4731-11-09 Prescribing to Persons Not Seen by the Physician

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ACTION: Original DATE: 10/18/2011 10:33 AM 4731-11-09 Prescribing to persons not seen by the physician. (A) Except in institutional settings, on call situations, cross coverage situations, situations involving new patients, protocol situations, situations involving nurses practicing in accordance with standard care arrangements, and hospice settings, as described in paragraphs (D) and (E) of this rule, a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided,
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  4731-11-09 Prescribing to persons not seen by the physician. (A) Except in institutional settings, on call situations, cross coverage situations, situationsinvolving new patients, protocol situations, situations involving nurses practicing inaccordance with standard care arrangements, and hospice settings, as described inparagraphs (D) and (E) of this rule, a physician shall not prescribe, dispense, orotherwise provide, or cause to be provided, any controlled substance to a personwho the physician has never personally physically examined and diagnosed.(B) Except in institutional settings, on call situations, cross coverage situations, situationsinvolving new patients, protocol situations, situations involving nurses practicing inaccordance with standard care arrangements, the utilization of expedited partnertherapy pursuant to rule 4731-11-12 of the Administrative Code, and hospicesettings, as described in paragraphs (D) and (E) of this rule, a physician shall notprescribe, dispense, or otherwise provide, or cause to be provided, any dangerousdrug which is not a controlled substance to a person who the physician has neverpersonally physically examined and diagnosed, except in accordance with one of the following requirements:(1) The physician is providing care in compliance with both of the following:(a) The care provided is in consultation with another physician who:(i) Has an ongoing professional relationship with the patient; and(ii) Has agreed to supervise the patient's use of the drug or drugs to beprovided.(b) The care provided meets all applicable standards of care and all applicablestatutory and regulatory requirements.(2) The psychiatrist is providing telepsychiatry to one patient per session who islocated at the Ohio office of an Ohio licensed physician or a communitymental health clinic certified by the Ohio department of mental health, and allof the following requirements are met:(a) The psychiatrist has reviewed records from a physical examination of thepatient that was conducted by a physician licensed under Chapter 4731.of the Revised Code within a reasonable period of time prior to thetelepsychiatry visit;(b) A licensed healthcare professional is available during the telepsychiatryvisit to provide various physical findings in accordance with the [ stylesheet: rule.xsl 2.14, authoring tool: i4i 2.0 ras3 Oct 17, 2011 11:14, (dv: 0, p: 88397, pa: 148964, ra: 290823, d: 358391) ] print date: 10/18/2011 09:07 PM ACTION: OriginalDATE: 10/18/2011 10:33 AM  licensed healthcare professional's scope of practice that the psychiatristmay need to complete an adequate assessment;(c) The psychiatrist agrees to do both of the following:(i) Be available to consult with another physician who has an ongoingprofessional relationship with the patient; and(ii) Supervise the patient's use of the drug or drugs prvided;(d) The psychiatrist's care of the patient meets all applicable standards of careand all applicable statutory and regulatory requirements.(C) A physician shall not advertise or offer, or permit the physician's name or certificateto be used in an advertisement or offer, to provide any dangerous drug in a mannerthat would violate paragraph (A) or paragraph (B) of this rule.(D) Paragraphs (A) and (B) of this rule do not apply to or prohibit the provision of drugsto a person who is admitted as an inpatient to or is a resident of an institutionalfacility. For purposes of this rule, institutional facility has the same meaning as inrule 4729-17-01 of the Administrative Code. This paragraph does not authorize orlegitimize practices that would violate other applicable standards or legalrequirements.(E) Paragraphs (A) and (B) of this rule do not apply to or prohibit:(1) The provision of controlled substances or dangerous drugs by a physician to aperson who is a patient of a colleague of the physician, if the drugs areprovided pursuant to an on call or cross coverage arrangement between thephysicians;(2) The provision of controlled substances or dangerous drugs by a physician to aperson who the physician has accepted as a patient, if the physician hasscheduled or is in the process of scheduling an appointment to examine thepatient and the drugs are intended to be used pending that appointment;(3) The provision of controlled substances or dangerous drugs by emergencymedical squad personnel, nurses, or other appropriately trained and licensedindividuals, in accordance with protocols approved by the state board of pharmacy pursuant to rule 4729-5-01 of the Administrative Code; or4731-11-09 2  (4) The provision of controlled substances or dangerous drugs by a nurse practicingin accordance with a standard care arrangement that meets the requirementsof Chapter 4723. of the Revised Code and rules promulgated by the board of nursing pursuant thereto.; or(5) The provision of controlled substances or dangerous drugs by a physician whois a medical director or hospice physician of a hospice program licensedpursuant to Chapter 3712. of the Revised Code, to a patient who is enrolled inthat hospice program.This paragragh does not authorize or legitimize practices that would violateother applicable standards or legal requirements.(F) For purposes of this rule, controlled substance has the same meaning as in section3719.01 of the Revised Code.(G) For purposes of this rule, dangerous drug has the same meaning as in section4729.01 of the Revised Code.(H) A violation of any provision of this rule, as determined by the board, shall constitute failure to maintain minimal standards applicable to the selection or administrationof drugs, as that clause is used in division (B)(2) of section 4731.22 of the RevisedCode; selling, prescribing, giving away, personally furnishing, prescribing, oradministering drugs for other than legal and legitimate therapeutic purposes, asthat clause is used in division (B)(3) of section 4731.22 of the Revised Code; and adeparture from, or the failure to conform to, minimal standards of care of similarpractitioners under the same or similar circumstances, whether or not actual injuryto a patient is established, as that clause is used in division (B)(6) of section4731.22 of the Revised Code.(I) For purposes of this rule:(1) Licensed healthcare professional means any of the following:(a) An individual licensed under Chapter 4731. of the Revised Code topractice allopathic medicine and surgery or osteopathic medicine andsurgery;(b) A physician assistant licensed under Chapter 4730. of the Revised Codewho is practicing in compliance with all applicable statutory and rulerequirements; and4731-11-09 3  (c) A nurse licensed under Chapter 4723. of the Revised Code who ispracticing in compliance with all applicable statutory and rulerequirements.(2) Psychiatrist means an individual licensed under Chapter 4731. of the RevisedCode to practice allopathic medicine and surgery or osteopathic medicine andsurgery who has successfully completed an approved psychiatry trainingprogram, as specified in the accreditation requirements that must be met toqualify as graduate medical education under section 4731.091 of the RevisedCode.(3) Telepsychiatry means the provision of psychiatric care via real-time, adequateresolution audio and video telecommunications when all of the followingrequirements are met:(a) Videoconferencing picture resolution, at a minimum, shall have a data rateof 30 frames per second (fps), with each frame containing 288 lines and352 pixels per line.(b) Systems shall have a minimum of 384 kilobytes per second (Kbps) of bandwidth, and the provider site shall have the capacity to zoom and tofollow the patient at the remote site.4731-11-09 4
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