reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.08 - Requirements For Collaborative Practice By Physicians And Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 collaborating physician shall:
(a) Provide
			 professional medical oversight and direction to the certified registered nurse
			 practitioner.
(b) Be readily
			 available for direct communication or by radio, telephone or
			 telecommunications.
(c) Be readily
			 available for consultation or referrals of patients from the certified
			 registered nurse practitioner.
(d)
			 Be readily available at each remote practice site.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.09 - Standards Of Practice For Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
The certified registered nurse practitioner shall practice in
				accordance with national standards and functions identified by the appropriate
				specialty-certifying agency as recognized by the Board of Nursing and as
				congruent with Alabama law.
Author:
Patricia E. Shaner, Attorney for the Board
				of Medical Examiners
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-24-53,
				  34-21-85.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.10 - Functions And Activities Of Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The certified
			 registered nurse practitioner is responsible and accountable for the continuous
			 and comprehensive management of a broad range of health services for which the
			 certified registered nurse practitioner is educationally prepared and for which
			 competency is maintained, with physician collaboration as described in these
			 rules. These services include but are not restricted to the following:
(a) Evaluate current health status and risk
			 factors of individuals based on comprehensive health history and comprehensive
			 physical examinations and assessments.
(b) Formulate a working diagnosis, develop
			 and implement a treatment plan, and evaluate/modify therapeutic regimens to
			 promote positive patient outcomes.
(c) Prescribe, administer and provide
			 therapeutic measures, tests, procedures, and drugs.
(d) Counsel, teach and assist
			 individuals/families to assume responsibility for self-care in prevention of
			 illness, health maintenance, and health restoration.
(e) Consult with refer to other health care
			 providers as appropriate.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.11 - Prescriptions And Medication Orders By Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Certified registered nurse practitioners engaged in collaborative practice with
			 physicians may be granted prescriptive authority upon submission of evidence of
			 completion of an academic course in pharmacology or evidence of integration of
			 pharmacology theory and clinical application in the certified registered nurse
			 practitioner curriculum.
(2)
			 Certified registered nurse practitioners practicing under protocols approved in
			 the manner prescribed by
Code of Ala. 1975
,
			 §§
								34-21-80 et seq. may prescribe
			 legend drugs to their patients, subject to the following conditions:
(a) The drug shall be included in the
			 formulary recommended by the Joint Committee and adopted by the Board of
			 Nursing and the State Board of Medical Examiners.
(b) The drug type, dosage, quantity
			 prescribed, and number of refills shall be authorized in an approved protocol
			 signed by the collaborating physician and the certified registered nurse
			 practitioner. This requirement may be met if written prescriptions adhere to
			 the standard recommended dosages of legend drugs as identified in the
			 Physicians Desk Reference or Product Information Insert, and do not:
1. Exceed the recommended treatment regimen
			 periods.
2. Include United States
			 Food and Drug Administration (FDA) non-approved supplements, drug products,
			 medication, and off label medications.
(c) Drugs and medications that do not have
			 FDA approval may be prescribed through protocol registration in a United States
			 Institutional Review Board or Expanded Access authorized clinical
			 trial.
(d) "Off label" use or
			 prescription of FDA-approved medications for uses other than that indicated by
			 the FDA is permitted when such practices are:
1. Within the current standard of care for
			 treatment of disease or condition.
2. Supported by evidence-based
			 research.
3. Approved by the
			 collaborating physician and entered into the patient record.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.12 - Limitations Upon Utilization Of Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A physician may
			 enter into collaborative agreements with certified registered nurse
			 practitioners not exceeding a cumulative three hundred and sixty (360) hours
			 (nine FTEs) per week. The physician shall not collaborate with or supervise any
			 combination of certified registered nurse practitioners, certified nurse
			 midwives and/or assistants to physicians exceeding three hundred and sixty
			 (360) hours per week (nine full-time equivalent positions). "One full- time
			 equivalent" (FTE) is herein described as a person/persons collectively working
			 forty hours a week, excluding time on call.
(a) A physician collaborating with more than
			 four FTEs per week shall engage in documented quality assurance review with
			 each CRNP every month for six (6) months following the commencement of a
			 collaborative practice with a new CRNP.
(b) A physician shall disclose to the Board
			 of Medical Examiners the existence of all collaborative and supervisory
			 agreements to which the physician is a party, including collaborative and
			 supervisory agreements in other states, and shall not be eligible to
			 collaborate with or supervise any combination of certified registered nurse
			 practitioners, certified nurse midwives and/or assistants to physicians
			 exceeding three hundred and sixty (360) hours per week (nine full-time
			 equivalent positions), inclusive of collaborative and supervisory agreements
			 existing in other states. Agreements with an individual certified registered
			 nurse practitioner, certified nurse midwife, and/or assistant to physician in
			 multiple states shall only be counted once for purposes of calculating the
			 total number of full-time equivalent positions
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.13 - Grounds For Denial/Withdrawal Of Approval Of The Certified Registered Nurse Practitioner And Collaborating Physician

