Senate Bill No. 244

Senate Bill No. 244-Committee on Commerce and Labor

March 27, 1997
____________

Referred to Committee on Commerce and Labor

SUMMARY--Makes various changes concerning regulation of health care. (BDR 54-868)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: No.

EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.

AN ACT relating to the regulation of health care; expanding the scope of certain provisions governing health care records; revising provisions governing proceedings before the board of medical examiners; revising provisions governing the investment of certain money received by the board; making various changes regarding the licensure of physicians and physicians' assistants; revising the fees that may be charged by the board; revising provisions governing disciplinary actions by the board; making various changes concerning prescriptions; and providing other matters properly relating thereto.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1 NRS 629.031 is hereby amended to read as follows:
629.031 1. "Provider of health care" means a physician licensed pursuant to chapter 630, 630A or 633 of NRS, dentist, licensed nurse, dispensing optician, optometrist, practitioner of respiratory care, registered physical therapist, podiatric physician, licensed psychologist, licensed marriage and family therapist, chiropractor, doctor of Oriental medicine in any form, medical laboratory director or technician, pharmacist or a licensed hospital as the employer of any such person.
2. For the purposes of NRS 629.051, 629.061 and 629.065, the term includes a facility that maintains the health care records of patients.
Sec. 2 Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a person, in a proceeding before the board:
(a) Disobeys or resists a lawful order of the board;
(b) Refuses to take an oath or affirmation as a witness before the board;
(c) Refuses to be examined before the board; or
(d) Engages in conduct during a hearing or so near the place thereof as to obstruct the proceeding,
the board may certify the facts to the district court of the county in which the proceeding is being conducted. Such a certification operates as a stay of all related disciplinary proceedings before the board. The court shall issue an order directing the person to appear before the court and show cause why he should not be held in contempt.
2. A copy of the statement of the board and the order of the district court issued pursuant to subsection 1 must be served on the person. Thereafter, the court has jurisdiction of the matter.
3. The same proceedings must be had, the same penalties may be imposed and the person may purge himself of the contempt in the same way as in the case of a person who has committed a contempt in the trial of a civil action.
Sec. 3 NRS 630.015 is hereby amended to read as follows:
630.015 "Physician's assistant" means a person who is a graduate of an academic program approved by the board or who, by general education, practical training and experience determined to be satisfactory by the board, is qualified to perform medical services under the supervision of a supervising physician and who has been issued a [certificate] license by the board.
Sec. 4 NRS 630.025 is hereby amended to read as follows:
630.025 "Supervising physician" means an active physician licensed in the State of Nevada who cosigns the application for [certification] licensure of a physician's assistant and who employs and supervises the physician's assistant.
Sec. 5 NRS 630.110 is hereby amended to read as follows:
630.110 1. Out of the money coming into the possession of the board, each member and advisory member of the board is entitled to receive:
(a) A salary of not more than $80 per day, as fixed by the board, while engaged in the business of the board; and
(b) A per diem allowance and travel expenses at a rate fixed by the board, while engaged in the business of the board. The rate must not exceed the rate provided for state officers and employees generally.
2. While engaged in the business of the board, each employee of the board is entitled to receive a per diem allowance and travel expenses at a rate fixed by the board. The rate must not exceed the rate provided for state officers and employees generally.
3. Expenses of the board and the expenses and salaries of its members and employees must be paid from the fees received by the board pursuant to the provisions of this chapter, and no part of the salaries or expenses of the board may be paid out of the state general fund or from the penalties imposed by the board pursuant to this chapter.
