reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OFFICE-BASED SURGERY RULES › Section 246-919-602 - Administration of deep sedation and general anesthesia by physicians in dental offices

Current through Register Vol. 24-14, July 15, 2024
(1) Purpose. The
				  purpose of this section is to govern the administration of deep sedation and
				  general anesthesia by physicians in dental offices. The commission establishes
				  these standards to promote effective perioperative communication and
				  appropriately timed interventions, and mitigate adverse events and
				  outcomes.
(2) Definitions. The
				  definitions in this subsection apply throughout this section unless the context
				  clearly requires otherwise.
(a)
				  "Administering physician" means an individual licensed under chapter 18.71 RCW
				  who administers deep sedation or general anesthesia to a patient in a dental
				  office.
(b) "Deep sedation" has the
				  same meaning as in WAC
				  246-919-601.
(c) "Dental office" means any facility where
				  dentistry is practiced, as defined in chapter 18.32 RCW, except a hospital
				  licensed under chapter 70.41 RCW or ambulatory surgical facility licensed under
				  chapter 70.230 RCW.
(d) "General
				  anesthesia" has the same meaning as in WAC
				  246-919-601.
(e) "Perioperative" includes the three phases
				  of surgery: Preoperative, intraoperative, and postoperative.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-605 - Use of laser, light, radiofrequency, and plasma devices as applied to the skin

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				  purposes of this rule, laser, light, radiofrequency, and plasma devices
				  (hereafter LLRP devices) are medical devices that:
(a) Use a laser, noncoherent light, intense
				  pulsed light, radiofrequency, or plasma to topically penetrate skin and alter
				  human tissue; and
(b) Are
				  classified by the federal Food and Drug Administration as prescription
				  devices.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-606 - Nonsurgical medical cosmetic procedures

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of this rule is to establish
				  the duties and responsibilities of a physician who delegates the injection of
				  medication or substances for cosmetic purposes or the use of prescription
				  devices for cosmetic purposes. These procedures can result in complications
				  such as visual impairment, blindness, inflammation, burns, scarring,
				  disfiguration, hypopigmentation and hyperpigmentation. The performance of these
				  procedures is the practice of medicine under
				  RCW
				  18.71.011(3).
(2) This rule does not apply to:
(a) Surgery;
(b) The use of prescription lasers,
				  noncoherent light, intense pulsed light, radiofrequency, or plasma as applied
				  to the skin; this is covered in WAC
				  246-919-605
				  and
				  246-918-125;
(c) The practice of a profession by a
				  licensed health care professional under methods or means within the scope of
				  practice permitted by such license;
(d) The use of nonprescription devices;
				  and
(e) Intravenous
				  therapy.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-610 - Use of drugs or autotransfusion to enhance athletic ability

Current through Register Vol. 24-14, July 15, 2024
(1) A physician
				  shall not prescribe, administer or dispense anabolic steroids, growth hormones,
				  testosterone or its analogs, human chorionic gonadotropin (HCG), other
				  hormones, or any form of autotransfusion for the purpose of enhancing athletic
				  ability.
(2) A physician shall
				  complete and maintain patient medical records which accurately reflect the
				  prescribing, administering or dispensing of any substance or drug described in
				  this rule or any form of autotransfusion. Patient medical records must indicate
				  the diagnosis and purpose for which the substance, drug, or autotransfusion is
				  prescribed, administered or dispensed and any additional information upon which
				  the diagnosis is based.
(3) A
				  violation of any provision of this rule constitutes grounds for disciplinary
				  action under
				  RCW
				  18.130.180(7). A violation
				  of subsection (1) of this section constitutes grounds for disciplinary action
				  under
				  RCW
				  18.130.180(6).
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-610, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-620 - Cooperation with investigation

