reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-666

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-666, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-667

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-667, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-668

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-668, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-669

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-669, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-670

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-670, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-671

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-671, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-672

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-672, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-673

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.22.240,
						18.22.015(5).
						11-10-063, § 246-922-673, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-675 - Patient notification, secure storage, and disposal

Current through Register Vol. 24-14, July 15, 2024
(1) The podiatric physician shall provide
				  information to the patient educating them of 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. The
				  podiatric physician shall document such notification in the patient
				  record.
(2) Patient notification
				  must occur, at a minimum, at the following points of treatment:
(a) The first issuance of a prescription for
				  an opioid; and
(b) The transition
				  between phases of treatment, as follows:
(i)
				  Acute nonoperative pain or acute perioperative pain to subacute pain;
				  and
(ii) Subacute pain to chronic
				  pain.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-680 - Use of alternative modalities for pain treatment

Current through Register Vol. 24-14, July 15, 2024
Podiatric physicians shall exercise professional judgment
					 in selecting appropriate treatment modalities for the treatment of pain,
					 including the use of nonopioid multimodal pharmacologic and nonpharmacologic
					 therapy as an alternative to opioids whenever reasonable, clinically
					 appropriate, evidence-based alternatives exist. Nonopioid pain management
					 modalities may include, but are not limited to, antidepressants,
					 anticonvulsants, anti-inflammatory medications, acetaminophen, interventional
					 procedures, or any non-pharmacological pain treatments, or any combination of
					 the above modalities.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-922-685 - Continuing education requirements for opioid prescribing

Current through Register Vol. 24-14, July 15, 2024
(1) In order to prescribe an opioid in
				  Washington state, a podiatric physician shall complete a one-time continuing
				  education regarding best practices in the prescribing of opioids and the rules
				  in this chapter on opioid prescribing. The continuing education must be at
				  least one hour in length.
(2) The
				  podiatric physician shall complete the one-time continuing education described
				  in subsection (1) of this section by the end of the podiatric 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
				  continuing education required under this section counts toward meeting any
				  applicable Category 1 continuing education requirements.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-922-690 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
Prior to prescribing opioids for acute nonoperative pain
					 or acute perioperative pain, the podiatric 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, including type, dosage, and quantity
				  prescribed.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-922-695 - Acute nonoperative pain

Current through Register Vol. 24-14, July 15, 2024
The podiatric physician shall comply with the requirements
					 in this section when prescribing opioid analgesics for acute nonoperative pain
					 and shall document completion of these requirements in the patient
					 record:
(1) The podiatric physician,
				  or his or her authorized designee, shall conduct queries of the PMP in
				  accordance with the provisions of WAC 246-922-790 and document their review and
				  any concerns in the patient record.
(2) If the podiatric 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; more than a
				  seven-day supply will rarely be needed. The podiatric physician shall not
				  prescribe beyond a seven day supply without clinical documentation in the
				  patient record to justify the need for such a quantity.
(3) The podiatric physician shall reevaluate
				  the patient who does not follow the expected course of recovery. If documented
				  improvement in function or pain control has not occurred, the podiatric
				  physician shall reconsider the continued use of opioids or whether tapering or
				  discontinuing opioids is clinically indicated.
(4) 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 planned
				  diagnostic evaluations to investigate causes of continued acute nonoperative
				  pain or other treatments.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-922-700 - Acute perioperative pain

