Subchapter C. CERTIFIED REGISTERED NURSE PRACTITIONERS


GENERAL PROVISIONS

Sec.


21.251.    Definitions.
21.252.    [Reserved].
21.253.    Fees.

LEGAL RECOGNITION


21.261.    Use of title; authorization to practice.

CERTIFICATION REQUIREMENTS


21.271.    Certification requirements.
21.272.    [Reserved].
21.273.    Application for certification.
21.281.    [Reserved].
21.282.    [Reserved].

CRNP PRACTICE


21.282a.    CRNP Practice.
21.283.    Authority and qualifications for prescribing, dispensing and ordering drugs.
21.284.    Prescribing and dispensing parameters.
21.284a.    Prescribing and dispensing drugs.
21.284b.    Prescribing, administering and dispensing controlled substances.
21.285.    Prescriptive authority collaborative agreements.
21.286.    Identification of the CRNP.
21.287.    [Reserved].
21.288.    CRNP standards of conduct.
21.291.    [Reserved].
21.292.    [Reserved].
21.293.    [Reserved].
21.294.    [Reserved].
21.311.    [Reserved].
21.321.    [Reserved].

MAINTENANCE OF CERTIFICATION


21.331.    Biennial renewal of certification.
21.332.    Requirement of continuing education.
21.332a.    Inactive status and reactivation.
21.333.    Continuing education content.
21.334.    Sources of continuing education.
21.335.    Requirements for courses.
21.336.    Continuing education course approval.
21.337.    CRNP responsibilities.
21.341.    [Reserved].

PENALTIES FOR VIOLATION


21.351.    Penalties for violation.

APPROVAL OF CERTIFIED REGISTERED NURSE PRACTITIONER PROGRAMS


21.361.    General criteria for approval of programs.
21.362.    Annual reports and compliance reviews; list of approved programs.
21.363.    Approval process.
21.364.    Removal from approved list; discontinuance of CRNP program.
21.365.    Establishment.
21.366.    Organizational requirements.
21.367.    Faculty requirements for CRNP programs.
21.368.    Faculty policies.
21.369.    General curriculum requirements.
21.370.    Evaluation.
21.371.    Curriculum changes requiring Board approval.
21.372.    CRNP program philosophy; purposes and objectives.
21.373.    Facility and resource requirements.
21.374.    Selection and admission standards.
21.375.    Advanced standing.
21.376.    Program records.
21.377.    Custody of records.

Authority

   The provisions of this Subchapter C issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); The Professional Nursing Law (63 P. S. § §  211—225); and sections 3 and 16 of the Medical Practice Act of 1974 (63 P. S. § §  421.3 and 421.16) (Repealed), unless otherwise noted.

Source

   The provisions of this Subchapter C adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063, unless otherwise noted.

Cross References

   This subchapter cited in 6 Pa. Code §  11.3 (relating to definitions); and 28 Pa. Code §  9.678 (relating to PCPs); 28 Pa. Code §  107.12a (relating to specified professional personnel—statement of policy); 55 Pa. Code §  1153.41a (relating to medication—statement of policy); 55 Pa. Code §  2380.122a (relating to labeling of medications—statement of policy); 55 Pa. Code §  2380.124a (relating to medication log—statement of policy); 55 Pa. Code §  2380.126a (relating to adverse reaction—statement of policy); 55 Pa. Code §  5200.42a (relating to medication prescription—statement of policy); 55 Pa. Code §  5210.58a (relating to medication prescription—statement of policy); 55 Pa. Code §  6400.162a (relating to labeling of medication—statement of policy); 55 Pa. Code §  6400.163a (relating to use of prescription medication—statement of policy); 55 Pa. Code §  6400.164a (relating to medication log—statement of policy); 55 Pa. Code §  6400.166a (relating to adverse reaction—statement of policy); 55 Pa. Code §  6500.132a (relating to labeling of medication—statement of policy); 55 Pa. Code §  6500.133a (relating to use of prescription medications—statement of policy); 55 Pa. Code §  6500.134a (relating to medication log—statement of policy); and 55 Pa. Code §  6500.136a (relating to adverse reaction—statement of policy).

GENERAL PROVISIONS


§ 21.251. Definitions.

 The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   Act—The Professional Nursing Law (63 P. S. § §  211—225.5).

   Board—The State Board of Nursing of the Commonwealth.

   CRNP—Certified Registered Nurse Practitioner—A professional nurse licensed in this Commonwealth who is certified by the Board in a specialty and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with a physician licensed to practice in this Commonwealth and in accordance with the act and this subchapter. Nothing in this subchapter is to be deemed to limit or prohibit a professional nurse from engaging in those activities which constitute the practice of professional nursing as defined in section 2 of the act (63 P. S. §  212).

   Certification—The authorization granted by the Board to a professional nurse who has demonstrated the qualifications for recognition as a CRNP.

   Collaboration—A process in which a CRNP works with one or more physicians to deliver health care services within the scope of the CRNP’s expertise. The process includes the following:

     (i)   Immediate availability of a licensed physician to a CRNP through direct communications or by radio, telephone or telecommunications.

     (ii)   A predetermined plan for emergency services.

     (iii)   A physician available to a CRNP on a regularly scheduled basis for referrals, review of the standards of medical practice incorporating consultation and chart review, drug and other medical protocols within the practice setting, periodic updating in medical diagnosis and therapeutics and cosigning records when necessary to document accountability by both parties.

   Collaborative agreement—The written and signed agreement between a CRNP and a collaborating physician in which they agree to the details of their collaboration including the elements in the definition of collaboration.

   Initial certification—The first certification or licensure as a nurse practitioner that an individual receives in any jurisdiction.

   National certification—Certification by a Board-recognized National certification organization which required passing a nurse practitioner National certifying examination in a specialty.

   Prescriptive authority collaborative agreement—The written and signed agreement between a CRNP with prescriptive authority and a collaborating physician in which they agree to the details of their collaboration.

   Specialty—The area of practice or population in which a CRNP is certified by the Board.

Source

   The provisions of this §  21.251 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (335543) to (335544).

Notes of Decisions

   Chart Review

   Physicians may render an opinion based on a review of records. Therefore, the physician was justified in formulating a medical opinion based on the information provided by the certified registered nurse practitioner and the suspension of the petitioner’s license based on incompetence under 67 Pa. Code §  83.5 was justified. Satler v. Department of Transportation, 670 A.2d 1205 (Pa. Cmwlth. 1996).

§ 21.252. [Reserved].


Source

   The provisions of this §  21.252 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (335544).

§ 21.253. Fees.

 (a)  The following fees are charged by the Board for services to licensees:

CRNP certification … $100
Verification of certification …$15
Application for prescriptive authority … $50
Each additional collaborative agreement for prescriptive authority … $30

 (b)  The following fees are charged by the Board to support its operations:

Biennial renewal of CRNP certification … $75
Biennial renewal of prescriptive authority approval …$25

 (c)  The following fees for approval and review of CRNP education programs are charged by the Board:

Application for approval of new nursing program … $735

 (d)  The following fees related to continuing education are charged by the Board:

Application for approval of CRNP continuing education course … $100

Authority

   The provisions of this §  21.253 issued under sections 8.1(c) and 11.2(a) and (d) of The Professional Nursing Law (63 P. S. § §  218.1(c) and 221.2(a) and (d)); amended under sections 11.2 and 17.5 of the Practical Nurse Law (63 P. S. § §  221.2 and 667.5).

Source

   The provisions of this §  21.253 adopted December 25, 1987, effective December 26, 1987, 17 Pa.B. 5329; amended June 12, 1992, effective immediately and applies to biennial renewals commencing May 1, 1992; amended June 16, 2000, effective June 17, 2000, 30 Pa.B. 3040; amended November 17, 2000, effective November 18, 2000, 30 Pa.B. 5952; amended December 9, 2005, effective December 10, 2005, 35 Pa.B. 6658; amended June 2, 2006, effective June 3, 2006, 36 Pa.B. 2673; amended July 3, 2008, effective July 5, 2008, 38 Pa.B. 3656; amended August 20, 2010, effective August 21, 2010, 40 Pa.B. 4755. Immediately preceding text appears at serial pages (348885) and (346577).