4. All money received by the board from:
(a) Fees must be deposited in financial institutions in this state which are federally insured [.] , invested in treasury bills or notes of the United States, deposited in institutions in this state whose business is the making of investments or invested as authorized by NRS 355.140.
(b) Penalties must be deposited with the state treasurer for credit to the state general fund.
Sec. 6. NRS 630.120 is hereby amended to read as follows:
630.1201. The board shall procure a seal.
2. All licenses issued to physicians and [certificates issued to] physicians' assistants must bear the seal of the board and the signatures of its president and secretary-treasurer.
Sec. 7. NRS 630.160 is hereby amended to read as follows:
630.160 1. Every person desiring to practice medicine must, before beginning to practice, procure from the board a license authorizing him to practice.
2. Except as otherwise provided in NRS 630.161 or 630.164, a license may be issued to any person who:
(a) Is a citizen of the United States or is lawfully entitled to remain and work in the United States;
(b) Has received the degree of Doctor of Medicine from a medical school:
(1) Approved by the Liaison Committee [for] on Medical Education of the American Medical Association and [American] Association of American Medical Colleges; or
(2) Which provides a course of professional instruction equivalent to that provided in medical schools in the United States approved by the Liaison Committee [for] on Medical Education ; [,
which he attended for a total of 2 years immediately preceding the granting of the degree;]
(c) Has passed:
(1) All parts of the examination given by the National Board of Medical Examiners;
(2) All parts of the Federation Licensing Examination;
(3) All parts of the United States Medical Licensing Examination;
(4) All parts of a licensing examination given by any state or territory of the United States, if the applicant is certified by a specialty board of the American Board of Medical Specialties; [or]
(5) All parts of the examination to become a licentiate of the Medical Council of Canada; or
(6) Any combination of the examinations specified in subparagraphs (1), (2) and (3) that the board determined to be sufficient;
(d) Has completed 3 years of:
(1) Graduate education as a resident in the United States or Canada in a program approved by the board, the Accreditation Council for Graduate Medical Education of the American Medical Association or the Coordinating Council of Medical Education of the Canadian Medical Association; or
(2) Fellowship training in the United States or Canada approved by the board or the Accreditation Council for Graduate Medical Education; and
(e) [Appears personally before the board and satisfactorily passes] Passes a written or oral examination, or both, as to his qualifications to practice medicine and provides the board with a description of the clinical program completed demonstrating that the applicant's clinical training met the requirements of paragraph (b) of this subsection.
Sec. 8. NRS 630.165 is hereby amended to read as follows:
630.165 1. [Any] An applicant for a license to practice medicine [shall] must submit to the board, on a form provided by the board, an application in writing, accompanied by an affidavit stating that:
(a) The applicant is the person named in the proof of graduation and that it was obtained without fraud or misrepresentation or any mistake of which the applicant is aware; and
(b) The information contained in the application and any accompanying material are complete and correct.
2. In addition to the other requirements for licensure, the board may require such further evidence of the mental, physical, medical or other qualifications of the applicant as it considers necessary.
3. The applicant bears the burden of proving and documenting his qualifications for licensure.
[4. If an applicant does not appear for two consecutive examinations after receiving notification by the board that his application is complete, the board shall reject the application.]
Sec. 9. NRS 630.253 is hereby amended to read as follows:
630.253 The board shall, as a prerequisite for the:
1. Renewal of a [certificate] license as a physician's assistant; or
2. Biennial registration of the holder of a license to practice medicine,
require each holder to comply with the requirements for continuing education adopted by the board. These requirements may provide for the completion of one or more courses of instruction relating to risk management in the performance of medical services.
