§ 25.1. Definitions.

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

   ACCME—The Accreditation Council on Continuing Medical Education.

   AMA PRA—American Medical Association Physician’s Recognition Award.

   AOA—The American Osteopathic Association.

   Act—The Osteopathic Medical Practice Act (63 P. S. § §  271.1—271.18).

   Agreement of affiliation—A written document evidencing the agreement between an approved hospital and an urgent care center, emergency center, surgicenter, office of a private practitioner or other health care facility for the training of osteopathic interns, residents or fellows.

   Approved activity—A continuing medical education activity accepted for AOA credit, ACCME credit or AMA PRA credit.

   Approved graduate osteopathic medical training—An approved internship or an approved residency.

   Approved internship—An osteopathic rotating internship program approved by the AOA and the Board.

   Approved residency—A training program approved by the AOA and the Board leading toward certification in a specialty or subspecialty.

   Board—State Board of Osteopathic Medicine.

   Bureau—Bureau of Professional and Occupational Affairs of the Department of State of the Commonwealth.

   Category 1 activities—Continuing medical education activities approved for AOA Category 1-A credit, AOA Category 1-B credit, ACCME Category 1 credit or AMA PRA Category 1 credit.

   Category 2 activities—Continuing medical education activities approved for AOA Category 2 credit, ACCME Category 2 credit or AMA PRA Category 2 credit.

   Emergency medical services personnel—Individuals who deliver emergency medical services and who are regulated by the Department of Health under the Emergency Medical Services Act (35 P. S. § §  6921—6938).

   FLEX—The uniform written examination of the Federation of State Medical Boards of the United States, Inc.

   Immediate family member—A parent, a spouse, a child or an adult sibling residing in the same household.

   NBOME—The National Board of Osteopathic Medical Examiners.

   National Board Examination—The uniform written examination of the NBOME.

   The provisions of this §  25.1 amended under sections 3, 10(d), 13.1(a) and (d) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.3, 271.10(d), 271.13a(a) and (d) and 271.16); section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)); amended under section 910 of the Medical Care Availability and Reduction of Error Act (40 P. S. §  1303.910).

   The provisions of this §  25.1 adopted October 29, 1969; amended January 20, 1989, effective January 21, 1989, 19 Pa.B. 236; amended January 10, 1992, effective January 11, 1992, 22 Pa.B. 209; amended December 16, 1994, effective December 17, 1994, 24 Pa.B. 6296; amended December 3, 2004, effective December 4, 2004, 34 Pa.B. 6414; amended May 20, 2005, effective May 21, 2005, 35 Pa.B. 3021. Immediately preceding text appears at serial pages (308277) to (308278).

 Admission to the practice of osteopathic medicine and surgery in this Commonwealth is granted by the Board to applicants who fulfill the applicable requirements of the act and Subchapter G (relating to licensing, education and graduate training).

   The provisions of this §  25.2 amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  Under 1 Pa. Code §  31.1 (relating to scope of part), 1 Pa. Code Part II (relating to general rules of administrative practice and procedure) is applicable to formal proceedings before the Board.

 (b)  Board delegations of specific cases to a hearing examiner shall be made under sections 901—907 of the Health Care Services Malpractice Act (40 P. S. § §  1301.901—1301.907) and proceedings shall be conducted in compliance with the requirements of that statute. The rules at 1 Pa. Code Part II apply if not inconsistent with that statute.

   The provisions of this §  25.3 amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.3 adopted January 30, 1976, effective January 31, 1976, 6 Pa.B. 159; amended January 10, 1992, effective January 11, 1992, 22 Pa.B. 209. Immediately preceding text appears at serial page (141028).

Subchapter B. [Reserved]

§ 25.11. [Reserved].

   The provisions of this §  25.84 adopted December 3, 1976, effective December 4, 1976, 6 Pa.B. 2984; reserved January 10, 1992, effective January 11, 1992, 22 Pa.B. 209. Immediately preceding text appears at serial page (133214).

Subchapter C. PHYSICIAN ASSISTANT PROVISIONS

GENERAL PROVISIONS

Sec.

§ 25.141. Purpose.

 The purpose of this subchapter is to implement the provisions of the act which provide for the certification of physician assistants. The legislation provides for more effective utilization of certain skills of osteopathic physicians enabling them to delegate certain medical tasks to qualified physician assistants when such delegation is consistent with the patient’s health and welfare.

   The provisions of this §  25.141 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.10(h) and 271.16).

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

   Certification—The approval of an individual by the Board to serve as a physician assistant; and the approval of a program by the Board for the training and education of physician assistants.

   Direct supervision—The physical presence of the supervising physician on the premises so that the supervising physician is immediately available to the physician assistant when needed. Where emergency rooms are concerned, direct supervision requires the presence of the supervising physician in the emergency room suite.

   NCCPA—The National Commission on the Certification of Physician Assistants.

   Protocol—Written treatment instructions prepared by the supervising osteopathic physician for use by the physician assistant, containing a detailed description of the manner in which the physician assistant will assist the physician in his practice, a list of functions to be delegated to the physician assistant including the procedures enumerated in §  25.171(a) (relating to generally) and other specified delegated tasks, detailed instructions for the use of the physician assistant in the performance of delegated tasks, the method and frequency of supervision and the geographic location where the physician assistant will serve.

   Registration—The approval by the Board of an osteopathic physician, licensed to practice osteopathic medicine and surgery without restriction, to supervise and utilize a specified physician assistant.

   Satellite operations—An office or clinic separate and apart from the office of the supervising physician established by the physician and manned exclusively by a physician assistant.

   Supervising physician—A physician licensed to practice osteopathic medicine and surgery in this Commonwealth who registers with the Board and who accepts the responsibility for the supervision of services rendered by physician assistants.

   Supervision—The opportunity or ability of the physician, or in his absence a substitute supervising physician, to provide or exercise control and direction over the services of physician assistants. Constant physical presence of the supervising physician on the premises is not required so long as the supervising physician and the physician assistant are or can easily be in contact with each other by radio, telephone or telecommunication. Supervision requires the availability of the supervising physician to the physician assistant. An appropriate degree of supervision includes:

     (i)   Active and continuing overview of the physician assistant’s activities to determine that the physician’s directions are being implemented.

     (ii)   Immediate availability of the supervising physician to the physician assistant for necessary consultations.

     (iii)   Personal and regular—at least weekly—review by the supervising physician of the patient records upon which entries are made by the physician assistant.

     (iv)   Periodic—at least monthly—education and review sessions held by the supervising physician for the physician assistant under his supervision for discussion of specific conditions, protocols, procedures and specific patients.

   Written agreement—The agreement between the physician assistant and supervising physician, which satisfies the requirements of §  25.162(a)(4) (relating to criteria for registration as supervising physician).

   The provisions of this §  25.142 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and (p) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and (p) and 271.16); amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.142 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332; amended January 10, 1992, effective January 11, 1992, 22 Pa.B. 209; amended August 7, 2009, effective August 8, 2009, 39 Pa.B. 4754. Immediately preceding text appears at serial pages (299581) to (299582).

PHYSICIAN ASSISTANT EDUCATIONAL PROGRAM

§ 25.151. Certification of physician assistant educational programs.

 (a)  Subject to the exceptions provided for by section 10(f)(2) of the act (63 P. S. §  271.10(f)(2)), only physician assistant education programs certified by the Board will be considered toward the training and education requirements for physician assistant certification.

 (b)  The criteria for certification by the Board of physician assistant educational programs is currently identical to the criteria developed by the Committee on Health Education and Accreditation of the American Medical Association. The Board will develop criteria for certification of physician assistant educational programs after consulting with and receiving advice from organizations and accrediting agencies as deemed appropriate by the Board.

 (c)  Other physician assistant educational programs seeking certification may be submitted to the Board for review and approval.

   The provisions of this §  25.151 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 The Board will maintain a current register of the programs meeting the Board’s criteria for physician assistant accredited education. The register will list the full name of the program, the institution of which it is a part, the program director, the mailing address of the institution and the date of accreditation. This register is available for public inspection.

   The provisions of this §  25.152 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

   The provisions of this §  25.152 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

CERTIFICATION OF PHYSICIAN ASSISTANTS AND REGISTRATION OF SUPERVISING PHYSICIANS

§ 25.161. Criteria for certification as a physician assistant.

 (a)  The Board has approved as a proficiency examination the national certification examination on primary care developed by the NCCPA. The Board will maintain a current register of approved proficiency examinations. This register will list the full name of the examination, the organization giving the examination, the mailing address of the examination organization and the date the proficiency examination received Board approval. This register shall be available for public inspection.

 (b)  The clinical experience required by the Board is at present identical to the clinical experience required by the NCCPA for taking the NCCPA examination on primary care. To qualify for an NCCPA proficiency examination, the applicant’s employment history must be verified by the NCCPA in cooperation with the Board and must be evaluated by the NCCPA in relation to specific work criteria.

 (c)  The Board will approve for certification as a physician assistant an applicant who:

   (1)  Is of good moral character and reputation.

   (2)  Has graduated from a physician assistant training program certified by the Board.

   (3)  Has submitted a completed application detailing his education and work experience, together with the required fee.

   (4)  Has passed a proficiency examination approved by the Board.

 (d)  The physician assistant may amend information regarding his education and work experience submitted under the requirements of subsection (c)(3), by submitting to the Board in writing additional detailed information. No additional fee will be required. The file for each physician assistant will be reviewed by the Board to determine whether the physician assistant possesses the necessary skills to perform the tasks that a physician, applying for registration to supervise and utilize the physician assistant, intends to delegate to him as set forth in the protocol contained in the physician’s application for registration.

 (e)  A person who has been certified as a physician assistant by the State Board of Medicine shall make a separate application to the Board if he intends to provide physician assistant services for a physician licensed to practice osteopathic medicine and surgery without restriction.

 (f)  An application for certification as a physician assistant by the Board may be obtained by writing to the Harrisburg office of the Board.

   The provisions of this §  25.161 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  The Board will approve for registration as a supervising physician, an applicant who:

   (1)  Possesses a current unrestricted license to practice osteopathic medicine and surgery in this Commonwealth.

   (2)  Has submitted a completed application together with the required fee. The application shall require detailed information regarding the physician’s professional background and specialties, medical education, internship, residency, continuing education, membership in American Boards of medical specialty, hospital or staff privileges and other information the Board may require.

   (3)  Has submitted a statement that he will direct and exercise supervision over the physician assistant in accordance with the provisions of this subchapter and that he recognizes that he retains full professional and legal responsibility for the performance of the physician assistant and the care and treatment of his patients.

   (4)  Has submitted a written agreement that satisfies the following requirements. The agreement must:

     (i)   Identify and be signed by the physician assistant and each physician the physician assistant will be assisting who will be acting as a supervising physician. At least one physician shall be an osteopathic physician.

     (ii)   Describe in detail the manner in which the physician assistant will be assisting each named physician. The description must list functions to be delegated to the physician assistant including the procedures enumerated in §  25.171(a) (relating to generally) and other delegated tasks.

     (iii)   Describe detailed instructions for the use of the physician assistant in the performance of delegated tasks.

     (iv)   Describe the time, place and manner, method and frequency of supervision and direction each named physician will provide the physician assistant, including the frequency of personal contact with the physician assistant.

     (v)   Designate one of the named physicians who shall be an osteopathic physician as the primary supervising physician.

     (vi)   Require that the supervising physician shall countersign the patient record completed by the physician assistant within a reasonable amount of time. This time period may not exceed 10 days.

     (vii)   Identify the locations and practice settings where the physician assistant will serve.

     (viii)   Provide the name, address and telephone number of at least two physicians who can substitute for the applicant when he is either absent or otherwise unavailable.

 (b)  An application for registration as a supervising physician shall be submitted for each physician assistant the physician intends to utilize and shall be accompanied by the fee required by §  25.231 (relating to schedule of fees). A physician may not be registered to supervise more than two physician assistants at any time. To expand the protocol for a physician assistant for whom the physician is already registered to supervise and utilize, the physician shall first secure approval from the Board. This can be accomplished by the physician submitting to the Board, in writing, a request for modification of the physician assistant utilization which enumerates the expanded manner in which the physician assistant will function and which contains additional instructions for the use of the physician assistant and other information pertinent to the intended departure from the former manner of practice, method and frequency of supervision, or geographic location. The fee required is that specified for initial registration in §  25.231. The Board will notify the physician, in writing, as to its approval or rejection of the requested modification. Departure from the original protocol is not permitted until the Board approves the request for modification.

