescription that the brand name drug or supply is medically necessary or that the drug or supply is included on the formulary of drugs and supplies that may not be interchanged as provided in chapter 465, in which case reimbursement must be based on the cost of the brand name drug or supply as specified in the reimbursement schedule adopted by the department.

464.012.Page 64 of 155 CODING:

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words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 464.012.

A worker employed by a public or private hospital in Pagethe 64state. of 154 CODING:

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words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 the state.

The board shall adopt rules to establish requirements for passing the physical examination, which rules shall establish minimum standards for the physical or mental capabilitiesPage necessary65 to carry out the professional duties of a155 certificatedCODING: deputy pilot.

Such standards shall include zero tolerance for any controlled substance regulated under chapter 893 unless that individual is under the care of a physician, an Page 65 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 advancedcapabilities practicenecessary registeredto nurse,carry anout autonomousthe physicianprofessional assistant,duties orof a physiciancertificated assistantdeputy andpilot. that controlled substance was prescribed by that physician, advanced practice registered nurse, autonomous physician assistant, or physician assistant.

Such standards shall include zero tolerance for any controlled substance regulated under chapter 893 unless that individual is under the care of a physician, an advanced practice registered nurse, an autonomous physician assistant, or a physician assistant and that controlled substance was prescribed by that physician, advanced practice registered nurse, autonomous physician assistant, or physician assistant.

The board shall adopt rules to establish requirements for passing the physical examination, which rules shallPage establish66 minimum standards for the physical or mental capabilities necessary to carry out the professional duties of a155 licensedCODING: state pilot.

Such standards shall include zero tolerance for any controlled substance regulated under chapter Page 66 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 893shall unlessestablish thatminimum individualstandards isfor under the carephysical ofor amental physician,capabilities annecessary advancedto practicecarry registeredout nurse,the anprofessional autonomousduties physicianof assistant, or a physicianlicensed assistantstate andpilot. that controlled substance was prescribed by that physician, advanced practice registered nurse, autonomous physician assistant, or physician assistant.

Such standards shall include zero tolerance for any controlled substance regulated under chapter 893 unless that individual is under the care of a physician, an advanced practice registered nurse, an autonomous physician assistant, or a physician assistant and that controlled substance was prescribed by that physician, advanced practice registered nurse, autonomous physician assistant, or physician assistant.

(b) Are in good physical and mental health as evidenced by documentary proof of having satisfactorily passed a physical examination administered by a licensed physician or physician assistantPage within67 eachof calendar155 year.CODING:

The board shall adopt rules to establish requirements for passing the physical examination, which rules shall establish minimum standards for the physical or mental capabilities necessary to carry out the professional Page 67 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 dutiesassistant ofwithin aeach licensedcalendar stateyear. pilot or a certificated deputy pilot.

The board shall adopt rules to establish requirements for passing the physical examination, which rules shall establish minimum standards for the physical or mental capabilities necessary to carry out the professional duties of a licensed state pilot or a certificated deputy pilot.

SectionPage 17.68 of 155 CODING:

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words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 Section 17.

permits for certain Pageproviders 68 of 154transportation CODING:services to persons who have disabilities.— (1) (b)1.

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 providers of transportation services to persons who have disabilities.— (1) (b)1.

e.Page 69 of 155 CODING:

Restriction by cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

Page 69 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 f.e.

Restriction by cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

f.

isolation and quarantines.—The State Health Officer is responsible for declaring public health emergencies, issuing publicPage health70 advisories,of and155 orderingCODING: isolation or quarantines.

(1) As used in this section, the term:

(c) "Public health emergency" means any occurrence, or threat thereof, whether natural or manmade, which results or may Page 70 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 result in substantial injury or harm to the public health fromadvisories, infectiousand disease,ordering chemicalisolation agents, nuclear agents, biological toxins, or situationsquarantines. involving mass casualties or natural disasters.

(1) As used in this section, the term:

(c) "Public health emergency" means any occurrence, or threat thereof, whether natural or manmade, which results or may result in substantial injury or harm to the public health from infectious disease, chemical agents, nuclear agents, biological toxins, or situations involving mass casualties or natural disasters.

Directing manufacturers of prescription drugs or over- the-counter drugs who are permitted under chapter 499 and wholesalers of prescription drugs located in this state who are permitted under chapter 499 to give priority to the shipping of specified drugs to pharmacies and health care providers within geographicPage areas71 thatof have155 beenCODING: identified by the State Health Officer.