Cross References

   This section cited in 49 Pa. Code §  21.273 (relating to application for certification); 49 Pa. Code §  21.283 (relating to authority and qualifications for prescribing, dispensing and ordering drugs); 49 Pa. Code §  21.285 (relating to prescriptive authority collaborative agreements); 49 Pa. Code §  21.331 (relating to biennial renewal of certification); and 49 Pa. Code §  21.336 (relating to continuing education course approval); and 49 Pa. Code §  21.605 (relating to biennial renewal).

LEGAL RECOGNITION


§ 21.261. Use of title; authorization to practice.

 (a)  A professional nurse who has satisfactorily met the requirements set forth in the act and this subchapter and holds current certification as a CRNP or whose certification is maintained on inactive status may use the designation CRNP.

 (b)  The Board will identify the specialty in which a CRNP is certified on the certification issued to the CRNP.

 (c)  Only an individual who holds current active certification may practice or offer to practice as a CRNP in this Commonwealth.

 (d)  A professional nurse may not practice or offer to practice as a CRNP in a specialty in this Commonwealth during the time the professional nurse’s certification in that specialty or the professional nurse’s RN license is inactive, lapsed or expired. A professional nurse may not practice or offer to practice as a CRNP in this Commonwealth if the professional nurse’s certification or RN license is revoked or suspended.

Source

   The provisions of this §  21.261 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (335545).

CERTIFICATION REQUIREMENTS


§ 21.271. Certification requirements.

 (a)  Initial certification. An applicant for initial certification shall meet the following requirements:

   (1)  Registered nurse license. An applicant for certification shall hold a current, unrestricted license as a professional nurse in this Commonwealth.

   (2)  Education. An applicant for certification shall have completed an accredited, Board-approved master’s or postmaster’s nurse practitioner program or other Board-approved program that awarded an advanced degree or a course of study considered by the Board to be equivalent to that required for certification in this Commonwealth at the time the course was completed.

   (3)  National certification. An applicant for initial certification after February 7, 2005, shall hold current National certification in the specialty in which the professional nurse is seeking certification.

 (b)  Certification by endorsement. An applicant for certification who holds a current, unrestricted license or certificate as a nurse practitioner from another state, territory or possession of the United States or a foreign country, shall meet the certification requirements that were effective at the time the applicant was licensed or certified as a nurse practitioner by the other jurisdiction. Applicants who were initially licensed or certified by another state, territory or possession of the United States or a foreign country after February 7, 2005, shall hold current National certification in the specialty in which the nurse is seeking certification. Nurse practitioners applying for certification from a jurisdiction that does not designate the nurse practitioner’s specialty will be required to present evidence satisfactory to the Board to demonstrate the nurse practitioner’s specialty.

 (c)  Addition of a specialty. A CRNP who holds an unrestricted certification to practice may apply for certification in an additional specialty. To be granted certification in an additional specialty, the CRNP shall meet the educational and National certification requirements for the specialty in which the CRNP is applying for certification.

Source

   The provisions of this §  21.271 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (335545) to (335546).

Cross References

   This section cited in 49 Pa. Code §  21.273 (relating to application for certification); and 49 Pa. Code §  21.332a (relating to inactive status and reactivation).

§ 21.272. [Reserved].


Source

   The provisions of this §  21.272 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (335546).

§ 21.273. Application for certification.

 (a)  Applicants for certification shall pay a fee set forth in §  21.253 (relating to fees), and submit an application form provided by the Board to the Board for its review and approval. Applicants shall verify compliance with section 8.7 of the act (63 P. S. §  218.7) regarding professional liability coverage.

 (b)  An applicant for initial certification shall include documentation satisfactory to the Board of the following:

   (1)  Proof of completion of a Board-approved education program or proof of completion and official transcript from another course of study that meets the requirements of §  21.271(a)(2) (relating to certification requirements).

   (2)  Proof of current National certification as set forth in §  21.271(a)(3).

 (c)  An applicant for certification by endorsement shall include documentation satisfactory to the Board of the following:

   (1)  Verification of current, unrestricted licensure or certification as a nurse practitioner issued by the proper licensing authority of another state, territory or possession of the United States or a foreign country.

   (2)  Copy of the licensure or certification requirements at the time the applicant was initially licensed or certified by another jurisdiction and a copy of the criteria under which the applicant was initially licensed or certified, obtained from the jurisdiction’s board of nursing or licensing authority.

   (3)  Official transcript from the applicant’s nurse practitioner program, including degree awarded.

   (4)  Proof of current National certification in the specialty in which the nurse is seeking certification by the Board, if the applicant obtained initial certification or licensure after February 7, 2005.

   (5)  Proof of specialty designation. For a nurse practitioner who obtained initial certification in a specialty before February 7, 2005, and who does not hold current National certification, the specialty designation shall be demonstrated by certification from the nurse practitioner’s original state of certification. For a nurse practitioner whose certification is from a state that does not designate a specialty, the specialty designation shall be demonstrated by the nurse practitioner’s educational program.

 (d)  An applicant who holds certification who is applying for certification in another specialty shall submit documentation of the following:

   (1)  Official transcript from the applicant’s nurse practitioner program and any additional educational programs, including degree awarded, demonstrating a concentration in the specialty in which the applicant is seeking certification.

   (2)  Proof of current National certification in the specialty in which the nurse is seeking certification by the Board.

 (e)  Applicants shall remit the fee set forth in §  21.253.

 (f)  Applicants shall submit additional information as identified on the application or as requested by the Board. Applications will remain on file for 12 months.

 (g)  All forms are available on the Board’s web site or by contacting the Board.

Source

   The provisions of this §  21.273 adopted December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994.

APPLICATION FOR APPROVAL


§ 21.281. [Reserved].


Source

   The provisions of this §  21.281 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (335546).

§ 21.282. [Reserved].


Source

   The provisions of this §  21.282 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (335546).

CRNP PRACTICE


§ 21.282a. CRNP Practice.

 (a)  A CRNP may collaborate only with physicians who hold a current license to practice in this Commonwealth.

 (b)  When acting in collaboration with a physician as set forth in a collaborative agreement and within the CRNP’s specialty, a CRNP may:

   (1)  Perform comprehensive assessments of patients and establish medical diagnoses.

   (2)  Order, perform and supervise diagnostic tests for patients and, to the extent the interpretation of diagnostic tests is within the scope of the CRNP’s specialty and consistent with the collaborative agreement, may interpret diagnostic tests.

   (3)  Initiate referrals to and consultations with other licensed professional health care providers, and consult with other licensed professional health care providers at their request.

   (4)  Develop and implement treatment plans, including issuing orders to implement treatment plans. However, only a CRNP with current prescriptive authority approval may develop and implement treatment plans for pharmaceutical treatments.

   (5)  Complete admission and discharge summaries.

   (6)  Order blood and blood components for patients.

   (7)  Order dietary plans for patients.

   (8)  Order home health and hospice care.

   (9)  Order durable medical equipment.

   (10)  Issue oral orders to the extent permitted by the health care facilities’ by-laws, rules, regulations or administrative policies and guidelines.

   (11)  Make physical therapy and dietitian referrals.

   (12)  Make respiratory and occupational therapy referrals.

   (13)  Perform disability assessments for the program providing temporary assistance to needy families (TANF).

   (14)  Issue homebound schooling certifications.

   (15)  Perform and sign the initial assessment of methadone treatment evaluations, provided that any order for methadone treatment shall be made only by a physician.

 (c)  The provisions of this section are subject to limitation as set forth in section 8.2(c.2) of the act (63 P. S. §  218.2(c.2)), regarding the authority of state agencies and health care facilities.

Source

   The provisions of this §  21.282a adopted December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994.