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The commission by a certified registered
			 nurse practitioner of any act, offense, or condition set forth in
Code of Ala. 1975
, §
								34-21-25 and/or Board of Nursing
			 Administrative Code Rule 610-X-8 and/or the commission by the collaborating
			 physician of any act, offense or condition set forth in
Code of
			 Ala. 1975
, §
								34-24-57 and §
								34-24-360, shall be grounds,
			 within the discretion of the respective board, to deny an application of the
			 certified registered nurse practitioner or collaborating physician.
(2) If upon examination of the application
			 for approval and after consideration of any information acquired by the Board
			 of Nursing and/or the Board of Medical Examiners pursuant to an investigation
			 into the qualifications of the physician or of the certified registered nurse
			 practitioner, either board determines there is probable cause to believe there
			 exists one or more grounds upon which the application may be denied, then the
			 respective board shall:
(a) Notify the
			 physician and/or the certified registered nurse practitioner of the grounds for
			 possible denial of approval and the procedure for obtaining a hearing before
			 the respective board. The failure to request a hearing within the time
			 specified in the notice shall be deemed a waiver of such hearing.
(b) All hearings under this rule shall be
			 conducted in accordance with the
Code of Ala. 1975
,
			 Alabama Administrative Procedure Act, §
									41-22-1, et. seq.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.14 - Denial, Suspension And Revocation Of License

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Board of Nursing may deny, suspend or
			 revoke the license of a certified registered nurse practitioner for any cause
			 set forth in
Code of Ala. 1975
, §
								34-21-25, and any rules
			 promulgated pursuant to law.
(2)
			 The Board of Medical Examiners may seek the denial, suspension or revocation of
			 the license of a physician for any cause set forth in
Code of Ala.
			 1975
, as amended, §
								34-24-57 and §
								34-24-360 and any rules
			 promulgated pursuant to law.
(3) A
			 CRNP who is denied a license or whose license is suspended or revoked may
			 appeal to the Circuit Court or a court of like jurisdiction of the county in
			 which said person resides, any order of the respective board under this section
			 within thirty days from date of decision of the board. The trial of appeals
			 hereunder shall be conducted in like manner, as nearly as may be, as provided
			 for in
Code of Ala. 1975
, as amended, §
								41-22-20.
(4) A physician who is denied a license or
			 whose license is suspended or revoked may appeal to the Alabama Court of Civil
			 Appeals according to
Code of Ala. 1975
, as amended,
			 §
								34-24-367.
Was previously Rule
				  540-X-8-.13, renumbered as per
				  certification filed August 25, 2003; effective September 29,
				  2003.
Author:
Patricia E. Shaner, Attorney for the
				  Board of Medical Examiners
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-21-25,
				  34-24-53,
				  34-24-57, 34-24-89,
				  34-24-360,
				  41-22-20.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.15 - Grounds For Termination Of Approval Of A Collaborating Practice

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The following
			 acts may constitute grounds for the termination of the approval of the State
			 Board of Medical Examiners of the collaborating practice of a physician:
(a) Prescribing by a physician or certified
			 registered nurse practitioner in violation of §§
									20-2-54,
			 20-2-254,
			 20-2-260, and
			 34-21-80 through
			 34-21-93 of the
Code
			 of Ala. 1975
or the rules of the State Board of Medical
			 Examiners.
(b) For a physician to
			 require or to knowingly permit or condone a certified registered nurse
			 practitioner to engage in any act or render any services not authorized in his
			 or her protocol.
(c) Failure of a
			 physician to maintain current or unrestricted licensure with the Medical
			 Licensure Commission of Alabama.
(d) Failure of a collaborating physician to
			 comply with any statute or rule governing collaborative practice.
(e) The commission of any act by a physician
			 which would constitute a violation of §
									34-24-360 of the
Code
			 of Ala. 1975
, or any rule of the Alabama Board of Medical
			 Examiners or Medical Licensure Commission of Alabama.
(f) Failure of a collaborating physician to
			 maintain or produce for inspection upon request by the Board of Medical
			 Examiners any documentation required to be maintained by the collaborative
			 physician.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.16 - Termination Of Approval Of A Collaborative Practice - Physicians And Certified Registered Nurse Practitioners