Sec. 10. NRS 630.255 is hereby amended to read as follows:
630.255 1. Any licensee who changes the location of his practice of medicine from this state to another state or country, has never engaged in the practice of medicine in this state after licensure or has ceased to engage in the practice of medicine in this state for 12 consecutive months [must] may be placed on inactive status [.] by order of the board.
2. Before resuming the practice of medicine in this state, the inactive registrant [shall:] must:
(a) Notify the board of his intent to resume the practice of medicine in this state;
(b) File an affidavit with the board describing his activities during the period of his inactive status;
(c) Complete the form for registration for active status;
(d) Pay the applicable fee for biennial registration; and
(e) Satisfy the board of his competence to practice medicine.
3. If the board determines that the conduct or competence of the registrant during the period of inactive status would have warranted denial of an application for a license to practice medicine in this state, the board may refuse to place the registrant on active status.
Sec. 11. NRS 630.271 is hereby amended to read as follows:
630.271 1. A physician's assistant may perform such medical services as he is authorized to perform pursuant to the terms of a [certificate] license issued to him by the board, if those services are rendered under the supervision and control of a supervising physician.
2. The board shall limit the authority of a physician's assistant to prescribe controlled substances to those schedules of controlled substances which his supervising physician is authorized to prescribe pursuant to state and federal law.
Sec. 12. NRS 630.273 is hereby amended to read as follows:
630.273 [1.] The board may issue a [certificate] license to an applicant who is qualified under the regulations of the board to perform medical services under the supervision of a supervising physician. The application for a [certificate] license as a physician's assistant must be cosigned by the supervising physician . [, and the certificate is valid only so long as that supervising physician employs and supervises the physician's assistant.
2. A supervising physician shall not cosign for, employ or supervise more than one physician's assistant at the same time, except that in a township whose population is less than 16,000, he may supervise two physician's assistants at the same time.]
Sec. 13. NRS 630.274 is hereby amended to read as follows:
630.274 1. A physician's assistant may, [under his certificate,] pursuant to his license, be supervised by an osteopathic physician licensed in this state in place of his supervising physician if:
(a) The physician's assistant works in a geographical area where he can be conveniently supervised only by an osteopathic physician;
(b) The physician's assistant remains in the employ of his supervising physician;
(c) The supervising physician and the osteopathic physician agree to the arrangement; and
(d) The board of medical examiners and the board of osteopathic medicine approve it.
2. For the purposes of chapter 633 of NRS, a physician's assistant so supervised is not an osteopathic physician's assistant and is not practicing osteopathic medicine solely because of that supervision.
3. The board shall adopt jointly with the board of osteopathic medicine regulations necessary to administer the provisions of this section.
Sec. 14. NRS 630.275 is hereby amended to read as follows:
630.275 The board shall adopt regulations regarding the [certification] licensure of a physician's assistant, including, but not limited to:
1. The educational and other qualifications of applicants.
2. The required academic program for applicants.
3. The procedures for applications for and the issuance of [certificates.] licenses.
4. The tests or examinations of applicants by the board.
5. The medical services which a physician's assistant may perform, except that he may not perform those specific functions and duties delegated or restricted by law to persons licensed as dentists, chiropractors, podiatric physicians and optometrists under chapters 631, 634, 635 and 636, respectively, of NRS, or as hearing aid specialists.
6. The duration, renewal and termination of [certificates.] licenses.
7. The grounds and procedures respecting disciplinary actions against physicians' assistants.
8. The supervision of medical services of a physician's assistant by a supervising physician.
Sec. 15. NRS 630.290 is hereby amended to read as follows:
630.290 1. The board shall charge and collect not more than the following fees:

