Florida Administrative Code › 64 - DEPARTMENT OF HEALTH › 64B8 - Board of Medicine › Chapter 64B8-9 - STANDARDS OF PRACTICE FOR MEDICAL DOCTORS › Section 64B8-9.0181 - Practice Standards for the Certification of Smoking Marijuana as a Route of Administration

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				standards of practice in this rule do not supersede the level of care, skill,
				and treatment recognized in general law related to healthcare licensure. All
				physicians who are authorized to issue a certification for the medical use of
				marijuana in a form for smoking as defined in Section
				381.986(1),
				F.S., shall comply with this rule.
(2) Standards. The nature and extent of the
				requirements set forth below will vary depending on the practice setting and
				circumstances presented to the qualified physician. In addition to the
				requirements set forth in Section
				381.986(4),
				F.S., the Board has adopted the following standards for the issuing of
				certifications by qualified physicians for the medical use of marijuana in a
				form for smoking:
(a) Evaluation of the
				Patient. The qualified physician must conduct a physical examination while
				physically present in the same room as the patient and a full assessment of the
				medical history of the patient, including family and social history with an
				emphasis on substance use disorder and mental health, and must document this
				information in the medical record. The medical record also shall document the
				presence of one or more qualifying medical conditions for the use of smokable
				marijuana and document previous treatments, if any.
(b) Treatment Plan. The written treatment
				plan shall indicate if any further diagnostic evaluations or other treatments
				are planned including other medications and therapies if indicated. After
				treatment begins, the qualified physician shall adjust dosing, if necessary, to
				the individual medical needs of each patient.
(c) Informed consent. The qualified physician
				will discuss and have the patient complete the "Medical Marijuana Consent Form"
				(DH-MQA-5026) set forth in Rule
				64B8-9.018, F.A.C. In addition,
				the qualified physician shall discuss the risks and benefits of the use of
				smokable marijuana including the risk of abuse and addiction, the negative
				health risks associated with smoking marijuana as well as physical dependence
				with the patient, persons designated by the patient, or with the patient's
				surrogate or guardian if the patient is incompetent. The discussion shall also
				include expected benefits, duration, options, and common side effects. Special
				attention must be given to those patients who are at risk of misuse or
				diversion of their medications.
(d)
				Periodic Reviews. A qualified physician must evaluate an existing qualified
				patient at least once every 30 weeks before issuing a new physician
				certification. Based on the circumstances presented, the qualified physician
				shall review the course of treatment and any new information about the etiology
				of the need to utilize smokable marijuana. Continuation or modification of
				therapy shall depend on the qualified physician's evaluation of the patient's
				progress. If treatment goals are not achieved, despite medication adjustments,
				the qualified physician shall reevaluate the patient and determine the
				appropriateness of continued treatment. The qualified physician shall monitor
				patient compliance of marijuana usage and related treatment plans.
(e) Consultation. The qualified physician
				shall refer the patient as necessary for additional evaluation and treatment in
				order to achieve treatment objectives. The management of patients with a
				history of substance abuse or with a comorbid psychiatric disorder requires
				extra care, monitoring, and documentation, and may require consultation with or
				referral to an expert in the management of such patients.
(f) Medical Records. The qualified physician
				is required to keep accurate, legible, and complete records to include, but not
				be limited to:
1. The medical history and a
				physical examination, including history of drug abuse or dependence, if
				indicated;
2. Qualifying medical
				condition or conditions;
3.
				Determination that the medical use of marijuana would likely outweigh the
				potential health risks for the patient; if the patient is younger than 18,
				inclusion of concurrence by second physician;
4. Whether the patient is pregnant;
5. Diagnostic, therapeutic, and laboratory
				results if performed by the qualified physician or received from another
				practitioner;
6. Evaluations and
				consultations if performed by the qualified physician or received from another
				practitioner;
7. Treatment
				objectives;
8. Discussion of risks
				and benefits;
9.
				Treatments;
10. Medications
				(including date, type, dosage, and quantity prescribed);
11. Document that the Prescription Drug
				Monitoring Program database was reviewed;
12. Instructions and agreements;
13. Informed written consent;
14. Drug testing results if
				indicated;
15. Periodic reviews.
				Records must remain current, maintained in an accessible manner, readily
				available for review, and must be in full compliance with Rule
				64B8-9.003, F.A.C., Sections
				381.986,
				456.057, and
				458.331(1)(m),
				F.S.
(g) Compliance with
				Laws and Rules. Qualified physicians shall at all times, remain in compliance
				with this rule and all state laws and regulations addressing the issuance of
				certifications for the medical use of marijuana in a form for
				smoking.