Current through Register Vol. 24-14, July 15, 2024
(1)
				  A physician must comply with a request, under
				  RCW
				  70.02.050, for health care records or
				  documents from an investigator who is acting on behalf of the disciplining
				  authority under
				  RCW
				  18.130.050(2).
(a) The physician shall submit the requested
				  items within twenty-one calendar days of receipt of the request by the
				  physician or the physician's attorney, whichever is first. If the physician
				  fails to comply with the request within twenty-one calendar days, the
				  investigator shall contact the physician or the physician's attorney by letter
				  as a reminder.
(b) Investigators
				  may extend the time for response if the physician requests an extension for
				  good cause for a period not to exceed thirty calendar days. Other requests for
				  extension may be granted by the commission chair or the commission's executive
				  director.
(c) If the physician
				  fails to comply with the request within three business days after the receipt
				  of the written reminder, a statement of charges may be issued under
				  RCW
				  18.130.180(8) and, if there
				  is sufficient evidence to support additional charges, those charges may be
				  included in the statement of charges.
(d) In negotiating a settlement on a
				  statement of charges based on
				  RCW
				  18.130.180(8), the
				  commission may take into consideration whether the physician has complied with
				  the request after the statement of charges has been issued.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-630 - Sexual misconduct

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  definitions in this subsection apply throughout this section unless the context
				  clearly requires otherwise.
(a) "Patient"
				  means a person who is receiving health care or treatment, or has received
				  health care or treatment without a termination of the physician-patient
				  relationship. The determination of when a person is a patient is made on a
				  case-by-case basis with consideration given to a number of factors, including
				  the nature, extent and context of the professional relationship between the
				  physician and the person. The fact that a person is not actively receiving
				  treatment or professional services is not the sole determining
				  factor.
(b) "Key third party" means
				  a person in a close personal relationship with the patient and includes, but is
				  not limited to, spouses, partners, parents, siblings, children, and guardians
				  or proxies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › STANDARDS FOR PROFESSIONAL CONDUCT › Section 246-919-640 - Abuse

Current through Register Vol. 24-14, July 15, 2024
(1) A physician
				  commits unprofessional conduct if the physician abuses a patient. A physician
				  abuses a patient when he or she:
(a) Makes
				  statements regarding the patient's body, appearance, sexual history, or sexual
				  orientation that have no legitimate medical or therapeutic purpose;
(b) Removes a patient's clothing or gown
				  without consent;
(c) Fails to treat
				  an unconscious or deceased patient's body or property respectfully;
				  or
(d) Engages in any conduct,
				  whether verbal or physical, which unreasonably demeans, humiliates,
				  embarrasses, threatens, or harms a patient.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-700 - Mandatory reporting

Current through Register Vol. 24-14, July 15, 2024
The commission adopts the rules for mandatory reporting in
					 chapter 246-16 WAC.
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-700, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-710 - Mandatory reporting requirement satisfied (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-710, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-730 - Medical associations or societies (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-730, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-740 - Health care service contractors and disability insurance carriers (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-740, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-750 - Courts (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-750, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-760 - State and federal agencies (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-760, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › MANDATORY REPORTING › Section 246-919-770 - Professional standards review organizations (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.017 and
						18.71A.020. 96-03-073, §
						246-919-770, filed 1/17/96, effective
						2/17/96.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-851 - Exclusions

Current through Register Vol. 24-14, July 15, 2024
WAC
					 246-919-850
					 through
					 246-919-985
					 do not apply to:
(1) The treatment of
				  patients with cancer-related pain;
(2) The provision of palliative, hospice, or
				  other end-of-life care;
(3) The
				  provision of procedural medications;
(4) The treatment of patients who have been
				  admitted to any of the following facilities for more than 24 hours:
(a) A cute care hospitals licensed under
				  chapter 70.41 RCW;
(b) Psychiatric
				  hospitals licensed under chapter 71.12 RCW;
(c) Nursing homes licensed under chapter
				  18.51 RCW and nursing facilities as defined in WAC
				  388-97-0001;
(d) Long-term acute care hospitals as defined
				  in
				  RCW
				  74.60.010; or
(e) Residential treatment facilities as
				  defined in
				  RCW
				  71.12.455; or
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-853

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-853, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-854

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-854, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-855

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-855, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-856

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-856, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-857

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-857, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-858

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-858, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-859

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-859, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-860

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-860, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-861

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-861, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-862

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-862, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-863

