ARIZONA ~ STATUTE Physician Assistants: State Laws and Regulations 10th edition, 2006 American Academy of Physician Assistants

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1 STATUTE et seq Arizona Revised Statutes DATE Enacted 1977 REGULATORY BODY Arizona Regulatory Board of Physician Assistants PA DEFINED Person licensed by the board who performs health care tasks in a dependent relationship with a physician SCOPE OF PRACTICE PA may take history and perform physical exam, order and perform diagnostic and therapeutic procedures, formulate a diagnostic impression, develop and implement a treatment plan, monitor the effectiveness of therapeutic interventions, assist in surgery, offer patient counseling and education, make referrals, perform minor surgery (defined as those delegated invasive procedures which are consistent with the training and experience of the PA, are normally taught in PA programs, and that are approved by the board as falling within the PA scope of practice; does not include surgical abortion), perform other non-surgical health care tasks taught in courses of training approved by the board that are consistent with the training and experience of the PA and that are delegated by the supervising physician Supervising physician or agent shall not delegate to the PA any health care task that the physician does not have training or experience in and does not perform PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN APPLICATION PA may prescribe Schedule II-V controlled medications and non-controlled medications All prescription orders issued by PA shall contain the name of the supervising physician. Rx for Schedule II or III controlled substance limited to 72 hours. Schedules II and III not refillable without written consent of physician. Schedules IV and V may not be prescribed more than 5 times in a 6-month period for an individual patient. Prescription-only drugs shall not be prescribed, dispensed or refillable for a period exceeding 1 year. PA may apply to board for certification to prescribe Schedule II or III medications for 14-day period. Certification requires 45 hours of pharmacology in 3 years preceding application or current NCCPA certification. PA may not dispense Schedule II or III except in emergency, when period of use shall be limited to 72 hours; other controlled substances may not be dispensed for period of use longer than 34 days. Except for samples provided by manufacturers, all drugs dispensed by PA must be prepackaged in unit-of-use package by supervising physician or pharmacists acting on physician s written order, labeled to show names of physician and PA. Except for samples, PA may not obtain drug from any source except supervising physician or pharmacist acting on physician s written order. PA must maintain complete, up-to-date log of all Schedule II and III controlled substances administered or dispensed. PAs who prescribe, dispense or administer controlled medications must register with the DEA. Board notifies pharmacy board of PAs approved to prescribe and dispense. Pharmacy board notifies pharmacies A physician s opportunity or ability to provide or exercise control and direction over the services of PA. Does not require the physician s physical presence if the supervising physician or the supervising physician s agent is or can be in contact with the PA by radio, telephone or telecommunication PA must meet in person with the supervising physician at least once each week. Requirement may be met by the supervising physician s agent if the supervising physician is unavailable due to vacation, illness or continuing education. PA may work in place geographically separate from physician s primary office if adequate provision exists for immediate communication, PA s performance is adequately supervised and reviewed, printed announcement is posted and board approves the arrangements Supervising physician is responsible for all aspects of the performance of PA, whether or not the supervising physician pays the PA a salary, and is responsible for directing and supervising PA to ensure that activities are within scope of PA s training and experience and limited to physician-delegated tasks. Alternate supervisors may be designated Supervising physician may not supervise more than 2 PAs who work the same hours at the same employment location PA applies for license on board forms, provides proof of qualifications. Interview, physical exam, mental evaluation, written competency exam or any combination thereof may be required and -2522

2 QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION Supervising physician must file application as prescribed by the board, hold a license as an M.D. or D.O. which is not under probation, restriction or suspension unrelated to rehabilitation and submit a statement that the physician or physician s agent is familiar with the laws regarding PA practice PA shall not perform health care tasks until the supervising physician receives approval of the notification of supervision from the board. Physician must file notification of supervision including information on field and type of practice, locations of PA employment, identity of all alternate supervisors and their professional relationship to supervising physician, supervision guidelines, and statement of whether physician has been approved for supervision. If notification of supervision includes request for authority to prescribe, administer or dispense schedule II or III controlled medications, the board may approve, modify or deny the request based on PA s qualifications and employment situation. Board may approve transfer of PA supervision from one supervising physician to another Completion of board-approved PA training course Passage of board-approved certifying exam Physically and mentally able to engage safely in PA health care tasks Have professional record that indicates applicant has not committed act or engaged in conduct constituting grounds for disciplinary action under Arizona PA statute PA license not refused, suspended, revoked, or surrendered in lieu of disciplinary action by any other jurisdiction for unprofessional conduct as defined Board may issue temporary license to applicant who meets all other qualifications and is eligible to take the certifying exam. Temporary license not effective for more than 16 months and expires upon failure to pass exam, issuance of regular license or expiration of term of temporary license. Applicant who has previously failed the NCCPA exam is ineligible PA with temporary license shall not prescribe controlled substances and must work only at the same geographic work site where the supervising physician sees patients PA and physician must notify board of termination of employment within 30 days. Notification must include date and reasons for termination. PA shall not work as a PA until board approves another supervising physician hours of Category I CME approved by AAPA (or other accrediting organization acceptable to the board) per year Person not licensed as a PA who holds himself out as PA or uses any term indicating or implying that he is licensed as a PA is guilty of a class 2 misdemeanor IDENTIFICATION When PA on duty, he shall at all times wear a name tag with designation physician assistant on it PHYSICIAN LIABILITY Supervising physician responsible for acts of PA FEE/RENEWAL SCHEDULE PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE Not to exceed: $400 application for regular license $400 issuance of active license $100 application for temporary license $300 conversion from temporary to regular license $25 issuance of duplicate license $400 annual renewal of regular license $350 application for approval of notification of supervision $200 application to transfer from supervising physician to alternate supervisor (board recognizes CAHEA, CCAAHEP or successor agencies on recommendation of the ARC-PA) Board composed of 4 licensed PAs appointed from list of qualified candidates submitted by Arizona State Association of PAs (additional candidates may be sought), 2 public members, 2 licensed osteopathic physicians (one of whom supervises a PA), 2 licensed allopathic physicians (one of whom supervises a PA). All members appointed by governor Board elects its chair and vice-chair