Current through Register Vol. 24-14, July 15, 2024
The podiatric physician shall comply with the requirements
					 in this section when prescribing opioid analgesics for perioperative pain and
					 shall document completion of these requirements in the patient record:
(1) The podiatric physician, or his or her
				  authorized designee, shall conduct queries of the PMP in accordance with the
				  provisions of WAC
				  246-922-790
				  and document their review and any concerns in the patient record.
(2) If the podiatric 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; more than a
				  fourteen-day supply will rarely be needed. The podiatric 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. For more specific best practices, the podiatric physician may refer
				  to clinical practice guidelines including, but not limited to, those produced
				  by the agency medical directors' group, the Centers for Disease Control and
				  Prevention, or the Bree Collaborative.
(3) The podiatric physician shall reevaluate
				  the patient who does not follow the expected course of recovery. If documented
				  improvement in function or pain control has not occurred, the podiatric
				  physician shall reconsider the continued use of opioids or whether tapering or
				  discontinuing opioids is clinically indicated.
(4) 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 planned
				  diagnostic evaluations or other treatments.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING FOR SUBACUTE PAIN › Section 246-922-705 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
The podiatric physician shall comply with the requirements
					 in this section when prescribing opioid analgesics for subacute pain and shall
					 document completion of these requirements in the patient record:
(1) Prior to prescribing an opioid for
				  subacute pain, the podiatric physician shall:
(a) Conduct an appropriate history and
				  physical examination or review and update the patient's existing history and
				  examination taken during the acute nonoperative or acute perioperative
				  phase;
(b) Evaluate the nature and
				  intensity of the pain;
(c) Inquire
				  about other medications the patient is prescribed or is taking, including type,
				  dosage, and quantity prescribed;
(d) Conduct, or cause his or her authorized
				  designee to conduct, a query of the PMP in accordance with provisions of WAC
				  246-922-790 and document the review and any concerns in the patient
				  record;
(e) Screen and document the
				  patient's potential for high-risk behavior and adverse events related to opioid
				  therapy. If the podiatric physician determines the patient is high-risk,
				  consider lower dose therapy, shorter intervals between prescriptions, more
				  frequent visits, increased biological specimen testing, and prescribing rescue
				  naloxone;
(f) Obtain a biological
				  specimen test if the patient's function is deteriorating or if pain is
				  escalating;
(g) Screen or refer the
				  patient for further consultation for psychosocial factors which may be
				  impairing recovery including, but not limited to, depression or
				  anxiety.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING FOR SUBACUTE PAIN › Section 246-922-710 - Subacute pain

Current through Register Vol. 24-14, July 15, 2024
(1) The podiatric
				  physician shall recognize the progression of a patient from the acute
				  nonoperative or acute perioperative phase to the subacute phase and take into
				  consideration the risks and benefits of continued opioid prescribing for the
				  patient.
(2) If tapering has not
				  begun prior to the six- to twelve-week subacute phase, the podiatric physician
				  shall reevaluate the patient who does not follow the expected course of
				  recovery. If documented improvement in function or pain control has not
				  occurred, the podiatric physician shall reconsider the continued use of opioids
				  or whether tapering or discontinuing the use of opioids is clinically
				  indicated. The podiatric physician shall make reasonable attempts to
				  discontinue the use of opioids prescribed for the acute pain event by no later
				  than the twelve-week conclusion of the subacute phase.
(3) If the podiatric physician prescribes
				  opioids for effective pain control, such prescription shall be in no greater
				  quantity than needed for the expected duration of pain severe enough to require
				  opioids. During the subacute phase, the podiatric physician shall not prescribe
				  beyond a fourteen-day supply of opioids without clinical documentation to
				  justify the need for such a quantity.
(4) If the podiatric physician elects to
				  prescribe a combination of opioids with a medication listed in WAC 246-922-775
				  or prescribes opioids to a patient known to be receiving a medication listed in
				  WAC 246-922-775 from another practitioner, the podiatric physician shall
				  prescribe in accordance with WAC 246-922-775.
(5) If the podiatric physician elects to
				  treat a patient with opioids beyond the six- to twelve-week subacute phase, the
				  podiatric 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 in WAC 246-922-715 through 246-922-760 shall apply.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-715 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
(1) For the purpose of this section, "risk
				  assessment tool" means validated tools or questionnaires appropriate for
				  identifying a patient's level of risk for substance abuse or misuse.
(2) The podiatric physician shall evaluate
				  and document the patient's health history and physical examination in the
				  patient record prior to treating for chronic pain.
(a) History. The patient's health history
				  must include:
(i) The nature and intensity of
				  the pain;
(ii) The effect of pain
				  on physical and psychosocial function;
(iii) Current and past treatments for pain,
				  including medications and their efficacy;
(iv) Review of any significant
				  comorbidities;
(v) Any current or
				  historical substance use disorder;
(vi) Current medications and, as related to
				  treatment of the pain, the efficacy of medications tried; and
(vii) Medication allergies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-720 - Treatment plan