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-919-863, filed 5/24/11, effective
						1/2/12.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-865 - Patient notification, secure storage, and disposal

Current through Register Vol. 24-14, July 15, 2024
(1) The physician shall discuss with the
				  patient the following information at the first issuance of a prescription for
				  opioids and at the transition from acute to subacute, and subacute to chronic:
(a) Risks associated with the use of opioids,
				  including the risk of dependence and overdose, as appropriate to the medical
				  condition, the type of patient, and the phase of treatment;
(b) Pain management alternatives to opioids,
				  including nonopioid pharmacological and nonpharmacological treatments, whenever
				  reasonable, clinically appropriate, evidence-based alternatives
				  exist;
(c) The safe and secure
				  storage of opioid prescriptions;
(d) The proper disposal of unused opioid
				  medications including, but not limited to, the availability of recognized drug
				  take-back programs; and
(e) That
				  the patient has the right to refuse an opioid prescription or order for any
				  reason. If a patient indicates a desire to not receive an opioid, the physician
				  must document the patient's request and avoid prescribing or ordering opioids,
				  unless the request is revoked by the patient.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-870 - Use of alternative modalities for pain treatment

Current through Register Vol. 24-14, July 15, 2024
The physician shall exercise their professional judgment
					 in selecting appropriate treatment modalities for acute nonoperative, acute
					 perioperative, subacute, or chronic pain including the use of multimodal
					 pharmacologic and nonpharmacologic therapy as an alternative to opioids
					 whenever reasonable, clinically appropriate, evidence-based alternatives
					 exist.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-875 - Continuing education requirements for opioid prescribing

Current through Register Vol. 24-14, July 15, 2024
(1) To prescribe an opioid in Washington
				  state, a physician licensed to prescribe opioids shall complete a one-time
				  continuing education requirement regarding best practices in the prescribing of
				  opioids or the opioid prescribing rules in this chapter. The continuing
				  education must be at least one hour in length.
(2) The physician shall complete the one-time
				  continuing education requirement described in subsection (1) of this section by
				  the end of the physician's first full continuing education reporting period
				  after January 1, 2019, or during the first full continuing education reporting
				  period after initial licensure, whichever is later.
(3) The hours spent completing training in
				  prescribing of opioids count toward meeting applicable continuing education
				  requirements in the same category specified in WAC
				  246-919-460.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-919-880 - Patient evaluation and patient record-Acute nonoperative pain

Current through Register Vol. 24-14, July 15, 2024
Prior to issuing an opioid prescription for acute
					 nonoperative pain or acute perioperative pain, the physician shall:
(1) Conduct and document an appropriate
				  history and physical examination including screening for risk factors for
				  overdose and severe postoperative pain;
(2) Evaluate the nature and intensity of the
				  pain or anticipated pain following surgery; and
(3) Inquire about any other medications the
				  patient is prescribed or is taking.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-919-885 - Treatment plan-acute nonoperative pain

Current through Register Vol. 24-14, July 15, 2024
The physician shall comply with the requirements in this
					 section when prescribing opioids for acute nonoperative pain.
(1) The physician should consider prescribing
				  nonopioids as the first line of pain control in patients unless not clinically
				  appropriate in accordance with the provisions of WAC 246-919-870.
(2) The physician, or their designee, shall
				  conduct queries of the PMP in accordance with the provisions of WAC
				  246-919-985.
(3) If the physician
				  prescribes opioids for effective pain control, such prescription must not be in
				  a greater quantity than needed for the expected duration of pain severe enough
				  to require opioids. A three-day supply or less will often be sufficient. The
				  physician shall not prescribe beyond a seven-day supply without clinical
				  documentation in the patient record to justify the need for such a
				  quantity.
(4) The physician shall
				  reevaluate the patient who does not follow the expected course of recovery, and
				  reconsider the continued use of opioids or whether tapering or discontinuing
				  opioids is clinically indicated.
(5) Follow-up visits for pain control must
				  include objectives or metrics to be used to determine treatment success if
				  opioids are to be continued. This may include:
(a) Change in pain level;
(b) Change in physical function;
(c) Change in psychosocial function;
				  and
(d) Additional indicated
				  diagnostic evaluations.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-919-890 - Treatment plan-Acute perioperative pain