§ 21.283. Authority and qualifications for prescribing, dispensing and ordering drugs.

 (a)  A CRNP with prescriptive authority approval may, when acting in collaboration with a physician as set forth in a prescriptive authority collaborative agreement and within the CRNP’s specialty, prescribe and dispense drugs and give written or oral orders for drugs and other medical therapeutic or corrective measures. These orders may include:

   (1)  Orders for drugs, total parenteral nutrition and lipids, in accordance with § §  21.284 and 21.285 (relating to prescribing and dispensing parameters; and prescriptive authority collaborative agreements).

   (2)  Disposables and devices adjunctive to a treatment plan.

 (b)  To obtain prescriptive authority approval, a CRNP shall:

   (1)  Successfully complete at least 45 hours of course work specific to advanced pharmacology in accordance with the following:

     (i)   The course work in advanced pharmacology may be either part of the CRNP education program or, if completed outside of the CRNP education program, an additional course or courses taken from an educational program or programs approved by the Board.

     (ii)   The course work shall be at an advanced level above a pharmacology course required by a professional nursing (RN) education program.

     (iii)   The course work shall have been completed within 5 years immediately preceding the date the applicant applies for initial prescriptive authority approval.

   (2)  Submit an application for prescriptive authority approval to the Board.

   (3)  Pay the fee set forth in §  21.253 (relating to fees).

 (c)  A CRNP who has prescriptive authority shall complete at least 16 hours of Board-approved continuing education in pharmacology in the 2 years prior to the biennial renewal date of the certification. The CRNP shall verify completion of the continuing education when submitting a biennial renewal.

Authority

   The provisions of this §  21.283 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. §  422.15(b)) (Repealed).

Source

   The provisions of this §  21.283 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (335546) and (319599).

Cross References

   This section cited in 49 Pa. Code §  21.285 (relating to prescriptive authority collaborative agreements); 49 Pa. Code §  21.332a (relating to inactive status and reactivation); and 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.284. Prescribing and dispensing parameters.

 (a)  The Board adopts the American Hospital Formulary Service Pharmacologic-Therapeutic Classification to identify drugs which the CRNP may prescribe and dispense subject to the parameters identified in this section.

 (b)  A CRNP with current prescriptive authority approval from the Board may prescribe, dispense and administer drugs and therapeutic or corrective measures consistent with the prescriptive authority collaborative agreement and relevant to the CRNP’s specialty from the following categories:

   (1)  Antihistamines.

   (2)  Anti-infective agents.

   (3)  Antineoplastic agents, unclassified therapeutic agents, devices and pharmaceutical aids.

   (4)  Autonomic drugs.

   (5)  Blood formation, coagulation and anticoagulation drugs, and thrombolytic and antithrombolytic agents.

   (6)  Cardiovascular drugs.

   (7)  Central nervous system agents.

   (8)  Contraceptives including foams and devices.

   (9)  Diagnostic agents.

   (10)  Disinfectants for agents used on objects other than skin.

   (11)  Electrolytic, caloric and water balance.

   (12)  Enzymes.

   (13)  Antitussive, expectorants and mucolytic agents.

   (14)  Gastrointestinal drugs.

   (15)  Local anesthetics.

   (16)  Eye, ear, nose and throat preparations.

   (17)  Serums, toxoids and vaccines.

   (18)  Skin and mucous membrane agents.

   (19)  Smooth muscle relaxants.

   (20)  Vitamins.

   (21)  Hormones and synthetic substitutes.

 (c)  A CRNP may not prescribe or dispense a drug from the following categories:

   (1)  Gold compounds.

   (2)  Heavy metal antagonists.

   (3)  Radioactive agents.

   (4)  Oxytocics.

   (5)  Schedule I controlled substances as defined by section 4 of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §  780-104).

 (d)  Restrictions on CRNP prescribing and dispensing practices are as follows:

   (1)  A CRNP may write a prescription for a Schedule II controlled substance for up to a 30-day supply as identified in the collaborative agreement.

   (2)  A CRNP may prescribe a Schedule III or IV controlled substance for up to a 90 day supply as identified in the collaborative agreement.

 (e)  A CRNP may not delegate prescriptive authority.

Authority

   The provisions of this §  21.284 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. §  422.15(b)) (Repealed).

Source

   The provisions of this §  21.284 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (319599) to (319601).

Cross References

   This section cited in 49 Pa. Code §  21.283 (relating to authority and qualifications for prescribing, dispensing and ordering drugs); and 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.284a. Prescribing and dispensing drugs.

 (a)  Professional samples. A CRNP who holds current prescriptive authority approval may request, receive and sign for professional samples and may dispense professional samples to patients.

 (b)  Prescriptions.

   (1)  Prescriptions must bear the name, title and Pennsylvania CRNP certification number of the CRNP.

   (2)  When appropriate, the CRNP’s National Provider Identifier (NPI) number must appear on the prescription.

   (3)  Prescriptions may not be presigned.

 (c)  Documentation requirements. When prescribing or dispensing a drug, the CRNP shall document in the patient’s medical record the name, amount and dosage of the drug, instructions for taking the drug, the number of refills, the date and the CRNP’s name.

 (d)  Packaging. Prescription drugs shall be dispensed in accordance with Federal regulations pertaining to packaging. (See 16 CFR Part 1700 (relating to poison prevention packaging)).

 (e)  Labeling of dispensed drugs.

   (1)  The label on a dispensed drug container must include the name of the drug, using abbreviations if necessary; the quantity; and the name of the manufacturer if the drug is a generic drug. If a CRNP specifically indicates that the name of the drug may not appear on the label, the recognized National drug code number shall be placed on the label if the number is available for the product. The label shall also bear the name and address of the CRNP, the date dispensed, the name of the patient and the directions for use of the drug by the patient.

   (2)  Drugs that, at the time of their dispensing, have full potency for less than 1 year, as determined by the expiration date placed on the original label by the manufacturer, may only be dispensed with a label that indicates the expiration date. The label must include the statement, ‘‘Do not use after manufacturer’s expiration date,’’ or similar wording.

 (f)  Compliance with regulations relating to prescribing, administering, dispensing, packaging and labeling of drugs. A CRNP shall comply with this section, §  21.284b (relating to prescribing, administering and dispensing controlled substances) and regulations of the Department of Health in 28 Pa. Code § §  25.51—25.58, 25.61—25.63, 25.72, 25.81 and 25.91—25.95.

Source

   The provisions of this §  21.284a adopted December 11, effective December 12, 2009, 39 Pa.B. 6994.

§ 21.284b. Prescribing, administering and dispensing controlled substances.

 (a)  A CRNP authorized to prescribe or dispense, or both, controlled substances shall register with the Drug Enforcement Administration.

 (b)  A CRNP shall carry out the following minimum standards when prescribing, administering or dispensing controlled substances:

   (1)  Initial evaluation. In a health care facility regulated by the Department of Health, the Department of Public Welfare or the Federal government, an initial medical history shall be taken and an initial physical examination shall be conducted to the extent required by the Department of Health in 28 Pa. Code (relating to health and safety) or Department of Public Welfare in 55 Pa. Code (relating to public welfare) or the Federal government in appropriate Federal regulations, whichever is applicable, and bylaws of the health care facility and its medical staff. In other practice settings, before commencing treatment that involves prescribing, administering or dispensing a controlled substance, an initial medical history shall be taken and an initial physical examination shall be conducted unless emergency circumstances justify otherwise. Alternatively, medical history and physical examination information recorded by another health care provider may be considered if the medical history was taken and the physical examination was conducted within the immediately preceding 30 days. The physical examination must include an evaluation of the heart, lungs, vital signs, pain level, and body functions that relate to the patient’s specific complaint.

   (2)  Reevaluations. Among the factors to be considered in determining the number and frequency of follow-up evaluations that should be recommended to the patient are the condition diagnosed, the controlled substance involved, expected results and possible side effects. For chronic conditions, periodic follow-up evaluations shall be recommended to monitor the effectiveness of the controlled substance in achieving the intended results.