The State Health Officer must identify the drugs to be shipped.

Manufacturers and wholesalers located in the state must respond to the State Health Officer's priority shipping Page 71 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 directivegeographic beforeareas shippingthat have been identified by the specifiedState drugs.Health Officer.

The State Health Officer must identify the drugs to be shipped.

Manufacturers and wholesalers located in the state must respond to the State Health Officer's priority shipping directive before shipping the specified drugs.

Only those health care practitioners specified in this paragraph who possess an unencumbered inactive license and who requestPage that72 suchof license155 beCODING: reactivated are eligible for reactivation.

An inactive license that is reactivated under this paragraph shall return to inactive status when the public health emergency ends or before the end of the public health emergency Page 72 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 ifrequest the State Health Officer determines that thesuch healthlicense carebe practitionerreactivated isare noeligible longerfor neededreactivation. to provide services during the public health emergency.

An inactive license that is reactivated under this paragraph shall return to inactive status when the public health emergency ends or before the end of the public health emergency if the State Health Officer determines that the health care practitioner is no longer needed to provide services during the public health emergency.

AnyPage order73 of the155 StateCODING: Health Officer given to effectuate this paragraph shall be immediately enforceable by a law enforcement officer under s.

381.0012.

Section 19.

Subsection (3) of section 381.00593, Florida Page 73 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 Statutes,Any isorder amendedof the State Health Officer given to read:effectuate this paragraph shall be immediately enforceable by a law enforcement officer under s.

381.0012.

Section 19.

Subsection (3) of section 381.00593, Florida Statutes, is amended to read:

381.026 Florida Patient's Bill of Rights and Responsibilities.—Page (2)74 DEFINITIONS.—Asof used155 inCODING: this section and s.

381.0261, the term:

(c) "Health care provider" means a physician licensed Page 74 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 underResponsibilities.— chapter(2) 458,DEFINITIONS.—As anused osteopathicin physicianthis licensedsection underand chapter 459, or a podiatric physician licensed under chapter 461, an advanced practice registered nurse registered under s.

381.0261, the term:

(c) "Health care provider" means a physician licensed under chapter 458, an osteopathic physician licensed under chapter 459, or a podiatric physician licensed under chapter 461, an advanced practice registered nurse registered under s.

The medical certification of cause of death shall be furnished to the funeral director, either in person or via certified mail or electronic transfer, by the physician, advanced practice registered nurse, autonomous physician assistant, physician assistant, or medical examiner Page 75 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 of cause of death shall be furnished to the funeral director, either in person or via certified mail or electronic transfer, by the physician, advanced practice registered nurse, autonomous physician assistant, physician assistant, or medical examiner responsible for furnishing such information.

(a) The department may grant the funeral director an extensionPage of76 time upon a good and sufficient showing of any155 ofCODING: the following conditions:

Words stricken are deletions;

words underlined are additions.

hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/CS/HB 821 2019 extension of time upon a good and sufficient showing of any of the following conditions:

Toxicology, laboratory, or other diagnostic reports Pagehave 76not ofbeen 154completed. CODING:

Words stricken are deletions;

words underlined are additions.

hb0821-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 821 2019 have not been completed.

The decedent's primary or attending practitioner physician or the district medical examiner of the county in which the death occurred or the body was found shall provide an estimated date for completion of the permanent certificate.Page 77 of 155 CODING:

(5) A permanent certificate of death or fetal death, containing the cause of death and any other information that was previously unavailable, shall be registered as a replacement for Page 77 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 the temporary certificate.

(5) A permanent certificate of death or fetal death, containing the cause of death and any other information that was previously unavailable, shall be registered as a replacement for the temporary certificate.

Paragraph (c) of subsection (1) of section 383.14,Page Florida78 Statutes,of is155 amendedCODING: to read:

383.14 Screening for metabolic disorders, other hereditary and congenital disorders, and environmental risk factors.— (1) SCREENING REQUIREMENTS.—To help ensure access to the Page 78 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 maternal383.14, and child health care system, the Department of Health shall promote the screening of all newborns born in Florida forStatutes, metabolic,is hereditary,amended and congenital disorders known to resultread: in significant impairment of health or intellect, as screening programs accepted by current medical practice become available and practical in the judgment of the department.