Current through Register Vol. 24-14, July 15, 2024
The physician shall comply with the requirements in this
					 section when prescribing opioids for perioperative pain.
(1) The physician should consider prescribing
				  nonopioids as the first line of pain control in patients, unless not clinically
				  appropriate, in accordance with the provisions of WAC 246-919-870.
(2) The physician, or their designee, shall
				  conduct queries of the PMP in accordance with the provisions of WAC
				  246-919-985.
(3) If the physician
				  prescribes opioids for effective pain control, such prescription must not be in
				  a greater quantity than needed for the expected duration of pain severe enough
				  to require opioids. A three-day supply or less will often be sufficient. The
				  physician shall not prescribe beyond a fourteen-day supply from the time of
				  discharge without clinical documentation in the patient record to justify the
				  need for such a quantity.
(4) The
				  physician shall reevaluate a patient who does not follow the expected course of
				  recovery and reconsider the continued use of opioids or whether tapering or
				  discontinuing opioids is clinically indicated.
(5) Follow-up visits for pain control should
				  include objectives or metrics to be used to determine treatment success if
				  opioids are to be continued. This may include:
(a) Change in pain level;
(b) Change in physical function;
(c) Change in psychosocial function;
				  and
(d) Additional indicated
				  diagnostic evaluations or other treatments.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-SUBACUTE PAIN › Section 246-919-895 - Patient evaluation and patient record-Subacute pain

Current through Register Vol. 24-14, July 15, 2024
The physician shall comply with the requirements in this
					 section when prescribing opioids for subacute pain.
(1) Prior to issuing an opioid prescription
				  for subacute pain, the physician shall assess the rationale for continuing
				  opioid therapy as follows:
(a) Conduct an
				  appropriate history and physical examination;
(b) Reevaluate the nature and intensity of
				  the pain;
(c) Conduct, or cause
				  their designee to conduct, a query of the PMP in accordance with the provisions
				  of WAC 246-919-985;
(d) Screen the
				  patient's level of risk for aberrant behavior and adverse events related to
				  opioid therapy;
(e) Obtain a
				  biological specimen test if the patient's functional status is deteriorating or
				  if pain is escalating; and
(f)
				  Screen or refer the patient for further consultation for psychosocial factors
				  if the patient's functional status is deteriorating or if pain is
				  escalating.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-SUBACUTE PAIN › Section 246-919-900 - Treatment plan-Subacute pain

