reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-320 - General provisions

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Applicability of requirements for office-based anesthesia.
1. The administration of topical anesthesia,
				  local anesthesia, minor conductive blocks, or minimal sedation/anxiolysis, not
				  involving a drug-induced alteration of consciousness other than minimal
				  preoperative tranquilization, is not subject to the requirements for
				  office-based anesthesia in this part. A health care practitioner administering
				  such agents shall adhere to an accepted standard of care as appropriate to the
				  level of anesthesia or sedation, including evaluation, drug selection,
				  administration, and management of complications.
2. The administration of moderate
				  sedation/conscious sedation, deep sedation, general anesthesia, or regional
				  anesthesia consisting of a major conductive block is subject to these
				  requirements for office-based anesthesia in this part. The administration of
				  300 milligrams or more of lidocaine or equivalent doses of local anesthetics
				  shall be deemed to be subject to these requirements for office-based anesthesia
				  in this part.
3. Levels of
				  anesthesia or sedation referred to in this chapter shall relate to the level of
				  anesthesia or sedation intended and documented by the practitioner in the
				  preoperative anesthesia plan.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-330 - Qualifications of providers

Current through Register Vol. 40, No. 24, July 15, 2024
A. Doctors
				  who utilize office-based anesthesia shall ensure that all medical personnel
				  assisting in providing patient care are appropriately trained, qualified and
				  supervised, are sufficient in numbers to provide adequate care, and maintain
				  training in basic cardiopulmonary resuscitation.
B. All providers of office-based anesthesia
				  shall hold the appropriate license and have the necessary training and skills
				  to deliver the level of anesthesia being provided.
1. Deep sedation, general anesthesia or a
				  major conductive block shall be administered by an anesthesiologist or by a
				  certified registered nurse anesthetist. If a major conductive block is
				  performed for diagnostic or therapeutic purposes, it may be administered by a
				  doctor qualified by training and scope of practice.
2. Moderate sedation/conscious sedation may
				  be administered by the operating doctor with the assistance of and monitoring
				  by a licensed nurse, a physician assistant or a licensed intern or
				  resident.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-340 - Procedure/anesthesia selection and patient evaluation

Current through Register Vol. 40, No. 24, July 15, 2024
A. A written protocol shall be developed and
				  followed for procedure selection to include but not be limited to:
1. The doctor providing or supervising the
				  anesthesia shall ensure that the procedure to be undertaken is within the scope
				  of practice of the health care practitioners and the capabilities of the
				  facility.
2. The procedure or
				  combined procedures shall be of a duration and degree of complexity that shall
				  not exceed four hours and that will permit the patient to recover and be
				  discharged from the facility in less than 24 hours. The procedure or combined
				  procedures may be extended for up to eight hours if the anesthesia is provided
				  by an anesthesiologist or a certified registered nurse anesthetist.
3. The level of anesthesia used shall be
				  appropriate for the patient, the surgical procedure, the clinical setting, the
				  education and training of the personnel, and the equipment available. The
				  choice of specific anesthesia agents and techniques shall focus on providing an
				  anesthetic that will be effective and appropriate and will address the specific
				  needs of patients while also ensuring rapid recovery to normal function with
				  maximum efforts to control post-operative pain, nausea, or other side
				  effects.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-350 - Informed consent

Current through Register Vol. 40, No. 24, July 15, 2024
A. Prior to
				  administration, the anesthesia plan shall be discussed with the patient or
				  responsible party by the health care practitioner administering the anesthesia
				  or supervising the administration of anesthesia. Informed consent for the
				  nature and objectives of the anesthesia planned shall be in writing and
				  obtained from the patient or responsible party before the procedure is
				  performed. Such consent shall include a discussion of discharge planning and
				  what care or assistance the patient is expected to require after discharge.
				  Informed consent shall only be obtained after a discussion of the risks,
				  benefits, and alternatives, contain the name of the anesthesia provider, and be
				  documented in the medical record.
B. The surgical consent forms shall be
				  executed by the patient or the responsible party and shall contain a statement
				  that the doctor performing the surgery is board certified or board eligible by
				  one of the American Board of Medical Specialties boards, the Bureau of
				  Osteopathic Specialists of the American Osteopathic Association, the American
				  Board of Podiatric Medicine, or the American Board of Foot and Ankle Surgery.
				  The forms shall either list which board or contain a statement that doctor
				  performing the surgery is not board certified or board eligible.
C. The surgical consent forms shall indicate
				  whether the surgery is elective or medically necessary. If a consent is
				  obtained in an emergency, the surgical consent form shall indicate the nature
				  of the emergency.
Statutory Authority: §
												54.1-2400
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-360 - Monitoring

