GA Code § 43-34-103 (2021)
2021 Georgia Code|Title 43 - Professions and Businesses|Chapter 34 - Physicians, Acupuncture, Physician Assistants, Cancer and Glaucoma Treatment, Respiratory Care, Clinical Perfusionists, and Orthotics and Prosthetics Practice|Article 4 - Physician Assistants|§ 43-34-103. (See Editor's notes.) Application for Licensure as a Physician Assistant; Authorized Delegated Authority; Prohibited Acts

    In order to obtain licensure as a physician assistant, an applicant shall submit an application to the board. Such application shall include:   Evidence submitted by the applicant of his or her good moral character; and   Evidence of his or her competency in a health care area related to the job description which, as a minimum, shall include:   Evidence of satisfactory completion of a training program approved by the board. If the applicant is not a graduate of an accredited school approved by the board, he or she shall be required to receive board approved refresher training and testing; and   Evidence that the applicant has passed the Physician Assistant National Certification Examination (PANCE) administered by the National Commission for the Certification of Physician Assistants (NCCPA), or its successor, or the National Association for the Certification of Anesthesia Assistants, (NACAA) or its successor.    The board may issue a temporary permit to any applicant for licensure who has satisfied the provisions of division (i) of this subparagraph and who is an applicant for the next available board approved or administered examination or who has completed this examination and is awaiting the results of such examination. The temporary permit shall expire upon notification of the applicant's failure to achieve a satisfactory score on the board approved or administered examination. A physician assistant licensed pursuant to this paragraph shall not be authorized to perform any medical acts of any sort except as approved for utilization by a physician in a job description pursuant to paragraph (2) of this subsection. The board may grant an inactive licensure status to a physician assistant who is licensed pursuant to this article but who is not practicing with the supervision of a board approved primary supervising physician.      In order to obtain approval for the utilization of a physician assistant, whether the utilization is in a private practice or through a public or private health care institution or organization, the licensed physician who will be responsible for the performance of such physician assistant shall submit an application to the board which shall include:   Evidence that the physician assistant is licensed pursuant to paragraph (1) of this subsection;   A job description meeting the requirements of paragraph (4) of Code Section 43-34-102; and   A fee, established by the board; provided, however, that no fee will be required if the physician assistant is an employee of the state or a county government.         No primary supervising physician shall enter into a job description with or supervise more than four physician assistants at a time except as provided in paragraph (3) or (4) of this subsection.   A primary supervising physician shall designate in writing to the board such other physicians who may serve as an alternate supervising physician for each physician assistant with which such primary supervising physician has entered into a job description. The board shall have authority to approve or deny such designations in whole or in part; provided, however, that a physician may be listed as an alternate supervising physician for any number of physician assistants so long as he or she only supervises as many physician assistants at any one time as allowed by paragraphs (1) and (3) of this subsection.   No primary supervising physician shall have more than eight physician assistants who have completed a board approved anesthesiologist assistant program licensed to him or her at a time or supervise more than four physician assistants who have completed a board approved anesthesiologist assistant program at any one time.   Except for physician assistants who have completed a board approved anesthesiologist assistant program, the limitation in paragraph (1) of this subsection shall not apply to a physician assistant who is practicing:   In a hospital licensed under Title 31;   In any college or university as defined in Code Section 20-8-1;   In the Department of Public Health;   In any county board of health;   In any community service board;   In any free health clinic;   In a birthing center;   In any entity:   Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or indigent Medicaid and Medicare patients; or   Which has been established under the authority of or is receiving funds pursuant to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act; or     In a health maintenance organization that has an exclusive contract with a medical group practice and arranges for the provision of substantially all physician services to enrollees in health benefits of the health maintenance organization.         At all times while providing patient services, a physician assistant shall have a signed job description submitted by his or her primary supervising physician and approved by the board.   Nothing in this article shall prevent a primary supervising physician from submitting to the board a new or amended physician assistant job description.     Nothing in this article shall prohibit the rendering of services to a patient by a physician assistant who is not in the physical presence of the supervising physician or preclude a physician assistant from making house calls, performing hospital duties, serving as an ambulance attendant, or performing any functions authorized by the supervising physician which the physician assistant is qualified to perform.   