 (c)  After the physician submits an initial application for registration as a supervising physician, which conforms with the requirements of subsection (a), for a second application and ensuing applications for registration, the physician shall only submit an abbreviated application which will be provided by the Board upon request. Only additions and deletions to the information provided in the initial application will be required.

 (d)  If the applicant supervising physician plans on utilizing physician assistants in satellite operations, he shall provide the Board with supplemental information as set forth in §  25.175 (relating to physician assistants and satellite operations) for specific approval.

 (e)  An application for registration as a supervising physician may be obtained by writing to the Harrisburg office of the Board.

   The provisions of this §  25.162 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and (p) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and (p) and 271.16); amended under section 13.1(a) and (d) of the Osteopathic Medical Practice Act (63 P. S. §  271.13a(a) and (d)).

   The provisions of this §  25.162 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332; amended January 20, 1989, effective January 21, 1989, 19 Pa.B. 236; amended August 7, 2009, effective August 8, 2009, 39 Pa.B. 4754. Immediately preceding text appears at serial pages (210036) and (222987).

 (a)  Upon approval of an application for certification as a physician assistant, the Board will issue a physician assistant certificate which contains his name, his certificate number and the date of issuance, after payment of the fee required by §  25.231 (relating to schedule of fees).

 (b)  A physician assistant’s right to continue his practice is conditioned upon biennial renewal and the payment of the fee required by §  25.231. Upon receipt of the form provided to the physician assistant by the Board in advance of the renewal period and the required fee, the Board will issue the physician assistant a biennial renewal certificate containing his name, his certification number and the beginning and ending dates of the biennial renewal period.

 (c)  Upon approval of an application for registration as a supervising physician, the Board will issue a supervising physician registration certificate which contains the name of the supervising physician, his registration number and the name of the physician assistant that he is authorized to supervise under that specific registration. The registration is not subject to renewal. When the physician submits a request to modify a protocol with respect to a physician assistant he is already registered to utilize, no new registration certificate will be issued; however, the physician will receive a letter from the Board confirming its approval of the expanded utilization.

 (d)  Only a physician registered with the Board may use the services of physician assistants. A physician assistant shall have a clearly identified supervising physician who is professionally and legally responsible for the physician assistant’s services. Whenever a physician assistant is employed by a professional corporation or partnership, an individual physician must still register as the supervising physician. Each member of a professional corporation or partnership may register as a supervising physician. When a physician assistant is employed by a professional corporation or partnership, the registered supervising physician is not relieved of the professional and legal responsibility for the care and treatment of patients attended by the physician assistant under his supervision.

 (e)  The Board will keep a current register of persons certified as physician assistants. This register will include the name of each physician assistant, his mailing address of record, his current business, the date of initial certification, biennial renewal record and current supervising physician. This register is available for public inspection.

 (f)  The Board will keep a current register of approved registered supervising physicians. This register will include the physician’s name, his mailing address of record, his current business address, the date of his initial registration, his satellite operation if applicable, the names of current physician assistants under his supervision and the names of physicians willing to provide substitute supervision in his absence. This register will be available for public inspection.

   The provisions of this §  25.163 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16); amended under section 13.1 of the Osteopathic Medical Practice Act (63 P. S. §  271.13a(a) and (d)).

   The provisions of this §  25.163 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332; amended January 20, 1989, effective January 21, 1989, 19 Pa.B. 236. Immediately preceding text appears at serial pages (119307) to (119308).

PHYSICIAN ASSISTANT UTILIZATION

§ 25.171. Generally.

 (a)  The physician assistant shall, under appropriate direction and supervision by a physician, augment the physician’s data gathering abilities to assist the supervising physician in reaching decisions and instituting care plans for the physician’s patients. The physician assistant shall have as a minimum, the knowledge and competency to perform the following functions and should under appropriate supervision be permitted by the Board to perform them. This list is not intended to be specific or all-inclusive:

   (1)  Screen patients to determine need for medical attention.

   (2)  Review patient records to determine health status.

   (3)  Take patient history.

   (4)  Perform a physical examination.

   (5)  Perform a development screening examination on children.

   (6)  Record pertinent information data.

   (7)  Make decisions regarding data gathering and appropriate management and treatment of patients being seen for the initial evaluation of a problem or the follow-up evaluation of a previously diagnosed and stablized condition.

   (8)  Prepare patient summaries.

   (9)  Initiate request for commonly performed initial laboratory studies.

   (10)  Collect specimens for and carry out commonly performed blood, urine and stool analyses and cultures.

   (11)  Identify normal and abnormal findings on history, physical examination and commonly performed laboratory studies.

   (12)  Initiate appropriate evaluation and emergency management for emergency situations, for example, cardiac arrest, respiratory distress, injuries, burns, hemorrhage.

   (13)  Perform clinical procedures such as:

     (i)   Venipuncture.

     (ii)   Intradermal tests.

     (iii)   Electrocardiogram.

     (iv)   Care and suturing of minor lacerations.

     (v)   Casting and splinting.

     (vi)   Control of external hemorrhage.

     (vii)   Application of dressings and bandages.

     (viii)   Administration of medications with the exception of controlled substances, whole blood and blood components.

     (ix)   Removal of superficial foreign bodies.

     (x)   Cardio-pulmonary resuscitation.

     (xi)   Audiometry screening.

     (xii)   Visual screening.

     (xiii)   Carrying out aseptic and isolation techniques.

   (14)  Provide counseling and instruction regarding common patient problems.

 (b)  The tasks physician assistants may perform are those which require technical skills, execution of standing orders, routine patient care tasks and such diagnostic and therapeutic procedures as the supervising physician may wish to delegate to the physician assistant after the supervising physician has satisfied himself as to the ability and competence of the physician assistant. The supervising physician may, with due regard to the safety of the patient and in keeping with sound medical practice, delegate to the physician assistant, subject to prior approval by the Board, such medical procedures and other tasks as are usually performed within the normal scope of the supervising physician’s practice and subject to the limitations set forth in this subchapter, the act and the training and expertise of the physician assistant.

   The provisions of this §  25.171 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and (p) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and (p) and 271.16).

   The provisions of this §  25.171 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

 (a)  A supervising physician may not permit a physician assistant to independently practice medicine. Supervision shall be maintained at all times.

 (b)  A physician assistant may not:

   (1)  Maintain or manage an office separate and apart from the supervising physician’s primary office for treating patients unless the Board has granted the supervising physician specific permission to establish a satellite operation under §  25.175 (relating to physician assistants and satellite operations).

   (2)  Independently bill patients for services provided.

   (3)  Independently delegate a task assigned to him by his supervising physician to another individual; list his name independently in a telephone directory or otherwise advertise, using the title ‘‘Physician Assistant’’ or ‘‘P.A.’’ or another term in a manner which would indicate that he functions as an independent health care provider.

   (4)  Perform acupuncture.

   (5)  Pronounce a patient dead.

   The provisions of this §  25.172 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act; amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 The supervising physician shall monitor and supervise the activities of the physician assistant and review documentation prepared by the physician assistant which should include organized medical records with symptoms, pertinent physical findings, impressions and treatment plans indicated. Also the supervising physician shall provide written protocols for the use of the physician assistant in the performance of delegated tasks. These established protocols may be modified to require additional steps to be followed by the physician assistant in the performance of delegated tasks. The modifications do not require prior approval by the Board. However, an expansion of the protocol to provide for the delegation of additional services or responsibilities does require prior approval by the Board as set forth in §  25.162(c) (relating to criteria for registration as supervising physician). The established protocol shall be available for public inspection upon request and may be reviewed by the Board or its agents without prior notice.

   The provisions of this §  25.173 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  If the registered supervising physician absents himself in such a manner or to such an extent that he is unavailable to aid the physician assistant when required, the registered supervising physician may not delegate patient care to his physician assistant unless he has made appropriate arrangements for substitute supervision. Supervision and review of the physician assistant’s practice by a substitute supervising physician may be no less encompassing and provide for no less personal contact than the supervision and review provided by the registered supervising physician.

 (b)  As set forth in §  25.162(a)(4) (relating to criteria for registration as supervising physician), the supervising physician shall provide the Board with the names of at least two physicians who are willing to assume the supervising responsibilities in his absence. The supervising physician will be notified by the Board upon issuance of his registration whether any of his delegated substitutes are unacceptable to the Board. Substitute supervision may be provided by another registered supervising physician without the need to notify the Board so long as such substitution is documented by the registered supervising physician. It is the responsibility of the designated supervising physician to insure that supervision is maintained in his absence. Failure to do so may provide grounds for revocation of his registration as a supervising physician.

 (c)  Service as a substitute supervising physician, at a given time, for the physician assistants registered to assist one other supervising physician, may not be considered with respect to the prohibition against a physician supervising more than two physician assistants at a time. The duration of substitute supervision may not be so excessive as to circumvent this prohibition.

 (d)  An allopathic physician may serve as a substitute supervising physician, but while serving in such capacity, he shall be subject to the standards imposed upon substitute supervising physicians as set forth in this chapter.

   The provisions of this §  25.174 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  No physician assistant may be permitted to be utilized in an office or clinic separate and apart from the supervising physician’s primary place for meeting patients unless the supervising physician has obtained specific approval from the Board. A supervising physician may supervise only one satellite operation. The criteria for granting approval is that the supervising physician demonstrate the following to the satisfaction of the Board:

   (1)  That the physician assistant will be utilized in an area of medical need recognized by the Board.

   (2)  That there is adequate provision for direct communication between the physician assistant and the supervising physician and that the distance between the main office and the satellite operation is not so great as to prohibit or impede appropriate support services.

   (3)  That provision is made for the supervising physician to see each regular patient every fifth visit, except for those patients referred to in paragraph (5).

   (4)  That the supervising physician will visit the remote office at least weekly and spend enough time on-site to provide supervision and personally review the records of each patient seen by the physician assistant in this setting.

   (5)  That the supervising physician will see every child patient from infancy to 2 years of age at least every third visit, and from 2 years of age to 18 years of age, at least every other visit.

   (6)  That the physician assistant to be utilized in the satellite office has been employed by a Pennsylvania Board approved supervising physician in his primary office for at least 1 year.

 (b)  Appropriate records of patient and supervisory contact shall be maintained and available for Board review. Failure to maintain the standards required for such an operation under the criteria listed in subsection (a) may result not only in the loss of the privilege to maintain a satellite operation but may result in the revocation of the supervising physician’s registration and license.

   The provisions of this §  25.175 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

   The provisions of this §  25.175 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

 (a)  Designated representatives of the Board will be authorized to make on-site visits to the office of registered supervising physicians and medical care facilities utilizing physician assistants to review the following:

   (1)  Supervision of physician assistants.

   (2)  Maintenance of the protocols and compliance with them.

   (3)  Utilization in conformity with the provisions of this subchapter.

   (4)  Identification of physician assistants.

   (5)  Compliance with certification and registration requirements.

 (b)  Reports shall be submitted to the Board and become a permanent record under the supervising physician’s registration. Deficiencies reported shall be reviewed by the Board and may provide a basis for disciplinary action against the certification of the physician assistant and the license or registration, or both, of the supervising physician.

 (c)  The Board reserves the right to review physician assistant utilization and records associated therewith, including patient records, without prior notice to either the physician assistant or the registered supervising physician. It will be considered a violation of this subchapter for a supervising physician to refuse to undergo a review by the Board.

   The provisions of this §  25.176 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  Prescribing, dispensing and administration of drugs.

   (1)  The supervising physician may delegate to the physician assistant the prescribing, dispensing and administering of drugs and therapeutic devices.

   (2)  A physician assistant may not prescribe or dispense Schedule I controlled substances as defined under section 4 of The Controlled Substances, Drug, Device and Cosmetic Act (35 P. S. §  780-104).

   (3)  A physician assistant may prescribe a Schedule II controlled substance for initial therapy, up to a 72-hour dose. The physician assistant shall notify the supervising physician of the prescription as soon as possible, but in no event longer than 24 hours from the issuance of the prescription. The physician assistant shall have no authority to prescribe a Schedule II controlled substance after the initial therapy of up to a 72-hour dose, until the patient has been examined by the supervising physician and the supervising physician has reviewed and approved the prescription of a Schedule II controlled substance by the physician assistant for up to a 30-day supply.

     (i)   If the supervising physician determines and documents that the patient is chronically ill, the physician assistant may write a prescription for a Schedule II controlled substance for up to a 30-day supply of the Schedule II controlled substance, only if the prescription of a Schedule II controlled substance by the physician assistant is reviewed and approved by the supervising physician at least every 30 days.