Current through Register Vol. 40, No. 24, July 15, 2024
A. A written
				  protocol shall be developed for monitoring equipment to include but not be
				  limited to:
1. Monitoring equipment shall be
				  appropriate for the type of anesthesia and the nature of the facility. At a
				  minimum, provisions shall be made for a reliable source of oxygen, suction,
				  resuscitation equipment and emergency drugs.
2. In locations where anesthesia is
				  administered, there shall be adequate anesthesia apparatus and equipment to
				  ensure appropriate monitoring of patients. All equipment shall be maintained,
				  tested and inspected according to manufacturer's specifications, and backup
				  power shall be sufficient to ensure patient protection in the event of an
				  emergency.
3. When anesthesia
				  services are provided to infants and children, the required equipment,
				  medication and resuscitative capabilities shall be appropriately sized and
				  calibrated for children.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-370 - Emergency and transfer protocols

Current through Register Vol. 40, No. 24, July 15, 2024
A. There shall be written protocols for
				  handling emergency situations, including medical emergencies and internal and
				  external disasters. All personnel shall be appropriately trained in and
				  regularly review the protocols and the equipment and procedures for handling
				  emergencies.
B. There shall be
				  written protocols for the timely and safe transfer of patients to a
				  prespecified hospital or hospitals within a reasonable proximity. For purposes
				  of this section, "reasonable proximity" shall mean that a licensed general
				  hospital capable of providing necessary services is normally accessible within
				  30 minutes of the office. There shall be a written or electronic transfer
				  agreement with such hospital or hospitals.
Statutory Authority: §§ 54.1-2400 and
						54.1-2912.1 of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-380 - Discharge policies and procedures

Current through Register Vol. 40, No. 24, July 15, 2024
A. There shall be written policies and
				  procedures outlining discharge criteria. Such criteria shall include stable
				  vital signs, responsiveness and orientation, ability to move voluntarily,
				  controlled pain, and minimal nausea and vomiting.
B. Discharge from anesthesia care is the
				  responsibility of the health care practitioner providing or the doctor
				  supervising the anesthesia care and shall only occur when:
1. The patient has met specific
				  physician-defined criteria; and
2.
				  The health care practitioner providing or the doctor supervising the anesthetic
				  care has given the order for discharge.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part VIII - Office-Based Anesthesia › Section 18VAC85-20-390 - Reporting requirements

Current through Register Vol. 40, No. 24, July 15, 2024
The doctor administering the anesthesia or supervising
					 such administration shall report to the board within 30 days any incident
					 relating to the administration of anesthesia that results in patient death,
					 either intraoperatively or within the immediate 72-hour postoperative period or
					 in transport of a patient to a hospital for a stay of more than 24
					 hours.
Statutory Authority
§§ 54.1-2400 and 54.1-2912.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part IX - Mixing, Diluting, or Reconstituting of Drugs for Administration › Section 18VAC85-20-410 - Requirements for low-risk, medium-risk, or high-risk sterile mixing, diluting, or reconstituting

Current through Register Vol. 40, No. 24, July 15, 2024
A. Any
				  mixing, diluting, or reconstituting of sterile products that does not meet the
				  criteria for immediate-use as set forth in
				  18VAC85-20-400
				  A shall be defined as low-risk, medium-risk, or high-risk compounding under the
				  definitions of Chapter 797 of the U.S. Pharmacopeia (USP).
B. Doctors of medicine or osteopathic
				  medicine who engage in low-risk, medium-risk, or high-risk mixing, diluting, or
				  reconstituting of sterile products shall comply with all applicable
				  requirements of the USP Chapter 797. Subsequent changes to the USP Chapter 797
				  shall apply within one year of the official announcement by USP.
C. A current copy, in any published format,
				  of USP Chapter 797 shall be maintained at the location where low-risk,
				  medium-risk, or high-risk mixing, diluting, or reconstituting of sterile
				  products is performed.
Statutory Authority: §
												54.1-2400
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Part IX - Mixing, Diluting, or Reconstituting of Drugs for Administration › Section 18VAC85-20-420 - Responsibilities of doctors who mix, dilute or reconstitute drugs in their practices