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Before terminating the approval of the State Board of Medical Examiners of a
			 collaborating practice of a physician and a certified registered nurse
			 practitioner on any of the grounds specified in this Chapter, the State Board
			 of Medical Examiners shall conduct a hearing under the provisions of the
			 Alabama Administrative Procedure Act, §§
								41-22-1 through
			 41-22-27 of the
Code
			 of Ala. 1975
, and Chapter 6 of the rules of the State Board of
			 Medical Examiners.
(2) Pursuant to
			 the requirements of §
								41-22-19(d) of
			 the
Code of Ala. 1975
, the State Board of Medical
			 Examiners may order the summary suspension of the Board's approval of the
			 collaborating practice of a physician and a certified registered nurse
			 practitioner for any of the reasons stated in §
								34-21-88 of the
Code
			 of Ala. 1975
, and Alabama Board of Medical Examiners Rule
			 540-X-8-.15 if the Board finds
			 that danger to the public health, safety or welfare requires the emergency
			 suspension.
(3) An order of summary
			 suspension of the Board's approval of a collaborating practice of a physician
			 and a certified registered nurse practitioner shall become effective
			 immediately, unless otherwise stated in the order. Simultaneously with the
			 issuance of an order of summary suspension, a proceeding for a hearing shall be
			 instituted. The suspension may be effective for a period of not longer than one
			 hundred and twenty (120) days.
Author:
Patricia E. Shaner, Attorney for the Board
				of Medical Examiners.
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-24-53,
				  34-21-81.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.17 - Qualifications For Approval As A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The applicant for approval to practice as
			 a certified nurse midwife shall have:
(a) An
			 active Alabama registered nurse license, or a multistate registered nurse
			 license issued by a party state, as defined in Chapter 610-X-4 of the Rules of
			 the Alabama Board of Nursing, unless authorized by the Board of
			 Nursing.
(b) Met all requirements
			 for completion of or graduation from an organized program of study and clinical
			 experience beyond the basic educational preparation as a registered nurse, that
			 prepares nurse midwives and is recognized by the Board of Nursing and the
			 appropriate specialty certifying agency.
(c) At least a master's or higher degree in
			 advanced practice nursing from an accredited program recognized by the Nursing
			 Board. The applicant for initial approval as a nurse midwife who meets one of
			 the following criteria is exempt from the requirement for a master's degree in
			 nursing:
1. Graduation prior to 1996 from a
			 Nursing-Board recognized post-baccalaureate program preparing nurse
			 midwives,
2. Graduation prior to
			 1984 from a non-baccalaureate program preparing nurse midwives, or
3. The Board of Nursing may grant a waiver of
			 the master's degree requirement at its discretion.
(d) Current certification as a certified
			 nurse midwife by the American College of Nurse Midwives or American College of
			 Nurse Midwives Certification Council.
(e) Effective January 1, 2024, obtained
			 continuing education prescribed by the Board of Nursing regarding the rules and
			 statutes governing collaborative practice in Alabama, not more than forty-eight
			 (48) months prior to or within twelve (12) months of commencement of the
			 collaborative practice.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.18 - Qualifications For Physician In Collaborative Practice With Certified Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 physician in collaborative practice with a certified nurse midwife shall:
(a) Possess a current, unrestricted license
			 to practice medicine in the State of Alabama;
(b) Have satisfied one of the following
			 experience requirements:
1. Have practiced
			 medicine for at least three years, including specifically the active practice
			 of obstetrics and/or gynecology.
2.
			 Have practiced medicine for at least one year, including specifically the
			 active practice of obstetrics and/or gynecology, and certified by one or more
			 of the specialty boards recognized by the American Board of Medical Specialties
			 or the American Osteopathic Association; or
3. Have practiced medicine for at least one
			 year, including specifically the active practice of obstetrics and/or
			 gynecology, and the collaboration's practice site is limited solely to a
			 general acute care hospital, a critical access hospital, or a specialized
			 hospital licensed as such by the Alabama Department of Public Health.
(c) Effective January 1, 2024,
			 have obtained continuing education prescribed by the Board of Medical Examiners
			 regarding the rules and statutes governing collaborative practice in Alabama,
			 not more than forty-eight (48) months prior to or within twelve (12) months of
			 commencement of the collaborative practice; and
(d) Have paid all collaborative practice fees
			 due to the Board of Medical Examiners and submitted to the Board of Medical
			 Examiners a Commencement of Collaborative Practice form. In the event no
			 application is received from the Alabama Board of Nursing within six (6) months
			 of submission, the submitted form will be withdrawn by the Board. The fee
			 submitted with the Commencement of Collaborative Practice form is
			 non-refundable and non-transferable.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.19 - Application For Approval To Practice As A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The physician
			 in collaborative practice with a certified nurse midwife shall have:
(a) A current, unrestricted license to
			 practice medicine in the State of Alabama; and
(b) Practiced medicine, including the active
			 practice of obstetrics and/or gynecology, for at least one year, if the
			 physician is certified by or eligible for board certification by a specialty
			 board approved by the American Medical Association or by the American
			 Osteopathic Association; or have practiced medicine, including the active
			 practice of obstetrics and/or gynecology, for at least three years.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.19.1 - Reinstatement Of Lapsed Approval For Practice As A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Lapsed approval
			 as a certified nurse midwife may be reinstated upon submission of a completed
			 application and compliance with the following:
(a) An active Alabama registered nurse
			 license, or a multistate registered nurse license issued by a party state, as
			 defined in Chapter 4 of these rules.
(b) Payment of current renewal and
			 reinstatement fees, as well as outstanding fees and fines, if
			 applicable.
(c) Official evidence
			 of current national certification as a certified nurse midwife by a national
			 certifying agency recognized by the Board.
(d) Documented evidence of completion of six
			 contact hours of pharmacology content specific to the prescriptive practice in
			 the approved area for collaborative practice earned within the 24 months
			 immediately preceding application.
(e) Effective January 1, 2024, has obtained
			 continuing medical education prescribed by the Board of Nursing regarding the
			 rules and statutes governing collaborative practice in Alabama, not more than
			 forty-eight (48) months prior to or within twelve (12) months of commencement
			 of the collaborative practice.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.20 - Authorization For Practice As A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Board of Nursing may grant a
			 certificate of qualification for advanced practice nursing as a nurse midwife
			 to applicants who meet all requirements of
			 540-X-8-.15.
(2) Use of the designation "CNM" or of any
			 titles that imply that they are certified nurse midwives shall be restricted to
			 those registered nurses who:
(a) Have been
			 issued a certificate of qualification by the Board of Nursing; and
(b) Have current approval for collaborative
			 practice in the state of Alabama or
(c) Are employed by the United States
			 government and working in federal facilities; or
(d) Hold teaching positions in nurse midwife
			 education programs recognized by the Alabama Board of Nursing.
(e) Prior to approval as a CNM, the
			 registered nurse may use only the designation or title granted by the national
			 certifying agency.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.21 - Temporary Approval To Practice As A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The applicant
			 for approval to practice as a certified nurse midwife may be granted temporary
			 approval for practice under the following stipulations until such time as the
			 application is approved or denied by the Board of Nursing and the Board of
			 Medical Examiners.
(a) The applicant shall
			 meet the requirements of Rules
			 540-X-8-.15 and
			 540-X-8-.17.
(b) The collaborating physician shall meet
			 the qualifications established in Rule
			 540-X-8-.16.
(c) Temporary approval is limited to the
			 standard protocol and formulary, including oxytocics, approved by the Joint
			 Committee of the Alabama Board of Nursing and the Alabama State Board of
			 Medical Examiners and does not include the authority to:
1. Perform additional skills as provided in
			 Rule 540-X-8-.22.
2. Prescribe drugs other than oxytocics that
			 are defined in the standard formulary with "Restrictions."
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.22 - Requirements For Collaborative Practice By Physicians And Certified Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 collaborating physician shall:
(a) Provide
			 professional medical oversight and direction to the certified nurse
			 midwife.
(b) Be readily available
			 for direct communication or by radio, telephone or
			 telecommunications.
(c) Be readily
			 available for consultation or referrals of patients from the certified nurse
			 midwife.
(d) Be readily available
			 during labor management to provide direct medical intervention and to attend
			 deliveries if needed.
(e) Be
			 readily available at each remote practice site.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.23 - Standards Of Practice Of Certified Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
The certified nurse midwife shall practice in accordance with
				the standards and functions developed by the American College of Nurse Midwives
				as recognized by the Board of Nursing and as congruent with Alabama law.
Author:
Patricia E. Shaner, Attorney for the Board
				of Medical Examiners
Was previously Rule
				  540-X-8-.21, renumbered as per
				  certification filed April 23, 2004; effective May 28,
				  2004.
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-21-85,
				  34-24-53.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.24 - Functions And Activities Of Certified Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The certified nurse midwife is
			 responsible and accountable for the continuous and comprehensive management of
			 women's health care focusing on pregnancy, childbirth, the postpartum period,
			 care of the newborn, family planning and gynecological needs for which the
			 certified nurse midwife is educationally prepared and for which competency is
			 maintained, with physician collaboration as described in these rules. These
			 services include but are not restricted to the following:
(a) Evaluate current health status and risk
			 factors of individuals based on comprehensive health history and comprehensive
			 physical examinations and assessments.
(b) Formulate a working diagnosis, develop
			 and implement a treatment plan, and evaluate/modify therapeutic regimens to
			 promote positive patient outcomes.
(c) Prescribe, administer and provide
			 therapeutic measures, tests, procedures, and drugs.
(d) Counsel, teach and assist
			 individuals/families to assume responsibility for self-care in prevention of
			 illness, health maintenance, and health restoration.
(e) Consult with and refer to other health
			 care providers as appropriate.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.25 - Prescriptions And Medication Orders By A Certified Nurse Midwife