     (ii)   If the supervising physician determines and documents that the patient is terminally ill, the physician assistant may write a prescription for a Schedule II controlled substance for up to a 30-day supply if the prescription of a Schedule II controlled substance by the physician assistant is reviewed and approved by the supervising physician at least every 120 days.

     (iii)   The prescription must clearly state on its face that it is for initial or ongoing therapy.

   (4)  A physician assistant may only prescribe or dispense a drug for a patient who is under the care of the physician responsible for the supervision of the physician assistant and only in accordance with the supervising physician’s instructions and written agreement.

   (5)  A physician assistant may request, receive and sign for professional samples and may distribute professional samples to patients.

   (6)  A physician assistant authorized to prescribe or dispense, or both, controlled substances shall register with the Drug Enforcement Administration (DEA).

 (b)  Prescription blanks. The requirements for prescription blanks are as follows:

   (1)  Prescription blanks must bear the license number of the physician assistant and the name of the physician assistant in printed format at the heading of the blank. The supervising physician’s name and license number must also be printed or preprinted on the prescription.

   (2)  The signature of a physician assistant must be followed by the initials ‘‘PA-C’’ or similar designation to identify the signer as a physician assistant. When appropriate, the physician assistant’s DEA registration number must appear on the prescription.

   (3)  The supervising physician is prohibited from presigning prescription blanks.

   (4)  The physician assistant may use a prescription blank generated by a hospital provided the information in paragraph (1) appears on the blank.

 (c)  Inappropriate prescription. The supervising physician shall immediately advise the patient, notify the physician assistant and, in the case of a written or oral prescription, advise the pharmacy if the physician assistant is prescribing or dispensing a drug inappropriately. The supervising physician shall advise the patient and notify the physician assistant to discontinue using the drug and, in the case of a written or oral prescription, notify the pharmacy to discontinue the prescription. The order to discontinue use of the drug or prescription shall be noted in the patient’s medical record by the supervising physician.

 (d)  Recordkeeping requirements. Recordkeeping requirements are as follows:

   (1)  When prescribing a drug, the physician assistant shall keep a copy of the prescription, including the number of refills, in a ready reference file, or record the name, amount, directions for use and doses of the drug prescribed, the number of refills, the date of the prescription and the physician assistant’s name in the patient’s medical records.

   (2)  When dispensing a drug, the physician assistant shall record the physician assistant’s name, the name of the medication dispensed, the amount of medication dispensed, the dose of the medication dispensed and the date dispensed in the patient’s medical records.

   (3)  The physician assistant shall report, orally or in writing, to the supervising physician within 36 hours, a drug prescribed or medication dispensed by the physician assistant while the supervising physician was not physically present, and the basis for each decision to prescribe or dispense in accordance with the written agreement.

   (4)  The supervising physician shall countersign the patient record at least weekly in accordance with §  25.178 (relating to medical records).

   (5)  The physician assistant and the supervising physician shall provide immediate access to the written agreement to anyone seeking to confirm the physician assistant’s authority to prescribe or dispense a drug. The written agreement must list the categories of drugs which the physician assistant is not permitted to prescribe.

 (e)  Compliance with regulations relating to prescribing, administering, dispensing, packaging and labeling of drugs. A physician assistant shall comply with this section and with the regulations of the Department of Health in 28 Pa. Code § §  25.51—25.58 and 25.91—25.95 (relating to prescriptions; and labeling of drugs, devices and cosmetics).

 The supervising physician shall timely review, at least weekly, the medical records prepared by the physician assistant to ensure that the requirements of §  25.213 (relating to medical records) have been satisfied.

   The provisions of this §  25.178 adopted August 7, 2009, effective August 8, 2009, 39 Pa.B. 4754.

PHYSICIAN ASSISTANTS AND MEDICAL CARE FACILITIES

§ 25.181. Physician assistants in medical care facilities.

 (a)  This chapter may not be construed to require medical care facilities to accept physician assistants or to use them within their premises. It is appropriate for the physician assistant to provide services to the hospitalized patients of the supervising physician under the supervision of that physician, if the medical care facility permits it.

 (b)  The medical staff of the facility should recommend to the facility’s governing authority the establishment of a standing committee to develop standards and procedures for physician assistants provided they are consistent with this chapter governing physician assistant utilization and prohibition.

 (c)  Physician assistants employed directly by medical care facilities shall perform services only under the supervision of a clearly identified and registered supervising physician and physician shall supervise no more than two physician assistants.

   The provisions of this §  25.181 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 A physician assistant may provide medical care or services in an emergency department so long as he has training in emergency medicine, functions under specific protocols which govern his performance, and is under the direct supervision of a physician with whom he has ready contact and who is willing to assume full responsibility for the physician assistant’s performance. A physician assistant may not substitute for a physician who is ‘‘on call’’ in the emergency department.

   The provisions of this §  25.182 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  In those medical care facilities providing services in which the practice of physician assistants involves the acts of medical diagnosis or prescription of medical therapeutic or corrective measures, there shall be a committee whose function is to establish standard policies and procedures in each area of practice, in writing, pertaining to the scope and circumstances of the practice of physician assistants in the medical management of the patient.

 (b)  The committee shall serve as a policymaking body and as an advisory and interpretative body to the various staff of medical care facility. The committee shall include representation from the medical staff, the nursing staff, the administration, and the physician assistant staff.

   The provisions of this §  25.183 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 The standard policies and procedures shall be reviewed and accepted by the committee at least annually and at such other times as necessary.

   The provisions of this §  25.184 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

   The provisions of this §  25.184 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

PHYSICIAN ASSISTANT REQUIREMENTS IN EMPLOYMENT

§ 25.191. Physician assistant identification.

 (a)  No physician assistant may render medical services nor a permitted task as set forth in this chapter to a patient until the patient has been informed of the following:

   (1)  That the physician assistant is not a physician.

   (2)  That the physician assistant may perform the services required as an employe of the physician and as directed by the supervising physician.

   (3)  That the patient has the right not to be treated by the physician assistant if he so desires.

 (b)  It shall be the supervising physician’s responsibility to ensure that patients are apprised of subsection (a) and it shall further be his responsibility to be alert to patient complaints concerning the type or quality of services provided by the physician assistant.

 (c)  In the supervising physician’s office and a satellite operation, a notice plainly visible to patients shall be posted in a prominent place explaining the meaning of the term ‘‘physician assistant.’’ The supervising physician shall display his registration to supervise the office. The physician assistant’s certificate shall be prominently displayed in all facilities in which he may function. Duplicate certificates may be obtained from the Board if required.

 (d)  The physician assistant shall wear an identification tag which uses the term ‘‘Physician Assistant,’’ in 16 point type or larger, conspicuously worn.

   The provisions of this §  25.191 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

 (a)  The physician assistant is required to notify the Board of a termination of employment or change of mailing address within 15 days. Failure to notify the Board, in writing, of change in mailing address may result in failure to receive pertinent material distributed by the Board.

 (b)  The supervising physician is required to notify the Board of a termination of his supervision of a physician assistant within 15 days.

 (c)  Failure to notify the Board of a termination in the physician/physician assistant relationship shall provide a basis for disciplinary action against the physician assistant’s certificate, the supervising physician’s license or registration as a supervising physician.

   The provisions of this §  25.192 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

   The provisions of this §  25.192 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

DISCIPLINARY ACTION AGAINST CERTIFICATION OF PHYSICIAN ASSISTANT

§ 25.201. Grounds for complaint.

 (a)  The bases upon which the Board may take disciplinary action against the certification of a physician assistant are set forth in section 15(b) of the act (63 P. S. §  271.15(b)). A complaint against a physician assistant shall allege that the physician assistant is performing tasks in violation of statute, regulation or good and acceptable standards of practice of physician assistants. The grounds include those specifically enumerated in section 15(b) of the act (63 P. S. §  271.15(b)). Unprofessional conduct shall include, but is not limited to, the following:

   (1)  Misrepresentation or concealment of a material fact in obtaining a certificate or a reinstatement thereof.

   (2)  Commission of an offense under a statute of the Commonwealth relating to the practice of physician assistants or under this chapter.

   (3)  The commission of an act involving moral turpitude, dishonesty or corruption when the act directly or indirectly affects the health, welfare or safety of citizens of the Commonwealth. If the act constitutes a crime, conviction thereof in a criminal proceeding will not be a condition precedent to disciplinary action.

   (4)  Conviction of a felony, defined as such under the statute of the Commonwealth or under the laws of another state, territory or country.

   (5)  Misconduct in his practice as a physician assistant or performing a task fraudulently, beyond its authorized scope, with incompetence or with negligence on a particular occasion or on repeated occasions.

   (6)  Performing tasks as a physician assistant while the ability to do so is impaired by alcohol, drugs, physical disability or mental instability.

   (7)  Impersonation of a licensed physician or another certified physician assistant.

   (8)  The offering, undertaking or agreeing to cure or treat disease by a secret method, procedure, treatment or medicine; the treating or prescribing for a human condition by a method, means or procedure which the physician assistant refuses to divulge upon demand of the Board; or the use of methods or treatment which are not in accordance with treatment processes accepted by a reasonable segment of the medical profession.

   (9)  Violation of this chapter fixing a standard of professional conduct.

 (b)  Subsection (a) supplements 1 Pa. Code §  35.10 (relating to form and content of formal complaints).

   The provisions of this §  25.201 issued under section 506 of The Administrative Code of 1929 (71 P. S. §  186); and sections 10(h) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) and 271.16).

   The provisions of this §  25.201 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

Subchapter D. MINIMUM STANDARDS OF PRACTICE

Sec.

§ 25.211. [Reserved].

   The provisions of this §  25.211 adopted January 16, 1987, effective July 17, 1987, 17 Pa.B. 255; amended October 9, 1987, effective October 1, 1987, 17 Pa.B. 4040; amended October 20, 1989, effective October 21, 1989, 19 Pa.B. 4511; reserved July 10, 1998, effective July 11, 1998, 28 Pa.B. 3282. Immediately preceding text appears at serial pages (210048) to (210050).

   Validity

 (a)  Advertising in any medium is permitted if it is not misleading, deceptive, untrue or fraudulent on its face or by its effect in actual practice.

 (b)  Advertising, letterhead, publications or transmissions shall designate or indicate the licensee’s school of medical practice by the term ‘‘D.O.,’’ ‘‘doctor of osteopathy,’’ ‘‘osteopathic physician’’ or ‘‘osteopathic physician and surgeon.’’

   The provisions of this §  25.212 issued under section 16 of the Osteopathic Medical Practice Act (63 P.S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A medical record shall be maintained for each patient, identifying the patient, the person making the entry, the date of each contact, pertinent clinical information, diagnoses, findings, laboratory results and other diagnostic, corrective or therapeutic procedures, including prescription drug orders, arising out of the licensee’s care of the patient.

 (b)  A patient’s medical record shall be retained for at least 7 years from the last entry. In addition, for minors, the medical record shall be retained until 2 years after the patient’s 18th birthday or 7 years from the last entry, whichever is later. Storage may be off-premises.

 (c)  Medical records shall be kept confidential, unless disclosure is required for bona fide treatment, with the patient’s written consent, except as follows:

   (1)  Upon receipt of a court order for the production of documents.

   (2)  Upon lawful demand by auditors for public or private third-party payers which have contracted to reimburse the licensee for services provided to the patient.

   (3)  To defend against allegations of civil or criminal medical malpractice, if the licensee’s treatment of the patient has been placed at issue by the complaining party, and only to the extent necessary to controvert factual allegations in the complaint.

   (4)  To comply with other relevant State or Federal health care laws.

 (d)  The licensee shall provide a patient with a complete copy of the patient’s medical record, within a reasonable time of the request of the patient or an authorized representative. Reasonable charges for copying may be made.

   The provisions of this §  25.213 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.213 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

 (a)  A licensee may hold ownership interests in businesses formed to provide goods or services related to the practice of medicine, if not otherwise prohibited by law, and if the licensee complies with the disclosure requirements of sections 1—3 of the act of May 26, 1988 (P. L. 403, No. 66) (35 P. S. § §  449.21—449.23).

 (b)  A licensee may form partnerships or professional corporations, for the practice of medicine, with other licensed physicians, allopathic or osteopathic, optometrists, dentists, psychologists, podiatrists and chiropractors if the incorporation is also authorized by Chapter 5, 16, 23, 29, 33 or 41.

 (c)  A licensee may practice under a fictitious name which is not misleading, deceptive, untrue or fraudulent, if not otherwise prohibited by law.