Current through Register Vol. 40, No. 24, July 15, 2024
A. Doctors
				  of medicine or osteopathic medicine who delegate the mixing, diluting or
				  reconstituting of sterile drug products for administration retain
				  responsibility for patient care and shall monitor and document any adverse
				  responses to the drugs.
B. Doctors
				  who engage in the mixing, diluting or reconstituting of sterile drug products
				  in their practices shall disclose this information to the board in a manner
				  prescribed by the board and are subject to unannounced inspections by the board
				  or its agents.
Statutory Authority
§ 54.1-2400 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Form - FORMS (18VAC85-20)

Current through Register Vol. 40, No. 24, July 15, 2024
Instructions
				  for Completing an Application to Practice Medicine in Virginia for Graduates of
				  Allopathic Medical Schools and Osteopathic Medical Schools (rev.
				  12/2017)
Instructions
				  for Completing an Application to Practice Chiropractic in Virginia (rev.
				  12/2017)
Instructions
				  for Completing an Application for Licensure by Endorsement (rev.
				  8/2020)
Instructions
				  for Completing Podiatric Medicine Application (rev. 12/2017)
Form
				  A, Intern/Resident, Memorandum from Associate Dean of Graduate Medical
				  Education or Program Director (rev. 8/2007)
Form
				  B, Intern/Resident Certificate of Professional Education (rev.
				  8/2007)
Form
				  G, Intern Resident, Request for Status Report of ECFMG Certification (eff.
				  8/2007)
Intern/Resident,
				  Transfer Request (rev. 6/2016)
Instructions
				  for Completing an Application for a Limited License to Foreign Medical
				  Graduates Pursuant to § 54.1-2936 (rev. 8/2007)
Application
				  for a Limited License to Foreign Medical Graduates Pursuant to 54.1-2936 (rev.
				  8/2007)
Form
				  A, MD Reinstatement, Claims History Sheet (rev. 9/2009)
MD/DO
				  Reinstatement Instructions and Application for MD and DO licenses in EXPIRED
				  status for more than two years ONLY (rev. 8/2020)
Instructions
				  for Reinstatement of a Chiropractic Licensure Application (rev.
				  4/2018)
Application
				  for Registration for Volunteer Practice (rev. 8/2015)
Sponsor
				  Certification for Volunteer Registration (rev. 3/2018)
Application
				  for Restricted Volunteer License (rev. 12/2007)
License
				  Verification Request (rev. 2/2024)
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 20 - REGULATIONS GOVERNING THE PRACTICE OF MEDICINE, OSTEOPATHIC MEDICINE, PODIATRY, AND CHIROPRACTIC › Section (18VAC85-20) - DOCUMENTS INCORPORATED BY REFERENCE

Current through Register Vol. 40, No. 24, July 15, 2024
Preventing
				  Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health
				  Care Settings (NIOSH Publication No. 2004-165), Appendix A (Drugs Considered
				  Hazardous), National Institute of Occupational Safety and
				  Health.
USP Chapter 797, United States Pharmacopeial
				  Convention.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part I - General Provisions › Section 18VAC85-21-10 - Applicability

Current through Register Vol. 40, No. 24, July 15, 2024
A. This chapter
				  shall apply to doctors of medicine, osteopathic medicine, and podiatry and to
				  physician assistants.
B. This
				  chapter shall not apply to:
1. The treatment
				  of acute or chronic pain related to (i) cancer, (ii) [ sickle cell, (iii) ] a
				  patient in hospice care, or (iv) a patient in palliative care;
2. The treatment of acute or chronic pain
				  during an inpatient hospital admission or in a nursing home or an assisted
				  living facility that uses a sole source pharmacy; or
3. A patient enrolled in a clinical trial as
				  authorized by state or federal law.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part I - General Provisions › Section 18VAC85-21-20 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
					 shall have the following meanings unless the context clearly indicates
					 otherwise:
"Acute pain" means pain that occurs within the normal
					 course of a disease or condition or as the result of surgery for which
					 controlled substances may be prescribed for no more than three months.
"Board" means the Virginia Board of Medicine.
"Chronic pain" means nonmalignant pain that goes beyond the
					 normal course of a disease or condition for which controlled substances may be
					 prescribed for a period greater than three months.
"Controlled substance" means drugs listed in The Drug
					 Control Act (§
										54.1-3400 et seq. of the
					 Code of Virginia) in Schedules II through IV.
"FDA" means the U.S. Food and Drug Administration.
"MME" means morphine milligram equivalent.
"Prescription Monitoring Program" means the electronic
					 system within the Department of Health Professions that monitors the dispensing
					 of certain controlled substances.
"SAMHSA" means the federal Substance Abuse and Mental
					 Health Services Administration.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part II - Management of Acute Pain › Section 18VAC85-21-21 - Electronic prescribing