Current through Register Vol. 24-14, July 15, 2024
(1) When the
				  patient enters the chronic pain phase, the podiatric physician shall reevaluate
				  the patient by treating the situation as a new disease.
(2) The chronic pain treatment plan must
				  state the objectives that will be used to determine treatment success and must
				  include:
(a) Any change in pain
				  relief;
(b) Any change in physical
				  and psychosocial function; and
(c)
				  Additional diagnostic evaluations or other planned treatments.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-725 - Written agreement for treatment

Current through Register Vol. 24-14, July 15, 2024
The podiatric physician shall use a written agreement for
					 treatment with the patient who requires long-term opioid therapy for chronic
					 pain. The written agreement shall outline the patient's responsibilities and
					 must include:
(1) The patient's
				  agreement to provide biological samples for biological specimen testing when
				  requested by the podiatric 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, such as violation of a written agreement;
(4) The requirement that all chronic opioid
				  prescriptions are provided by a single prescriber, a single clinic, or a
				  multidisciplinary pain clinic;
(5)
				  The requirement that all chronic opioid prescriptions are to be dispensed by a
				  single pharmacy or pharmacy system whenever possible;
(6) The patient's agreement to not abuse
				  substances that can put the patient at risk for adverse outcomes;
(7) A written authorization for:
(a) The podiatric physician to release the
				  agreement for treatment to:
(i) Local
				  emergency departments;
(ii) Urgent
				  care facilities;
(iii) Other
				  practitioners caring for the patient who might prescribe pain medications;
				  and
(iv) Pharmacies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-730 - Periodic review

Current through Register Vol. 24-14, July 15, 2024
(1) The podiatric
				  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 246-922-790 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 podiatric
				  physician's discretion.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-735 - Consultation-Recommendations and requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  podiatric physician shall consider referring the chronic pain 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. The management
				  of chronic pain in patients with a history of substance abuse or with comorbid
				  psychiatric disorders may require extra care, monitoring, documentation, and
				  consultation with, or referral to, an expert in the management of such
				  patients.
(2) The mandatory
				  consultation threshold is one hundred twenty milligrams MED per day. Unless the
				  consultation is exempt under WAC 246-922-740 or 246-922-745, a podiat-ric
				  physician who prescribes a dosage amount at or above the mandatory consultation
				  threshold must comply with the pain management specialist consultation
				  requirements described in WAC 246-922-750. 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 podiatric
				  physician;
(c) An audio-visual
				  evaluation conducted by the pain management specialist remotely, where the
				  patient is present with either the podiatric physician or with a practitioner
				  designated by the podiatric physician or the pain management specialist;
				  or
(d) Other chronic pain
				  evaluation services as approved by the board.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-740 - Consultation-Exemptions for exigent and special circumstances

Current through Register Vol. 24-14, July 15, 2024
A podiatric physician is not required to consult with a
					 pain management specialist as defined in WAC 246-922-750 when they have
					 documented adherence to all standards of practice as defined in WAC 246-922-715
					 through 246-922-760 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
				  expected return to their baseline dosage level or below;
(3) The podiatric physician documents
				  reasonable attempts to obtain a consultation with a pain management specialist
				  and the circumstances justifying prescribing at or above one hundred twenty MED
				  per day without first obtaining a consultation; or
(4) The podiatric physician documents the
				  patient's pain and function is stable and the patient is on a nonescalating
				  dosage of opioids.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-745 - Consultation-Exemptions for the podiatric physician

Current through Register Vol. 24-14, July 15, 2024
A podiatric physician is not required to consult with a
					 pain management specialist as defined in WAC 246-922-735 if one or more of the
					 following qualifications are met:
(1)
				  The podiatric physician is a pain management specialist under WAC
				  246-922-750;
(2) The podiatric
				  physician has successfully completed, every four years, a minimum of twelve
				  continuing education hours on chronic pain management in accordance with WAC
				  246-922-310.
				  At least two of these hours must be in substance use disorders;
(3) The podiatric physician is a pain
				  management practitioner working in a pain management clinic or a
				  multidisciplinary academic research facility; or
(4) The podiatric physician has a minimum of
				  three years of clinical experience in a pain management clinic, 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 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-750 - Pain management specialist