383.14 Screening for metabolic disorders, other hereditary and congenital disorders, and environmental risk factors.— (1) SCREENING REQUIREMENTS.—To help ensure access to the maternal and child health care system, the Department of Health shall promote the screening of all newborns born in Florida for metabolic, hereditary, and congenital disorders known to result in significant impairment of health or intellect, as screening programs accepted by current medical practice become available and practical in the judgment of the department.

(c) Release of screening results.—Notwithstanding any law to the contrary, the State Public Health Laboratory may release, directly or through the Children's Medical Services program, the results of a newborn's hearing and metabolic tests or screenings Page 79 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (c) Release of screening results.—Notwithstanding any law to the contrary, the State Public Health Laboratory may release, directly or through the Children's Medical Services program, the results of a newborn's hearing and metabolic tests or screenings to the newborn's health care practitioner, the newborn's parent or legal guardian, the newborn's personal representative, or a person designated by the newborn's parent or legal guardian.

390.0111 Termination of pregnancies.— (3) CONSENTS REQUIRED.—A termination of pregnancy may not be performed or induced except with the voluntary and informed written consent of the pregnant woman or, in the case of a mental incompetent, the voluntary and informed written consent ofPage her80 court-appointedof guardian.155 CODING:

(a) Except in the case of a medical emergency, consent to a termination of pregnancy is voluntary and informed only if:

1.

The physician who is to perform the procedure, or the Page 80 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 referringof physician,her has,court-appointed atguardian. a minimum, orally, while physically present in the same room, and at least 24 hours before the procedure, informed the woman of:

(a) Except in the case of a medical emergency, consent to a termination of pregnancy is voluntary and informed only if:

1.

The physician who is to perform the procedure, or the referring physician, has, at a minimum, orally, while physically present in the same room, and at least 24 hours before the procedure, informed the woman of:

If the woman accepts the opportunity to view the images and hear the explanation, a physician or a registered nurse, licensed practical nurse, advanced practice registered nurse, autonomous physician assistant,Page or81 physicianof assistant155 workingCODING: in conjunction with the physician must contemporaneously review and explain the images to the woman before the woman gives informed consent to having an abortion procedure performed.

Page 81 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (III)assistant, Theor womanphysician hasassistant aworking rightin toconjunction declinewith tothe viewphysician andmust hearcontemporaneously thereview explanationand ofexplain the live ultrasound images afterto shethe iswoman informedbefore ofthe herwoman rightgives andinformed offeredconsent an opportunity to viewhaving thean imagesabortion andprocedure hearperformed. the explanation.

(III) The woman has a right to decline to view and hear the explanation of the live ultrasound images after she is informed of her right and offered an opportunity to view the images and hear the explanation.

(IV) Unless requested by the woman, the person performing the ultrasound may not offer the opportunity to view the images and hear the explanation and the explanation may not be given if, at the time the woman schedules or arrives for her appointment to obtain an abortion, a copy of a restraining order, police report, medical record, or other court order or documentation is presented which provides evidence that the woman is obtaining the abortion because the woman is a victim of rape, incest, domestic violence, or human trafficking or that the woman has been diagnosed as having a condition that, on the basisPage of82 a physician's good faith clinical judgment, would create a serious risk of substantial155 andCODING: irreversible impairment of a major bodily function if the woman delayed terminating her pregnancy.

Page 82 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 c.basis of a physician's good faith clinical judgment, would create a serious risk of substantial and irreversible impairment of a major bodily function if the woman delayed terminating her pregnancy.

c.

3.Page 83 of 155 CODING:

The woman acknowledges in writing, before the termination of pregnancy, that the information required to be provided under this subsection has been provided.

Page 83 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 Nothing3. in this paragraph is intended to prohibit a physician from providing any additional information which the physician deems material to the woman's informed decision to terminate her pregnancy.

The woman acknowledges in writing, before the termination of pregnancy, that the information required to be provided under this subsection has been provided.

Nothing in this paragraph is intended to prohibit a physician from providing any additional information which the physician deems material to the woman's informed decision to terminate her pregnancy.

The abortion clinic designate a medical director who is licensed to practice medicine in this state, and all physicians who perform abortions in the clinic have admitting privileges at a hospital within reasonable proximity to the clinic, unless the clinic has a written patient transfer agreement with a hospital within reasonable proximity to the clinic which includes the transfer of the patient's medical records held by both the clinicPage and84 theof treating155 physician.CODING:

2.