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Beginning July 1, 2020, a prescription for a controlled substance that contains
				  an opioid shall be issued as an electronic prescription consistent with §
										54.1-3408.02
				  of the Code of Virginia, unless the prescription qualifies for an exemption as
				  set forth in subsection C of §
										54.1-3408.02.
B. Upon written request, the board
				  may grant a one-time waiver of the requirement of subsection A of this section
				  for a period not to exceed one year due to demonstrated economic hardship,
				  technological limitations that are not reasonably within the control of the
				  prescriber, or other exceptional circumstances demonstrated by the
				  prescriber.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part II - Management of Acute Pain › Section 18VAC85-21-30 - Evaluation of the acute pain patient

Current through Register Vol. 40, No. 24, July 15, 2024
A. Nonpharmacologic and non-opioid treatment
				  for pain shall be given consideration prior to treatment with opioids. If an
				  opioid is considered necessary for the treatment of acute pain, the
				  practitioner shall give a short-acting opioid in the lowest effective dose for
				  the fewest possible days.
B. Prior
				  to initiating treatment with a controlled substance containing an opioid for a
				  complaint of acute pain, the prescriber shall perform a history and physical
				  examination appropriate to the complaint, query the Prescription Monitoring
				  Program as set forth in §
										54.1-2522.1
				  of the Code of Virginia, and conduct an assessment of the patient's history and
				  risk of substance misuse.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part II - Management of Acute Pain › Section 18VAC85-21-40 - Treatment of acute pain with opioids

Current through Register Vol. 40, No. 24, July 15, 2024
A. Initiation of opioid treatment for
				  patients with acute pain shall be with short-acting opioids
.
1. A prescriber providing treatment for acute
				  pain shall not prescribe a controlled substance containing an opioid in a
				  quantity that exceeds a seven-day supply as determined by the manufacturer's
				  directions for use, unless extenuating circumstances are clearly documented in
				  the medical record. This shall also apply to prescriptions of a controlled
				  substance containing an opioid upon discharge from an emergency
				  department.
2. An opioid prescribed
				  as part of treatment for a surgical procedure shall be for no more than 14
				  consecutive days in accordance with manufacturer's direction and within the
				  immediate perioperative period, unless extenuating circumstances are clearly
				  documented in the medical record.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part II - Management of Acute Pain › Section 18VAC85-21-50 - Medical records for acute pain

Current through Register Vol. 40, No. 24, July 15, 2024
The medical record shall include a description of the pain,
					 a presumptive diagnosis for the origin of the pain, an examination appropriate
					 to the complaint, a treatment plan, and the medication prescribed or
					 administered to include the date, type, dosage, and quantity prescribed or
					 administered.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-60 - Evaluation of the chronic pain patient

Current through Register Vol. 40, No. 24, July 15, 2024
A. Prior to initiating management of chronic
				  pain with a controlled substance containing an opioid, a medical history and
				  physical examination, to include a mental status examination, shall be
				  performed and documented in the medical record, including:
1. The nature and intensity of the
				  pain;
2. Current and past
				  treatments for pain;
3. Underlying
				  or coexisting diseases or conditions;
4. The effect of the pain on physical and
				  psychological function, quality of life, and activities of daily
				  living;
5. Psychiatric, addiction,
				  and substance misuse history of the patient and any family history of addiction
				  or substance misuse;
6. A urine
				  drug screen or serum medication level;
7. A query of the Prescription Monitoring
				  Program as set forth in §
											54.1-2522.1
				  of the Code of Virginia;
8. An
				  assessment of the patient's history and risk of substance misuse; and
9. A request for prior applicable
				  records.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-70 - Treatment of chronic pain with opioids