   (3)  Patient counseling. Appropriate counseling shall be given to the patient regarding the condition diagnosed and the controlled substance prescribed, administered or dispensed. Unless the patient is in an inpatient care setting, the patient shall be specifically counseled about dosage levels, instructions for use, frequency and duration of use and possible side effects.

   (4)  Medical records. In a health care facility regulated by the Department of Health, the Department of Public Welfare or the Federal government, information pertaining to the prescription, administration or dispensation of a controlled substance shall be entered in the medical records of the patient and the health care facility under 28 Pa. Code or 55 Pa. Code or appropriate Federal regulations, whichever is applicable, and bylaws of the health care facility and its medical staff. In other practice settings, certain information shall be recorded in the patient’s medical record on each occasion when a controlled substance is prescribed, administered or dispensed. This information must include the name of the controlled substance, its strength, the quantity and the date it was prescribed, administered or dispensed. On the initial occasion when a controlled substance is prescribed, administered or dispensed to a patient, the medical record must also include a specification of the symptoms observed and reported, the diagnosis of the condition for which the controlled substance is being given and the directions given to the patient for the use of the controlled substance. If the same controlled substance continues to be prescribed, administered or dispensed, the medical record must reflect changes in the symptoms observed and reported, in the diagnosis of the condition for which the controlled substance is being given and in the directions given to the patient.

   (5)  Emergency prescriptions. In the case of an emergency contact by a known patient, a prudent, short-term prescription for a controlled substance may be issued. Neither a refill nor a consecutive issuance of this emergency prescription may be given unless a physical examination and evaluation of the patient are first conducted. The results of this examination and evaluation must be set forth in the patient’s medical record together with the diagnosis of the condition for which the controlled substance is being prescribed. An emergency oral prescription for a Schedule II controlled substance shall be covered by a written prescription delivered to the pharmacist within 72 hours. In certain health care facilities regulated by the Department of Health, the Department of Public Welfare and the Federal government, an order for the immediate, direct administration of a Schedule II controlled substance to a patient is not considered a prescription and is, therefore, not subject to the requirements in this paragraph. Further information regarding this exclusion can be found in The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § §  780-101—780-144) and 28 Pa. Code Chapter 25 (relating to controlled substances, drugs, devices, and cosmetics).

 (c)  This section establishes minimum standards for the prescription, administration and dispensation of controlled substances by a CRNP. This section does not restrict or limit the application of The Controlled Substance, Drug, Device and Cosmetic Act or of another statute or regulation, and does not relieve a CRNP from complying with more stringent standards that may be imposed by another statute or regulation, or policy of the CRNP’s employer or facility in which the CRNP is employed.

 (d)  Compliance with this section will not be treated as compliance with the standards of acceptable and prevailing practice as a CRNP when medical circumstances require that the CRNP exceed the requirements of this section.

Source

   The provisions of this §  21.284b adopted December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994.

Cross References

   This section cited in 49 Pa. Code §  21.284a (relating to prescribing and dispensing drugs).

§ 21.285. Prescriptive authority collaborative agreements.

 (a)  The prescriptive authority collaborative agreement between a physician and a CRNP who will prescribe and dispense drugs and other medical therapeutic or corrective measures, as set forth in §  21.283(a) (relating to authority and qualifications for prescribing, dispensing and ordering drugs) must satisfy the following requirements. The agreement must:

   (1)  Be in writing, identify the parties, including the collaborating physician, the CRNP, and at least one substitute physician who will provide collaboration if the collaborating physician is unavailable, include the signature of the CRNP and the collaborating physician, and contain the date that the agreement is signed and the date that the agreement is effective.

   (2)  Identify the specialty in which the CRNP is certified.

   (3)  Identify the categories of drugs from which the CRNP may prescribe or dispense in accordance with section 8.3 (a)(2)(ii) of the act (63 P. S. §  218.3(a)(2)(ii)).

   (4)  Specify the circumstances and how often the collaborating physician will personally see the patient.

   (5)  Be kept at the primary practice location of the CRNP and a copy filed with the Bureau of Professional and Occupational Affairs.

   (6)  Be made available for inspection to anyone who requests it and be provided, without charge, to any licensed pharmacist or pharmacy upon request.

   (7)  Be reviewed and updated by the parties at least once every 2 years or whenever the agreement is changed.

   (8)  Specify the amount of professional liability insurance that covers the CRNP.

 (b)  The CRNP shall notify the Board, in writing, whenever a prescriptive authority collaborative agreement is updated or terminated, and, when appropriate, shall file the ‘‘Change Of Prescriptive Authority Collaborative Agreement’’ form and the amended prescriptive authority collaborative agreement with the Board and pay the fee set forth in §  21.253 (relating to fees).

Authority

   The provisions of this §  21.285 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. §  422.15(b)) (Repealed).

Source

   The provisions of this §  21.285 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; amended December 29, 2000, effective November 18, 2000, 30 Pa.B. 6911; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (319601) to (319602).

Cross References

   This section cited in 49 Pa. Code §  21.283 (relating to authority and qualifications for prescribing, dispensing and ordering drugs); 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.286. Identification of the CRNP.

 (a)  A CRNP shall comply with State, Federal and facility regulations regarding identification of personnel.

 (b)  The listing of a CRNP in an advertisement or publicly displayed sign shall identify CRNPs who use the designation ‘‘Dr.’’ as CRNPs by using the title CRNP following the individual’s name.

Authority

   The provisions of this §  21.286 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. §  422.15(b)) (Repealed).

Source

   The provisions of this §  21.286 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (319602) to (319603).

Cross References

   This section cited in 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.287. [Reserved].


Authority

   The provisions of this §  21.287 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. §  422.15(b)) (Repealed).

Source

   The provisions of this §  21.287 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (319603).

Cross References

   This section cited in 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.288. CRNP standards of conduct.

 A CRNP shall undertake a specific practice or procedure only if the CRNP has the necessary knowledge, preparation, experience and competency to properly execute the practice or procedure and the practice is within the scope of the CRNP’s specialty and consistent with the CRNP’s collaborative agreement. A CRNP shall comply with §  21.18 (relating to standards of nursing conduct).

Source

   The provisions of this §  21.288 adopted December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994.

§ 21.291. [Reserved].


Source

   The provisions of this §  21.291 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (319603) to (319604).

Cross References

   This section cited in 28 Pa. Code §  107.12a (relating to specified professional personnel—statement of policy).

§ 21.292. [Reserved].


Source

   The provisions of this §  21.292 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (319604).

§ 21.293. [Reserved].


Source

   The provisions of this §  21.293 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (319604).

§ 21.294. [Reserved].


Source

   The provisions of this §  21.294 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (319604).

§ 21.311. [Reserved].


Source

   The provisions of this §  21.311 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (308269).

§ 21.321. [Reserved].


Source

   The provisions of this §  21.231 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (308269).

MAINTENANCE OF CERTIFICATION


§ 21.331. Biennial renewal of certification.

 (a)  The certification, and prescriptive authority approval, if applicable, of a CRNP will expire at the same time as the CRNP’s registered nurse license as provided in §  21.29 (relating to expiration and renewal of license).

 (b)  Notice of application for renewal will be forwarded biennially to each active CRNP at the CRNP’s address of record with the Board prior to the expiration date of the current biennial period.

 (c)  As a condition of biennial renewal, a CRNP shall:

   (1)  Renew the CRNP’s registered nurse license.

   (2)  Verify completion of a minimum of 30 hours of Board-approved continuing education in the 2 years prior to renewal. As a condition of biennial renewal of prescriptive authority approval, a CRNP shall complete a minimum of 16 of the 30 hours of Board-approved continuing education in pharmacology in the 2 years prior to renewal.

   (3)  Demonstrate current National certification, if the CRNP was certified by the Board after February 7, 2005

   (4)  Pay the required biennial renewal fee set forth in §  21.253 (relating to fees).

   (5)  Verify compliance with section 8.7 of the act (63 P. S. §  218.7) regarding liability coverage.