 (d)  Before filing with the Corporation Bureau of the Department of State, a licensee of the Board shall first file corporate documents with the Board for review and approval under this section.

   The provisions of this §  25.214 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)); amended under 15 Pa.C.S. §  2903(d)(ii).

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

   Board-regulated practitioner—An osteopathic physician, physician assistant, respiratory care practitioner, athletic trainer, acupuncturist or an applicant for a license or certificate issued by the Board.

   Immediate family member—A parent or guardian, child, sibling, spouse or other family member, whether related by blood or marriage, with whom a patient resides.

   Sexual behavior—Any sexual conduct which is nondiagnostic and nontherapeutic; it may be verbal or physical and may include expressions of thoughts and feelings or gestures that are sexual in nature or that reasonably may be construed by a patient as sexual in nature.

   Sexual exploitation—Any sexual behavior that uses trust, knowledge, emotions or influence derived from the professional relationship.

   The provisions of this §  25.215 issued under sections 10.1(c), 15(a)(8) and (b)(9) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10a(c), 271.15(a)(8) and (b)(9) and 271.16).

 (a)  Sexual exploitation by a Board-regulated practitioner of a current or former patient, or of an immediate family member of a patient, constitutes unprofessional conduct, is prohibited, and subjects the practitioner to disciplinary action under section 15(a)(8) and (b)(9) of the act (63 P. S. §  271.15(a)(8) and (b)(9)).

 (b)  Sexual behavior that occurs with a current patient other than the Board-regulated practitioner’s spouse, constitutes unprofessional conduct, is prohibited, and subjects the practitioner to disciplinary action under section 15(a)(8) and (b)(9) of the act.

 (c)  When a Board-regulated practitioner has been involved with the management or treatment of a patient other than the practitioner’s spouse for a mental health disorder, sexual behavior with that former patient which occurs prior to the 2-year anniversary of the termination of the professional relationship constitutes unprofessional conduct, is prohibited, and subjects the practitioner to disciplinary action under section 15(a)(8) and (b)(9) of the act.

 (d)  A practitioner who engages in conduct prohibited by this section will not be eligible for placement into an impaired professional program in lieu of disciplinary or corrective actions.

 (e)  Consent is not a defense to conduct prohibited by this section.

   The provisions of this §  25.216 issued under sections 10.1(c), 15(a)(8) and (b)(9) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10a(c), 271.15(a)(8) and (b)(9) and 271.16).

 (a)  An osteopathic physician may delegate to a health care practitioner or technician the performance of a medical service if the following conditions are met:

   (1)  The delegation is consistent with the standards of acceptable medical practice embraced by the osteopathic physician community in this Commonwealth. Standards of acceptable medical practice may be discerned from current peer reviewed medical literature and texts, teaching facility practices and instruction, the practice of expert practitioners in the field and the commonly accepted practice of practitioners in the field.

   (2)  The delegation is not prohibited by the statutes or regulations relating to the other health care practitioner.

   (3)  The osteopathic physician has knowledge that the delegatee has education, training, experience and continued competency to safely perform the medical service being delegated.

   (4)  The osteopathic physician has determined that the delegation to a health care practitioner or technician does not create an undue risk to the particular patient being treated.

   (5)  The nature of the service and the delegation of the service has been explained to the patient and the patient does not object to the performance by the health care practitioner or technician. Unless otherwise required by law the explanation may be oral and may be given by the osteopathic physician or the osteopathic physician’s designee.

   (6)  The osteopathic physician assumes the responsibility for the delegated medical service, including the performance of the service, and is available to the delegatee as appropriate to the difficulty of the procedure, the skill of the delegatee and risk to the particular patient.

 (b)  An osteopathic physician may not delegate the performance of a medical service if performance of the medical service or if recognition of the complications or risks associated with the delegated medical service requires knowledge and skill not ordinarily possessed by nonphysicians.

 (c)  An osteopathic physician may not delegate a medical service which the osteopathic physician is not trained, qualified and competent to perform.

 (d)  An osteopathic physician shall be responsible for the medical services delegated to the health care practitioner or technician.

 (e)  An osteopathic physician may approve a standing protocol delegating medical acts to another health care practitioner who encounters a medical emergency that requires medical services for stabilization until the osteopathic physician or emergency medical services personnel are available to attend to the patient.

 (f)  This section does not prohibit a health care practitioner who is licensed or certified by a Commonwealth agency from practicing within the scope of that license or certificate or as otherwise authorized by law. For example, this section is not intended to restrict the practice of certified registered nurse anesthetists, nurse midwives, certified registered nurse practitioners, physician assistants, or other individuals practicing under the authority of specific statutes or regulations.

   The provisions of this §  25.217 issued under sections 3 and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.3 and 271.16).

   The provisions of this §  25.217 adopted December 3, 2004, effective December 4, 2004, 34 Pa.B. 6414.

Subchapter E. PERFORMANCE OF RADIOLOGIC PROCEDURES BY AUXILIARY PERSONNEL

Sec.

§ 25.221. Definitions.

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

   ARRT—The American Registry of Radiologic Technologists.

   Auxiliary personnel—Persons other than a medical doctor—allopathic physician—osteopathic physician, dentist, podiatrist or chiropractor.

   Direct supervision—Directly controlling the performance of a procedure by authorizing performance of that procedure under the specific instructions of the osteopathic physician, and monitoring performance of the procedure to ensure compliance with those instructions.

   Ionizing radiation—Gamma rays and X-rays, alpha and beta particles, high-speed electrons, neutrons, protons and other nuclear particles. The term does not include ultrasound, sound or radio waves or visible, infrared or ultraviolet light.

   Premises of an osteopathic physician—A location at which an osteopathic physician practices medicine, other than a health care facility regulated by the Department of Health, the Department of Public Welfare or the Federal government.

   Radiologic procedure—A medical diagnostic or therapeutic procedure that utilizes ionizing radiation.

   The provisions of this §  25.221 issued under sections 13a and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.13a and 271.16); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

 (a)  Auxiliary personnel who take the ARRT Examination in Radiography, and who pass that examination as determined by ARRT, or who have been certified by ARRT, or by another certifying body recognized by the Board, as the result of satisfactory completion of a test and an educational course accredited by an accrediting body recognized by the Board, as a radiologic technologist in radiography, may apply ionizing radiation to human beings for diagnostic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to personally observe performance of the procedure, nor be on the premises when the diagnostic procedure is performed.

 (b)  Auxiliary personnel who take the ARRT Examination in Radiation Therapy Technology, and who pass that examination as determined by ARRT, or who have been certified by ARRT, or by another certifying body recognized by the Board, as the result of satisfactory completion of a test and an educational course accredited by an accrediting body recognized by the Board, in radiation therapy technology, may apply ionizing radiation to human beings for therapeutic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to personally observe performance of the procedure. The physician shall be on the premises when the therapeutic procedure is performed.

 (c)  Auxiliary personnel who take the ARRT Examination in Nuclear Medicine Technology, and who pass that examination as determined by ARRT, or who have been certified by ARRT, or by another certifying body recognized by the Board, as the result of satisfactory completion of a test and an educational course accredited by an accrediting body recognized by the Board, in nuclear medicine technology, may use radionuclide agents on human beings for diagnostic or therapeutic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician shall be on the premises when the diagnostic or therapeutic procedure is performed.

 (d)  Auxiliary personnel who take the ARRT Limited Examination in Radiography, and who receive a score of 70 or higher on that examination as determined by ARRT, may use ionizing radiation on the thorax and extremities of human beings for diagnostic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to personally observe the performance of the procedure. The use of ionizing radiation is restricted to producing radiographs of the thorax and the extremities to demonstrate the following:

   (1)  Ankle.

   (2)  Chest.

   (3)  Clavicle.

   (4)  Elbow.

   (5)  Femur.

   (6)  Foot.

   (7)  Hand.

   (8)  Humerus.

   (9)  Knee.

   (10)  Radius and ulna.

   (11)  Scapula.

   (12)  Shoulder.

   (13)  Soft tissue (foreign body localization).

   (14)  Tibia and fibula.

   (15)  Wrist.

 (e)  Auxiliary personnel who take the ARRT Limited Examination in Radiography—Skill and Sinuses, and who receive a score of 70 or higher on that examination as determined by ARRT, may use ionizing radiation on the skull and sinuses of human beings for diagnostic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to personally observe the performance of the procedure. The use of ionizing radiation is restricted to producing radiographs of the skull and sinuses to demonstrate the following:

   (1)  Facial bones.

   (2)  Mandible.

   (3)  Paranasal sinuses.

   (4)  Skull.

 (f)  Auxiliary personnel who take the Examination in Nuclear Medicine Technology of the Nuclear Medicine Technology College Board, and who pass that examination as determined by the Nuclear Medicine Technology College Board, or who have been certified by the Nuclear Medicine Technology College Board as a radiologic technologist in nuclear medicine technology as the result of satisfactory completion of a test and an educational course accredited by an accrediting body recognized by the Board, may use radionuclide agents on human beings for diagnostic or therapeutic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to personally observe performance of the procedure. The osteopathic physician shall be on the premises when the diagnostic or therapeutic procedure is performed.

 (g)  A person licensed by the State Board of Dentistry as a dental hygienist may use ionizing radiation on the maxilla, mandible and adjacent structures of human beings for diagnostic purposes on the premises of an osteopathic physician under the direct supervision of a physician. The physician is not required to be on the premises when the diagnostic procedure is performed.

   The provisions of this §  25.222 issued under sections 13a and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.13a and 271.16); and section 812.1 of The Administrative Code of 1929 (71 P. S. § §  279.3a); amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.222 adopted July 17, 1987, effective July 18, 1987, 17 Pa.B. 3021; amended November 15, 1991, effective November 16, 1991, 21 Pa.B. 5342. Immediately preceding text appears at serial pages (148346) and (119323) to (119324).

 (a)  A person may apply to take any of the following examinations by securing an application from the Bureau of Professional and Occupational Affairs, and by submitting the application accompanied by the required fee to Health Boards, Bureau of Professional and Occupational Affairs, Post Office Box 2649, Harrisburg, Pennsylvania 17105-2649:

   (1)  ARRT Examination in Radiography.

   (2)  ARRT Examination in Radiation Therapy Technology.

   (3)  ARRT Examination in Nuclear Medicine Technology.

   (4)  ARRT Limited Examination in Radiography.

   (5)  ARRT Limited Examination in Radiography—Skull and Sinuses.

 (b)  An application for the ARRT examinations in radiography, radiation therapy technology and nuclear medicine technology may be filed directly with ARRT. However, ARRT is a private certifying body and may require the satisfaction of minimum education and training criteria for certification purposes. An examination application may not be filed with ARRT if the applicant wishes to take the ARRT Limited Examination in Radiography or the ARRT Limited Examination in Radiology—Skull and Sinuses, or if the applicant does not qualify for or desire private certification of competence to perform the radiologic procedures covered by the other ARRT certification examinations. Alternatively, an application shall be filed with ARRT and not with the Bureau of Professional and Occupational Affairs if the applicant desires to not only perform radiologic procedures as authorized in §  25.222 (relating to auxiliary personnel performing radiologic procedures), but also desires certification by ARRT in the field of radiologic procedures covered by the examination.

   The provisions of this §  25.223 issued under sections 13a and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.13a and 271.16); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a); amended under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.223 adopted July 17, 1987, effective July 18, 1987, 17 Pa.B. 3021; amended November 15, 1991, effective November 16, 1991, 21 Pa.B. 5342; amended June 30, 2006, effective July 1, 2006, 36 Pa.B. 3236. Immediately preceding text appears at serial pages (210055) to (210056).

 The Bureau of Professional and Occupational Affairs will begin accepting applications to take an examination set forth in §  25.223(a) (relating to applications for examination) prior to July 18, 1987. After January 1, 1988, no auxiliary person may administer radiologic procedures on the premises of an osteopathic physician except as set forth in this subchapter.

   The provisions of this §  25.225 issued under sections 13a and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.13a and 271.16); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a).

   The provisions of this §  25.225 adopted July 17, 1987, effective July 18, 1987, 17 Pa.B. 3021.

Subchapter F. FEES

Sec.

§ 25.231. Schedule of fees.