Current through Register Vol. 40, No. 24, July 15, 2024
A. Nonpharmacologic and non-opioid treatment
				  for pain shall be given consideration prior to treatment with
				  opioids.
B. In initiating and
				  treating with an opioid, the practitioner shall:
1. Carefully consider and document in the
				  medical record the reasons to exceed 50 MME/day;
2. Prior to exceeding 120 MME/day, the
				  practitioner shall document in the medical record the reasonable justification
				  for such doses or refer to or consult with a pain management
				  specialist;
3. Prescribe naloxone
				  for any patient when risk factors of prior overdose, substance misuse, doses in
				  excess of 120 MME/day, or concomitant benzodiazepine are present; and
4. Document the rationale to continue opioid
				  therapy every three months.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-80 - Treatment plan for chronic pain

Current through Register Vol. 40, No. 24, July 15, 2024
A. The medical record shall include a
				  treatment plan that states measures to be used to determine progress in
				  treatment, including pain relief and improved physical and psychosocial
				  function, quality of life, and daily activities.
B. The treatment plan shall include further
				  diagnostic evaluations and other treatment modalities or rehabilitation that
				  may be necessary depending on the etiology of the pain and the extent to which
				  the pain is associated with physical and psychosocial impairment.
C. The prescriber shall document in the
				  medical record the presence or absence of any indicators for medication misuse
				  or diversion and shall take appropriate action.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-90 - Informed consent and agreement for treatment for chronic pain

Current through Register Vol. 40, No. 24, July 15, 2024
A. The practitioner
				  shall document in the medical record informed consent, to include risks,
				  benefits, and alternative approaches, prior to the initiation of opioids for
				  chronic pain.
B. There shall be a
				  written treatment agreement signed by the patient in the medical record that
				  addresses the parameters of treatment, including those behaviors that will
				  result in referral to a higher level of care, cessation of treatment, or
				  dismissal from care.
C. The
				  treatment agreement shall include notice that the practitioner will query and
				  receive reports from the Prescription Monitoring Program and permission for the
				  practitioner to:
1. Obtain urine drug screens
				  or serum medication levels when requested; and
2. Consult with other prescribers or
				  dispensing pharmacists for the patient.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-100 - Opioid therapy for chronic pain

Current through Register Vol. 40, No. 24, July 15, 2024
A. The practitioner shall review the course
				  of pain treatment and any new information about the etiology of the pain and
				  the patient's state of health at least every three months.
B. Continuation of treatment with opioids
				  shall be supported by documentation of continued benefit from such prescribing.
				  If the patient's progress is unsatisfactory, the practitioner shall assess the
				  appropriateness of continued use of the current treatment plan and consider the
				  use of other therapeutic modalities.
C. The practitioner shall check the
				  Prescription Monitoring Program at least every three months after the
				  initiation of treatment.
D. The
				  practitioner shall order and review a urine drug screen or serum medication
				  levels at the initiation of chronic pain management and [ thereafter randomly
				  at the discretion of the practitioner but ] at least [ once a year ].
E. The practitioner (i) shall regularly
				  evaluate the patient for opioid use disorder and (ii) shall initiate specific
				  treatment for opioid use disorder, consult with an appropriate health care
				  provider, or refer the patient for evaluation for treatment if
				  indicated.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-110 - Additional consultations

Current through Register Vol. 40, No. 24, July 15, 2024
A. When
				  necessary to achieve treatment goals, the prescriber shall refer the patient
				  for additional evaluation and treatment.
B. When a prescriber makes the diagnosis of
				  opioid use disorder, treatment for opioid use disorder shall be initiated or
				  the patient shall be referred for evaluation and treatment.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part III - Management of Chronic Pain › Section 18VAC85-21-120 - Medical records for chronic pain