 (d)  Any written communication with the Board must be typed or printed and include the CRNP’s full name, including former names, the current address and certification number.

Source

   The provisions of this §  21.331 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; amended October 18, 1985, effective October 19, 1985, 15 Pa.B. 3726; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (308269) to (308270).

§ 21.332. Requirement of continuing education.

 (a)  A CRNP shall comply with this section and § §  21.332a—21.337.

 (b)  Continuing education requirements shall be completed each biennial renewal cycle.

   (1)  A CRNP who does not meet the continuing education requirements for a biennial period will be subject to formal disciplinary action under section 14(a)(3) of the act (63 P. S. 244(a)(3)).

   (2)  The Board may waive the requirements of continuing education in cases of illness or undue hardship. It is the duty of each CRNP who seeks a waiver to notify the Board in writing and request the waiver at least 90 days prior to the end of the renewal period. The Board will grant, deny or grant in part the request for waiver.

   (3)  A CRNP who requests a waiver may not prescribe or dispense drugs after the expiration of his current prescriptive authority until the Board grants the waiver request or the prescriptive authority approval has been renewed.

Authority

   The provisions of this §  21.332 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.332 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (308270) to (308271).

Cross References

   This section cited in 49 Pa. Code §  21.332a (relating to inactive status and reactivation).

§ 21.332a. Inactive status and reactivation.

 (a)  A CRNP who places his certification on inactive status is not required to meet the continuing education requirements in section 8.1(c) of the act (63 P. S. §  218.1(c)) during the period the certification is on inactive status. Upon application for reactivation of certification, the CRNP shall show proof of meeting the continuing education requirements for the biennial period immediately preceding the request for reactivation, and, if the certification has been lapsed or on inactive status for 5 years or longer, the CRNP must have a current, active professional nurse license, reactivated in accordance with the continued competency requirements in §  21.30a (related to continued competency), and at least one of the following:

   (1)  Proof of current National certification in the specialty in which the nurse is seeking reactivation, if the CRNP is subject to section 8.1(b) of the act.

   (2)  Evidence that the applicant has practiced as a nurse practitioner in another jurisdiction at some period of time within the last 5 years under a current license or certification during that time.

 (b)  A CRNP who places his prescriptive authority approval on inactive status for less than 3 years is not required to meet the continuing education requirements in §  21.332(b)(2) (relating to requirement of continuing education) during the period the prescriptive authority approval is on inactive status. Upon application for reactivation of prescriptive authority approval, the CRNP shall show proof of meeting the continuing education requirements for the biennial period immediately preceding the request for reactivation.

 (c)  A CRNP who places his prescriptive authority approval on inactive status for 3 years or longer or whose prescriptive authority approval is lapsed for 3 years or longer, may reactivate the prescriptive authority approval by meeting one of the following conditions:

   (1)  Complete the requirement in §  21.283(b)(1) (relating to authority and qualifications for prescribing, dispensing and ordering drugs) by taking at least 45 hours of course work in advanced pharmacology.

   (2)  Provide evidence to the Board that:

     (i)   The CRNP has practiced, for at least 1 of the last 3 years, as a CRNP with prescriptive authority in another jurisdiction.

     (ii)   The scope of the prescriptive authority in the other jurisdiction is equivalent to prescriptive authority in this Commonwealth.

     (iii)   The CRNP was required, as a condition for continued practice in the other jurisdiction, to complete continuing education that is substantially equivalent to the requirements of §  21.283(b)(1).

     (iv)   The CRNP met the continuing education requirements of the other jurisdiction within 1 year of the request for reactivation of prescriptive authority.

 (d)  A CRNP whose certification has been suspended for 5 years or longer shall meet the requirements in §  21.332(b), and any other requirements set forth by Board order. A CRNP whose prescriptive authority approval has been suspended for 3 years or longer shall, in addition to meeting the requirements to renew the CRNP certification, meet the requirements in subsection (c), and any other requirements set forth by Board order.

 (e)  A CRNP whose certification has been revoked shall meet all of the requirements for certification in §  21.271(a) (relating to certification requirements), the requirements in §  21.332(b), and any other requirements set forth by Board order. A CRNP whose prescriptive authority approval has been revoked shall, in addition to meeting the requirements to reinstate the CRNP certification, meet the requirements in subsection (c), and any other requirements by Board order.

Authority

   The provisions of this §  21.332a issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.332a adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (308271) to (308272).

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education).

§ 21.333.  Continuing education content.

 (a)  Continuing education activities must address the CRNP’s specialty.

 (b)  Pharmacology continuing education activities must provide the knowledge and skills to understand the pharmacokinetics and pharmacodynamics of broad categories of drugs or drugs used in the CRNP’s specialty and to analyze the relationship between pharmacologic agents and physiologic/pathologic responses.

Authority

   The provisions of this §  21.333 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.333 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (308272).

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education).

§ 21.334. Sources of continuing education.

 (a)  The following providers of continuing education and credentialing organizations have currently met the standards for approval for continuing education. Therefore, all activities offered by these providers are approved for continuing education hours required for biennial license renewal.

   (1)  Board-approved CRNP educational programs and CRNP educational programs approved by other state boards of nursing or that hold current accreditation issued by a National nursing accreditation organization.

   (2)  National and international nursing organizations and their state and local affiliates.

   (3)  National and international medical and osteopathic organizations and their state and local affiliates.

   (4)  National pharmaceutical organizations and their state and local affiliates.

   (5)  National nursing specialty organizations.

   (6)  Continuing education programs approved by other state boards of nursing for advanced practice nurses or nurse practitioners.

 (b)  CRNPs may obtain hours for continuing education activities offered by providers not indicated in subsection (a)(1)—(6) if the provider receives approval of the activity under §  21.336 (relating to continuing education course approval) prior to its implementation.

 (c)  CRNPs may obtain credit for continuing education hours on an individual basis if the CRNP, prior to attendance at the course, obtains Board approval by submitting a request for course approval and supporting documentation listed in §  21.336(b).

 (d)  CRNPs may obtain credit for correspondence courses, taped study courses and other independent study courses if the course is Board approved.

 (e)  Up to 4 hours will be credited for service as a teacher, preceptor, lecturer or speaker and for publication in a refereed journal or other scholarly publication relating to pharmacology or the CRNP’s area of practice. Application shall be made prior to the service or within 90 days of the publication to assure that the Board will approve the service or publication and to allow the Board to determine the number of contact hours that will be granted.

 (f)  An hour for purposes of nurse practitioner continuing education is 50 minutes.

Authority

   The provisions of this §  21.334 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.334 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial pages (308272) to (308273).

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education); 49 Pa. Code §  21.336 (relating to continuing education course approval); and 49 Pa. Code §  21.337 (relating to CRNP responsibilities).

§ 21.335. Requirements for courses.

 Each course shall have:

   (1)  An established mechanism to measure its quality, established criteria for selecting and evaluating faculty, and established criteria for the evaluation of each participant who completes the course.

   (2)  Adequate facilities with appropriate instructional materials to carry out continuing education programs.

   (3)  Instructors who have suitable qualifications as detailed in §  21.336(d) (relating to continuing education course approval).

Authority

   The provisions of this §  21.335 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.335 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409.

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education).

§ 21.336. Continuing education course approval.

 (a)  As a condition of approval, providers and credentialing organizations are required to provide CRNPs who complete continuing education courses with a certificate of completion which contains the information listed in §  21.337(a) (relating to CRNP responsiblities). Providers and credentialing organizations shall maintain records of course attendance for at least 5 years.

 (b)  Providers referenced in §  21.334(b) (relating to sources of continuing education) or CRNPs applying for individual approval in §  21.334(c), when seeking Board approval of a continuing education course shall pay the required fee (see §  21.253 (relating to fees)) and complete and submit an application for course approval at least 60 days prior to the date the course is to be offered, which shall include the following information:

   (1)  The full name and address of the provider.

   (2)  The title of the program.