 An applicant for a license, certificate, registration or service shall pay the following fees at the time of application:

 Application for unrestricted license to practice as osteopathic
  physician—original, reciprocal, boundary or by endorsement … $45

 Application for short-term camp license as osteopathic physician … $30

 Temporary training license or graduate training certificate … $30

 Annual renewal of temporary training license or graduate training
  certificate… $25

 Application for physician assistant certificate … $30

 Application for supervising physician … $95

 Uncertified verification of any license, certification or permit… $15

 Certification of any licenses, certifications, examination grades or hours… $25

 Application for athletic trainer certification… $20

 Biennial renewal—athletic trainer… $37

 Biennial renewal—physicians … $220

 Biennial renewal—physician assistants … $10

 Penalty for late biennial renewal—per month or part of month … $5

 Duplicate license or certificate … $5

 Application for radiology examinations … $25

 Application for acupuncturist registration … $30

 Biennial renewal—acupuncturists… $25

 Application for acupuncturist supervisor registration… $30

   The provisions of this §  25.231 amended under section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a); sections 7.1(d), 8(f), 13(a), 13.1, 13a, 16 and 16d(a), of the Osteopathic Medical Practice Act (63 P. S. § §  271.7a(d), 271.8(f), 271.13(a), 271.13a, 271.16 and 271.16d(a)).

   The provisions of this §  25.231 adopted January 20, 1989, effective January 21, 1989, 19 Pa.B. 236; amended May 25, 1990, effective May 26, 1990, 20 Pa.B. 2749; amended November 15, 1991, effective November 16, 1991, 21 Pa.B. 5342; amended November 22, 1991, effective November 23, 1991, 21 Pa.B. 5407; corrected January 31, 1992, effective November 16, 1991, 22 Pa.B. 494; amended April 23, 1993, effective April 24, 1993, 23 Pa.B. 1950; amended January 21, 1994, effective January 22, 1994, 24 Pa.B. 514; amended August 5, 1994, effective August 6, 1994, 24 Pa.B. 3845; amended February 2, 1996, effective February 3, 1996, and apply to examinations administered on and after September 1, 1995, 26 Pa.B. 485; amended August 9, 1996, effective August 10, 1996, 26 Pa.B. 3832; amended January 28, 2000, effective January 29, 2000, 30 Pa.B. 533; amended July 5, 2002, effecitve July 6, 2002, 32 Pa.B. 3220; amended June 30, 2006, effective July 1, 2006, 36 Pa.B. 3236; amended July 13, 2007, effective July 14, 2007, 37 Pa.B. 3230; amended March 12, 2010, effective March 13, 2010, 40 Pa.B. 1404. Immediately preceding text appears at serial pages (328713) to (328714).

   This section cited in 49 Pa. Code §  25.162 (relating to criteria for registration as supervising physician); 49 Pa. Code §  25.163 (relating to approval and effect of certification and biennial renewal of physician assistants and registration of supervising physicians); 49 Pa. Code §  25.271 (relating to requirements for renewal); 49 Pa. Code §  25.605 (relating to biennial renewal); and 49 Pa. Code §  25.704 (relating to application for certification).

Subchapter G. LICENSING, EDUCATION AND
GRADUATE TRAINING

LICENSURE REQUIREMENTS

Sec.

§ 25.241. Unrestricted license by examination.

 To secure an unrestricted license for the practice of osteopathic medicine and surgery by examination, the applicant shall meet the following educational and professional requirements. The applicant shall have:

   (1)  Graduated from an approved osteopathic medical college.

   (2)  Received passing scores on Parts I, II and III of the National Board Examination. The applicant shall pay the required examination fee at the direction of the National Board.

   (3)  Received a passing score on the practical examination in osteopathic diagnosis and manipulative therapy developed and administered by the Board or a designated professional testing organization.

   (4)  Successfully completed an approved internship.

   (5)  Complied with the malpractice insurance requirements of the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006) and regulations thereunder.

   (6)  Completed an application obtained from the Board detailing education and experience and indicating compliance with the applicable provisions of the act and this chapter, submitted with the required fees.

   The provisions of this §  25.241 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 To secure an unrestricted license for the practice of osteopathic medicine and surgery by endorsement, the applicant shall meet the following educational and professional requirements. The applicant shall have:

   (1)  Provided evidence of a valid license in good standing to practice osteopathic medicine and surgery in another state or territory of the United States or Canada whose standards are substantially equivalent to those established by the Board and who reciprocate with the Commonwealth.

   (2)  Graduated from an approved osteopathic medical college.

   (3)  Received a passing score on the National Board Examination, FLEX or a written state or territorial examination developed by the NBOME or otherwise acceptable to the Board.

   (4)  Received a passing score on the practical examination in osteopathic diagnosis and manipulative therapy developed and administered by the Board or a designated professional testing organization.

   (5)  Successfully completed an approved internship.

   (6)  Complied with the malpractice insurance requirements of the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006) and regulations thereunder.

   (7)  Completed an application obtained from the Board detailing education and experience and indicating compliance with the applicable provisions of the act and this chapter, submitted with the required fees.

   The provisions of this §  25.242 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A licensed osteopathic physician residing in or maintaining an office of practice in an adjoining state near the boundary line between that state and this Commonwealth whose practice extends into this Commonwealth shall apply for the privilege, in the form of a boundary license, to practice osteopathic medicine and surgery in this Commonwealth.

 (b)  Specific requirements for boundary licensure are as follows. The applicant shall:

   (1)  Possess a valid, current and unrestricted license in the physician’s state of residence and primary practice. The physician shall arrange for certification of licensure to be transmitted to the Board by the authorized licensing body of that state.

   (2)  Comply with the malpractice insurance requirements of the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006) and regulations thereunder.

   (3)  Submit an application obtained from the Board, together with the required fee.

 (c)  The issuance of a boundary license depends upon whether the adjoining state of licensure reciprocates by extending similar privileges to licensees of the Commonwealth.

 (d)  A record of persons granted a boundary license will be maintained in the office of the Board.

 (e)  Since a boundary license is invalidated by practice location changes, a person granted a boundary license shall inform the Board within 10 days of changes in residence or office of practice location which affect the maintenance of the license.

   The provisions of this §  25.243 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A temporary license is required of an osteopathic medical college graduate for permission to participate in an approved graduate osteopathic or medical training program in this Commonwealth.

 (b)  Specific requirements for temporary training licensure are as follows. The applicant shall have:

   (1)  Graduated from an approved osteopathic medical college.

   (2)  Submitted an application obtained from the Board, together with the required fee.

 (c)  The temporary training license permits the graduate to train only within the complex of the hospital and its affiliates where the graduate is engaged in an approved graduate osteopathic or medical training program.

 (d)  The temporary training license is valid for 1 year, after which it shall be surrendered to the Board. The Board may extend the validity of the temporary training license within its discretion.

   The provisions of this §  25.244 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A graduate training certificate is required of an osteopathic physician licensed in this Commonwealth or another state or territory of the United States or Canada who has applied for training or certification in special departments of osteopathic medicine and surgery in AOA-approved institutions.

 (b)  Specific requirements for graduate training certification are as follows. The applicant shall:

   (1)  Possess a valid, current and unrestricted license in this Commonwealth or another state or territory of the United States or Canada. A physician not licensed in this Commonwealth shall arrange for certification of licensure to be transmitted to the Board by the authorized licensing body of the other jurisdiction.

   (2)  Submit an application obtained from the Board, together with the required fee.

 (c)  The graduate training certificate permits the physician to train only within the complex of the hospital and its affiliates or community hospitals where the physician is engaged in the training.

 (d)  The graduate training certificate is valid for 1 year, but may be renewed annually by the filing of a renewal form obtained from the Board and payment of the required fee.

   The provisions of this §  25.245 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A short-term license valid for a period not exceeding 3 months may be granted by the Board to an osteopathic physician licensed in good standing in another state or Canada who intends to practice osteopathic medicine and surgery in camps in this Commonwealth.

 (b)  Specific requirements for short-term camp licensure are as follows. The applicant shall:

   (1)  Possess a valid, current and unrestricted license in another state or territory of the United States or Canada. The physician shall arrange for certification of licensure to be transmitted to the Board by the authorized licensing body of the other jurisdiction.

   (2)  Comply with the malpractice insurance requirements of the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006) and regulations thereunder.

   (3)  Submit an application obtained from the Board, together with the required fee.

   The provisions of this §  25.246 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 A license or certificate may be limited or restricted by order of the Board under its disciplinary powers in section 15(c)(3) of the act (63 P. S. §  271.15(c)(3)).

   The provisions of this §  25.247 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.247 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

LICENSURE EXAMINATIONS

§ 25.251. General requirements.

 (a)  An applicant is eligible for unrestricted licensure only if the applicant has passed the required written examination and the practical examination.

 (b)  An applicant shall apply directly to the NBOME for admission to the required parts of the National Board Examination and shall pay the required fees at the direction of the NBOME.

 (c)  An applicant for admission to the practical examination in osteopathic diagnosis and manipulative therapy shall be a graduate of an approved osteopathic medical college and shall fulfill the requirements of the act and this chapter.

 (d)  An applicant is eligible for admission to the practical examination after graduation from an approved osteopathic medical college, but is not eligible for unrestricted licensure until the applicant has completed an approved internship.

 (e)  An applicant for the practical examination and State written examination, if applicable, may obtain an application form by contacting the Board office at the following address: State Board of Osteopathic Medicine, Post Office Box 2649, Harrisburg, Pennsylvania 17105-2649.

   The provisions of this §  25.251 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A candidate who, prior to July 1, 1995, takes the State written examination, shall obtain the passing score established for each administration of the examination.

 (b)  A candidate who takes Parts I, II and III of the National Board Examination shall obtain the passing score established by the NBOME for each administration of the examination.

   The provisions of this §  25.252 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 A candidate who fails the State examination may be reexamined in compliance with section 8(d) of the act (63 P.S. §  271.8(d)) upon payment of the required fee. A candidate who fails any part of the National Board Examination may retake the failed parts in accordance with the requirements of the NBOME.

   The provisions of this §  25.253 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  A minimum of two written and four practical examinations shall be administered each year.

 (b)  The practical examination in osteopathic diagnosis and manipulative therapy shall test diagnostic and therapeutic techniques applicable to the entire body.

   The provisions of this §  25.254 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.254 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

EDUCATION AND GRADUATE TRAINING PROGRAMS

§ 25.261. Approved osteopathic medical colleges.

 The Board will work cooperatively with the AOA under standards established by the Bureau of Professional Education of the AOA to evaluate and approve osteopathic medical colleges offering osteopathic training. AOA-approved osteopathic medical colleges are approved by the Board, but the Board may conduct or cause to be conducted inspections it deems necessary to assure educational quality.

   The provisions of this §  25.261 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  The Board will work cooperatively with the AOA under standards established by the Committee on Post-Doctoral Training of the AOA to evaluate and approve internship programs prerequisite to unrestricted licensure in this Commonwealth. AOA-approved programs are approved by the Board, but the Board may conduct or cause to be conducted inspections it deems necessary to assure educational quality.

 (b)  Internship programs which have not been approved by the AOA Board of Trustees may be approved by the Board at its discretion, in the event of exigent circumstances wherein a sufficient number of AOA-approved internship positions are not available to accommodate osteopathic medical school graduates desiring to obtain unrestricted licensure in this Commonwealth.

   The provisions of this §  25.262 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.262 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

 The Board will work cooperatively with the AOA under standards established by the Committee on Post-Doctoral Training of the AOA to evaluate and approve other supervised graduate training programs leading to certification in a medical specialty by the appropriate specialty board of the AOA. AOA-approved programs are approved by the Board, but the Board may conduct or cause to be conducted inspections it deems necessary to assure educational quality.

   The provisions of this §  25.263 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 (a)  On and after July 1, 1992, internships prerequisite to unrestricted licensure shall have been approved in accordance with §  25.262 (relating to approved internships).

 (b)  A candidate for unrestricted licensure applying on or after July 1, 1993, shall have completed an AOA-approved internship in accordance with §  25.262, or an internship which had been approved by the Board at the time the candidate participated in the program.

   The provisions of this §  25.264 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.264 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

LICENSURE RENEWAL AND CONTINUING EDUCATION

§ 25.271. Requirements for renewal.

 (a)  A licensee shall biennially renew his license by completing a form obtained from the Board in advance of October 31 of every even-numbered year, and by paying the required fee. The application shall indicate the following:

   (1)  Other states where the applicant is licensed.

   (2)  Disciplinary action taken against the applicant by the licensing boards in other states.

   (3)  A verdict of guilty, guilty plea or plea of nolo contendere by the applicant to a felony, crime of moral turpitude or crime related to the practice of osteopathic medicine in this or another jurisdiction occurring within the 2 years immediately preceding renewal.