3 BOARD POWERS License and regulate PAs Approve supervising physicians Discipline and rehabilitate PAs Adopt rules necessary for implementation of law Order and evaluate examinations of licensees and applicants Initiate investigations Establish fees for services not specified in statute Develop and recommend standards governing profession Exchange information with other regulatory boards and professional associations Prepare and circulate education material to licensees Certify PAs for 14-day prescribing privileges for Schedule II or III controlled medications Reinstate revoked license DISCIPLINARY POWERS VIOLATIONS/PENALTY Board may enter an advisory letter or a letter of reprimand into the license holder s file, censure, impose stipulations, order PA to pay restitution of patient fees, order education or rehabilitation at licensee s expense, place on probation, suspend or revoke license. Board may impose civil penalty in amount of not less than $300 and not more than $10,000 for each violation Board may by rule prescribe civil penalty for violations relating to charting, wearing tags, identifying prescriptions and posting signs in geographically separated locations. Penalty not to exceed $ Unprofessional conduct, which is defined as: violation of any federal or state law or rule that applies to performance of health care tasks as PA holding oneself out or permitting another to represent one as physician performing health care task not delegated by supervising physician habitual substance abuse or habitual intemperance in use of alcohol signing a blank, undated or predated prescription form gross malpractice, repeated malpractice or any malpractice resulting in death of a patient representing that an incurable disease or infirmity can be permanently cured or cured by secret method or treatment if this is not true refusing to divulge treatment methods to the board providing any controlled substance or Rx-only drug for other than accepted therapeutic purposes or prescribing beyond delegated approval or in excess of authorized amount conduct harmful or dangerous to patient or public violation of board order or stipulation failure to clearly identify oneself as a PA in course of employment failure to use or affix initials PA or PA-C after name on charts, prescriptions or professional correspondence procuring or attempting to procure PA license by fraud or misrepresentation failing or refusing to maintain adequate patient records self-administration of any controlled substance prescribing controlled substances to immediate family members knowingly making any written or oral false or fraudulent statement in connection with any health care task commission of a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude refusal, revocation, suspension, limitation or restriction of a certification by any other jurisdiction for the inability to safely practice medicine or for unprofessional conduct as defined by that jurisdiction which directly or indirectly corresponds to any act of unprofessional conduct as here defined sanctions imposed by an agency of the federal government violating or assisting in violation of this chapter using the term doctor or the abbreviation Dr. in a way that leads the public to believe that the PA is licensed to practice as a physician failing to furnish legally requested information to the board failing to allow board personnel to examine documents making false statements on a form required by the board or in correspondence to the board failing to submit to a body fluid examination pursuant to an agreement with the board violating a formal board order betraying a professional secret or violating privileged communication allowing licensee s name to enhance the continuance of activities of an illegal practitioner or unlicensed practitioner

4 false advertising failure to disclose a financial interest in a separate diagnostic or treatment agency or in nonroutine goods or services that the patient is being prescribed. Does not apply to referral to a physician or PA within a group using chelation therapy in the treatment of arteriosclerosis or as any other form of therapy prescribing, dispensing, or administering anabolic or androgenic steroids for other than therapeutic purposes prescribing without examining patient (specific circumstances exempted) sexual conduct with patient discipline by another jurisdiction performing health care tasks under false or assumed name PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS OTHER Student enrolled in a PA program approved by the board is exempted from state licensure. Student shall register with the board on a form prescribed by the board PA licensed by this chapter, licensed or certified by another jurisdiction or credentialed as PA by a federal employer may provide medical care in natural disaster, accident or other emergency with or without supervision. Physician who supervises PA who is providing medical care in disaster, accident or emergency is not required to comply with requirements relating to supervising physician