   (3)  The dates and location of the program.

   (4)  The faculty names, titles, affiliations, degrees and areas of expertise.

   (5)  The schedule of program—title of subject, lecturer and time allocated.

   (6)  The total number of hours requested.

   (7)  The method of certifying and assuring attendance, and draft of certificate of attendance to be provided to course participants.

   (8)  The course objectives.

   (9)  The target audience.

   (10)  The core subjects.

   (11)  The program coordinator.

   (12)  The instruction and evaluation methods.

   (13)  Other information requested by the Board.

 (c)  Upon approval of a course, the Board will assign a course number and determine the number of hours awarded. The provider shall place the course number on the certificate of attendance and shall provide CRNPs who successfully complete a course with a certificate of attendance.

 (d)  Courses will be approved only in the instructor’s demonstrated areas of expertise. Expertise may be demonstrated by the instructor’s certification in the specialty area to be presented.

 (e)  A separate application shall be submitted whenever a change is made to any information submitted under subsection (b), except for information related to a change in date or location, or both, of the program submitted under subsection (b)(3).

Authority

   The provisions of this §  21.336 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.336 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409.

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education); 49 Pa. Code §  21.334 (relating to sources of continuing education); and 49 Pa. Code §  21.335 (relating to requirements for courses).

§ 21.337. CRNP responsibilities.

 (a)  A CRNP is required to maintain documentation of completion of continuing education, including:

   (1)  CRNP name.

   (2)  Dates attended.

   (3)  Continuing education hours.

   (4)  Title of course.

   (5)  Course provider.

   (6)  Location of course.

   (7)  Course number.

 (b)  Primary responsibility for documenting completion of the continuing education requirements rests with the CRNP. A CRNP seeking to renew certification or prescriptive authority shall verify compliance with continuing education requirements. Documentation of completion of continuing education requirements must be maintained for 5 years. The certificate issued by the course provider must be acceptable documentation. Acceptable documentation of hours obtained through §  21.334(c) or (e) (relating to sources of continuing education) must be the Board approval letter sent to the applicant.

 (c)  Falsification of information required under this section or failure to complete continuing education requirements by those who continue to practice as a CRNP or to prescribe, may result in the institution of formal disciplinary action under section 14(a)(3) of the act (63 P. S. §  224(a)(3)).

Authority

   The provisions of this §  21.337 issued under sections 2.1(k) and 8.1(c) of the Professional Nursing Law (63 P. S. § §  211(k) and 218.1(c)).

Source

   The provisions of this §  21.337 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6409.

Cross References

   This section cited in 49 Pa. Code §  21.332 (relating to requirement of continuing education); and 49 Pa. Code §  21.336 (relating to continuing education course approval).

§ 21.341. [Reserved].


Source

   The provisions of this §  21.341 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; reserved December 25, 1987, effective December 26, 1987, 17 Pa.B. 5329. Immediately preceding text appears at serial page (117197).

PENALTIES FOR VIOLATION


§ 21.351. Penalties for violation.

 Certification as a CRNP may be suspended, revoked or otherwise restricted or subjected to remedial measures when, after notice and opportunity to be heard, the Board finds that:

   (1)  The CRNP has engaged in the performance of medical functions and tasks beyond the scope of practice permitted for a CRNP, beyond the scope of the CRNP’s specialty, or in violation of the CRNP’s collaborative agreement, as provided in the act and this subchapter.

   (2)  The CRNP has performed a medical task or function which the CRNP does not have the necessary knowledge, preparation, experience and competency to perform properly or is not qualified under the act and this subchapter to perform.

   (3)  The CRNP has violated the act or this subchapter, or engaged in any conduct prohibited for professional nurses.

Source

   The provisions of this §  21.351 adopted July 22, 1977, effective July 23, 1977, 7 Pa.B. 2063; amended December 11, 2009, effective December 12, 2009, 39 Pa.B. 6994. Immediately preceding text appears at serial page (319606).

APPROVAL OF CERTIFIED REGISTERED NURSE
PRACTITIONER PROGRAMS


§ 21.361. General criteria for approval of programs.

 (a)  A CRNP program must require, at a minimum, a baccalaureate degree in nursing for admission and must culminate with a master’s degree in nursing or postmaster’s certificate.

 (b)  A CRNP program must prepare the registered nurse (RN) to function as a nurse practitioner in an expanded role in a particular specialty.

 (c)  A CRNP program must prepare the registered nurse to perform acts of medical diagnosis and prescription of medical, therapeutic or corrective measures in collaboration with a physician licensed to practice medicine in this Commonwealth.

 (d)  A CRNP program may be formed as a master’s program, an RN to master’s program, an RN to nursing doctorate program or a pilot or accelerated program that culminates with at least a master’s degree in nursing.

Authority

   The provisions of this §  21.361 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.361 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section is cited in 49 Pa. Code §  21.363 (relating to process).

§ 21.362. Annual reports and compliance reviews; list of approved programs.

 (a)  Approved programs must complete an annual report to the Board on a form provided by the Board. The annual report must update information regarding the program’s administration, faculty, curriculum and student enrollment.

 (b)  Approved programs must conduct a compliance review of CRNP programs at least once every 3 years. The compliance review shall be submitted to the Board on a form provided by the Board. The compliance review must include information regarding accreditation, administration, clinical sites, faculty, curriculum, testing, educational resources and student body of the program.

 (c)  The Board will send a written report of recommendations or requirements, or both, including compliance deadlines, based on the CRNP program’s compliance review, to the CRNP program. The Board will conduct an announced or unannounced site compliance visit at its discretion.

 (d)  Lists of approved CRNP programs will be compiled and published annually (the approved list) and will be made available for distribution. The approved list will consist of programs on initial, full and provisional approval status.

Authority

   The provisions of this §  21.362 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.362 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

§ 21.363. Approval process.

 (a)  A program that meets and maintains the requirements of § §  21.361, 21.365—21.369 and 21.372—21.375 will be granted full approval status.

 (b)  The Board will place a CRNP program on provisional approval status if, as evidenced by the compliance review or other information, the program is not in compliance with the Board’s regulations. At its discretion, the Board will require progress reports or other information deemed necessary for the evaluation of a program on provisional approval status. Two years will be the maximum time allowed for the correction of the deficiencies that resulted in the program being placed on provisional approval status. If the program on provisional approval status is not in compliance within this designated time, the CRNP program will be removed from the approved list.

 (c)  The Board may return a CRNP program on provisional approval status to full approval status if the program attains and maintains the acceptable standards in § §  21.365—21.377, and adheres to the policies and regulations of the Board.

Authority

   The provisions of this §  21.363 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.363 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

§ 21.364. Removal from approved list; discontinuance of CRNP program.

 (a)  The Board will give at least 30 days notice of intent to remove a CRNP program from full approval status to provisional approval status or from provisional approval status to removal from the approved list and will provide an opportunity for the program’s officials to present documentation, within 10 days of notification of intent to remove, to show why approval should not be withdrawn. The Board will hold a hearing, within 30 days of the submission of documentation, at which the program official may appear and present additional evidence to show cause as to why approval should not be withdrawn. The 30 day period for holding a hearing may be waived by consent of the parties. Failure to hold a hearing within 30 days will not be cause to withdraw the notice of intent to remove.

 (b)  Programs planning to discontinue must follow the procedures in §  21.41 (relating to notification; completion of program; records).

Authority

   The provisions of this §  21.364 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.364 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

§ 21.365. Establishment.

 (a)  A CRNP program must be developed and maintained under the authority of a regionally accredited university or college or have current accreditation by the Credentialing Commission for Nurse Education or the National League of Nursing.

 (b)  A CRNP program must be under the direction of a faculty member who holds an active certification as a Pennsylvania CRNP and an earned doctorate degree or a specific plan for and evidence toward completion of the doctoral degree within 5 years. The length of appointment of temporary and acting directors of CRNP programs may not exceed 1 year.