Current through Register Vol. 40, No. 24, July 15, 2024
The prescriber shall keep current, accurate, and complete
					 records in an accessible manner readily available for review to include:
1. The medical history and physical
				  examination;
2. Past medical
				  history;
3. Applicable records from
				  prior treatment providers or any documentation of attempts to obtain those
				  records;
4. Diagnostic,
				  therapeutic, and laboratory results;
5. Evaluations and consultations;
6. Treatment goals;
7. Discussion of risks and
				  benefits;
8. Informed consent and
				  agreement for treatment;
9.
				  Treatments;
10. Medications
				  (including date, type, dosage, and quantity prescribed and refills);
11. Patient instructions; and
12. Periodic reviews.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part IV - Prescribing of Buprenorphine for Addiction Treatment › Section 18VAC85-21-130 - General provisions pertaining to prescribing of buprenorphine for addiction treatment

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Practitioners engaged in office-based opioid addiction treatment with
				  buprenorphine shall have obtained a SAMHSA waiver and the appropriate U.S. Drug
				  Enforcement Administration registration.
B. Practitioners shall abide by all federal
				  and state laws and regulations governing the prescribing of buprenorphine for
				  the treatment of opioid use disorder.
C. Physician assistants and nurse
				  practitioners who have obtained a SAMHSA waiver shall only prescribe
				  buprenorphine for opioid addiction pursuant to a practice agreement with a
				  waivered doctor of medicine or doctor of osteopathic medicine.
D. Practitioners engaged in
				  medication-assisted treatment shall either provide counseling in their practice
				  or refer the patient to a mental health service provider, as defined in §
										54.1-2400.1
				  of the Code of Virginia, who has the education and experience to provide
				  substance misuse counseling. The practitioner shall document provision of
				  counseling or referral in the medical record.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part IV - Prescribing of Buprenorphine for Addiction Treatment › Section 18VAC85-21-140 - Patient assessment and treatment planning for addiction treatment

Current through Register Vol. 40, No. 24, July 15, 2024
A. A practitioner
				  shall perform and document an assessment that includes a comprehensive medical
				  and psychiatric history, substance misuse history, family history and
				  psychosocial supports, appropriate physical examination, urine drug screen,
				  pregnancy test for women of childbearing age and ability, a check of the
				  Prescription Monitoring Program, and, when clinically indicated, infectious
				  disease testing for human immunodeficiency virus, hepatitis B, hepatitis C, and
				  tuberculosis.
B. The treatment plan
				  shall include the practitioner's rationale for selecting medication-assisted
				  treatment, patient education, written informed consent, how counseling will be
				  accomplished, and a signed treatment agreement that outlines the
				  responsibilities of the patient and the prescriber.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part IV - Prescribing of Buprenorphine for Addiction Treatment › Section 18VAC85-21-150 - Treatment with buprenorphine for addiction

Current through Register Vol. 40, No. 24, July 15, 2024
A. Buprenorphine without naloxone
				  (buprenorphine mono-product) shall not be prescribed except:
1. When a patient is pregnant;
2. When converting a patient from methadone
				  or buprenorphine mono-product to buprenorphine containing naloxone for a period
				  not to exceed seven days;
3. In
				  formulations other than tablet form for indications approved by the FDA;
				  or
4. For patients who have a
				  demonstrated intolerance to naloxone; such prescriptions for the mono-product
				  shall not exceed 3.0% of the total prescriptions for buprenorphine written by
				  the prescriber, and the exception shall be clearly documented in the patient's
				  medical record.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part IV - Prescribing of Buprenorphine for Addiction Treatment › Section 18VAC85-21-160 - Special populations in addiction treatment

Current through Register Vol. 40, No. 24, July 15, 2024
A. Pregnant women may be treated with the
				  buprenorphine mono-product, usually 16 milligrams per day or less.
B. Patients younger than the age of 16 years
				  shall not be prescribed buprenorphine for addiction treatment unless such
				  treatment is approved by the FDA.
C. The progress of patients with chronic pain
				  shall be assessed by reduction of pain and functional objectives that can be
				  identified, quantified, and independently verified.
D. Practitioners shall (i) evaluate patients
				  with medical comorbidities by history, physical exam, [ and ] appropriate
				  laboratory studies and (ii) be aware of interactions of buprenorphine with
				  other prescribed medications.
E.
				  Practitioners shall not undertake buprenorphine treatment with a patient who
				  has psychiatric comorbidities and is not stable. A patient who is determined by
				  the prescriber to be psychiatrically unstable shall be referred for psychiatric
				  evaluation and treatment prior to initiating medication-assisted
				  treatment.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 21 - REGULATIONS GOVERNING PRESCRIBING OF OPIOIDS AND BUPRENORPHINE › Part IV - Prescribing of Buprenorphine for Addiction Treatment › Section 18VAC85-21-170 - Medical records for opioid addiction treatment