For application for and issuance of a license by written examination, in addition to the actual cost to the board of the examination [$400] $600

For application for and issuance of a temporary, locum tenens, limited, restricted or special license 300

For renewal of a limited, restricted or special license [50] 200

For application for and issuance of a [certificate] license as a physician's assistant [200] 300

For renewal of a [certificate] license as a physician's assistant [100] 300

For biennial registration [600] 800

For biennial registration for a physician who is retired, on inactive status or not practicing medicine in Nevada 200

[For the administration of the Federation Licensing Examination the United States Medical Licensing Examination 400

For the administration of any one part of the Federation Licensing Examination 200

For re-examination of the Federation Licensing Examination 200

For the administration of any one part of the Federation Licensing Examination as a courtesy to a person who is applying for licensure in another state 200]

For written verification of licensure 50

For a duplicate identification card 25

For a duplicate license 50

For computer printouts or labels [50] 300

For verification of a listing of physicians, per hour 20

For furnishing [a directory of physicians to a person who is not licensed pursuant to this chapter 10

For furnishing] a list of new physicians [to a person who is not in the medical profession] [30] 50

2. In addition to the fees prescribed in subsection 1, the board shall charge and collect:
(a) A fee to reimburse it for the cost of the [Federation Licensing Examination or the] United States Medical Licensing Examination; and
(b) Necessary and reasonable fees for its other services.
3. The cost of any special meeting called at the request of a licensed physician, institution, organization, state agency or applicant for licensure must be paid for by the person or entity requesting the special meeting. Such a special meeting must not be called until the person or entity requesting it has paid a cash deposit with the board sufficient to defray all expenses of the meeting.
Sec. 16. NRS 630.301 is hereby amended to read as follows:
630.301 The following acts, among others, constitute grounds for initiating disciplinary action or denying licensure:
1. Conviction of a felony, any offense involving moral turpitude or any offense relating to the practice of medicine or the ability to practice medicine. A plea of nolo contendere is a conviction for the purposes of this subsection.
2. Conviction of violating any of the provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310, or 616D.350 to 616D.440, inclusive.
3. The suspension, modification or limitation of the license to practice any type of medicine by any other jurisdiction or the surrender of the license or discontinuing the practice of medicine while under investigation by any licensing authority, a medical facility, a branch of the armed services of the United States, an insurance company, an agency of the Federal Government or an employer.
4. [Gross or repeated malpractice,] Malpractice, which may be evidenced by claims [of malpractice] settled against a practitioner.
5. The engaging by a practitioner in any sexual activity with a patient who is currently being treated by the practitioner.
Sec. 17. NRS 630.352 is hereby amended to read as follows:
630.352 1. Any member of the board, except for an advisory member serving on a panel of the board hearing charges, may participate in the final order of the board. If the board, after a formal hearing, determines from [clear and convincing] a preponderance of the evidence that a violation of the provisions of this chapter or of the regulations of the board has occurred, it shall issue and serve on the physician charged an order, in writing, containing its findings and any sanctions.
2. If the board determines that no violation has occurred, it shall dismiss the charges, in writing, and notify the physician that the charges have been dismissed. If the disciplinary proceedings were instituted against the physician as a result of a complaint filed against him, the board may provide the physician with a copy of the complaint, including the name of the person, if any, who filed the complaint.
3. Except as otherwise provided in subsection 4, if the board finds that a violation has occurred, it may by order:
(a) Place the person on probation for a specified period on any of the conditions specified in the order;
(b) Administer to him a public reprimand;
(c) Limit his practice or exclude one or more specified branches of medicine from his practice;
(d) Suspend his license for a specified period or until further order of the board;
(e) Revoke his license to practice medicine;
(f) Require him to participate in a program to correct alcohol or drug dependence or any other impairment;
(g) Require supervision of his practice;
(h) Impose a fine not to exceed $5,000;
(i) Require him to perform public service without compensation;
(j) Require him to take a physical or mental examination or an examination testing his competence; [and]
(k) Require him to fulfill certain training or educational requirements [.] ; and
(l) Require him to pay all costs incurred by the board relating to his disciplinary proceedings.
4. If the board finds that the physician has violated the provisions of NRS 439B.425, the board shall suspend his license for a specified period or until further order of the board.
Sec. 18. NRS 630.400 is hereby amended to read as follows:
630.400 A person who:
1. Presents to the board as his own the diploma, license or credentials of another;
2. Gives either false or forged evidence of any kind to the board;
3. Practices medicine under a false or assumed name or falsely personates another licensee;
4. Except as otherwise provided by specific statute, practices medicine without being licensed under this chapter;
5. Holds himself out as a physician's assistant or who uses any other term indicating or implying that he is a physician's assistant without being [certified] licensed by the board; or