 (c)  A university or college may conduct CRNP programs within the graduate program of the university or college where it resides, if the college or university has a professional nurse program and the philosophy of the parent institution encompasses dual programs of education. A college or university desiring to establish a program of nursing is required to:

   (1)  Submit a proposal to the Board, at least 12 months prior to the first intended admission of students, which includes the following:

     (i)   Sufficient statistical data to support the need for a CRNP program within the community and to assure availability of an adequate number of interested candidates.

     (ii)   Letters of intent from the cooperating agencies indicating positive commitment to the CRNP program and the availability of sufficient clinical resources to meet the educational requirements of the CRNP program.

     (iii)   The projected cost of the CRNP program including costs for faculty, clinical teaching resources, educational supplies, office supplies, and the like, and sufficient evidence of stable financial support.

   (2)  Employ the director of the CRNP program prior to the intended admission date of students.

 (d)  The planned CRNP educational program proposal must include:

   (1)  A statement of the organization and administrative policies of the college or university.

   (2)  A statement of the administrative structure and functions of the nursing school.

   (3)  A statement of the educational preparation and nursing experience of faculty members employed, which conforms to §  21.367(b) (relating to faculty requirements for CRNP programs).

   (4)  A statement of the philosophy, purposes and objectives of the program, which are congruent with the philosophy of the university or college.

   (5)  A statement of the curriculum, based on sound educational concepts, and including detailed course descriptions, objectives and descriptions of the relevant clinical practice related to the specialty area.

   (6)  A statement of admissions policies.

   (7)  A statement identifying the National educational standards and guidelines used in the development of the nursing practitioner program.

   (8)  Statements of financial viability for 5 years.

   (9)  A description of the clinical facilities.

 (e)  Following the review of the CRNP program proposal and before final Board action is taken to grant permission to recruit students, an initial facility survey may be made by the designee of the Board.

Authority

   The provisions of this §  21.365 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.365 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process); and 49 Pa. Code §  21.367 (relating to approval process).

§ 21.366. Organizational requirements.

 (a)  The CRNP program must be a definable entity distinguishable from other educational programs and services within the institution.

 (b)  Relationships with central administrative officers, interrelationships among other disciplines and services of the college or university, and representation on college or university councils and committees for faculty in a CRNP program must be consistent with the interaction and responsibilities accorded to other faculty members of the college or university.

 (c)  Adequate funds shall be allocated and properly budgeted for the sound and effective operation of the CRNP program.

 (d)  Policies in effect for faculty members of the CRNP program must be those in effect for faculty members throughout the college or university.

 (e)  The resources, facilities and services of the college or university must be available to and used by the CRNP program and be adequate to meet the needs of the faculty and students.

Authority

   The provisions of this §  21.366 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.366 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.367. Faculty requirements for CRNP programs.

 (a)  The minimum faculty requirements submitted under §  21.365(d)(3) (relating to establishment) for the program are:

   (1)  Qualified faculty members teaching in their areas of specialized practice encompassed within the curriculum.

   (2)  Additional faculty members as needed to insure an educationally effective student-faculty ratio.

 (b)  Faculty qualifications for clinical courses in the CRNP program are as follows:

   (1)  Faculty members shall provide evidence of expertise in their subject areas, and when appropriate, be currently licensed and certified in this Commonwealth and hold and maintain National certification. Faculty members already employed in a CRNP program who do not hold National certification in their area of specialization shall obtain National certification, if available, by June 3, 2008.

   (2)  Faculty members shall give evidence of maintaining expertise in their clinical or functional areas of specialization.

   (3)  Faculty members shall maintain currency in clinical practice through ongoing clinical practice.

   (4)  Faculty members shall meet specialty requirements for continuing competency in accordance with their educational program responsibilities.

Authority

   The provisions of this §  21.367 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.367 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process); and 49 Pa. Code §  21.365 (relating to establishment).

§ 21.368. Faculty policies.

 (a)  The faculty shall be employed by and be responsible to the college or university.

 (b)  Policies, including personnel policies in effect for CRNP program faculty, must be those in effect for faculty members throughout the college or university.

 (c)  Functions and responsibilities of each faculty member shall be defined in writing.

 (d)  Teaching hours of CRNP faculty must be consistent with the policies of the college or university.

Authority

   The provisions of this §  21.368 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.368 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.369. General curriculum requirements.

 (a)  The curriculum shall be developed, implemented and evaluated by the faculty and be based on the philosophy and objectives of the school.

 (b)  The curriculum must be organized and developed to include the knowledge, attitudes, skills and abilities necessary for practice as a CRNP and in accordance with this chapter as related to CRNP practice.

 (c)  The curriculum must provide for both clinical and theoretical experiences. The curriculum must have the following components incorporated into each CRNP program:

   (1)  Graduate nursing core. The graduate nursing core must include the following content:

     (i)   Research.

     (ii)   Health care policy and organization.

     (iii)   Ethics.

     (iv)   Professional role development.

     (v)   Theoretical foundations of nursing practice.

     (vi)   Human diversity and social issues.

     (vii)   Health promotion and disease prevention.

   (2)  Advanced nursing practice core. The advanced nursing practice core must include the following content:

     (i)   Advanced health/physical assessment.

     (ii)   Advanced physiology and pathophysiology.

     (iii)   Advanced pharmacology.

   (3)  Specialty content. The CRNP student shall receive sufficient clinical experience to provide depth and breadth in a given specialty or with designated populations, geared to nurse practitioner practice. Clinical hours must meet at least National certification requirements with a minimum of 500. Additional hours must be provided for specialties that provide care to multiple age groups (for example, family CRNPs) or for those who will practice in multiple care settings. When defining additional clinical hours, the complexity of the specialty content, as well as the need for clinical experience to enhance retention and skills, shall be considered. The expected graduate competencies must be the key determinant of the clinical component.

   (4)  Advanced pharmacology.

     (i)   CRNP program graduates shall have a well-grounded understanding of pharmacologic principles, which includes the cellular response level. This area of core content must also include both pharmacotherapeutics and pharmacokinetics of broad categories of pharmacologic agents. Advanced pharmacology shall be taught in a separate or dedicated 3-credit or 45-hour course. Pharmacology content shall also be integrated into the other content areas identified in the advanced practice nursing core. Additional application of this content shall also be presented within the specialty course content and clinical experiences of the program to prepare the CRNP to practice within a specialty scope of practice.

     (ii)   The purpose of this content is to provide the graduate with the knowledge and skills to assess, diagnose and manage (including the prescription of pharmacologic agents) a patient’s common health problems in a safe, high quality, manner.

     (iii)   The course work must provide graduates with the knowledge and skills to:

       (A)   Comprehend the pharmacotherapeutics of broad categories of drugs.

       (B)   Analyze the relationship between pharmacologic agents and physiologic/pathologic responses.

       (C)   Understand the pharmacokinetics and pharmacodynamics of broad categories of drugs.

       (D)   Understand the motivations of clients in seeking prescriptions and the willingness to adhere to prescribed regimens.

       (E)   Safely and appropriately select pharmacologic agents for the management of client health problems based on client variations, the problem being managed, and cost effectiveness.

       (F)   Provide comprehensive and appropriate client education in relation to prescribed pharmacologic agents.

       (G)   Analyze the effects of single and multiple drug regimens on the client’s health and functioning.

       (H)   Understand the variety of State legal requirements for CRNP prescriptive authority.

       (I)   Fulfill legal requirements for writing prescriptions as a CRNP in this Commonwealth in accordance with § §  21.283—21.287 (relating to CRNP).

   (5)  Professional role content. The course work must provide graduates with curriculum in:

     (i)   Management of client health/illness status.

     (ii)   The nurse-client relationship.

     (iii)   The teaching-mentoring function.

     (iv)   Professional role.

     (v)   Managing and negotiating health care delivery systems.

     (vi)   Monitoring and ensuring the quality of health care practice.

 (d)  The instructional strategies must be appropriate and consistent with the program’s philosophy, mission and objectives.