Current through Register Vol. 24-14, July 15, 2024
A pain management specialist shall meet one or more of the
					 following qualifications:
(1) If a
				  podiatric physician, the podiatric physician must:
(a) Be board certified or board eligible by a
				  specialty that includes a focus on pain management by the American Board of
				  Foot and Ankle Surgery or its predecessor, the American Board of Podiatric
				  Medicine, the American Board of Podiatric Orthopedics and Primary Podiatric
				  Medicine, or other accredited certifying board as approved by the Washington
				  state podiatric medical board; or
(b) Have a minimum of three years of clinical
				  experience in a chronic pain management care clinic;
(c) Be credentialed in pain management by a
				  Washington state podiatric medical board-approved national professional
				  association, pain association, or other credentialing entity;
(d) Have successfully completed a minimum of
				  at least eighteen continuing education hours in pain management during the past
				  two years; and
(e) At least thirty
				  percent of the podiatric physician's current practice is the direct provision
				  of pain management care.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-755 - Evaluation of, or change in, treatment plan

Current through Register Vol. 24-14, July 15, 2024
(1) The podiatric physician shall assess and
				  document the appropriateness of continued use of the current treatment plan if
				  the patient's response to or compliance with the current treatment plan is
				  unsatisfactory.
(2) The podiatric
				  physician shall consider tapering, changing, discontinuing treatment, or
				  referral for a substance use disorder evaluation when:
(a) The patient requests tapering, changing,
				  discontinuing treatment, or referral for a substance use disorder;
(b) The patient experiences a deterioration
				  in function or pain;
(c) The
				  patient is noncompliant with the written agreement;
(d) Other treatment modalities are
				  indicated;
(e) There is evidence of
				  misuse, abuse, substance use disorder, or diversion;
(f) The patient experiences a severe adverse
				  event or overdose;
(g) There is
				  unauthorized escalation of doses; or
(h) When the patient is receiving an
				  escalation in opioid dosage with no improvement in pain, function, or quality
				  of life.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-922-760 - Patients with chronic pain, including those on high doses-Establishing a relationship with a new podiatric physician

Current through Register Vol. 24-14, July 15, 2024
(1) When a patient receiving chronic opioid
				  pain medications changes to a new podiatric physician, it is normally
				  appropriate for the podiatric physician to initially maintain the patient's
				  current opioid doses. Over time, the podiatric physician may evaluate if any
				  tapering or other adjustments in the treatment plan can or should be
				  done.
(2) A podiatric physician's
				  treatment of a new high-dose chronic pain patient is exempt from the mandatory
				  consultation requirements of WAC 246-922-735 and the tapering requirements of
				  WAC 246-922-755 for the first three months of newly established care if:
(a) The patient was previously being treated
				  with a dosage of opioids at or above one hundred twenty milligrams MED per day
				  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 demonstrated history in their record of compliance with treatment plans and
				  written agreements as 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 dose.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-922-765 - Special populations-Patients twenty-five years of age or under, pregnant patients, and aging populations

Current through Register Vol. 24-14, July 15, 2024
(1)
				  Patients twenty-five years of age or under. In the treatment of pain for
				  patients twenty-five years of age or under, the podiatric 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. Use of MAT opioids,
				  such as methadone or buprenorphine, by a pregnant patient shall not be
				  discontinued without oversight by the MAT prescribing practitioner. The
				  podiatric physician shall weigh carefully the risks and benefits of opioid
				  detoxification during pregnancy.
(3) Aging populations. As people age, their
				  tolerance and metabolizing of opioids may change. The podiatric physician shall
				  treat pain in a manner commensurate with 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 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-922-770 - 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 podiatric physician knows is being treated with opioids for
				  chronic pain, such as for emergency or urgent care, the podiatric physician
				  shall review the PMP and document the review and any concerns in the patient
				  record.
(2) A podiatric physician
				  providing episodic care to a patient who the podiatric physician knows is being
				  treated with opioids for chronic pain should provide additional opioids equal
				  to the severity of the acute pain. If opioids are provided, the podiatric
				  physician shall limit the use of opioids to the minimum amount necessary to
				  control the acute nonoperative pain, acute perioperative pain, or similar acute
				  exacerbation of pain until the patient can receive care from the practitioner
				  who is managing the patient's chronic pain treatment.
(3) The episodic care podiatric physician
				  shall report known violations of the patient's written agreement to the
				  patient's treatment practitioner who provided the agreement for
				  treatment.
(4) The episodic care
				  podiatric physician shall coordinate care with the patient's chronic pain
				  treatment practitioner if that person is known to the episodic care podiatric
				  physician, when practicable.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-922-775 - Coprescribing of opioids with certain medications