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Certified nurse
			 midwives engaged in collaborative practice with physicians may be granted
			 prescriptive authority upon submission of evidence of completion of an academic
			 course in pharmacology or evidence of integration of pharmacology theory and
			 clinical application in the certified nurse midwifery curriculum.
(2) Certified nurse midwives practicing under
			 protocols approved in the manner prescribed by the
Code of Ala.
			 1975
, §
								34-21-80,
et.
			 seq.
, may prescribe legend drugs to their patients, subject to the
			 following conditions:
(a) The drug shall be
			 included in the formulary recommended by the Joint Committee and adopted by the
			 Board of Nursing and the Board of Medical Examiners.
(b) The drug type, dosage, quantity
			 prescribed, and number of refills shall be authorized in an approved protocol
			 signed by the collaborating physician and the certified nurse midwife. This
			 requirement may be met if written prescriptions adhere to the standard
			 recommended doses of legend drugs as identified in the Physicians Desk
			 Reference or Product Information Insert, and do not:
1. Exceed the recommended treatment regimen
			 periods.
2. Include United States
			 Food and Drug Administration (FDA) non-approved supplements, drug products,
			 medication, and off label medications.
(c) Drugs and medications that do not have
			 FDA approval may be prescribed through protocol registration in a United States
			 Institutional Review Board or Expanded Access authorized clinical
			 trial.
(d) "Off label" use or
			 prescription of FDA-approved medications for uses other than that indicated by
			 the FDA, is permitted when such practices are:
1. Within the current standard of care for
			 treatment of disease or condition.
2. Supported by evidence-based
			 research.
3. Approved by the
			 collaborating physician and entered into the patient record.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.26 - Limitations Upon Utilization Of Certified Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A physician may enter into a
			 collaborative agreement with certified nurse midwives not exceeding a
			 cumulative three hundred and sixty (360) hours (nine FTEs) per week. The
			 physician shall not collaborate with or supervise any combination of certified
			 registered nurse practitioners, certified nurse midwives and/or assistants to
			 physicians exceeding three hundred and sixty (360) hours per week (nine
			 full-time equivalent positions). "One full- time equivalent" (FTE) is herein
			 described as a person/persons collectively working forty hours a week,
			 excluding time on call.
(a) A physician
			 collaborating with more than four FTEs per week shall engage in documented
			 quality assurance review with each CNM every month for six (6) months following
			 the commencement of a collaborative practice with a new CNM.
(b) A physician shall disclose to the Board
			 of Medical Examiners the existence of all collaborative and supervisory
			 agreements to which the physician is a party, including collaborative and
			 supervisory agreements in other states, and shall not be eligible to
			 collaborate with or supervise any combination of certified registered nurse
			 practitioners, certified nurse midwives and/or assistants to physicians
			 exceeding three hundred and sixty (360) hours per week (nine full-time
			 equivalent positions), inclusive of collaborative and supervisory agreements
			 existing in other states. Agreements with an individual certified registered
			 nurse practitioner, certified nurse midwife, and/or assistant to physician in
			 multiple states shall only be counted once for purposes of calculating the
			 total number of full-time equivalent positions.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.27 - Grounds For Denial/Withdrawal Of Approval Of The Certified Nurse Midwife And Collaborating Physician