If a physician is not present after an abortion is performed, a registered nurse, licensed practical nurse, advanced practice registered nurse, autonomous physician Page 84 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 assistant, or physician assistant be present and remain at the clinic to provide postoperative monitoring and care until the patienttreating isphysician. discharged.

2.

If a physician is not present after an abortion is performed, a registered nurse, licensed practical nurse, advanced practice registered nurse, autonomous physician assistant, or physician assistant be present and remain at the clinic to provide postoperative monitoring and care until the patient is discharged.

3.Page 85 of 155 CODING:

Appropriate use of general and local anesthesia, analgesia, and sedation if ordered by the physician.

4.

Appropriate precautions, such as the establishment of intravenous access at least for patients undergoing post-first Page 85 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 trimester3. abortions.

Appropriate use of general and local anesthesia, analgesia, and sedation if ordered by the physician.

4.

Appropriate precautions, such as the establishment of intravenous access at least for patients undergoing post-first trimester abortions.

A physician sign the discharge order and be readily accessible and available until the last patient is discharged to facilitatePage the86 transfer of emergency155 casesCODING: if hospitalization of the patient or viable fetus is necessary.

5.

A physician discuss Rho(D) immune globulin with each patient for whom it is indicated and ensure that it is offered Page 86 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 tofacilitate the patienttransfer inof theemergency immediatecases postoperativeif periodhospitalization orof willthe bepatient availableor toviable herfetus withinis 72necessary. hours after completion of the abortion procedure.

5.

A physician discuss Rho(D) immune globulin with each patient for whom it is indicated and ensure that it is offered to the patient in the immediate postoperative period or will be available to her within 72 hours after completion of the abortion procedure.

Equipment and services be readily accessible to provide appropriatePage emergency87 resuscitative and life support procedures pending the transfer of the155 patientCODING: or viable fetus to the hospital.

Section 26.

Paragraphs (a) and (f) of subsection (2) of Page 87 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 sectionappropriate 394.463,emergency Floridaresuscitative Statutes,and arelife amendedsupport procedures pending the transfer of the patient or viable fetus to read:the hospital.

Section 26.

Paragraphs (a) and (f) of subsection (2) of section 394.463, Florida Statutes, are amended to read:

A facility accepting the patient based on this order must send a copy of the order to the department the next working day.Page 88 of 155 CODING:

The order may be submitted electronically through existing data systems, if available.

The order shall be valid only until the person is delivered to the facility or for the period specified in the order itself, whichever comes first.

If no time Page 88 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 limitday. is specified in the order, the order shall be valid for 7 days after the date that the order was signed.

The order may be submitted electronically through existing data systems, if available.

The order shall be valid only until the person is delivered to the facility or for the period specified in the order itself, whichever comes first.

If no time limit is specified in the order, the order shall be valid for 7 days after the date that the order was signed.

If other less restrictive means, such as voluntary appearance for outpatient evaluation,Page are89 notof available,155 aCODING: law enforcement officer shall take into custody the person named in the certificate and deliver him or her to the appropriate, or nearest, facility within the designated receiving system pursuant to s.

394.462 Page 89 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 forevaluation, involuntaryare examination.not available, a law enforcement officer shall take into custody the person named in the certificate and deliver him or her to the appropriate, or nearest, facility within the designated receiving system pursuant to s.

394.462 for involuntary examination.

The patient may not be released by the receiving facility or its contractor without the documented approval of a psychiatrist or a clinical psychologist or, if the receiving facility is owned or operated by a hospital or health system, the release may also be approved by a psychiatric nurse performing within the framework of an establishedPage protocol90 with a psychiatrist, or an attending emergency department physician with experience in the diagnosis and treatment of mental155 illnessCODING: after completion of an involuntary examination pursuant to this subsection.

A Page 90 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 psychiatricestablished nurseprotocol maywith nota approvepsychiatrist, theor releasean ofattending aemergency patientdepartment ifphysician with experience in the involuntarydiagnosis examinationand wastreatment initiatedof bymental aillness psychiatristafter unlesscompletion theof releasean isinvoluntary approvedexamination bypursuant theto initiatingthis psychiatrist.subsection.