Current through Register Vol. 24-14, July 15, 2024
(1) The podiatric physician shall not
				  knowingly prescribe opioids in combination with the following Schedule II-IV
				  medications without documentation of clinical judgment:
(a) Benzodiazepines;
(b) Barbiturates;
(c) Sedatives;
(d) Carisoprodol; or
(e) Nonbenzodiazepine hypnotics, also known
				  as Z drugs.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-922-780 - Coprescribing of opioids for patients receiving medication assisted treatment

Current through Register Vol. 24-14, July 15, 2024
(1) Where
				  practicable, the podiatric physician providing acute nonoperative pain or acute
				  perioperative pain treatment to a patient known to be receiving MAT shall
				  prescribe opioids for pain relief either in consultation with the MAT
				  prescribing practitioner or a pain specialist.
(2) The podiatric physician shall not
				  discontinue MAT medications when treating acute nonoperative pain or acute
				  perioperative pain without documentation of the reason for doing so, nor shall
				  these medications be used to deny necessary operative intervention.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-COPRESCRIBING › Section 246-922-785 - Coprescribing of naloxone

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  podiatric physician shall confirm or provide a current prescription for
				  naloxone when high-dose opioids are prescribed to a high-risk
				  patient.
(2) The podiatric
				  physician should counsel and provide an option for a current prescription for
				  naloxone to patients being prescribed opioids as clinically
				  indicated.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › OPIOID PRESCRIBING-PRESCRIPTION MONITORING PROGRAM › Section 246-922-790 - Prescription monitoring program-Required registration, queries, and documentation

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  podiatric physician shall register to access the PMP or demonstrate proof of
				  having registered to access the PMP if the podiatric physician prescribes
				  opioids in Washington state.
(2)
				  The podiatric physician is permitted to delegate performance of a required PMP
				  query to an authorized designee in accordance with WAC
				  246-470-050.
(3) At a minimum, the podiatric physician
				  shall ensure a PMP query is performed prior to the prescription of an opioid 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.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-001 - Guidelines for the promulgation of administrative rules

Current through Register Vol. 24-14, July 15, 2024
The examining board of psychology shall not promulgate rules
				  which restrict access to information from applicant/employee psychological
				  evaluations sought by public safety agencies.
Statutory Authority:
					 RCW
					 18.83.050. 91-04-020 (Order 117B), recodified
					 as § 246-924-001, filed 1/28/91, effective 2/28/91. Statutory Authority:
					 RCW
					 18.83.050(1). 86-19-061
					 (Order PM 616), § 308-122-001, filed
					 9/16/86.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply throughout this chapter
				  unless the context clearly states otherwise.
(1) "Acquired immunodeficiency syndrome" or
				"AIDS" means the clinical syndrome of HIV-related illness as defined by the
				board of health by rule.
(2) "APA"
				means American Psychological Association.
(3) "APPIC" means Association of Psychology
				Postdoctoral and Internship Centers.
(4) "CPA" means Canadian Psychological
				Association.
(5) "Face to face"
				means in-person contact in the same physical space not assisted by
				technology.
(6) "Office on AIDS"
				means that section within the department of social and health services or any
				successor department with jurisdiction over public health matters as defined in
				chapter 70.24 RCW.
(7)
				"Out-of-state" means any state or territory of the United States.
(8) "Probationary license" means a temporary
				license issued to out-of-state applicants qualifying for licensure reciprocity
				in Washington state under the restrictions and conditions of
				RCW
				18.225.140 and this chapter.
(9) "Reciprocity" means licensure of
				out-of-state licensed psychologists based on substantial equivalence between
				Washington state scope of practice and the scope of practice of the other state
				or territory, subject to a probationary licensure period to complete
				outstanding Washington state licensure requirements as determined necessary to
				gain full licensure.
Statutory Authority:
					 RCW
					 18.83.050. 91-04-020 (Order 117B), recodified
					 as § 246-924-010, filed 1/28/91, effective 2/28/91. Statutory Authority:
					 1988 c 206 § 604. 88-23-059 (Order PM 798), § 308-122-005, filed
					 11/15/88.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-030 - Guidelines for the employment and/or supervision of auxiliary staff