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The commission by a certified nurse
			 midwife of any act, offense, or condition set forth in
Code of Ala.
			 1975
, §
								34-21-25 and Board of Nursing
			 Administrative Code Rule (old: 610-X-8) and/or the commission by the
			 collaborating physician of any act, offense or condition set forth in
Code of Ala. 1975
, §
								34-24-57 and/or §
								34-24-360 shall be grounds, within
			 the discretion of the respective board, to deny an application for the
			 certified nurse midwife or collaborating physician.
(2) If under examination of the application
			 for approval and after consideration of any information acquired by the Board
			 of Nursing and/or the Board of Medical Examiners pursuant to an investigation
			 into the qualifications of the physician or of the certified nurse midwife,
			 either board determines there is probable cause to believe there exists one or
			 more grounds upon which the application may be denied, then the respective
			 board shall:
(a) Notify the physician and/or
			 the certified nurse midwife of the grounds for possible denial of approval and
			 the procedure for obtaining a hearing before the respective board. The failure
			 to request a hearing within the time specified in the notice shall be deemed a
			 waiver of such hearing.
(b) All
			 hearings under this rule shall be conducted in accordance with the
Code of Ala. 1975
, Alabama Administrative Procedures
			 Act, §
									41-22-1, et. seq.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.28 - Denial, Suspension And Revocation Of License