A psychiatric nurse may not approve the release of a patient if the involuntary examination was initiated by a psychiatrist unless the release is approved by the initiating psychiatrist.

395.602 Rural hospitals.— (3) USE OF FUNDS.—It is the intent of the Legislature that funds as appropriated shall be utilized by the department for the purpose of increasing the number of primary care physicians, autonomous physician assistants, physician assistants, certified nurse midwives, nurse practitioners, and nurses in rural areas, either through the Medical Education Reimbursement and Loan Page 91 of 154155 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 the purpose of increasing the number of primary care physicians, autonomous physician assistants, physician assistants, certified nurse midwives, nurse practitioners, and nurses in rural areas, either through the Medical Education Reimbursement and Loan Repayment Program as defined by s.

Within the boundaries of a hospital tax district which encompassesPage a92 population of no155 greaterCODING: than 100 persons per square mile.

If the department administers a federal loan repayment program, Page 92 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 priorityencompasses shalla bepopulation givenof tono obligatinggreater statethan and100 federalpersons matchingper fundssquare pursuantmile. to paragraphs (a) and (b).

If the department administers a federal loan repayment program, priority shall be given to obligating state and federal matching funds pursuant to paragraphs (a) and (b).

(2) RIGHT TO NONDISCRIMINATORY SERVICES.— (a) Service providers may not deny an individual access to substance abuse services solely on the basis of race, gender, ethnicity, age, sexual preference, human immunodeficiency virus status, prior service departures against medical advice, disability,Page or93 number of relapse155 episodes.CODING:

Service providers may not deny an individual who takes medication prescribed by a physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse access to substance abuse Page 93 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 servicesdisability, solelyor onnumber thatof basis.relapse episodes.

Service providers may not deny an individual who takes medication prescribed by a physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse access to substance abuse services solely on that basis.

397.675 may be admitted to a hospital or to a licensed detoxification facility or addictions receiving facility for emergency assessment and stabilization, or to a less intensive component of a licensed service provider for assessment only, upon receipt by the facility of a certificate by a physician, an advanced practice registered nurse, a psychiatric nurse, a clinical psychologist, a clinical social worker, a marriage and family therapist, a mental health counselor, an autonomous physician assistant, a physician assistant working under the scope of practice of the supervising physician, or a master's- level-certified addictions professional for substance abuse services, if the certificate is specific to substance abuse impairment, and the completion of an application for emergency admission.Page 94 of 155 CODING:

Section 31.

Subsection (1) of section 397.6793, Florida Statutes, is amended to read:

397.6793 Professional's certificate for emergency Page 94 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 admission.— (1) A physician, a clinical psychologist, a physician assistant working under the scope of practice of the supervising physician, an autonomous physician assistant, a psychiatric nurse, an advanced practice registered nurse, a mental health counselor, a marriage and family therapist, a master's-level- certified addictions professional for substance abuse services, or a clinical social worker may execute a professional's certificate for emergency admission.

Section 31.

Subsection (1) of section 397.6793, Florida Statutes, is amended to read:

397.6793 Professional's certificate for emergency admission.— (1) A physician, a clinical psychologist, a physician assistant working under the scope of practice of the supervising physician, an autonomous physician assistant, a psychiatric nurse, an advanced practice registered nurse, a mental health counselor, a marriage and family therapist, a master's-level- certified addictions professional for substance abuse services, or a clinical social worker may execute a professional's certificate for emergency admission.

(b) The reason for the belief that because of such impairment the person has lost the power of self-control with respectPage to95 substanceof abuse;155 CODING:

and (c)1.

The reason for the belief that, without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself;

that such neglect or refusal Page 95 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 posesrespect a real and present threat of substantial harm to hissubstance orabuse; her well-being;

and (c)1.

The reason for the belief that, without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself;

that such neglect or refusal poses a real and present threat of substantial harm to his or her well-being;

(8) "Geriatric outpatient clinic" means a site for providing outpatient health care to persons 60 years of age or older, which is staffed by a registered nurse, a physician assistant, or a licensed practical nurse under the direct supervision of a registered nurse, advanced practice registered nurse,Page physician96 assistant,of autonomous155 physicianCODING: assistant, or physician.

Section 33.