6. Uses the title M.D., when not licensed by the board pursuant to this chapter, unless otherwise authorized by a specific statute,
is guilty of a category D felony and shall be punished as provided in NRS 193.130.
Sec. 19. NRS 632.473 is hereby amended to read as follows:
632.473 1. A nurse licensed pursuant to the provisions of this chapter, while working at an institution of the department of prisons, may treat patients, including the administration of a dangerous drug, poison or related device, pursuant to orders given by a physician's assistant if those orders are given pursuant to a protocol approved by the board of medical examiners and the supervising physician. The orders must be cosigned by the supervising physician or another physician within 72 hours after treatment.
2. A copy of the protocol under which orders are given by a physician's assistant must be available at the institution for review by the nurse.
3. This section does not authorize a physician's assistant to give orders for the administration of any controlled substance.
4. For the purposes of this section:
(a) "Physician's assistant" means a physician's assistant [certified] licensed by the board of medical examiners pursuant to chapter 630 of NRS who:
(1) Is employed at an institution of the department of prisons;
(2) Has been awarded a bachelor's degree from a college or university recognized by the board of medical examiners; and
(3) Has received at least 40 hours of instruction regarding the prescription of medication as a part of either his basic educational qualifications or a program of continuing education approved by the board of medical examiners.
(b) "Protocol" means the written directions for the assessment and management of specified medical conditions, including the drugs and devices the physician's assistant is authorized to order, which the physician's assistant and the supervision have agreed upon as a basis for their practice.
(c) "Supervising physician" has the meaning ascribed to it in NRS 630.025.
Sec. 20. NRS 639.0125 is hereby amended to read as follows:
639.0125"Practitioner" means:
1. A physician, dentist, veterinarian or podiatric physician who holds a valid license to practice his profession in this state;
2. A hospital, pharmacy or other institution licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or administer drugs in the course of professional practice or research in this state;
3. An advanced practitioner of nursing who has been authorized to prescribe poisons, dangerous drugs and devices; or
4. A physician's assistant who:
(a) Holds a [certificate] license issued by the board of medical examiners or certificate issued by the state board of osteopathic medicine; and
(b) Is authorized by the board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices under the supervision of a physician or osteopathic physician as required by chapter 630 or 633 of NRS.
Sec. 21. NRS 639.0745 is hereby amended to read as follows:
639.0745 1. The board may adopt regulations concerning:
(a) The transfer of information between pharmacies relating to prescriptions.
(b) The electronic transmission and the transmission by a facsimile machine of a prescription from a practitioner to a pharmacist for the dispensing of a drug.
2. The board shall adopt regulations governing the exchange of information between pharmacists and practitioners relating to prescriptions filled by the pharmacists for persons who are suspected of:
(a) Misusing prescriptions to obtain excessive amounts of drugs.
(b) Failing to use a drug in conformity with the directions for its use or taking a drug in combination with other drugs in a manner that could result in injury to that person.
The pharmacists and practitioners shall maintain the confidentiality of the information exchanged pursuant to this subsection.
Sec. 22. NRS 639.1373 is hereby amended to read as follows:
639.1373 1. A physician's assistant may, if authorized by the board, possess, administer, prescribe or dispense controlled substances, or possess, administer, prescribe or dispense poisons, dangerous drugs or devices in or out of the presence of his supervising physician only to the extent and subject to the limitations specified in the physician's assistant's certificate as issued by the board.
2. Each physician's assistant who is authorized by his physician's assistant's [certificate] license issued by the board of medical examiners or certificate issued by the state board of osteopathic medicine to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs or devices must apply for and obtain a registration certificate from the board, pay a fee to be set by regulations adopted by the board and pass an examination administered by the board on the law relating to pharmacy before he can possess, administer, prescribe or dispense controlled substances, or possess, administer, prescribe or dispense poisons, dangerous drugs or devices.
3. The board shall consider each application separately and may, even though the physician's assistant's [certificate] license issued by the board of medical examiners or the certificate issued by the state board of osteopathic medicine authorizes the physician's assistant to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs and devices:
(a) Refuse to issue a registration certificate;
(b) Issue a registration certificate limiting the physician's assistant's authority to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs or devices, the area in which the physician's assistant may possess controlled substances, poisons, dangerous drugs and devices, or the kind and amount of controlled substances, poisons, dangerous drugs and devices; or
(c) Issue a registration certificate imposing other limitations or restrictions which the board feels are necessary and required to protect the health, safety and welfare of the public.
4. If the registration of the physician's assistant is suspended or revoked, the physician's controlled substance registration may also be suspended or revoked.