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The Board of Nursing may deny, suspend or
			 revoke the license of a certified nurse midwife by any cause set forth in
Code of Ala. 1975
, §
								34-21-25, and any rules
			 promulgated pursuant to law.
(2)
			 The Board of Medical Examiners may seek the denial, suspension or revocation of
			 the license of a physician for any cause set forth in
Code of Ala.
			 1975
, §
								34-24-57 and/or §
								34-24-360 and any rules
			 promulgated pursuant to law.
(3)
			 Any person who is denied a license or whose license is suspended or revoked may
			 appeal to the Circuit Court or a court of like jurisdiction of the county in
			 which said person resides, any order of the respective board under this section
			 within thirty days from date of decision of the board. The trial of appeals
			 hereunder shall be conducted in like manner, as nearly as may be, as provided
			 for in
Code of Ala. 1975
, §
								41-22-20.
Was previously Rule
				  540-X-8-.24, renumbered as per
				  certification filed August 25, 2003; effective September 29, 2003. Was
				  previously Rule
				  540-X-8-.26, renumbered as per
				  certification filed April 23, 2004; effective May 28,
				  2004.
Author:
Alabama Board of Medical
				  Examiners
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-21-25,
				  34-21-89,
				  34-24-53,
				  34-24-57,
				  34-24-360,
				  41-22-20.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.29 - Grounds For Termination Of Approval Of A Collaborating Practice

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The following
			 acts may constitute grounds for the termination of the approval of the State
			 Board of Medical Examiners of the collaborating practice of a physician:
(a) Prescribing by a physician or certified
			 nurse midwife in violation of §§
									20-2-54,
			 20-2-254,
			 20-2-260, and
			 34-21-80 through
			 34-21-93 of the
Code
			 of Ala. 1975
or the rules of the State Board of Medical
			 Examiners.
(b) For a physician to
			 require or to knowingly permit or condone a certified nurse midwife to engage
			 in any act or render any services not authorized in his or her
			 protocol.
(c) Failure of a
			 physician to maintain current or unrestricted licensure with the Medical
			 Licensure Commission of Alabama.
(d) Failure of a collaborating physician to
			 comply with any statute or rule governing collaborative practice.
(e) The commission of any act by a physician
			 which would constitute a violation of §
									34-24-360 of the
Code
			 of Ala. 1975
, as amended, or any rule of the Alabama Board of
			 Medical Examiners or Medical Licensure Commission of Alabama.
(f) Failure of a collaborating physician to
			 maintain or produce for inspection upon request by the Board of Medical
			 Examiners any documentation required to be maintained by the collaborating
			 physician.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-8 - ADVANCED PRACTICE NURSES: COLLABORATIVE PRACTICE › Section 540-X-8-.30 - Termination Of Approval Of A Collaborative Practice - Physicians And Registered Nurse Midwives