Current through Register Vol. 40, No. 24, July 15, 2024
A. Records shall be timely, accurate,
				  legible, complete, and readily accessible for review.
B. The treatment agreement and informed
				  consent shall be maintained in the medical record.
C. Confidentiality requirements of 42 CFR
				  Part 2 shall be followed.
D.
				  Compliance with
				  18VAC85-20-27,
				  which prohibits willful or negligent breach of confidentiality or unauthorized
				  disclosure of confidential Prescription Monitoring Program information, shall
				  be maintained.
Statutory Authority: §§
												54.1-2400
						and
						54.1-2928.2
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part I - General Provisions › Section 18VAC85-40-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
A. The following
				  words and terms when used in this chapter shall have the meanings ascribed to
				  them in § 54.1-2900 of the Code of Virginia:
Board
Qualified medical direction
B. The following words and terms when used in
				  this chapter shall have the following meanings unless the context clearly
				  indicates otherwise:
"AARC" means the American Association for Respiratory
					 Care.
"Accredited educational program" means a program
					 accredited by the Commission on Accreditation for Respiratory Care or any other
					 agency approved by the NBRC for its entry level certification
					 examination.
"Active practice" means a minimum of 160 hours of
					 professional practice as a respiratory therapist within the 24-month period
					 immediately preceding renewal or application for licensure if previously
					 licensed or certified in another jurisdiction. The active practice of
					 respiratory care may include supervisory, administrative, educational or
					 consultative activities or responsibilities for the delivery of such
					 services.
"Advisory board" means the Advisory Board on Respiratory
					 Care to the Board of Medicine as specified in § 54.1-2956 of the Code of
					 Virginia.
"NBRC" means the National Board for Respiratory Care,
					 Inc.
"Respiratory therapist" means a person as specified in
					 § 54.1-2954 of the Code of Virginia.
Statutory Authority: §§
												54.1-2400 and
						54.1-2912.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part I - General Provisions › Section 18VAC85-40-20 - Public participation

Current through Register Vol. 40, No. 24, July 15, 2024
A separate board regulation,
					 18VAC85-10-10 et seq., provides
					 for involvement of the public in the development of all regulations of the
					 Virginia Board of Medicine.
Statutory Authority
§§ 54.1-2400, 54.1-2900 and 54.1-2954 through
						54.1-2956.1 of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part I - General Provisions › Section 18VAC85-40-25 - Current name and address

Current through Register Vol. 40, No. 24, July 15, 2024
Each licensee shall furnish the board his current name and
					 address of record. All notices required by law or by this chapter to be given
					 by the board to any such licensee shall be validly given when sent to the
					 latest address of record provided or served to the licensee. Any change of name
					 or change in the address of record or public address, if different from the
					 address of record, shall be furnished to the board within 30 days of such
					 change.
Statutory Authority: §
												54.1-2400
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part I - General Provisions › Section 18VAC85-40-30 - Violations

Current through Register Vol. 40, No. 24, July 15, 2024
Any violation of Chapter 29 of Title 54.1 of the Code of
					 Virginia shall be subject to the statutory sanctions as set forth in the
					 Act.
Statutory Authority
§§ 54.1-2400, 54.1-2954, 54.1-2954.1,
						54.1-2955 and 54.1-2956 of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part I - General Provisions › Section 18VAC85-40-35 - Fees