 (b)  A penalty fee as specified by §  25.231 (relating to schedule of fees) will be imposed on a licensee who continues to practice without having timely renewed his license. The licensee may also be subject to other criminal, civil or administrative penalties.

 (c)  Proof of completion of 100 credit hours of continuing medical education in the preceding biennial period will be required for licensure renewal for osteopathic physicians.

   (1)  Beginning with the licensure renewal period commencing November 1, 2006, at least 20 credit hours shall be completed in AOA category 1-A approved activities. At least 12 credit hours shall be completed in Category 1 or Category 2 approved activities in the area of patient safety and risk management. Approved activities in the area of patient safety and risk management may include topics such as improving medical records and recordkeeping, reducing medical errors, professional conduct and ethics, improving communications, preventative medicine and healthcare quality improvement. The remaining credit hours shall be completed in any Category 1 or Category 2 approved activities. Credit will not be granted for courses in office management or practice building.

   (2)  Physicians shall retain official documentation of attendance for 2 years after renewal, and shall certify completed activities on a form provided by the Board for that purpose, to be filed with the biennial renewal form. Official documentation proving attendance shall be produced, upon Board demand, pursuant to random audits of reported credit hours. Electronic submission of documentation is permissible to prove compliance with this subsection. Noncompliance may result in disciplinary proceedings under section 15(a)(6) of the act (63 P. S. §  271.15(a)(6)).

   (3)  The following exemptions apply for certain physicians:

     (i)   A physician applying for licensure in this Commonwealth for the first time shall be exempt from the continuing medical education requirement for the biennial renewal period following initial licensure.

     (ii)   A physician holding a current temporary training license shall be exempt from the continuing medical education requirement.

     (iii)   A retired physician who provides care only to immediate family members shall be exempt from the continuing medical education requirement.

     (iv)   A physician who is on inactive status shall be exempt from the continuing medical education requirement, except that a physician who is seeking to reinstate an inactive or lapsed license shall show proof of compliance with the continuing education requirement for the preceding biennium.

   (4)  A physician suspended for disciplinary reasons is not exempt from the requirements of this section.

   (5)  Waiver of the requirements may be permitted, as follows:

     (i)   The Board may grant a hardship waiver of all or a part of the continuing medical education requirement in cases of serious illness, military service or other good cause provided that the public’s safety and welfare will not be jeopardized by the granting of the waiver.

     (ii)   Requests for waiver must be made in writing, with appropriate documentation, and include a description of circumstances sufficient to show why compliance is impossible.

     (iii)   Waiver requests will be evaluated by the Board on a case-by-case basis. The Board will send written notification of its approval or denial of a waiver request.

   The provisions of this §  25.271 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)); amended under sections 10(d) and 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(d) and 271.16); amended under section 910 of the Medical Care Availability and Reduction of Error Act (40 P. S. §  1303.910).

   The provisions of this §  25.271 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209; amended December 16, 1994, effective December 17, 1994, 24 Pa.B. 6296; amended May 20, 2005, effective May 21, 2005, 35 Pa.B. 3021. Immediately preceding text appears at serial pages (238299) to (238300).

 It is the responsibility of each licensee to notify the Board of a change in name or mailing address within 10 business days of the change.

   The provisions of this §  25.272 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.272 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

HEALTH CARE SERVICES MALPRACTICE ACT

§ 25.281. Malpractice insurance requirements.

 An applicant for original licensure or a licensee applying for biennial renewal shall maintain the required amount of professional liability insurance or an approved self-insurance plan and shall have paid the required fees and surcharges as set forth in the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006), and regulations thereunder. A licensee practicing solely as a Federal employe and a licensee who provides no medical services in this Commonwealth are not required to comply with the insurance requirements of the Health Care Services Malpractice Act. Proof of nonpractice shall be furnished by notarized statement.

   The provisions of this §  25.281 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 Upon issuance of an original license, a licensee may not enter upon the practice of osteopathic medicine and surgery in this Commonwealth unless the licensee is in compliance with the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006).

   The provisions of this §  25.282 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

 A licensee applying for biennial renewal may not continue to practice osteopathic medicine and surgery in this Commonwealth unless the licensee is in compliance with the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006).

   The provisions of this §  25.283 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.283 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

 Failure to comply with the Health Care Services Malpractice Act (40 P. S. § §  1301.101—1301.1006), regulations thereunder and this subchapter may result in the suspension or revocation of a license after a formal hearing before the Board.

   The provisions of this §  25.284 issued under section 16 of the Osteopathic Medical Practice Act (63 P. S. §  271.16); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   The provisions of this §  25.284 adopted January 10, 1992, effective January 11, 1992, 22 Pa.B. 209.

Subchapter H. STATEMENTS OF POLICY

Sec.

§ 25.291. Disclosure of financial or ownership interest.

 (a)  Purpose. This statement of policy provides guidelines for compliance with the act of May 26, 1988 (Act 66) (P. L. 403, No. 66) (35 P. S. § §  449.21—449.23).

 (b)  General rule. Act 66 requires an osteopathic physician referring a patient for health-related services, tests, pharmaceuticals, appliances or devices to a facility or entity in which he has an ownership interest to disclose that interest prior to making the referral, and to notify the patient of his freedom to choose an alternate provider. Ownership interests will be considered by the Board to include proprietary or beneficial interests through which the physician earns or has the potential to earn income, or which produce a direct or indirect economic benefit.

 (c)  Compliance. An osteopathic physician holding or benefiting from this ownership interest may comply with the requirements of Act 66 by providing both general and specific notice to his patients.

   (1)  General notice. A printed notice, legible from 3 feet, may be posted in the patient waiting area, substantially in the following form:

  ACT 66 OF 1988 REQUIRES US TO NOTIFY YOU THAT YOUR PHYSICIAN MAY REFER YOU FOR A MEDICAL SERVICE, PRODUCT OR DEVICE TO A FACILITY OR BUSINESS IN WHICH HE OR SHE HAS A FINANCIAL INTEREST. IF THAT HAPPENS, WE WILL LET YOU KNOW. YOU WILL ALWAYS HAVE THE FREEDOM TO CHOOSE AN ALTERNATE PROVIDER.

   (2) Specific notice. When a physician makes such a referral, the physician or the physician’s delegate may retain a signed document in the patient’s medical records, substantially in the following form:

  I have been referred to

 (d)  Referrals for certain patients. Specific disclosures for referrals for patients who are minors, unconscious or legally incompetent, may be made to a parent, legal guardian or custodial adult or adult next of kin.

 (e)  Civil penalty. Failure to comply with Act 66 may result in the imposition of a civil penalty, not to exceed $1,000, for each violation, after formal proceedings before the Board.

 (f)  Exception. Compliance with Act 66 will not be required in the event of an emergency.

   The provisions of this §  25.291 adopted April 3, 1992, effective April 4, 1992, 22 Pa.B. 1574.

Subchapter I. REGISTRATION AND PRACTICE OF
ACUPUNCTURISTS

Sec.

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

   Acupuncture—The stimulation of certain points on or near the surface of the body by the insertion of needles to prevent or alleviate the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body.

   Acupuncture examination—An examination offered or recognized by the Board to test whether an individual has accumulated sufficient academic knowledge with respect to the practice of acupuncture to qualify for the privilege of practicing as an acupuncturist. The term includes the combination of the NCCA examinations in acupuncture and sterilization procedures. The Board may approve other examinations acceptable to it.

   Acupuncture medical program—An academic or clinical program of study in acupuncture which is acceptable to the Board and has been given category I or II continuing education credit in an institution accredited or recognized by the AOA or the Accreditation Council on Continuing Medical Education to conduct these courses.

   Acupuncture program—An academic and clinical program of study in acupuncture which has been approved by the Board or by an accrediting body recognized by the Board.

   Acupuncturist—An individual registered to practice acupuncture by the Board.

   Acupuncturist supervisor—An osteopathic physician registered with the Board as a supervisor of acupuncturists.

   General supervision—An acupuncturist supervisor doing the following in supervising an acupuncturist:

     (i)   Performing a medical diagnostic examination or reviewing the results of a recently performed medical diagnostic examination with respect to an ailment or condition to be treated by acupuncture prior to the treatment.

     (ii)   Being personally available to the acupuncturist for consultation on the premises or being available by telephone contact, chart review or other means approved by the Board.

     (iii)   Placing conditions and restrictions on the course of treatment if that action is required as a matter of sound osteopathic medical practice.

   NCCA—The National Commission for the Certification of Acupuncturists.

 (a)  An osteopathic physician who intends to practice acupuncture and other individuals who intend to practice acupuncture at the direction and under the supervision of an osteopathic physician shall register with the Board as an acupuncturist.

 (b)  Only an osteopathic physician registered as an acupuncturist supervisor may delegate the performance of acupuncture services to an acupuncturist. An acupuncturist who is not an osteopathic physician may only perform acupuncture services under the direction and supervision of an acupuncturist supervisor, unless otherwise authorized by statute.

 (a)  The Board will register as an acupuncturist a nonosteopathic physician who satisfies the following requirements:

   (1)  Has successfully completed an acupuncture program which includes a course in needle sterilization techniques.

     (i)   If the acupuncture education program is taken within the United States, the applicant shall complete 2 academic years of acupuncture training and shall complete 2 academic years of a college level educational program.

     (ii)   If the educational program is taken outside of the United States, an applicant shall graduate from a college with a program of study including Oriental medicine and document 300 class hours of study in acupuncture training.

   (2)  Has obtained a passing grade on an acupuncture examination or has been certified by NCCA by credential review. The Board accepts the passing grade on the certifying examination of the NCCA as determined by the NCCA, and accepts a passing grade on any state’s acupuncture examination taken prior to January 1, 1987, as determined by the licensing or registering authority in the other state. If the examination was not taken in English, but is otherwise acceptable and a passing score was secured, the Board will accept the examination result if the applicant has also secured a score of 550 on the test of English as a Foreign Language (TOEFL).

   (3)  Submits an application to register as an acupuncturist accompanied by the required fee.

 (b)  The Board will register as an acupuncturist an osteopathic physician who satisfies the following requirements:

   (1)  Has successfully completed 200 hours of training in acupuncture medical programs including examinations required by those programs or has engaged in clinical acupuncture practice for at least 3 years prior to January 1, 1987, documented to the satisfaction of the Board.

   (2)  Submits an application to register as an acupuncturist accompanied by the required fee.

 (c)  The Board will register as an acupuncturist supervisor an osteopathic physician who satisfies the following requirements:

   (1)  Possesses a license without restriction.

   (2)  Submits an application to register as an acupuncturist supervisor accompanied by the required fee.

 (a)  An acupuncturist shall register biennially and submit the appropriate registration fee to engage in the practice of acupuncture for the biennial period.

 (b)  There is no biennial registration requirement for an acupuncturist supervisor.

 (a)  Responsibilities to patient. In relation to the acupuncture patient, the acupuncturist shall comply with the following:

   (1)  Receive, in writing, from the acupuncturist supervisor, approval to initiate acupuncture treatment.

   (2)  Comply strictly with conditions or restrictions that may be placed on the course of acupuncture treatment by the acupuncturist supervisor.

   (3)  Not diagnose a physical or mental ailment or condition or prescribe or dispense a drug.

   (4)  Comply strictly with sterilization standards relative to aseptic practices.

 (b)  Responsibility to acupuncturist supervisor. In relation to the acupuncturist supervisor, the acupuncturist shall comply with the following:

   (1)  Consult promptly with the acupuncturist supervisor regarding a new ailment or condition or a worsened ailment or condition of an acupuncture patient.

   22)  Consult with the acupuncturist supervisor upon request of either the acupuncturist supervisor or the acupuncture patient.

   (3)  Practice acupuncture only under the general supervision of an acupuncturist supervisor.

 (c)  Scope of acupuncturist’s responsibility.

   (1)  An acupuncturist is responsible solely for acupuncture evaluation and acupuncture treatment. The medical diagnosis is the responsibility of the acupuncturist supervisor.

   (2)  An acupuncturist is not required to practice acupuncture in the physical presence of the acupuncturist supervisor or at the location where the acupuncturist supervisor provides osteopathic medical services. Where the acupuncturist may provide acupuncture services without the acupuncture supervisor being physically present, shall be determined by the acupuncture supervisor.

 (d)  Identification of acupuncturist. An acupuncturist who is not an osteopathic physician shall wear a tag or badge with lettering clearly visible to the patient bearing his name and the title ‘‘acupuncturist.’’

 (a)  Responsibility to acupuncture patient. In relation to the acupuncture patient, the acupuncturist supervisor shall comply with the following:

   (1)  Perform or review the results of a recently performed medical diagnostic examination with respect to an ailment or condition to be treated by acupuncture before the treatment.