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Before
			 terminating the approval of the State Board of Medical Examiners of a
			 collaborating practice of a physician and a certified nurse midwife on any of
			 the grounds specified in this Chapter, the State Board of Medical Examiners
			 shall conduct a hearing under the provisions of the Alabama Administrative
			 Procedure Act, §§
								41-22-1 through
			 41-22-27 of the
Code
			 of Ala. 1975
, and Chapter 6 of the rules of the State Board of
			 Medical Examiners.
(2) Pursuant to
			 the requirements of §
								41-22-19(d) of
			 the
Code of Ala. 1975
, the State Board of Medical
			 Examiners may order the summary suspension of the Board's approval of the
			 collaborating practice of a physician and a certified nurse midwife for any of
			 the reasons stated in §
								34-21-88 of the
Code
			 of Ala. 1975
, and Alabama Board of Medical Examiners Rule
			 540-X-8-.29 if the Board finds
			 that danger to the public health, safety or welfare requires the emergency
			 suspension.
(3) An order of summary
			 suspension of the Board's approval of a collaborating practice of a physician
			 and a certified nurse midwife shall become effective immediately, unless
			 otherwise stated in the order. Simultaneously with the issuance of an order of
			 summary suspension, a proceeding for a hearing shall be instituted. The
			 suspension may be effective for a period of not longer than one hundred and
			 twenty (120) days.
Author:
Patricia E. Shaner, Attorney for the Board
				of Medical Examiners.
Statutory Authority:
Code of Ala.
				  1975
, §§
										34-24-53,
				  34-21-81.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.02 - Therapeutic Research Program

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 Board creates and establishes a Therapeutic Research Review Committee
			 consisting of physicians practicing in the categories as specified by state
			 law.
(2) The members of the
			 Therapeutic Research Review Committee shall select a chairman among their
			 number who shall serve at the pleasure of the committee. The committee shall
			 meet at the discretion of the chairman or when called into session by the
			 Board, and the chairman shall set the time, date, and place for the
			 meetings.
(3) The commission shall
			 review applicants for inclusion into the Therapeutic Research Program and make
			 recommendations to the Board for final action on those applications.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §§
										20-2-113,
				  20-2-115,
				  20-2-116.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.03 - Repeal Of Existing Regulations

Current through Register Vol. 42, No. 9, June 28, 2024
On the date that the foregoing rules and regulations shall
				become effective, all previous rules and regulations of the Board of Medical
				Examiners are hereby repealed.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §
										41-22-1.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.04 - Gender Reference

Current through Register Vol. 42, No. 9, June 28, 2024
All references to the male gender in the Rules and Regulations
				of the Board of Medical Examiners are intended to apply equally to the female
				gender and all references to the female gender are intended to apply equally to
				the male gender.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §
										34-24-53.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.05 - Special Purpose Examination (SPEX)

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Persons applying to take the Special
			 Purpose Examination (SPEX) shall submit to the Alabama State Board of Medical
			 Examiners an application fee in the amount of $175.00.
(2) In addition to the application fee stated
			 above, persons applying to take the Special Purpose Examination (SPEX) shall
			 pay that fee which, pursuant to an official notice from the Federation of State
			 Medical Boards of the United States, is in effect at the time the application
			 to take the SPEX is filed with the Alabama Board of Medical Examiners. All
			 official notices regarding SPEX fees from the Federation of State Medical
			 Boards of the United States shall be kept on file in the office of the
			 executive director of the Alabama State Board of Medical Examiners.
Author:
Patricia E. Shaner
Statutory Authority:
Code of Ala.
				  1975
, §
										10-4-402.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.10 - Joint Rules Of The State Board Of Medical Examiners And Medical Licensure Commission For Medical Records Management

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definitions.
(a) ACTIVE PATIENTS. Active patients are any
			 patients treated by the physician one or more times during the immediately
			 preceding thirty-six (36) months.
(b) NOTIFICATION. Notification shall be
			 conducted by US Mail in a form letter to the active patients at their last
			 known address or an electronic message sent via a HIPAA compliant electronic
			 record system or HIPAA-compliant electronic health record system that provides
			 a means of electronic communication to the patient and is capable of sending
			 the patient a notification that a message is in the patient's portal.
(c) PERSONAL REPRESENTATIVE. The
			 executor, administrator, or such other person as may be authorized under Title
			 43 to act as a fiduciary and to settle and distribute the estate of a decedent.
			 The trustee of a trust established as a substantial part of the estate plan of
			 a deceased physician or any other person having legal control over the medical
			 records of the patients of a deceased physician shall also be responsible for
			 compliance with these rules in the same manner as a personal
			 representative.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.11 - Contact With Patients Before Prescribing