Current through Register Vol. 40, No. 24, July 15, 2024
The following fees are required:
1. The application fee, payable at the time
				  the application is filed, shall be $130.
2. The biennial fee for renewal of active
				  licensure shall be $135 and for renewal of inactive licensure shall be $70,
				  payable in each odd-numbered year in the license holder's birth month. For
				  2021, the fee for renewal of an active license shall be $108, and the fee for
				  renewal of an inactive license shall be $54.
3. The additional fee for late renewal of
				  licensure within one renewal cycle shall be $50.
4. The fee for reinstatement of a license
				  issued by the Board of Medicine pursuant to §
										54.1-2904
				  of the Code of Virginia, which has lapsed for a period of two years or more,
				  shall be $180 and must be submitted with an application for licensure
				  reinstatement.
5. The fee for
				  reinstatement of a license pursuant to §
										54.1-2408.2
				  of the Code of Virginia shall be $2,000.
6. The fee for a duplicate license shall be
				  $5.00, and the fee for a duplicate wall certificate shall be $15.
7. The handling fee for a returned check or a
				  dishonored credit card or debit card shall be $50.
8. The fee for a letter of good standing or
				  verification to another jurisdiction shall be $10. The fee for certification of
				  grades to another jurisdiction shall be $25.
9. The fee for an application or for the
				  biennial renewal of a restricted volunteer license shall be $35, due in the
				  licensee's birth month. An additional fee for late renewal of licensure shall
				  be $15 for each renewal cycle.
Statutory Authority: §
												54.1-2400
						of the Code of Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part II - Requirements for Licensure as a Respiratory Therapist › Section 18VAC85-40-40 - Licensure requirements

Current through Register Vol. 40, No. 24, July 15, 2024
An applicant for licensure shall submit the following on
					 forms provided by the board:
1. A
				  completed application and a fee as prescribed in
				  18VAC85-40-35.
2. Verification of professional education in
				  respiratory care as required in
				  18VAC85-40-45.
3. Verification of practice as required on
				  the application form.
4. Evidence
				  of passage of the national examination as required in
				  18VAC85-40-50.
5. If licensed or certified in any other
				  jurisdiction, documentation of active practice as a respiratory therapist or
				  documentation of 20 hours of continuing education within the 24-month period
				  immediately preceding application and verification that there has been no
				  disciplinary action taken or pending in that jurisdiction.
Statutory Authority: §§
												54.1-2400 and
						54.1-2912.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part II - Requirements for Licensure as a Respiratory Therapist › Section 18VAC85-40-45 - Educational requirements

Current through Register Vol. 40, No. 24, July 15, 2024
An applicant for licensure shall:
1. Be a graduate of an accredited educational
				  program for respiratory therapists; or
2. Hold current credentialing as a Certified
				  Respiratory Therapist (CRT) or a Registered Respiratory Therapist (RRT) from
				  the NBRC or any other credentialing body determined by the board to be
				  equivalent.
Statutory Authority: §§
												54.1-2400 and
						54.1-2912.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part II - Requirements for Licensure as a Respiratory Therapist › Section 18VAC85-40-50 - Examination requirements

Current through Register Vol. 40, No. 24, July 15, 2024
An applicant for a license to practice as a licensed
					 respiratory therapist shall submit to the board evidence that the applicant has
					 passed the NBRC entry level examination for respiratory care, or its equivalent
					 as approved by the board.
Statutory Authority: §§
												54.1-2400 and
						54.1-2912.1 of the Code of
						Virginia.
Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 85 - BOARD OF MEDICINE › Chapter 40 - REGULATIONS GOVERNING THE PRACTICE OF RESPIRATORY THERAPISTS › Part II - Requirements for Licensure as a Respiratory Therapist › Section 18VAC85-40-55 - Registration for voluntary practice by out-of-state licensees

Current through Register Vol. 40, No. 24, July 15, 2024
Any respiratory therapist who does not hold a license to
					 practice in Virginia and who seeks registration to practice under subdivision
					 27 of §
										54.1-2901 of the Code of
					 Virginia on a voluntary basis under the auspices of a publicly supported, all
					 volunteer, nonprofit organization that sponsors the provision of health care to
					 populations of underserved people shall:
1. File a complete application for
				  registration on a form provided by the board at least five business days prior
				  to engaging in such practice. An incomplete application will not be
				  considered;
2. Provide a complete
				  record of professional licensure in each state in which he has held a license
				  and a copy of any current license;
3. Provide the name of the nonprofit
				  organization, the dates and location of the voluntary provision of
				  services;
4. Pay a registration fee
				  of $10; and
5. Provide a notarized
				  statement from a representative of the nonprofit organization attesting to its
				  compliance with provisions of subdivision 27 of § 54.1-2901 of the Code of
				  Virginia.
Statutory Authority: §§
												54.1-2400 and
						54.1-2912.1 of the Code of
						Virginia.