Current through Register Vol. 24-14, July 15, 2024
(1) Qualifications
				of the supervisor: The supervisor shall be licensed in Washington state for the
				practice of psychology and have adequate training, knowledge, and skill to
				evaluate the competence of the work of the auxiliary staff. The supervisor may
				not be employed by the auxiliary staff.
(2) Qualifications of the auxiliary staff:
				The staff person must have the background, training, and experience that is
				appropriate to the functions performed. The supervisor is responsible for
				determining the adequacy of the qualifications of the staff person and the
				designation of his/her title.
(3)
				Responsibilities of the supervisor: The supervisor accepts full legal and
				professional responsibility for all services that may be rendered by the
				auxiliary staff. To this end, the supervisor shall have sufficient knowledge of
				all clients, including face-to-face contact when necessary, in order to plan
				and assure the delivery of effective services. The supervisor is responsible
				for assuring that appropriate supervision is available or present at all times.
				The supervisor is responsible for assuring that auxiliary staff are informed of
				and adhere to requirements of confidentiality. The supervisor shall assure that
				the staff person providing services is appropriately covered by professional
				liability insurance and adheres to accepted business practices.
(4) Conduct of supervision: It is recognized
				that variability in preparation for duties to be assumed will require
				individually tailored supervision. In the case of auxiliary staff providing
				psychological services, a detailed job description shall be developed and a
				contract for supervision prepared.
(5) Conduct of services that may be provided
				by auxiliary staff: Procedures to be carried out by the auxiliary staff shall
				be planned in consultation with the supervisor. Clients of the auxiliary staff
				shall be informed as to his/her status and shall be given specific information
				as to his/her qualifications and functions. Clients shall be informed of the
				identity of the supervisor. They shall be informed that they might meet with
				the supervisor at their own request, the auxiliary staff person's or the
				supervisor's request. Written reports and communications shall be countersigned
				by the supervisor.
Statutory Authority:
					 RCW
					 18.83.050. 91-04-020 (Order 117B), recodified
					 as § 246-924-030, filed 1/28/91, effective 2/28/91. Statutory Authority:
					 RCW
					 18.83.050(5). 86-04-087
					 (Order PL 578 ), § 308-122-060, filed
					 2/5/86.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-043 - Education and experience requirements for licensure

Current through Register Vol. 24-14, July 15, 2024
(1) To obtain a license, applicants must
				complete:
(a) A doctoral degree program as
				described in WAC
				246-924-046.
(b) A practicum of at least 300 hours as
				described in WAC
				246-924-049;
				and
(c) An experience requirement
				consisting of no fewer than two years supervised experience totaling 3000 hours
				that includes:
(i) A minimum of 1500 hours of
				supervised experience that must be completed as an internship experience as
				outlined in WAC
				246-924-056.
(ii) The remaining 1500 supervised hours may
				be obtained through:
(A) A preinternship as
				described in WAC
				246-924-053;
(B) Accumulation of supervised experience
				hours in excess of the 1500 hours required in (c)(i) of this subsection that
				meet the requirements in WAC
				246-924-056;
(C) A postdoctoral experience as described in
				WAC
				246-924-059;
(D) A combination of preinternship and
				postdoctoral experience.
(iii) For applicants who demonstrate proof of
				being credentialed as a substance use disorder professional for three years in
				the previous ten years, the total hours required in (c)(ii) of this subsection
				are reduced from 1500 to 1020 hours.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-046 - Doctoral degree program