Subsection (3) of section 400.172, Florida Statutes, is amended to read:

Page 96 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 400.172nurse, Respitephysician careassistant, provided in nursing home facilities.— (3) A prospective respite care resident must provide medical information from a physician, autonomous physician assistant, physician assistant, or nursephysician. practitioner and any other information provided by the primary caregiver required by the facility before or when the person is admitted to receive respite care.

Section 33.

Subsection (3) of section 400.172, Florida Statutes, is amended to read:

400.172 Respite care provided in nursing home facilities.— (3) A prospective respite care resident must provide medical information from a physician, autonomous physician assistant, physician assistant, or nurse practitioner and any other information provided by the primary caregiver required by the facility before or when the person is admitted to receive respite care.

or chapter 486, the attendingPage physician,97 autonomous physician assistant, physician assistant, or advanced practice registered nurse, acting within his or her respective scope of practice,155 shallCODING: establish treatment orders for a patient who is to receive skilled care.

Page 97 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 Theattending treatment orders must be signed by the physician, autonomous physician assistant, physician assistant, or advanced practice registered nursenurse, beforeacting awithin claimhis foror paymenther forrespective thescope skilledof servicespractice, isshall submittedestablish bytreatment theorders homefor healtha agency.patient who is to receive skilled care.

The treatment orders must be signed by the physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse before a claim for payment for the skilled services is submitted by the home health agency.

(a) When, in accordance with the privileges and restrictions imposed upon a nurse under part I of chapter 464, the delivery of care to a patient is under the direction or supervision of a physician or when a physician is responsible forPage the98 medical care of the155 patient,CODING: a medical plan of treatment must be established for each patient receiving care or treatment provided by a licensed nurse in the home.

The original medical plan of treatment must be timely signed by the physician, Page 98 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 autonomousfor physicianthe assistant,medical physiciancare assistant,of orthe advancedpatient, practicea registeredmedical nurse,plan actingof withintreatment hismust orbe herestablished respectivefor scopeeach ofpatient practice,receiving andcare reviewedor intreatment consultationprovided withby thea licensed nurse atin leastthe everyhome. 2 months.

The original medical plan of treatment must be timely signed by the physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse, acting within his or her respective scope of practice, and reviewed in consultation with the licensed nurse at least every 2 months.

400.9973 Client admission, transfer, and discharge.— (5) A client admitted to a transitional living facility must be admitted upon prescription by a licensed physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse and must remain under the care of a licensed physician, autonomous physician assistant, physician assistant,Page or99 advanced practice registered nurse for the duration of the155 client'sCODING: stay in the facility.

(7) A person may not be admitted to a transitional living facility if the person:

Page 99 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 (b)assistant, Is a danger to himself or herself or others as determined by a physician, autonomous physician assistant, physician assistant, advanced practice registered nurse,nurse orfor athe mentalduration healthof practitionerthe licensedclient's understay chapterin 490 or chapter 491, unless the facilityfacility. provides adequate staffing and support to ensure patient safety;

(7) A person may not be admitted to a transitional living facility if the person:

(b) Is a danger to himself or herself or others as determined by a physician, autonomous physician assistant, physician assistant, advanced practice registered nurse, or a mental health practitioner licensed under chapter 490 or chapter 491, unless the facility provides adequate staffing and support to ensure patient safety;

400.9976Page Administration100 of medication.—155 (1)CODING: An individual medication administration record must be maintained for each client.

A dose of medication, including a self-administered dose, shall be properly recorded in the Page 100 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 client's400.9976 record.Administration of medication.— (1) An individual medication administration record must be maintained for each client.

A dose of medication, including a self-administered dose, shall be properly recorded in the client's record.

The client's physician, autonomous physician assistant, physician assistant, or advanced practice registered nurse must be informed of the interdisciplinary team's decision that self-administration of medication is an objectivePage for101 theof client.155 CODING:

A client may not self-administer medication until he or she demonstrates the competency to take the correct medication in the correct dosage at the correct time, to respond to missed doses, and to contact the appropriate Page 101 of 154 CODING:

hb0821-02-c2hb0821-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 821 2019 personobjective withfor questions.the client.

A client may not self-administer medication until he or she demonstrates the competency to take the correct medication in the correct dosage at the correct time, to respond to missed doses, and to contact the appropriate person with questions.

The client and, if applicable, the client's representativePage shall102 be informed of the155 facility'sCODING: chemical restraint policies and procedures when the client is admitted.