   (2)  Advise the patient of the results of the medical diagnostic examination and the treatment alternatives.

   (3)  Place conditions or restrictions on the course of treatment in acupuncture to be provided by the acupuncturist, if conditions or restrictions are required as a matter of sound osteopathic medical practice.

   (4)  Advise the patient in writing that he is available at reasonable times for consultation by appointment or by telephone. The written notice shall contain an address and telephone number at which the acupuncture supervisor may be reached.

   (5)  If he is not an acupuncturist, advise the patient in writing that he is not an acupuncturist, that he is not qualified to direct the course of acupuncture treatment and that he does not have responsibility for the course of acupuncture treatment.

   (6)  Monitor the patient’s progress under acupuncture treatment and comply with normal responsibilities to a patient if the patient does not respond to treatment within the anticipated time.

 (b)  Responsibility to acupuncturist. In relation to the supervised acupuncturist, the acupuncturist supervisor shall satisfy the following:

   (1)  Advise the acupuncturist of the results of the medical diagnostic examination that are relevant to acupuncture treatment and of conditions or restrictions that are to be placed on the course of acupuncture treatment.

   (2)  Not delegate to the acupuncturist the right to prescribe or dispense drugs or the responsibility for diagnosing a physical or mental ailment or condition.

   (3)  Confer promptly with the acupuncturist in the event of the following:

     (i)   The acupuncturist supervisor decides to impose conditions or restrictions on the course of acupuncture treatment.

     (ii)   The patient has requested further consultation with the acupuncturist supervisor.

     (iii)   The patient’s condition is not improving or the patient requires emergency medical treatment.

   (4)  Designate an alternative acupuncturist supervisor to provide general supervision of the acupuncturist during periods in which the acupuncturist supervisor is unable to provide general supervision, if the substitute acupuncturist supervisor agrees to accept the responsibility set forth in this section.

 (c)  Scope of acupuncturist supervisor’s responsibility.

   (1)  In providing general supervision to the acupuncturist, the acupuncturist supervisor maintains the diagnostic responsibility and the physician-patient relationship. It is the responsibility of the acupuncturist and not of the acupuncturist supervisor to conduct an acupuncture evaluation and perform acupuncture treatment.

   (2)  An acupuncturist supervisor may not provide general supervision to more than two acupuncturists without applying for and receiving specific approval from the Board.

 (a)  The nonosteopathic physician acupuncturist and the acupuncturist supervisor shall provide written notice to the Board prior to the date when the acupuncturist supervisor is to begin general supervision of the acupuncturist. The written notice shall comply with the following:

   (1)  Be filled out on a form supplied by the Board.

   (2)  Provide the name of the acupuncturist supervisor and the acupuncturist and a current address and telephone number at which each can be reached.

   (3)  Contain an acknowldgement by the acupuncturist supervisor that he understands and agrees to accept his responsibilities to the supervised acupuncturist and the acupuncture patient as set forth in this subchapter.

   (4)  Contain an acknowledgment by the acupuncturist that he understands and accepts his responsibility to the acupuncturist supervisor and the acupuncture patient as set forth in this subchapter.

   (5)  Contain the verified signatures of the acupuncturist supervisor and the supervised acupuncturist.

 (b)  Written notice of termination of an arrangement between an acupuncturist supervisor and an acupuncturist shall be given to the Board by both individuals within 10 days following termination of the relationship. Notice may be provided by both through one document or by each through separate documents.

 (a)  The Board may refuse, revoke, suspend, limit or attach conditions to the registration of an acupuncturist for engaging in conduct prohibited by section 15 of the act (63 P. S. §  271.15) for Board-regulated practitioners.

 (b)  The Board will order the emergency suspension of the registration of an acupuncturist who presents an immediate and clear danger to the public health and safety, as required by section 14(a) of the act (63 P. S. §  271.14(a)).

 (c)  The Board will notify an acupuncturist of the automatic suspension of registration upon the acupuncturist’s commitment to a mental institution or conviction of a drug felony, as required by section 14(b) of the act (63 P. S. §  271.14(b)).

   This section cited in 49 Pa. Code §  5.81 (relating to unprofessional and immoral conduct).

Subchapter J. CHILD ABUSE REPORTING REQUIREMENTS

GENERAL

Sec.

§ 25.401. Definitions.

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

   Child abuse—A term meaning any of the following:

     (i)   A recent act or failure to act by a perpetrator which causes nonaccidental serious physical injury to a child under 18 years of age.

     (ii)   An act or failure to act by a perpetrator which causes nonaccidental serious mental injury to or sexual abuse or sexual exploitation of a child under 18 years of age.

     (iii)   A recent act, failure to act or series of acts or failures to act by a perpetrator which creates an imminent risk of serious physical injury to or sexual abuse or sexual exploitation of a child under 18 years of age.

     (iv)   Serious physical neglect by a perpetrator constituting prolonged or repeated lack of supervision or the failure to provide the essentials of life, including adequate medical care, which endangers a child’s life or development or impairs the child’s functioning.

   ChildLine—An organizational unit of the Department of Public Welfare which operates a 24-hour a day Statewide toll free telephone system for receiving reports of suspected child abuse, referring reports for investigation and maintaining the reports in the appropriate file.

   Individual residing in the same home as the child—An individual who is 14 years of age or older and who resides in the same home as the child.

   Perpetrator—A person who has committed child abuse and is a parent of the child, a person responsible for the welfare of a child, an individual residing in the same home as a child or a paramour of a child’s parent.

   Person responsible for the child’s welfare—A person who provides permanent or temporary care, supervision, mental health diagnosis or treatment, training or control of a child in lieu of parental care, supervision and control. The term does not include a person who is employed by or provides services or programs in a public or private school, intermediate unit or area vocational-technical school.

   Recent acts or omissions—Acts or omissions committed within 2 years of the date of the report to the Department of Public Welfare or county agency.

   Serious mental injury—A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that does one or more of the following:

     (i)   Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child’s life or safety is threatened.

     (ii)   Seriously interferes with a child’s ability to accomplish age-appropriate developmental and social tasks.

   Serious physical injury—An injury that causes a child severe pain or significantly impairs a child’s physical functioning, either temporarily or permanently.

   Sexual abuse or exploitation—The employment, use, persuasion, inducement, enticement or coercion of a child to engage in or assist another person to engage in sexually explicit conduct or a simulation of sexually explicit conduct for the purpose of producing a visual depiction, including photographing, videotaping, computer depicting or filming, of sexually explicit conduct or the rape, sexual assault, involuntary deviate sexual intercourse, aggravated indecent assault, molestation, incest, indecent exposure, prostitution, statutory sexual assault or other form of sexual exploitation of children.

CHILD ABUSE REPORTING REQUIREMENTS

§ 25.411. Suspected child abuse—mandated reporting requirements.

 (a)  General rule. Under 23 Pa.C.S. §  6311 (relating to persons required to report suspected child abuse), osteopathic physicians, physician assistants or certified respiratory care therapists who, in the course of their employment, occupation or practice of their profession, come into contact with children shall report or cause a report to be made to the Department of Public Welfare when they have reasonable cause to suspect on the basis of their professional or other training or experience, that a child coming before them in their professional or official capacity is a victim of child abuse.

 (b)  Staff members of public or private agencies, institutions and facilities. Osteopathic physicians, physician assistants or certified respiratory care therapists who are staff members of a medical or other public or private institution, school, facility or agency, and who, in the course of their employment, occupation or practice of their profession, come into contact with children shall immediately notify the person in charge of the institution, school, facility or agency or the designated agent of the person in charge when they have reasonable cause to suspect on the basis of their professional or other training or experience, that a child coming before them in their professional or official capacity is a victim of child abuse. Upon notification by the osteopathic physician, physician assistant or certified respiratory care therapist, the person in charge or the designated agent shall assume the responsibility and have the legal obligation to report or cause a report to be made in accordance with subsections (a), (c) and (d).

 (c)  Reporting procedure. Reports of suspected child abuse shall be made by telephone and by written report.

   (1)  Oral reports. Oral reports of suspected child abuse shall be made immediately by telephone to ChildLine, (800) 932-0313.

   (2)  Written reports. Written reports shall be made within 48 hours after the oral report is made by telephone. Written reports shall be made on forms available from a county children and youth social service agency.

 (d)  Written reports. Written reports shall be made in the manner and on forms prescribed by the Department of Public Welfare. The following information shall be included in the written reports, if available:

   (1)  The names and addresses of the child and the parents or other person responsible for the care of the child, if known.

   (2)  Where the suspected abuse occurred.

   (3)  The age and sex of the subjects of the report.

   (4)  The nature and extent of the suspected child abuse including any evidence of prior abuse to the child or siblings of the child.

   (5)  The name and relationship of the persons responsible for causing the suspected abuse, if known, and any evidence of prior abuse by those persons.

   (6)  Family composition.

   (7)  The source of the report.

   (8)  The person making the report and where that person can be reached.

   (9)  The actions taken by the reporting source, including the taking of photographs and X-rays, removal or keeping of the child or notifying the medical examiner or coroner.

   (10)  Other information which the Department of Public Welfare may require by regulation.

 An osteopathic physician, physician assistant or certified respiratory care therapist may take or cause to be taken photographs of the child who is subject to a report and, if clinically indicated, cause to be performed a radiological examination and other medical tests on the child. Medical summaries or reports of the photographs, X-rays and relevant medical tests taken shall be sent to the county children and youth social service agency at the time the written report is sent or as soon thereafter as possible. The county children and youth social service agency shall have access to actual photographs or duplicates and X-rays and may obtain them or duplicates of them upon request.

 An osteopathic physician, physician assistant or certified respiratory care therapist who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the coroner of the county where death occurred or, in the case where the child is transported to another county for medical treatment, to the coroner of the county where the injuries were sustained.

 (a)  Disciplinary action. An osteopathic physician, physician assistant or certified respiratory care therapist who willfully fails to comply with the reporting requirements in § §  25.411—25.413 (relating to suspected child abuse—mandated reporting requirements; photographs, medical tests and X-rays of child subject to report; and suspected death as a result of child abuse—mandated reporting requirement) will be subject to disciplinary action under section 15(a)(6) or (b)(7) of the act (63 P. S. §  271.15(a)(6) or (b)(7)).

 (b)  Criminal penalties. Under 23 Pa.C.S. §  6319 (relating to penalties for failure to report), an osteopathic physician, physician assistant or certified respiratory care therapist who is required to report a case of suspected child abuse who willfully fails to do so commits a summary offense for the first violation and a misdemeanor of the third degree for a second or subsequent violation.

Subchapter K. RESPIRATORY CARE PRACTITIONERS

Sec.

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

   AARC—American Association for Respiratory Care, an organization which provides continuing professional development programs.

   AMA—American Medical Association, an organization which provides continuing professional development programs.

   AOA—American Osteopathic Association, an organization which provides continuing professional development programs.

   Act—The Osteopathic Medical Practice Act (63 P. S. § §  271.1—271.18).

   CRTT—The Certification Examination For Entry Level Respiratory Therapy Practitioners, a National uniform examination developed and administered by the NBRC for certified respiratory care therapy practitioners.

   CSRT—Canadian Society of Respiratory Therapists, an organization which provides continuing professional development programs.

   JRCRTE—The Joint Review Committee on Respiratory Therapy Education, which accredits respiratory care programs.

   NBRC—The National Board for Respiratory Care, the agency recognized by the Board to certify respiratory care practitioners.

   Respiratory care practitioner—A person who has been certified in accordance with the act and this subchapter.

   The provisions of this §  25.502 amended under section 10.2(f) of the Osteopathic Medical Practice Act (63 P. S. §  271.10b(f)).

 The following is the schedule of fees charged by the Board:

   (1)  Temporary permit … $30

   (2)  Initial license application … $30

   (3)  Certification examination … $100

   (4)  Reexamination … $60

   (5)  Biennial renewal of certification … $25

 (a)  A person may not practice or hold himself out as being able to practice as a respiratory care practitioner in this Commonwealth unless the person holds a valid, current temporary permit or certificate issued by the Board, or the State Board of Medicine under Chapter 18 (relating to State Board of Medicine—practitioners other than medical doctors) or is exempted under section 10.1(e) of the act (63 P. S. § §  271.10a(e)) or section 13.1(e) of the Medical Practice Act of 1985 (63 P. S. §  422.13a(e)).