5. The board shall adopt regulations controlling the maximum amount to be administered, possessed and dispensed, and the storage, security, recordkeeping and transportation of controlled substances and the maximum amount to be administered, possessed, prescribed and dispensed and the storage, security, recordkeeping and transportation of poisons, dangerous drugs and devices by physicians' assistants. In the adoption of those regulations, the board shall consider, but is not limited to, the following:
(a) The area in which the physician's assistant is to operate;
(b) The population of that area;
(c) The experience and training of the physician's assistant;
(d) The distance to the nearest hospital and physician; and
(e) The effect on the health, safety and welfare of the public.
6. For the purposes of this section, the term "physician's assistant" includes an osteopathic physician's assistant and the term "supervising physician" includes an employing osteopathic physician as defined in chapter 633 of NRS.
Sec. 23. NRS 639.2353 is hereby amended to read as follows:
639.2353 1. A prescription must be given:
(a) Directly from the practitioner to a pharmacist;
(b) Indirectly by means of an order signed by the practitioner; [or]
(c) By an oral order transmitted by an agent of the practitioner [.] ; or
(d) By electronic transmission or transmission by a facsimile machine pursuant to the regulations of the board.
2. A written prescription must contain:
(a) The name and signature of the practitioner, and his address if not immediately available to the pharmacist;
(b) The classification of his license;
(c) His registration number assigned by the Drug Enforcement Administration if the prescription is for a controlled substance;
(d) The name of the patient, and his address if not immediately available to the pharmacist;
(e) The name, strength and quantity of the drug or drugs prescribed;
(f) Directions for use; and
(g) The date of issue.
3. The directions for use must be specific in that they indicate the portion of the body to which the medication is to be applied or, if to be taken into the body by means other than orally, the orifice or canal of the body into which the medication is to be inserted or injected.
4. Each written prescription must be written in such a manner that any registered pharmacist would be able to dispense it. A prescription must be written in Latin or English and may include any character, figure, cipher or abbreviation which is generally used by pharmacists and practitioners in the writing of prescriptions.
Sec. 24. NRS 652.210 is hereby amended to read as follows:
652.210 No person other than a licensed physician, a licensed practical nurse, a registered nurse, a licensed or certified physician's assistant, a certified intermediate emergency medical technician, a certified advanced emergency medical technician or a licensed dentist may manipulate a person for the collection of specimens, except that technical personnel of a laboratory may collect blood, remove stomach contents, perform certain diagnostic skin tests or field blood tests or collect material for smears and cultures.
Sec. 25. NRS 244.1605 is hereby amended to read as follows:
244.1605 The boards of county commissioners may:
1. Establish, equip and maintain limited medical facilities in the outlying areas of their respective counties to provide outpatient care and emergency treatment to the residents of and those falling sick or being injured or maimed in those areas.
2. Provide a full-time or part-time staff for the facilities which may include a physician, a [certified] licensed physician's assistant, a registered nurse or a licensed practical nurse, a certified emergency medical technician and such other personnel as the board deems necessary or appropriate to ensure adequate staffing commensurate with the needs of the area in which the facility is located.
3. Fix the charges for the medical and nursing care and medicine furnished by the facility to those who are able to pay for them, and to provide that care and medicine free of charge to those persons who qualify as medical indigents under the county's criteria of eligibility for medical care.
4. Purchase, equip and maintain, either in connection with a limited medical facility as authorized in this section or independent therefrom, ambulances and ambulance services for the benefit of the residents of and those falling sick or being injured or maimed in the outlying areas.
Sec. 26 NRS 450B.160 is hereby amended to read as follows:
450B.160 1. The health authority may issue licenses to attendants and to firemen employed by or serving as volunteers with a fire-fighting agency.
2. Each license must be evidenced by a card issued to the holder of the license, is valid for a period not to exceed 2 years and is renewable.
3. An applicant for a license must file with the health authority:
(a) A current, valid certificate evidencing his successful completion of a program or course for training in emergency medical technology, if he is applying for a license as an attendant, or, if a volunteer attendant, at a level of skill determined by the board.
(b) A current valid certificate evidencing his successful completion of a program for training as an intermediate emergency medical technician or advanced emergency medical technician if he is applying for a license as a fireman with a fire-fighting agency.
(c) A signed statement showing:
(1) His name and address;
(2) His employer's name and address; and
(3) A description of his duties.
(d) Such other certificates for training and such other items as the board may specify.
4. The board shall adopt such regulations as it determines are necessary for the issuance, suspension, revocation and renewal of licenses.
5. Each operator of an ambulance or air ambulance and each fire-fighting agency shall annually file with the health authority a complete list of the licensed persons in its service.
