§ 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.

   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 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) 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. Immediately preceding text appears at serial pages (119302) to (119303).

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 his 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 his physician assistant and the care and treatment of his patients.

   (4)  Has submitted an application, approved by the Board, 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, the geographical location where the physician assistant will serve, and 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). No physician may 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 at §  25.231. The Board will notify the physician, in writing, as to its approval or rejection of the requested modification. No departure from the original protocol is 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, he need 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 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) 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. Immediately preceding text appears at serial pages (119305) to (119307).

 (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 16 of the Osteopathic Medical Practice Act (63 P. S. § §  271.10(h) 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).

   The provisions of this §  25.176 adopted April 23, 1982, effective April 24, 1982, 12 Pa.B. 1332.

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 … $440

 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 issued and amended under: section 13.1 and of the Osteopathic Medical Practice Act (63 P. S. §  271.13a); and section 812.1 of The Administrative Code of 1929 (71 P. S. §  279.3a); sections 13.1, 16 and 16.1 of the Osteopathic Medical Practice Act (63 P. S. § §  271.13a, 271.16 and 271.16d); and section 902(b) of the Health Care Services Malpractice Act (40 P. S. §  1301.902(b)).

   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. 3211; amended June 30, 2006, effective July 1, 2006, 36 Pa.B. 3236; amended July 13, 2007, effective July 14, 2007, 37 Pa.B. 3230. Immediately preceding text appears at serial pages (320535) to (320536).

   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)).