Current through Register Vol. 24-14, July 15, 2024
To meet the education requirements of
				  RCW
				  18.83.070, an applicant must possess a
				  doctoral degree from a regionally accredited institution. Regional
				  accreditation is awarded to an institution by one of the regional accrediting
				  agencies, each of which covers a specified portion of the United States and its
				  territories, or equivalent accreditation in another country, upon approval by
				  the board.
(1) The doctoral degree
				program must include:
(a) At least forty
				semester credits, or sixty quarter credits, of graduate courses in curriculum
				areas described in subsection (3) of this section.
(i) Courses must be clearly identified by
				title and course content as being part of an integrated psychology
				program.
(ii) Courses taken before
				the doctoral degree program may be accepted if the doctoral degree program
				accepted the course(s).
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-047 - Courses completed outside the doctoral degree granting program

Current through Register Vol. 24-14, July 15, 2024
(1) The board will
				accept no more than two courses completed outside the applicant's doctoral
				degree-granting program to meet the requirements of WAC
				246-924-046(3).
(2) Course(s) may be used to satisfy the
				requirements of WAC
				246-924-046 if all of the
				following are met:
(a) The applicant meets
				all the requirements in WAC
				246-924-046(1) and
				(2), but the doctoral degree program did not
				include all of the courses described in WAC
				246-924-046(3);
(b) The doctoral degree was granted without
				the course (s);
(c) Courses were
				taken for credit from a regionally accredited graduate program in psychology;
				and
(d) Courses are documented on
				an official transcript.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-049 - Practicum

Current through Register Vol. 24-14, July 15, 2024
(1) Applied
				experience.
(a) Until June 30, 2021, the
				doctoral degree program required in WAC
				246-924-046
				must include a practicum of at least two semesters or three quarters and at
				least 300 hours of direct experience, 100 hours of which must meet the
				requirements in subsection (3) of this section for supervision.
(b) Effective July 1, 2021, the doctoral
				degree program required in WAC
				246-924-046
				must include a practicum of at least nine months and 300 hours of direct
				experience, 100 hours of which must meet the requirements in subsection (3) of
				this section for supervision.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-053 - Preinternship

Current through Register Vol. 24-14, July 15, 2024
A preinternship experience occurs between the practicum
				  required by WAC
				  246-924-049 and internship
				  required by WAC
				  246-924-056. A preinternship can
				  include up to 1500 hours of supervised experience, but is not required. If
				  preinternship experience is used to satisfy the experience requirement of WAC
				  246-924-043(1)(c),
				  it must meet the following requirements:
(1) Before beginning the program, the
				student, the doctoral program, and the preinternship program must agree on and
				document the goals, the student's expectations, and the methods of the
				preinternship experience. The goals must meet the requirements of this
				section.
(2) Every 20 hours of
				preinternship experience must include the following:
(a) At least 2 hours of regularly scheduled,
				formal, face-to-face individual supervision that addresses the direct
				psychological services provided by the student; and
(b) At least 2 hours of other learning
				activities such as case conferences, seminars on applied issues, conducting
				cotherapy with a staff person including discussion of the case, and group
				supervision.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-924 - Psychologists › Section 246-924-059 - Postdoctoral supervised experience

Current through Register Vol. 24-14, July 15, 2024
If 3000 hours of supervised experience has not been completed
				  at the end of the doctoral degree program, then up to 1500 hours of supervised
				  postdoctoral experience can be used to satisfy the total requirement.
				  Postdoctoral supervised experience must be completed only if an applicant does
				  not already have 3000 hours of supervised experience.
(1) Organization of the postdoctoral
				supervised experience.
(a) The supervisor is
				ethically and legally responsible for all supervisee work covered by the
				supervision agreement. Therefore, the supervisor has authority to alter service
				plans and direct the course of psychological work.
(b) Supervisees must use titles indicating
				their training status, such as "psychological resident," "psychological
				intern," or "psychological supervisee."
(c) Clients must be informed of the identity
				and responsibilities of the supervisor and how they can speak directly to the
				supervisor.
(d) Services rendered
				by the supervisee must not be represented to third parties as having been
				rendered by the supervisor. Insurance forms must be filled out indicating the
				nature of the supervisory relationship.