(NRS403 441A.165,to 441A.169)Senate SectionBill 5No. of this bill provides that a pharmacist is a provider of health care for the purposes of these provisions.

-229 81stPage Session4 (2021)chemical –agent. 2 – EXPLANATION – Matter in bolded italics is new;

matter(NRS between441A.165, brackets441A.169) [omittedSection material]5 of this bill provides that a pharmacistr is materiala toprovider beof omitted.health care for the purposes of these provisions.

 The term does not include the changing of a prescription by a pharmacist or practitioner without the consent of the prescribing practitioner, except as otherwise provided in NRS 639.2583.ribing639.2583. Sec.

Sec.

To enter into a collaborative practice agreement, a practitioner must:must [:] (a) [Be] be licensed in good standing to practice his or her profession in this State .

- 81st Session (2021) – 3 – (a) Be licensed in good standing to practice his or her profession in this State;

and (b) [Agree to maintain an ongoing relationship with a patient who is referred by the practitioner to a pharmacist pursuant to a management;ve practice agreement for collaborative drug therapy (c)] Agree to obtain the informed, written consent from a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management .

(b) Agree to maintain an ongoing relationship with a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management;

(c) Agree to obtain the informed, written consent from a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management;

The Board may grant such a request upon a showing of good cause.] TheSenate provisionsAmendment ofNo. this paragraph must not be construed to require a patient to obtain a referral from a practitioner before a pharmacist may engage in the collaborative practice of pharmacy or collaborative drug therapy management.

3.403 to Senate Bill No.

229 Page 5 3.

Except as otherwise provided in this subsection, a practitioner shall not enter a collaborative practice agreement that includes diagnosis or initiating treatment unless the practitioner actively practices his or her profession in this State or provides those services using telehealth.

[3.] 5.

[3.][3. 6.

4.] 6.

- 81st Session (2021) – 4 – (b) Document in the medical record of the patient, on the chart of the patient or in a separate log book any decision or action concerning the management of drug therapy pursuant to a collaborative practice agreement after making such a decision or tak(c)taking Maintainsuch allan recordsaction; concerning the care or treatment provided to a patient pursuant to a collaborative practice agreement in written or electronic form for at least 7 years;

(c) Maintain all records concerning the care or treatment provided to a patient pursuant to a collaborative practice agreement in written or electronic form for at least 7 years;

[4.][4. 7.

and (b) Is not a physician, osteopathic physician, advanced practice registered nurse or physician assistantassistant; .

[;and (c) May not diagnose.

and5. 5.) MA practitioner may not enter into a collaborative practice agreement with a pharmacist for the management of controlled substances.

6.]A 8.practitioner may not enter into a collaborative practice agreement with a pharmacist for the management of controlled substances.

6.

5.] 7.

(a)Senate AAmendment descriptionNo. of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, which may include a specific description of the diseases and - 81st Session (2021) – 5 – therapy;r which the pharmacist is authorized to manage drug (b) A detailed explanation of the procedures that the pharmacist must follow when engaging in the collaborative practice of pharmacy, including, without limitation, the manner in which the pharmacist must document decisions concerning treatment and care in accordance with subsection [3] 6 of NRS 639.2623, report such decisions to the practitioner and receive feedback from the practitioner;

403 to Senate Bill No.

229 Page 6 (a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, which may include a specific description of the diseases and drugs for which the pharmacist is authorized to manage drug therapy;

(b) A detailed explanation of the procedures that the pharmacist must follow when engaging in the collaborative practice of pharmacy, including, without limitation, the manner in which the pharmacist must document decisions concerning treatment and care in accordance with subsection [3 4] 6 of NRS 639.2623, report such decisions to the practitioner and receive feedback from the practitioner;

(e) A description of the means by which the practitioner will monitor clinical outcomes of a patient and intercede when necessary treatment prescribed for the patient;or accomplish the goals of the (f) Authorization for the practitioner to override the agreement if necessary to protect the health of the patient or accomplish the goals of the treatment prescribed for the patient;

(f) Authorization for the practitioner to override the agreement if necessary to protect the health of the patient or accomplish the goals of the treatment prescribed for the patient;

[and]and (j) The address of the location where the records described in subsection [3][3 4] 6 of NRS 639.2623 will be maintained;maintained .

and[; (k) The process by which the pharmacist will obtain the NRS 639.2623.tten consent required by subsection [4] 7 of 2.

and (k) The process by which the pharmacist will obtain the informed, written consent required by subsection 4 of NRS 639.2623.] 2.

- 81st Session (2021) – 6 – Sec.

laboratory(a) testsMay andauthorize examinations.toa pharmacist to order and use the findings of (b)laboratory Maytests provideand forexaminations. collaborative drug therapy management for a patient receiving care:

(b) May provide for collaborative drug therapy management for a patient receiving care:

A pharmacist who modifies a drug therapy of a patient receiving care in a setting that is affiliated with a medical facility shall, within 72 hours after initiating or modifying the drug therapy, provide written notice of the initiation or modification of the drug therapy to the collaborating practitioner or enter the appropriate informationSenate concerningAmendment theNo. drug therapy in an electronic patient record system shared by the pharmacist and the collaborating practitioner.