Current through Register Vol. 24-14, July 15, 2024
The physician, having recognized the progression of a
					 patient from the acute nonoperative or acute perioperative phase to the
					 subacute phase shall develop an opioid treatment plan.
(1) If tapering has not begun prior to the
				  six- to twelve-week subacute phase, the physician shall reevaluate the patient.
				  Based on effect on function or pain control, the physician shall consider
				  whether opioids will be continued, tapered, or discontinued.
(2) If the physician prescribes opioids for
				  effective pain control, such prescription must not be in a greater quantity
				  than needed for the expected duration of pain that is severe enough to require
				  opioids. During the subacute phase the physician shall not prescribe beyond a
				  fourteen-day supply of opioids without clinical documentation to justify the
				  need for such a quantity.
(3) If a
				  prescription results in the patient receiving a combination of opioids with a
				  sedative medication listed in WAC 246-919-970, such prescribing must be in
				  accordance with WAC 246-919-970.
(4) If the physician elects to treat a
				  patient with opioids beyond the six- to twelve-week subacute phase, the
				  physician shall document in the patient record that the patient is
				  transitioning from subacute pain to chronic pain. Rules governing the treatment
				  of chronic pain, WAC 246-919-905 through 246-919-955, shall apply.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-905 - Patient evaluation and patient record-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
When the patient enters the chronic pain phase, the
					 patient shall be reevaluated as if presenting with a new disease. The physician
					 shall include in the patient's record:
(1) An appropriate history including:
(a) The nature and intensity of the
				  pain;
(b) The effect of pain on
				  physical and psychosocial function;
(c) Current and relevant past treatments for
				  pain, including opioids and other medications and their efficacy; and
(d) Review of comorbidities with particular
				  attention to psychiatric and substance use.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-910 - Treatment plan-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
The physician, having recognized the progression of a
					 patient from the subacute phase to the chronic phase, shall develop an opioid
					 treatment plan as follows:
(1)
				  Treatment plan and objectives including:
(a)
				  Documentation of any medication prescribed;
(b) Biologic specimen testing
				  ordered;
(c) Any labs, diagnostic
				  evaluations, referrals, or imaging ordered;
(d) Other planned treatments; and
(e) Written agreement for treatment as
				  provided in WAC 246-919-915.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-915 - Written agreement for treatment-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
The physician shall use a written agreement that outlines
					 the patient's responsibilities for opioid therapy. This written agreement for
					 treatment must include the following provisions:
(1) The patient's agreement to provide
				  samples for biological specimen testing when requested by the
				  physician;
(2) The patient's
				  agreement to take medications at the dose and frequency prescribed with a
				  specific protocol for lost prescriptions and early refills;
(3) Reasons for which opioid therapy may be
				  discontinued;
(4) The requirement
				  that all opioid prescriptions for chronic pain are provided by a single
				  prescriber or a single clinic, except as provided in WAC 246-919-965 for
				  episodic care;
(5) The requirement
				  that all opioid prescriptions for chronic pain are to be dispensed by a single
				  pharmacy or pharmacy system whenever possible;
(6) The patient's agreement to not abuse
				  alcohol or use other medically unauthorized substances;
(7) A violation of the agreement may result
				  in a tapering or discontinuation of the prescription; and
(8) The patient's responsibility to safeguard
				  all medications and keep them in a secure location.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-920 - Periodic review-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The physician shall periodically review the course of treatment for chronic
				  pain. The frequency of visits, biological testing, and PMP queries in
				  accordance with the provisions of WAC 246-919-985, must be determined based on
				  the patient's risk category:
(a) For a
				  high-risk patient, at least quarterly;
(b) For a moderate-risk patient, at least
				  semiannually;
(c) For a low-risk
				  patient, at least annually;
(d)
				  Immediately upon indication of concerning aberrant behavior; and
(e) More frequently at the physician's
				  discretion.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-925 - Long-acting opioids-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
Long-acting opioids should only be prescribed by a
					 physician who is familiar with its risks and use, and who is prepared to
					 conduct the necessary careful monitoring. Special attention should be given to
					 patients who are initiating such treatment. The physician prescribing
					 long-acting opioids should have a one-time completion of at least four hours of
					 continuing education relating to this topic.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-930 - Consultation-Recommendations and requirements-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
(1) The physician shall consider referring
				  the patient for additional evaluation and treatment as needed to achieve
				  treatment objectives. Special attention should be given to those chronic pain
				  patients who are under eighteen years of age or who are potential high-risk
				  patients.
(2) The mandatory
				  consultation threshold is one hundred twenty milligrams MED. In the event a
				  physician prescribes a dosage amount that meets or exceeds the consultation
				  threshold of one hundred twenty milligrams MED per day, a consultation with a
				  pain management specialist as described in WAC 246-919-945 is required, unless
				  the consultation is exempted under WAC 246-919-935 or 246-919-940.
(3) The mandatory consultation must consist
				  of at least one of the following:
(a) An
				  office visit with the patient and the pain management specialist;
(b) A telephone, electronic, or in-person
				  consultation between the pain management specialist and the
				  physician;
(c) An audio-visual
				  evaluation conducted by the pain management specialist remotely where the
				  patient is present with either the physician or a licensed health care
				  practitioner designated by the physician or the pain management specialist;
				  or
(d) Other chronic pain
				  evaluation services as approved by the commission.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-935 - Consultation-Exemptions for exigent and special circumstances-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
A physician is not required to consult with a pain
					 management specialist as defined in WAC 246-919-945 when the physician has
					 documented adherence to all standards of practice as defined in WAC 246-919-905
					 through 246-919-925, and when one or more of the following conditions are
					 met:
(1) The patient is following a
				  tapering schedule;
(2) The patient
				  requires treatment for acute pain, which may or may not include
				  hospitalization, requiring a temporary escalation in opioid dosage, with an
				  expected return to their baseline dosage level or below;
(3) The physician documents reasonable
				  attempts to obtain a consultation with a pain management specialist and the
				  circumstances justifying prescribing above one hundred twenty milligrams
				  morphine equivalent dose (MED) per day without first obtaining a consultation;
				  or
(4) The physician documents the
				  patient's pain and function are stable and the patient is on a nonescalating
				  dosage of opioids.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-940 - Consultation-Exemptions for the physician-Chronic pain