6. Licensed physicians, registered nurses and [certified] licensed physicians' assistants may serve as attendants without being licensed under the provisions of this section. A registered nurse who performs advanced emergency care in an ambulance or air ambulance must perform the care in accordance with the regulations of the state board of nursing. A [certified] licensed physician's assistant who performs advanced emergency care in an ambulance or air ambulance must perform the care in accordance with the regulations of the state board of medical examiners.
7. Each licensed physician, registered nurse and [certified] licensed physician's assistant who serves as an attendant must have current certification of completion of training in:
(a) Advanced life-support procedures for patients who require cardiac care;
(b) Life-support procedures for pediatric patients who require cardiac care; or
(c) Life-support procedures for patients with trauma that are administered before the arrival of those patients at a hospital.
The certification must be issued by the board of medical examiners for a physician or [certified] licensed physician's assistant or by the state board of nursing for a registered nurse.
8. The board of medical examiners and the state board of nursing shall issue a certificate pursuant to subsection 7 if the licensed physician, [certified] licensed physician's assistant or registered nurse attends:
(a) A course offered by a national organization which is nationally recognized for issuing such certification;
(b) Training conducted by the operator of an ambulance or air ambulance; or
(c) Any other course or training,
approved by the board of medical examiners or the state board of nursing, whichever is issuing the certification. The board of medical examiners and the state board of nursing may require certification of training in all three areas set forth in subsection 7 for a licensed physician, [certified] licensed physician's assistant or registered nurse who primarily serves as an attendant in a county whose population is 400,000 or more.
Sec. 27 NRS 453.126 is hereby amended to read as follows:
453.126"Practitioner" means:
1. A physician, dentist, veterinarian or podiatric physician who holds a valid license to practice his profession in this state and is registered pursuant to this chapter.
2. An advanced practitioner of nursing who holds a certificate from the state board of nursing and a certificate from the state board of pharmacy permitting him to dispense controlled substances.
3. A scientific investigator or a pharmacy, hospital or other institution licensed, registered or otherwise permitted by this state to distribute, dispense, conduct research with respect to, to administer, or use in teaching or chemical analysis, a controlled substance in the course of professional practice or research.
4. A euthanasia technician who is licensed by the Nevada state board of veterinary medical examiners and registered pursuant to this chapter, when he possesses or administers sodium pentobarbital pursuant to his license and registration.
5. A physician's assistant who:
(a) Holds a [certificate] license from the board of medical examiners or a certificate from the state board of osteopathic medicine; and
(b) Is authorized by the board to possess, administer, prescribe or dispense controlled substances under the supervision of a physician or osteopathic physician as required by chapter 630 or 633 of NRS.
Sec. 28 NRS 453.385 is hereby amended to read as follows:
453.385 1. Each prescription for a controlled substance listed in schedule II must be written on a separate prescription blank or as an order on the chart of a patient. The chart of a patient may be used to order multiple prescriptions for that patient.
2. A prescription for a controlled substance must contain:
(a) The name of the practitioner, his signature if the prescription was not transmitted orally and his address if not immediately available to the pharmacist;
(b) The classification of his license;
(c) His registration number from the Drug Enforcement Administration if it is not immediately available to the pharmacist;
(d) The name of the patient, and his address if not immediately available to the pharmacist;
(e) The name, strength and quantity of the drug or drugs prescribed;
(f) Directions for use; and
(g) The date of issue.
3. A prescription for a controlled substance listed in:
(a) Schedule III, IV or V must be signed by the practitioner [as provided by regulation] pursuant to the regulations of the board and may be preprinted or written by an agent of the practitioner [.] , or may be transmitted electronically or by a facsimile machine from the practitioner to a pharmacy pursuant to the regulations of the board.
(b) Schedule II must be written and signed entirely by hand by the practitioner who issued it, except that:
(1) The addresses of the patient and the practitioner may be added by the pharmacist.
(2) The name of the practitioner, his address, the classification of his license and his registration number for the Drug Enforcement Administration may be preprinted on the prescription form.
(3) The prescription may be transmitted by the practitioner or an agent of the practitioner to a pharmacy by a facsimile machine if the original written prescription is presented to the pharmacist for review before the dispensing of the controlled substance, except that:
(I) If the controlled substance is to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion, the transmission from the facsimile machine shall be deemed to be the original written prescription.
(II) If the controlled substance is prescribed for a resident of a facility for long-term care, the transmission from the facsimile machine shall be deemed to be the original written prescription and must be maintained in accordance with 21 C.F.R. § 1304.04(h).
4. Directions for use must be specific in that they must indicate the portion of the body to which the medication is to be applied, or, if to be taken into the body by means other than orally, the orifice or canal of the body into which the medication is to be inserted or injected.