5 ARIZONA ~ REGULATIONS REGULATIONS DATE REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN APPLICATION Chapter 17; Sec R et seq 1998; Rules to implement statutory changes enacted in 1998, 2002 and 2004 not yet adopted. Arizona Regulatory Board of Physician Assistants Supervising physician shall delegate health care tasks to PA if the supervising physician has training in those tasks and the supervising physician performs those tasks. R Prescribe means to issue a signed, written order to pharmacist for drugs or devices, or an order transmitted to pharmacist by word of mouth, phone or other means. Dispense means to issue 1 or more doses of medication in suitable container with label meeting the pharmacy board requirements, for use by patients. R Supervising physician must obtain board approval to delegate authority to prescribe, dispense or administer Schedule II or III controlled substances to PA. Physician and PA must submit application on board forms with information, including disciplinary information, if applicable, on physician and PA. Board may order evaluation of physician and PA as allowed by statute. Application must contain statements that both physician and PA will abide by all laws that govern prescribing, and that physician accepts responsibility for PA. Board shall approve applications that show appropriate training and experience of PA for prescribing Schedule II and III medications and professional record of appropriate prescribing. PA and supervising physician must be able to communicate in person or via telecommunication while PA is providing health care services. R All drugs dispensed by PA must be labeled to show name and address of PA, name of supervising physician (or his agent) and patient, date, serial number of Rx, directions for use (including cautionary statements, if any). R Opportunity or ability of physician to provide or exercise control and direction over PA services. The constant physical presence of the physician is not required so long as easy contact possible by phone, radio, telecommunication. R PA and supervising physician must meet in person at least once a week to discuss patient management. Additional meetings may be required by the board and may be conducted by phone or radio. R PA applies for certification on board forms. Application includes employment history, history of previous licensure, history of any disciplinary actions, hospital privilege restriction, or malpractice judgment in excess of $20,000. Application also contains information on any communicable disease, other medical condition that limits ability to provide health care and history of psychiatric disorders. Application includes history of performance in PA training program including any leaves of absence. All employers or supervising physicians of applicant within the last 5 years must provide information on PA s employment and health. R Prior to beginning practice as a PA, PA and supervising physician shall submit notification of supervision on board forms. Notification must contain information on physician, including any disciplinary information, information on other PAs supervised and information on health care tasks (including prescriptive authority) delegated to the PA. Notification also contains information on PA, including any disciplinary information. Notification must include information on practice sites, hours PA will work and whether sites are geographically separate from supervising physician. If PA is employed by more than 1 supervising physician, PA must file notification of supervision for each supervising physician. R QUALIFICATIONS Passage of the appropriate NCCPA exam within preceding 6 years. R TEMPORARY PERMIT Applicant for temporary certification must submit information on education, previous practice and employment and any disciplinary action, restriction of hospital privileges or malpractice judgments in excess of $20,000. Applicant must provide information on communicable diseases or medical conditions that impair safe practice and any history of bi-polar disorder, schizophrenia, paranoia or other psychotic disorder. Applicant must provide information on any leaves of absence taken during training and employment history since graduation. Applicant must provide proof of graduation from accredited PA program and letter from the NCCPA verifying applicant s registration for examination. Any supervising physicians within the last 5 years must supply information on applicant s employment.

6 ARIZONA REGULATIONS PA with temporary certification must practice only in settings where supervising physician practices medicine at the same geographic location. Temporary certificate terminates 6 months from date of issuance, upon issuance of permanent certificate, or immediately upon PA failing NCCPA exam, whichever occurs first. R TERMINATION Within 15 days of termination of supervision of PA, supervising physician shall report to the board reasons for and circumstances surrounding termination. R Termination of supervision does not result in suspension or revocation of PA certificate but suspension, revocation or expiration of PA certificate automatically results in immediate termination of notice of supervision. R CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY FEE/RENEWAL SCHEDULE PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS DISCIPLINARY POWERS 20 hours of CME required yearly. Annual submission of affidavit showing CME completed and logged in previous year. Acceptable CME activities include advanced degree courses in medical or medically related field at accredited institution; instruction of students or residents; publication or presentation of a clinically relevant paper or book; reading of medical journals and books; accredited medical education courses (including self-instruction, recertification exam preparation). Board may grant extensions of time to complete CME requirements if extenuating circumstances prevent completion of requirements in normal time frame. R Notification of supervision includes signed statement by the supervising physician that assures that supervising physician accepts responsibility for supervising the PA. R Annual renewal requires submission of affidavit of completion of CME requirements and information on events affecting PA during previous year including practice information, whether PA maintains current NCCPA certification, any malpractice judgment in excess of $20,000, any disciplinary action by any federal or state agency, whether PA has been convicted of Medicare or Medicaid fraud, presence of communicable disease or medical condition that impairs or limits PA s ability to practice safely, history of leave of absence and information on specific psychiatric diagnoses or substance abuse. R Board shall terminate PA s supervision by a supervising physician immediately upon restriction, suspension or revocation of supervising physician s license. R Board may impose citations and $50 fine for violations of name tag and sign posting requirements. R VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS Students in accredited programs must apply for exemption from regular certification. Application must contain information on student and program, including anticipated date of graduation. R OTHER