 (e)  The clinical facilities of the CRNP program must provide a variety of experiences with sufficient quality and quantity. Clinical experiences must be consistent with the scope of practice.

 (f)  CRNP courses and curriculum must be organized to continue the development of values, understandings, knowledge and skills needed in all aspects of practice as a CRNP and emphasize specialty areas.

 (g)  The ratio of students to faculty must insure optimal learning opportunities in clinical laboratory sessions, be consistent with the objectives of the CRNP courses, and comply with §  21.373(c)(3)(ii) (relating to facility and resource requirements).

 (h)  The curriculum for CRNP programs must give evidence of providing learning experiences which will prepare graduates for CRNP practice. The standards of practice are defined and delineated by the profession and § §  21.18 and 21.284 (relating to standards of nursing conduct; and prescribing and dispensing parameters).

 (i)  Course syllabi that identify all aspects of each course must be developed and readily available.

Authority

   The provisions of this §  21.369 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.369 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.370. Evaluation.

 (a)  As part of the CRNP program approval process, the CRNP program shall submit an outline of, and appropriate time line for, its planned evaluative process. The evaluative process must include, at a minimum, the following:

   (1)  A self-evaluation process completed by faculty, administrators and students of the CRNP program evidencing input into the CRNP program by faculty, administrators and students. The self-evaluative process must include:

     (i)   Peer evaluation of teacher effectiveness.

     (ii)   Student evaluation of teaching and program effectiveness.

     (iii)   Periodic evaluation of the program by faculty, students and graduates of the program.

     (iv)   Periodic evaluation of the program’s human and fiscal resources, program policies, facilities and services.

   (2)  Provisions for the program’s curriculum evaluation process, completed by faculty, students and graduates of the program. The curriculum must:

     (i)   Assess the program’s effectiveness relative to current standards of practice.

     (ii)   Assess the program’s effectiveness relative to current trends in education and health care.

     (iii)   Assess the program’s effectiveness in attaining program objectives.

     (iv)   Demonstrate that curriculum changes have been evaluated by the CRNP program faculty and are consistent with core competencies in the CRNP specialties.

   (3)  Provision for ongoing student evaluative process that assesses the student’s progress toward and ultimate achievement of program objectives. The student evaluative process must:

     (i)   Be evident in the course outlines provided to students at the beginning of each course.

     (ii)   Include documentation of faculty-supervised performance evaluation of students.

     (iii)   Utilize evaluation tools that reflect nurse practitioner National competencies in the specialty areas.

     (iv)   Include student evaluation of the quality of clinical experiences.

 (b)  Programs must measure outcomes of graduates at 1-year and 3-year intervals postgraduation.

Authority

   The provisions of this §  21.370 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.370 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to process).

§ 21.371. Curriculum changes requiring Board approval.

 Curriculum changes that require Board approval include changes in:

   (1)  Program objectives, course content or instruction that affect the integration of material into the total curriculum.

   (2)  An approved program which deems a new or different certification specialty title for graduates of that program requires approval as a new CRNP education program.

Authority

   The provisions of this §  21.371 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.371 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to process).

§ 21.372. CRNP program philosophy; purposes and objectives.

 (a)  A clear statement of philosophy and purposes of the CRNP program, consistent with the philosophy and purposes of the college or university, shall be formulated and adopted.

 (b)  The philosophy, purposes and objectives of the CRNP program shall be developed and clearly stated by the faculty and be reviewed and revised at stated time intervals by this group.

 (c)  The philosophy and purposes of the CRNP program must be consistent with currently accepted social, educational and CRNP standards.

Authority

   The provisions of this §  21.372 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.372 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.373. Facility and resource requirements.

 (a)  The support of the college or university must be adequate to meet CRNP program needs and include the following:

   (1)  Faculty and staff offices.

   (2)  Classrooms, conference rooms and laboratories.

   (3)  Administrative and secretarial support.

   (4)  Interactive information systems (computer/technical support) sufficient to develop, manage and evaluate the program.

 (b)  There must be current, appropriate, adequate and available learning resources to include audio/visual equipment, computers and library materials.

 (c)  The CRNP program must provide appropriate clinical resources and experience for students, including:

   (1)  Space for faculty’s and students’ needs.

   (2)  Exposure of appropriate duration to a patient population sufficient in number to insure that the student will meet program goals.

   (3)  Faculty to provide adequate supervision and evaluation.

     (i)   Supervision of all students in the clinical areas is the responsibility of the CRNP program faculty.

     (ii)   One program faculty member shall supervise no more than six students in a clinical course. If faculty are providing onsite preceptorship, the maximum ratio is two students per faculty member. If faculty are managing their own caseload of patients, the maximum ratio is one student per faculty member.

     (iii)   Onsite clinical preceptors may include:

       (A)   Advanced practice nurses who are currently licensed.

       (B)   Physicians who are currently licensed.

       (C)   CRNPs who are currently licensed and certified.

Authority

   The provisions of this §  21.373 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.373 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process); and 49 Pa. Code §  21.369 (relating to general curriculum requirements).

§ 21.374. Selection and admission standards.

 (a)  Policies and procedures related to the selection and admission of students are the responsibility of the individual program. Consideration must be given to scholastic aptitude, academic achievement, personal qualities and physical and emotional health necessary to fulfill the objectives of the program.

 (b)  Students admitted to CRNP programs shall meet the requirements for admission to the university or college for a master’s degree in nursing program and additional requirements that may be established for the CRNP program.

 (c)  Students admitted to CRNP programs shall have successfully completed the equivalent of a baccalaureate degree in nursing from an accredited institution of higher learning in a nursing program.

 (d)  Students admitted to CRNP programs shall be currently licensed as a registered nurse (RN) or, if enrolled in an RN to Master of Science in Nursing (MSN) or RN to Nursing Doctorate (ND) program, shall complete all competencies for undergraduate requirements prior to taking graduate courses.

Authority

   The provisions of this §  21.374 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.374 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.375. Advanced standing.

 The school shall have a written policy consistent with its philosophy and objectives concerning criteria for granting advanced standing. The policy of master’s degree programs must be consistent with that of the college or university.

Authority

   The provisions of this §  21.375 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.375 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.376. Program records.

 (a)  The program shall employ a record system that ensures the operation of the program. Records shall be maintained in locked files which assure their safe keeping.

 (b)  Each nursing faculty shall select record forms specifically for the CRNP program that include the following:

   (1)  Student records, including the permanent record, containing both clinical and theoretical experience and achievement, shall be kept for 50 years.

   (2)  Faculty records, including the following:

     (i)   ‘‘Display portion’’ of current Pennsylvania licenses and certifications.

     (ii)   Records of preparation and experience, including official college transcripts.

     (iii)   Current records of continuing education activities.

     (iv)   Records of National certification, if applicable.

   (3)  Administrative records, including the following:

     (i)   Affiliation agreements with cooperating agencies.

     (ii)   Minutes of meetings.

     (iii)   Annual reports.

     (iv)   Follow-up studies of graduates.

     (v)   Budgets.

     (vi)   Current written policies.

   (4)  School bulletins, including the following:

     (i)   Comprehensive and current information.

     (ii)   Clearly defined refund policies governing fees and tuition paid by the students.

     (iii)   Clearly defined policies relating to admission, promotion, retention, transfer, advanced placement and dismissal.

Authority

   The provisions of this §  21.376 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.376 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).

§ 21.377. Custody of records.

 (a)  When a program closes, the college or university is responsible for the safekeeping of the records of students for at least 50 years after graduation of the last class.

 (b)  If the college or university also closes, advice should be obtained from the Board concerning the permanent safekeeping and availability of the records of the school of nursing.

Authority

   The provisions of this §  21.377 issued under sections 6.1 and 8.1 of the Professional Nursing Law (63 P. S. § §  216.1 and 218.1).

Source

   The provisions of this §  21.377 adopted June 2, 2006, effective June 3, 2006, 36 Pa.B. 2667.

Cross References

   This section cited in 49 Pa. Code §  21.363 (relating to approval process).



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