Current through Register Vol. 42, No. 9, June 28, 2024
(1) It is the position of the Board that,
			 when prescribing medications to an individual, the prescriber, when possible,
			 should personally examine the patient. Before prescribing a medication, a
			 physician should make an informed medical judgment based on appropriate medical
			 history, the circumstances of the situation and on his or her training and
			 experience. This process must be documented appropriately.
(2) Prescribing medications for a patient
			 whom the physician has not personally examined may be suitable under certain
			 circumstances. These circumstances may include, but not be limited to,
			 electronic encounters such as those in telemedicine; admission orders for a
			 patient newly admitted to a health care facility, prescribing for a patient of
			 another physician for whom the prescribing physician is taking call, continuing
			 medication on a short-term basis for a new patient prior to the patient's first
			 appointment, or prescribing for the sexual partner(s) of a patient in
			 accordance with an Expedited Partner Therapy (EPT) and/or Patient Delivered
			 Partner Therapy (PDPT) protocol for the prevention of transmission and spread
			 of sexually transmitted diseases.
(3) Licensees are expected to adhere to all
			 federal and state statutes regarding the prescribing of controlled substances
			 and all Alabama Board of Medical Examiners' Rules regarding the prescribing of
			 controlled substances.
Author:
Alabama Board of Medical
				  Examiners
Statutory Authority:
Code of Ala., 1975, §
										34-24-53.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-10 - OFFICE-BASED SURGERY › Section 540-X-10-.03 - Standards For Each Level Of Anesthesia - Preoperative Assessment

Current through Register Vol. 42, No. 9, June 28, 2024
A medical history, a physical examination consistent with the
				type and level of anesthesia and/or analgesia and the level of surgery to be
				performed, and the appropriate laboratory studies should be performed by a
				practitioner qualified to assess the impact of co-existing disease processes on
				surgery and anesthesia. A pre-anesthetic examination and evaluation should be
				conducted immediately prior to surgery by the physician or by a qualified
				person who will be administering or directing the anesthesia. If a qualified
				person will be administering the anesthesia, the physician shall review with
				the qualified person the pre-anesthesic examination and evaluation. The data
				obtained during the course of the pre-anesthesia evaluations (focused history
				and physical, including airway assessment and significant historical data not
				usually found in a primary care or surgical history 6 that may alter care or
				affect outcome) should be documented in the medical record.
Authors:
Alabama Board of Medical Examiners
ad hoc
Committee: Arthur F. Toole, III, M.D.; Jorge A. Alsip,
				M.D.; James G. Chambers, III, M.D.; Craig H. Christopher, M.D.; Alcus Ray
				Hudson, M.D.; Pamela D. Varner, M.D.; James E. West, M.D.; and Task Force
				Sub-Committee: Jeff Plagenhoef, M.D.; Eric Crum, M.D.; Dan J. Coyle, Jr., M.D.;
				Gary Monheit, M.D.; Robert Hurlbutt, IV, M.D.; C. Paul Perry, M.D.; W. Guinn
				Paulk, M.D.; Mark McIlwain, D.M.D., M.D.; Jerald Clanton, D.M.D., M.D.; Patrick
				J. Budny, M.D.; James W. Northington, M.D.; David Franco, M.D.; Thomas E.
				Moody, M.D.
Statutory Authority:
Code of Ala.
				  1975
, §
										34-24-53.
Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-10 - OFFICE-BASED SURGERY › Section 540-X-10-.04 - Standards For Office-Based Procedures - Local Anesthesia

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Equipment and
			 supplies: Oral airway positive pressure ventilation device, epinephrine, and
			 atropine should be available.
(2)
			 Training required: The physician is expected to be knowledgeable in proper drug
			 dosages, recognition and management of toxicity or hypersensitivity to local
			 anesthetic and other drugs. It is recommended that the physician be currently
			 trained in Basic Cardiac Life Support (BCLS).
(3) Assistance of other personnel: No other
			 assistance is required, unless dictated by the scope of the surgical procedure.
Authors:
Alabama Board of Medical Examiners
ad hoc
Committee: Arthur F. Toole, III, M.D.; Jorge A. Alsip,
				M.D.; James G. Chambers, III, M.D.; Craig H. Christopher, M.D.; Alcus Ray
				Hudson, M.D.; Pamela D. Varner, M.D.; James E. West, M.D.; and Task Force
				Sub-Committee: Jeff Plagenhoef, M.D.; Eric Crum, M.D.; Dan J. Coyle, Jr., M.D.;
				Gary Monheit, M.D.; Robert Hurlbutt, IV, M.D.; C. Paul Perry, M.D.; W. Guinn
				Paulk, M.D.; Mark McIlwain, D.M.D., M.D.; Jerald Clanton, D.M.D., M.D.; Patrick
				J. Budny, M.D.; James W. Northington, M.D.; David Franco, M.D.; Thomas E.
				Moody, M.D.
Statutory Authority:
Code of Ala.
				  1975
, §
										34-24-53.