403 to Senate Bill No.

229 Page 7 information concerning the drug therapy in an electronic patient record system shared by the pharmacist and the collaborating practitioner.

(d) MustMust] be approved by the Board.] must include, without limitation:

(a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, i(1)including, Awithout specificlimitation: description of the diseases, drugs and categories of drugs covered by the guidelines;

(1) A specific description of the diseases, drugs and categories of drugs covered by the guidelines;

-[ 81st Session (2021) – 7 – 2.

The Boardwritten mayguidelines adoptestablished regulationspursuant whichto [:subsection 1 and any modifications to those guidelines must be approved by the Board.] 2.

[3.] The Board may adopt regulations which [:

and (b) Set forth the process for obtaining the approval of the Board of such written guidelines and protocols.] Sec.

5.ittNRS5. 441A.110 is hereby amended to read as follows:

NRS 441A.110 is hereby amended to read as follows:

(b) A registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a physician, physician assistant, dentist, podiatric physicianSenate orAmendment advancedNo. practice registered nurse, or pursuant to a chart order, for administration to a patient at another location.

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229 Page 8 physician or advanced practice registered nurse, or pursuant to a chart order, for administration to a patient at another location.

or - 81st Session (2021) – 8 – (III) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.

(e) A medical student, student in training to become a physician assistant or student nurse in the course of his or her studies at an accredited college of medicine or approved school of professional or practical nursing, at the direction of a physician or physician assistant and:

(i) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as intodefined byin theNRS ultimate449.017, user.rsuantpursuant to a written agreement entered (j)into In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental agency whose duties include the controlultimate ofuser. domestic, wild and predatory animals.

(j) In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental agency whose duties include the control of domestic, wild and predatory animals.

- 81st Session (2021) – 9 – (l) A registered pharmacist pursuant to written guidelines and protocols developed pursuant to NRS 639.2629 or a collaborative practice agreement, as defined in NRS 639.0052.

As used in this section, “accredited college of medicine” mea(a)means: A medical school that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations;

Senate Amendment No.

403 to Senate Bill No.

229 Page 9 (a) A medical school that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations;

(d) In accordance with applicable regulations of the Board, a practicalregistered nurse wholicensed is:ed to practice professional nursing or licensed (1)practical Employednurse bywho ais: health care agency or health care facility that is authorized to provide emergency care, or to respond to the immediate needs of a patient, in the residence of the patient;

(1) Employed by a health care agency or health care facility that is authorized to provide emergency care, or to respond to the immediate needs of a patient, in the residence of the patient;

(f) Except as otherwise provided in paragraph (g), an advanced emergency medical technician or a paramedic, as authorized by - 81st Session (2021) – 10 – regulation of the State Board of Pharmacy and in accordance with any applicable regulations of:

(2) A county board of health in a county whose population is 100,000 or more;

or board of health in a county whose population is (3) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.

Senate AAmendment medicalNo. student or student nurse may administer a dangerous drug in the presence or under the supervision of a registered nurse would be authorized to administer it personally.e registered nurse (k) Any person designated by the head of a correctional institution.

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229 Page 10  A medical student or student nurse may administer a dangerous drug in the presence or under the supervision of a registered nurse alone only if the circumstances are such that the registered nurse would be authorized to administer it personally.

(k) Any person designated by the head of a correctional institution.

- 81st Session (2021) – 11 – (1) Used for cooling and stretching external tissue during therapeutic treatments;

or ultrasound.II)(II) The transmission of drugs through the skin using (p)ultrasound. In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.

(p) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.

(t) A person who is enrolled in a training program to become a physician assistant licensed pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced emergency medical technician, paramedic, respiratory therapist, dialysis technician, physicalcian,physical therapist or veterinary technician or to obtain a license to engage in radiation therapy and radiologic imaging pursuant to chapter 653 of NRS if the person possesses and administers the drug or medicine in the same manner and under the same conditions that apply, respectively, to a physician assistant licensed pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced emergency medical technician, paramedic, respiratory therapist, dialysis technician, physical therapist, veterinary technician or person licensed to engage in radiation therapy and radiologic imaging who may possess and administer the drug or medicine, and under the direct supervision of a person licensed or registered to perform the respective medical art or a supervisor of such a person.

- 81st Session (2021) – 12 – (1) Board of Medical Examiners, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.

(2)Senate StateAmendment BoardNo. of Osteopathic Medicine, at the direction of or physician assistant.an and under the supervision of a physician 2.

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229 Page 11 (2) State Board of Osteopathic Medicine, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.

2.

Sec.[Sec.

7.] Sec.

Sections 1 to [6,] 8, inclusive, of this act become effective:

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