Current through Register Vol. 24-14, July 15, 2024
The physician is exempt from the consultation requirement
					 in WAC 246-919-930 if one or more of the following qualifications is
					 met:
(1) The physician is a pain
				  management specialist under WAC 246-919-945;
(2) The physician has successfully completed
				  a minimum of twelve category I continuing education hours on chronic pain
				  management within the previous four years. At least two of these hours must be
				  dedicated to substance use disorders;
(3) The physician is a pain management
				  physician working in a multidisciplinary chronic pain treatment center or a
				  multidisciplinary academic research facility; or
(4) The physician has a minimum of three
				  years of clinical experience in a chronic pain management setting, and at least
				  thirty percent of their current practice is the direct provision of pain
				  management care.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-945 - Pain management specialist- Chronic pain

Current through Register Vol. 24-14, July 15, 2024
A pain management specialist shall meet one or more of the
					 following qualifications:
(1) If an
				  allopathic physician or osteopathic physician:
(a) Is board certified or board eligible by
				  an American Board of Medical Specialties-approved board (ABMS) or by the
				  American Osteopathic Association (AOA) in physical medicine and rehabilitation,
				  neurology, rheumatology, or anesthesiology;
(b) Has a subspecialty certificate in pain
				  medicine by an ABMS-approved board;
(c) Has a certification of added
				  qualification in pain management by the AOA;
(d) Is credentialed in pain management by an
				  entity approved by the commission for an allopathic physician or the Washington
				  state board of osteopathic medicine and surgery for an osteopathic
				  physician;
(e) Has a minimum of
				  three years of clinical experience in a chronic pain management care setting;
				  and
(i) Has successful completion of a
				  minimum of at least eighteen continuing education hours in pain management
				  during the past two years for an allopathic physician or three years for an
				  osteopathic physician; and
(ii) Has
				  at least thirty percent of the allopathic physician's or osteopathic
				  physician's current practice is the direct provision of pain management care or
				  is in a multidisciplinary pain clinic.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-950 - Tapering considerations- Chronic pain

Current through Register Vol. 24-14, July 15, 2024
The physician shall consider tapering or referral for a
					 substance use disorder evaluation when:
(1) The patient requests;
(2) The patient experiences a deterioration
				  in function or pain;
(3) The
				  patient is noncompliant with the written agreement;
(4) Other treatment modalities are
				  indicated;
(5) There is evidence of
				  misuse, abuse, substance use disorder, or diversion;
(6) The patient experiences a severe adverse
				  event or overdose;
(7) There is
				  unauthorized escalation of doses; or
(8) The patient is receiving an escalation in
				  opioid dosage with no improvement in their pain or function.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-919-955 - Patients with chronic pain, including those on high doses of opioids, establishing a relationship with a new physician

Current through Register Vol. 24-14, July 15, 2024
(1) When a patient receiving chronic opioid
				  pain medications changes to a new physician, it is normally appropriate for the
				  new physician to initially maintain the patient's current opioid doses. Over
				  time, the physician may evaluate if any tapering or other adjustments in the
				  treatment plan can or should be done.
(2) A physician's treatment of a new high
				  dose chronic pain patient is exempt from the mandatory consultation
				  requirements of WAC 246-919-930 if:
(a) The
				  patient was previously being treated with a dosage of opioids in excess of a
				  one hundred twenty milligram MED for chronic pain under an established written
				  agreement for treatment of the same chronic condition or conditions;
(b) The patient's dose is stable and
				  nonescalating;
(c) The patient has
				  a history of compliance with treatment plans and written agreements documented
				  by medical records and PMP queries; and
(d) The patient has documented functional
				  stability, pain control, or improvements in function or pain control at the
				  presenting opioid dose.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-919-960 - Special populations-Children or adolescent patients, pregnant patients, and aging populations