 (a)  Under section 10.1(d) of the act (63 P. S. §  271.10a(d)), a respiratory care practitioner may implement direct respiratory care to an individual being treated by either a licensed medical doctor or a licensed doctor of osteopathic medicine, upon physician prescription or referral, or under medical direction and approval consistent with standing orders or protocols of an institution or health care facility. This care may constitute indirect services such as consultation or evaluation of an individual and also includes, but is not limited to, the following services:

   (1)  Administration of medical gases.

   (2)  Humidity and aerosol therapy.

   (3)  Administration of aerosolized medications.

   (4)  Intermittent positive pressure breathing.

   (5)  Incentive spirometry.

   (6)  Bronchopulmonary hygiene.

   (7)  Management and maintenance of natural airways.

   (8)  Maintenance and insertion of artificial airways.

   (9)  Cardiopulmonary rehabilitation.

   (10)  Management and maintenance of mechanical ventilation.

   (11)  Measurement of ventilatory flows, volumes and pressures.

   (12)  Analysis of ventilatory gases and blood gases.

 (a)  A temporary permit will be issued to an applicant who submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:

   (1)  Has graduated from a respiratory care program approved by the JRCRTE.

   (2)  Is enrolled in a respiratory care program approved by the JRCRTE and expects to graduate within 30 days of the date of application to the Board for a temporary permit.

   (3)  Has continuously provided respiratory care services for a minimum of 12 months immediately preceding December 28, 1993.

 The Board will approve for certification as a respiratory care practitioner an applicant who:

   (1)  Submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:

     (i)   Has graduated from a respiratory care program approved by the JRCRTE and passed the CRTT as determined by the NBRC.

     (ii)   Has been credentialed as a Certified Respiratory Therapy Technician or Registered Respiratory Therapist by the NBRC.

     (iii)   Holds a valid license, certificate or registration as a respiratory care practitioner in another state, territory or the District of Columbia which has been issued based on requirements substantially the same as those required by the Commonwealth, including the examination requirement.

     (iv)   Has continuously provided respiratory care services for a minimum of 12 months immediately preceding December 28, 1993, and has passed the CRTT as determined by the NBRC.

 (a)  A certification issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.

 (b)  Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.

 (c)  To retain the right to engage in practice, the certificateholder shall renew certification in the manner prescribed by the Board, pay the required fee and comply with the continuing education requirement of §  25.509a (relating to requirement of continuing education), prior to the expiration of the current biennium.

 (d)  When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee.

   The provisions of this §  25.509 amended under section 10.2(f) of the Osteopathic Medical Practice Act (63 P. S. §  271.10b(f)).

 (a)  Commencing with the biennial period January 1, 2007, through December 31, 2008, and each subsequent biennial period, an applicant for biennial renewal or reactivation of certification is required to complete a minimum of 20 hours of continuing education as set forth in section 10.2(f)(2) of the act (63 P. S. §  271.10b(f)(2)) subject to the following:

   (1)  No more than 10 credit hours may be completed in nontraditional continuing education such as prerecorded presentations, Internet-based presentations and journal review programs. To qualify, the provider shall make available documented verification of completion of the course or program.

   (2)  One hour each must be completed in medical ethics and in patient safety.

 (b)  An individual applying for the first time for certification in this Commonwealth is exempt from the continuing education requirement for the biennial renewal period following initial certification.

 (c)  The Board may waive all or a portion of the requirements of continuing education in cases of serious illness, undue hardship or military service. It shall be the duty of each certificateholder who seeks a waiver to notify the Board in writing and request the waiver prior to the end of the renewal period. The request must be made in writing, with appropriate documentation, and include a description of circumstances sufficient to show why the certificateholder is unable to comply with the continuing education requirement. The Board will grant, deny or grant in part the request for waiver and will send the certificateholder written notification of its approval or denial of the waiver request. A certificateholder who requests a waiver may not practice as a respiratory care practitioner after the expiration of the certificateholder’s current certificate until the Board grants the waiver request.

 (d)  A certificateholder shall maintain the information and documentation concerning compliance with the continuing education requirement or the waiver granted for a period of at least 2 years.

   The provisions of this §  25.509a issued under section 10.2(f) of the Osteopathic Medical Practice Act (63 P. S. §  271.10b(f)).

   The provisions of this §  25.509a adopted November 24, 2006, effective November 25, 2006, 36 Pa.B. 7137.

 (a)  The Board approves respiratory care continuing education programs designated for professional development credits by the AARC, the AMA, the AOA and the CSRT.

   (1)  Qualifying AMA continuing education programs must be in AMA PRA Category I credits, as defined in §  25.1 (relating to definitions).

   (2)  Qualifying AOA continuing education programs must be in Category I-A or I-B credits, as defined in §  25.1.

 (b)  Advanced course work in respiratory care successfully completed at a degree-granting institution of higher education approved by the United States Department of Education which offers academic credits are also approved for continuing education credit by the Board. Advanced course work is course work beyond the academic requirements necessary for certification as a respiratory care practitioner.

 (c)  The Board will not accept courses of study which do not relate to the actual provision of respiratory care. Examples of unacceptable courses are those in office management and financial procedures.

   The provisions of this §  25.509b issued under section 10.2(f) of the Osteopathic Medical Practice Act (63 P. S. §  271.10b(f)).

 (a)  A certificateholder who does not intend to practice in this Commonwealth and who does not desire to renew certification shall inform the Board in writing. Written confirmation of inactive status will be forwarded to the certificateholder.

 (b)  A certificateholder shall notify the Board, in writing, of his desire to reactivate the registration.

 (c) A certificateholder who is applying to return to active status is required to pay fees which are due for the current biennium and submit a sworn statement stating the period of time during which the certificateholder was not engaged in practice in this Commonwealth.

 (d)  The applicant for reactivation will not be assessed a fee or penalty for preceding biennial periods in which the applicant did not engage in practice in this Commonwealth.

Subchapter L. VOLUNTEER LICENSE

Sec.

 (a)  This subchapter implements the Volunteer Health Services Act (35 P. S. § §  449.41—449.50) and provides for the issuance of a volunteer license to a qualified Board-regulated practitioner as defined in section 2 of the act (63 P. S. §  271.2), who retires from active practice and seeks to provide professional services as a volunteer. A volunteer license authorizes the holder to practice only in an organized community-based clinic without remuneration.

 A volunteer license may be issued to a Board-regulated practitioner who documents to the satisfaction of the Board that the applicant will practice without personal remuneration in approved clinics and meets one of the following conditions:

   (1)  Holds a currently renewed, active, unrestricted license, registration or certificate in this Commonwealth and retires from active practice at the time the applicant applies for a volunteer license.

 An applicant for a volunteer license shall complete an application obtained from the Board. In addition to providing information requested by the Board, the applicant shall provide:

   (1)  An executed verification on forms provided by the Board certifying that the applicant intends to practice exclusively:

     (i)   Without personal remuneration for professional services.

     (ii)   In an approved clinic.

 A volunteer license shall be renewed biennially on forms provided by the Board.

   (1)  As a condition of biennial renewal, the applicant shall satisfy the same continuing education requirements as the holder of an active, unrestricted license under §  25.271 (relating to requirements for renewal).

 A volunteer license holder shall be subject to the disciplinary provisions of the act and this chapter. Failure of the licensee to comply with the Volunteer Health Services Act (35 P. S. § §  449.41—449.50) or this subchapter may also constitute grounds for disciplinary action.

Subchapter M. ATHLETIC TRAINERS

Sec.

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

   Approved athletic training education programs—An athletic training education program that is accredited by a Board-approved Nationally recognized accrediting agency.

   Athletic training services—The management and provision of care of injuries to a physically active person, with the direction of a licensed physician.

     (i)   The term includes the rendering of emergency care, development of injury prevention programs and providing appropriate preventative and supportive devices for the physically active person.

     (ii)   The term also includes the assessment, management, treatment, rehabilitation and reconditioning of the physically active person whose conditions are within the professional preparation and education of a certified athletic trainer.

     (iii)   The term also includes the use of modalities such as: mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage, and the use of therapeutic exercise, reconditioning exercise and fitness programs.

 (a)  A person may not use the title of ‘‘athletic trainer’’ or ‘‘certified athletic trainer’’ or use any abbreviation including ‘‘A.T.C.,’’ ‘‘C.A.T.,’’ or ‘‘A.T.’’ or any similar designation to indicate that the person is an athletic trainer unless that person has been certified by the Board.

 (b)  Except as otherwise provided by this subsection, a person may not perform the duties of an athletic trainer unless that person has been certified by the Board. This provision is not intended to prevent the following:

   (1)  A person trained and licensed or certified under any other law from engaging in the licensed or certified practice in which the person is trained.

   (2)  An athletic trainer from another state, province, territory or the District of Columbia, who is employed by an athletic team or organization that is competing in this Commonwealth on a visiting basis, who provides athletic training services to the members of their respective athletic team or organization.

   (3)  An athletic training student who practices athletic training that is coincidental to required clinical education and is within the scope of the student’s education and training.

 (c)  Former athletic training certificateholders under the Physical Therapy Practice Act (63 P. S. § §  1301—1313) prior to July 14, 2007, are deemed certified by the Board.

 (a)  The applicant shall submit the following on forms supplied by the Board:

   (1)  A completed application and the fee set forth in §  25.231 (relating to schedule of fees).

   (2)  Verification of professional education in athletic training in accordance with §  25.705 (relating to educational requirements).

   (3)  Documentation of passage of the National examination in accordance with §  25.706 (relating to examination requirement).

   (4)  Documentation of practice as an athletic trainer, if licensed or certified in another jurisdiction, and verification as to whether there has been disciplinary action taken in that jurisdiction.

 An applicant for certification shall comply with one of the following:

   (1)  Be a graduate of an approved athletic training education program.

   (2)  Hold current credentialing as a Certified Athletic Trainer (ATC) from the BOC or another credentialing body approved by the Board.

 An applicant for a certificate to practice as a certified athletic trainer shall submit to the Board written evidence that the applicant has passed the BOC certification examination for athletic trainers or its equivalent, as determined by the Board.

 (a)  A certificate issued under this subchapter shall be renewed biennially. An application form will be mailed to the most recent address of the certificateholder as it appears on the records of the Board. The certificateholder shall complete the renewal application and return it to the Board with a renewal fee before December 31 of the year in which the application was received. Certificates other than temporary certificates expire on December 31 of each even-numbered year. Upon receipt of an application and renewal fee, the Board will verify the accuracy of the application and issue to the applicant a certificate of renewal for the next biennial period.

 (b)  When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee, as set forth in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. §  1401—225).

 (a)  Athletic trainers certified by the Board or by the proper licensing or certification authority of another state, province, territory or the District of Columbia shall comply with the following:

   (1)  Ensure that the physically active person has secured a written referral or prescription from a licensed physician, dentist or podiatrist or is subject to a written protocol for treatment by a certified athletic trainer from a licensed physician.

   (2)  Comply strictly with conditions or restrictions that may be placed on the course of athletic training services by the referring physician, dentist or podiatrist.

   (3)  Ensure that the physically active person has undergone a medical diagnostic examination or has had the results of a recently performed medical diagnostic examination reviewed by the referring physician, dentist or podiatrist.

   (4)  Keep a copy of the referral or prescription and the results of the medical diagnostic examination in the physically active person’s file.

   (5)  Consult promptly with the referring physician, dentist or podiatrist regarding a new ailment or condition or a worsened ailment or condition of the physically active person.

   (6)  Consult with the referring physician, dentist or podiatrist upon request of either the referring physician, dentist or podiatrist or the physically active person.

   (7)  Refer a physically active person with conditions outside the scope of athletic training services to a licensed physician, dentist or podiatrist.

 (b)  Athletic trainers certified by the Board or by the proper licensing authority of another state, province, territory or the District of Columbia who are working in a team setting, treating injuries which arise in the course of practices or team sports events, may treat the participant at the events under the conditions of the referral, the standing written prescription or written protocol.

 (a)  The Board may refuse to issue a certificate, and after notice and hearing, may suspend or revoke the certificate of a person who is subject to disciplinary action under section 15(b) of the act (63 P. S. §  271.15(b)).

 (a)  Beginning with the biennial period commencing on the next biennial renewal period following July 14, 2007, athletic trainers shall complete the continuing education requirements prescribed by the BOC.

 (b)  Applicants for renewal of a certificate shall provide a signed statement verifying that the continuing education requirement has been met.

 (c)  Proof of completion of the required continuing education shall be retained for 4 years after completion.

   This section cited in 49 Pa. Code §  25.708 (relating to renewal of certificate).