A physician assistant may not be utilized to perform the duties of a pharmacist licensed under Chapter 4 of Title 26, relating to pharmacists.   A physician employed by the Department of Public Health or by any institution thereof or by a local health department whose duties are administrative in nature and who does not normally provide health care to patients as such employee shall not be authorized to apply for or utilize the services of any physician assistant employed by the Department of Public Health or by any institution thereof or by a local health department.   Nothing in this article shall be construed to prohibit a physician assistant from performing those acts the performance of which have been delegated to that physician assistant pursuant to and in conformity with Code Section 43-34-23.   A physician and a physician assistant may enter into a temporary practice agreement exempt from any filing fees with the board by which agreement the physician supervises the services provided by the physician assistant to patients at a specific facility or program that provides medical services only to indigent patients in medically underserved or critical need population areas of the state, as determined by the board, or pursuant to Article 8 of Chapter 8 of Title 31, provided that:   Such services are provided primarily to financially disadvantaged patients;   Such services are free or at a charge to the patient based solely on the patient's ability to pay and provided, further, that such charges do not exceed the actual cost to the facility or program;   The supervising physician and the physician assistant voluntarily and gratuitously donate their services;   Prior to providing any patient services, a copy of the temporary practice agreement, signed by both the supervising physician and the physician assistant, is on file at the facility or program and is sent to the board;   The temporary practice agreement is for a specified period of time, limits the services of the physician assistant to those within the usual scope of practice of the supervising physician, and is signed by both the supervising physician and the physician assistant prior to the physician assistant providing patient services; and   The facility or program has notified the board of its intent to provide patient services and utilize licensed physicians and physician assistants under the conditions set out in this subsection.       Notwithstanding any provision of this article to the contrary, a physician assistant licensed pursuant to this article or licensed, certified, or otherwise authorized to practice in any other state or federal jurisdiction and whose license, certification, or authorization is in good standing who responds to a need for medical care created by conditions which characterize those of a state of emergency or public health emergency may render such care that the physician assistant is able to provide with such supervision as is available at the immediate scene or at the local site where such need for medical care exists or at a relief site established as part of a state or local safety plan established pursuant to Chapter 3 of Title 38. Such services shall be provided by a physician assistant in response to the request of an appropriate state or local official implementing a state or local emergency management plan or program, and in accordance with applicable guidelines established by such officials or plans. The authority granted by this Code section shall last no longer than 48 hours or such time as the board may establish under guidelines for supervision of the physician assistant rendering medical care.   For the purposes of this subsection, the term "public health emergency" has the same meaning as in paragraph (6) of Code Section 38-3-3, and the term "state of emergency" has the same meaning as in paragraph (7) of Code Section 38-3-3.     A physician assistant shall be allowed to make a pronouncement of death pursuant to authority delegated by the supervising physician of the physician assistant and to certify such pronouncement in the same manner as a physician.   It shall be unlawful for a physician to be an employee of a physician assistant, alone or in combination with others, if the physician is required to supervise the physician assistant; provided, however, that this shall not apply to arrangements of this nature which were approved by the board on or before July 1, 2009. Arrangements approved prior to such date are nontransferable. Such conduct shall be subject to sanctions by the board as to the physician and the physician assistant.   Except for death certificates and assigning a percentage of a disability rating, a physician assistant may be delegated the authority to sign, certify, and endorse all documents relating to health care provided to a patient within his or her scope of authorized practice, including, but not limited to, documents relating to physical examination forms of all state agencies and verification and evaluation forms of the Department of Human Services, the State Board of Education, local boards of education, the Department of Community Health, and the Department of Corrections.    (e.1) (1)In addition to and without limiting the authority granted by Code Section 43-34-23, a physician may delegate to a physician assistant, in accordance with a job description, the authority to issue a prescription drug order or orders for any device as defined in Code Section 26-4-5 or to issue any dangerous drug as defined in Code Section 16-13-71 or any Schedule III, IV, or V controlled substance as defined in Code Section 16-13-21 on a prescription drug order or prescription device order form as specified in paragraph (3) of this subsection. Delegation of such authority shall be contained in the job description required by this Code section. The delegating physician shall remain responsible for the medical acts of the physician assistant performing such delegated acts and shall adequately supervise the physician assistant. If an existing job description for a physician assistant does not contain such authority to order a prescription drug or device order as provided by this subsection, that physician assistant may not issue any such prescription drug or device order until a new job description delegating such authority is submitted to and approved by the board. Nothing in this Code section shall be construed to authorize the written prescription drug order of a Schedule I or II controlled substance.   Nothing in this subsection shall be construed to create a presumption of liability, either civil or criminal, on the part of a pharmacist who is duly licensed under Title 26 and who in good faith fills a prescription drug or device order presented by a patient pursuant to this subsection. The pharmacist shall presume that the prescription drug or device order was issued by a physician assistant duly licensed under this article who has qualified under this Code section to prescribe pharmaceutical agents. The pharmacist shall also presume that the pharmaceutical agent prescribed by the physician assistant is an approved pharmaceutical agent, unless the pharmacist has actual or constructive knowledge to the contrary.   The physician assistant shall only be authorized to exercise the rights granted under this subsection using a prescription drug or device order form which includes the name, address, and telephone number of the prescribing supervising or alternate supervising physician, the patient's name and address, the drug or device prescribed, the number of refills, and directions to the patient with regard to the taking and dosage of the drug. A prescription drug order which is transmitted either electronically or via facsimile shall conform to the requirements set out in paragraphs (1) and (2) of subsection (c) of Code Section 26-4-80, respectively. Any form containing less information than that described in this paragraph shall not be offered to or accepted by any pharmacist who is duly licensed under Title 26.   Nothing in this Code section shall be construed to authorize a physician assistant to authorize refills of any drug for more than 12 months from the date of the original prescription drug or device order.   A supervising physician or alternate supervising physician shall evaluate or examine, at least every three months, any patient receiving controlled substances.   In addition to the copy of the prescription drug or device order delivered to the patient, a record of such prescription shall be maintained in the patient's medical record in the following manner:   The physician assistant carrying out a prescription drug or device order shall document such order either in writing or by electronic means; and   The supervising physician shall periodically review patient records. Such review may be achieved with a sampling of such records as determined by the supervising physician.   A physician assistant is not permitted to prescribe drugs or devices except as authorized in the physician assistant's job description and in accordance with this article.   The board shall adopt rules establishing procedures to evaluate an application for a job description containing the authority to order a prescription drug or device and any other rules the board deems necessary or appropriate to regulate the practice of physician assistants, to carry out the intent and purpose of this article, or to protect the public welfare.   A physician assistant authorized by a primary supervising physician to order controlled substances pursuant to this Code section is authorized to register with the federal Drug Enforcement Administration.   A physician assistant delegated the authority by the primary supervising physician to issue a prescription drug or device order shall be required to complete a minimum of three hours of continuing education biennially in practice specific pharmaceuticals in which the physician assistant has prescriptive order privileges.   A managed care system, health plan, hospital, insurance company, or other similar entity shall not require a physician to be a party to a job description as a condition for participation in or reimbursement from such entity.   (e.2)A physician assistant may be delegated the authority to request, receive, and sign for professional samples and may distribute professional samples to patients so long as delegation of such authority is contained in a job description and the professional samples are within the specialty of the supervising physician. The office or facility at which the physician assistant is working must maintain a general list of professional samples approved by the supervising physician for request, receipt, and distribution by the physician assistant as well as a complete list of the specific number and dosage of each professional sample received. Professional samples that are distributed by a physician assistant shall be so noted in the patient's medical record. In addition to the requirements of this Code section, all professional samples shall be maintained as required by applicable state and federal law and regulations. As used in this subsection, the term "professional samples" means complimentary doses of a drug, medication vouchers, or medical devices provided by the manufacturer for use in patient care.   (Ga. L. 1972, p. 676, § 4; Ga. L. 1982, p. 1148, § 2; Ga. L. 1984, p. 22, § 43; Ga. L. 1984, p. 611, § 1; Ga. L. 1989, p. 261, § 4; Ga. L. 1995, p. 827, § 2; Ga. L. 1997, p. 935, § 3; Ga. L. 1999, p. 81, § 43; Ga. L. 2001, p. 788, § 1; Ga. L. 2002, p. 1043, § 2; Ga. L. 2004, p. 581, § 2; Ga. L. 2005, p. 1232, § 1/SB 173; Ga. L. 2006, p. 475, § 1/HB 873; Ga. L. 2006, p. 476, § 1/HB 832; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2010, p. 878, § 43/HB 1387; Ga. L. 2011, p. 441, § 3/HB 303; Ga. L. 2011, p. 705, § 5-26/HB 214; Ga. L. 2018, p. 243, § 1/SB 364; Ga. L. 2020, p. 650, § 2/SB 321; Ga. L. 2021, p. 922, § 43/HB 497.)    The 2020 amendment,  effective January 1, 2021, in paragraph (b)(1), substituted "enter into a job description with or supervise" for "have", substituted "paragraphs (3) or (4)" for "paragraph (4)" and deleted "; provided, however, that no physician may supervise more than two physician assistants at any one time except as provided in paragraph (2) of this subsection"; deleted former paragraph (b)(2), which read: "(b)(2)(A) A physician may supervise as many as four physician assistants at any one time while practicing in a group practice in which other physician members of such group practice are primary supervising physicians.   "(B) A physician may supervise as many as four physician assistants at any one time while acting as an alternate supervising physician:   "(i) In an institutional setting such as a hospital or clinic;   "(ii) On call for a primary supervising physician or a group practice; or   "(iii) If otherwise approved by the board to act as an alternate supervising physician."; redesignated former paragraphs (b)(3) and (b)(4) as present paragraphs (b)(2) and (b)(3), respectively; in paragraph (b)(2), in the first sentence, substituted "with which" for "licensed to" and inserted "has entered into a job description" and substituted "paragraphs (1) and (3)" for "paragraph (2)" in the last sentence; added "or supervise more than four physician assistants who have completed a board approved anesthesiologist assistant program at any one time" at the end of paragraph (b)(3); added paragraph (b)(4); in subsection (d), substituted "Nothing" for "A physician assistant is authorized to practice in those public or private places or facilities where the supervising physician or alternate supervising physician regularly sees patients, provided that nothing"; deleted former paragraph (e.1)(4), which read: "The physician assistant or office staff shall notify the patient that the patient has the right to see the physician prior to any prescription drug or device order being issued by the physician assistant."; redesignated former paragraphs (e.1)(5) through (e.1)(12) as present paragraphs (e.1)(4) through (e.1)(11), respectively; and rewrote subparagraph (e.1)(6)(B), which read: "Except in facilities operated by the Department of Public Health, the supervising physician shall review the prescription drug or device order copy and medical record entry for prescription drug or device orders issued within the past 30 days by the physician assistant. Such review may be achieved with a sampling of no less than 50 percent of such prescription drug or device order copies and medical record entries."    The 2021 amendment,  effective May 10, 2021, part of an Act to revise, modernize, and correct the Code, substituted "paragraph (3) or (4)" for "paragraphs (3) or (4)" near the end of paragraph (b)(1).   For application of this statute in 2021, see Executive Order 01.22.21.07.   A listing of Executive Orders issued in 2021 can be found at https://gov.georgia.gov/executive-action/executive-orders.   Law reviews.   - For article on the 2011 amendment of this Code section, see 28 Georgia St. U.L. Rev. 147 (2011). For note on 1989 amendment to this Code section, see 6 Georgia. St. U. L. Rev. 304 (1989). For note on 1995 amendments to this Code section and § 43-34-102, see 12 Georgia. St. U. L. Rev. 301 (1995).   JUDICIAL DECISIONS    Supervision of student nurse anesthetists is not one of the functions properly delegated to a physician's assistant trained in anesthesia. Central Anesthesia Assocs. v. Worthy, 254 Ga. 728, 333 S.E.2d 829 (1985).   Differentiating physician's assistants and nurse practitioners not unlawful under federal equal pay provisions.   - Pattern of state regulation, which differentiated physician's assistants and nurse practitioners, in that a physician's assistant may perform "any functions performed by the applying physician which the physician's assistant is qualified to perform," while nurse practitioners are confined by their guidelines and protocols, constituted an "other factor other than sex" that created a defense for the employer under the federal Equal Pay Act, 29 U.S.C. § 206(d)-(1)(iv). Beall v. Curtis, 603 F. Supp. 1563 (M.D. Ga.), aff'd, 778 F.2d 791 (11th Cir. 1985).   Negligence per se.    - As it was undisputed that the physician's assistant who treated and prescribed drugs for the malpractice plaintiff had not been supervised as required by O.C.G.A. §§ 43-34-103(e.1)(1) and43-34-105, no testimony from a member of the Composite State Board of Medical Examiners (now Georgia Composite Medical Board) was required to show a violation of these statutes, and the plaintiff was entitled to summary judgment on plaintiff's claim of negligence per se. Rockefeller v. Kaiser Found. Health Plan, 251 Ga. App. 699, 554 S.E.2d 623 (2001).    Cited in United States v. Composite State Bd. of Medical Exmrs., 487 F. Supp. 495 (N.D. Ga. 1980); Cardio TVP Surgical Assocs., P.C. v. Gillis, 272 Ga. 404, 528 S.E.2d 785 (2000).   OPINIONS OF THE ATTORNEY GENERAL   Authority of physician's assistants to prescribe controlled substances.   - Physician's assistants may prescribe Schedule III, IV, and V controlled substances when acting under the requisite supervision of a physician. 2000 Op. Att'y Gen. No. 00-10.