Current through Register Vol. 24-14, July 15, 2024
(1) Children or
				  adolescent patients. In the treatment of pain for children or adolescent
				  patients, the physician shall treat pain in a manner equal to that of an adult
				  but must account for the weight of the patient and adjust the dosage prescribed
				  accordingly.
(2) Pregnant patients.
				  The physician shall not initiate opioid detoxification without consultation
				  with a provider with expertise in addiction medicine. Medication assisted
				  treatment for opioids, such as methadone or buprenorphine, must not be
				  discontinued during pregnancy without consultation with a MAT prescribing
				  practitioner.
(3) Aging
				  populations. As people age, their sensitivities to and metabolizing of opioids
				  may change. The physician shall consider the distinctive needs of patients who
				  are sixty-five years of age or older and who have been on chronic opioid
				  therapy or who are initiating opioid treatment.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-919-965 - Episodic care of chronic opioid patients

Current through Register Vol. 24-14, July 15, 2024
(1) When providing episodic care for a
				  patient who the physician knows is being treated with opioids for chronic pain,
				  such as for emergency or urgent care, the physician or their designee, shall
				  review the PMP and document their review and any concerns.
(2) A physician providing episodic care to a
				  patient who the physician knows is being treated with opioids for chronic pain
				  should provide additional analgesics, including opioids when appropriate, to
				  adequately treat acute pain. If opioids are provided, the physician shall limit
				  the use of opioids to the minimum amount necessary to control the acute pain
				  until the patient can receive care from the practitioner who is managing the
				  patient's chronic pain.
(3) The
				  episodic care physician shall coordinate care with the patient's chronic pain
				  treatment practitioner, if possible.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-919-970 - Coprescribing of opioids with certain medications

Current through Register Vol. 24-14, July 15, 2024
(1) The physician shall not knowingly
				  prescribe opioids in combination with the following medications without
				  documentation of medical decision making:
(a)
				  Benzodiazepines;
(b)
				  Barbiturates;
(c)
				  Sedatives;
(d) Carisoprodol;
				  or
(e) Nonbenzodiazepine
				  hypnotics.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-919-975 - Coprescribing of opioids for patients receiving medication assisted treatment

Current through Register Vol. 24-14, July 15, 2024
(1) Where
				  practicable, the physician providing acute nonoperative pain or acute
				  perioperative pain treatment to a patient who is known to be receiving MAT
				  medications shall prescribe opioids when appropriate for pain relief either in
				  consultation with a MAT prescribing practitioner or a pain
				  specialist.
(2) The physician
				  providing acute nonoperative pain or acute perioperative pain treatment shall
				  not discontinue MAT medications without documentation of the reason for doing
				  so, nor shall the use of these medications be used to deny necessary operative
				  intervention.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-919-980 - Coprescribing of naloxone

Current through Register Vol. 24-14, July 15, 2024
The opioid prescribing physician shall confirm or provide
					 a current prescription for naloxone when opioids are prescribed to a high-risk
					 patient.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-PRESCRIPTION MONITORING PROGRAM › Section 246-919-985 - Prescription monitoring program-Required registration, queries, and documentation

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  physician shall register to access the PMP or demonstrate proof of having
				  assured access to the PMP if they prescribe Schedule II-V medications in
				  Washington state.
(2) The physician
				  is permitted to delegate performance of a required PMP query to an authorized
				  designee.
(3) At a minimum, the
				  physician shall ensure a PMP query is performed prior to the prescription of an
				  opioid or of a medication listed in WAC 246-919-970 at the following times:
(a) Upon the first refill or renewal of an
				  opioid prescription for acute nonoperative pain or acute perioperative
				  pain;
(b) The time of transition
				  from acute to subacute pain; and
(c) The time of transition from subacute to
				  chronic pain.