reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-320 - Participation in substance use disorder monitoring program

Current through Register Vol. 24-14, July 15, 2024
(1) The osteopathic physician who has been
				investigated by the board may accept board referral into the monitoring
				program. This may occur as a result of disciplinary action.
(a) The osteopathic physician shall undergo a
				complete physical and psychosocial evaluation before entering the monitoring
				program. This evaluation is to be performed by a health care professional(s)
				with expertise in impairing health conditions. The person(s) performing the
				evaluation shall not be the provider of the recommended treatment.
(b) The osteopathic physician shall enter
				into a contract with the board and the monitoring program to comply with the
				requirements of the program which may include, but not be limited to:
(i) The osteopathic physician will undergo
				treatment of an impairing health condition by a treatment facility.
(ii) An agreement to abstain from the use of
				all mind-altering substances, including alcohol, except for medications
				prescribed by an authorized prescriber, as defined in RCW  69.41.030 and
				69.50.101. The prescriber shall notify the monitoring program of all drugs
				prescribed within 14 days of the date care was provided.
(iii) Completion of any prescribed aftercare
				program of the treatment facility. This may include individual or group
				psychotherapy, or both.
(iv)
				Directing the treatment counselor(s) and authorized prescriber(s) to provide
				reports to the appropriate monitoring program at specified intervals. Reports
				shall include treatment prognosis, goals, drugs prescribed, etc.
(v) Submitting to random drug screening, with
				observed specimen collection, as specified by the monitoring program.
(vi) Attending osteopathic physician support
				groups facilitated by health care professionals or twelve-step group meetings,
				or both as specified by the contract.
(vii) Complying with specified employment
				conditions and restrictions as defined by the contract.
(viii) Signing a waiver allowing the
				monitoring program to release information to the board if the osteopathic
				physician does not comply with the requirements of the contract.
(c) The osteopathic physician is
				responsible for paying the costs of the physical and psychosocial evaluation,
				treatment of the impairing health condition, random urine screens, and other
				personal expenses incurred in compliance with the contract.
(d) The osteopathic physician may be subject
				to disciplinary action under RCW  18.130.160 and 18.130.180 if the osteopathic
				physician does not consent to be referred to the monitoring program, does not
				comply with specified practice restrictions, or does not successfully complete
				the program.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-330 - Confidentiality

Current through Register Vol. 24-14, July 15, 2024
(1) The treatment
				and pretreatment records of license holders referred to or voluntarily
				participating in approved monitoring programs shall be confidential, shall be
				exempt from RCW 42.17.250 through 42.17.450 and shall not be subject to
				discovery by subpoena or admissible as evidence except for monitoring records
				reported to the disciplinary authority for cause as defined in WAC
				246-853-320. Records held by the
				board under this section shall be exempt from RCW 42.17.250 through 42.17.450
				and shall not be subject to discovery by subpoena except by the license
				holder.
(2) Notwithstanding
				subsection (1) of this section, board orders shall be subject to RCW 42.17.250
				through 42.17.450.
Statutory Authority:
					 RCW
					 18.57.005 and
					 18.130.175. 91-10-043 (Order
					 159B), § 246-853-330, filed 4/25/91, effective
					 5/26/91.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-340 - Examination appeal procedures

Current through Register Vol. 24-14, July 15, 2024
(1) Any
				candidate who takes and does not pass the osteopathic practices and principles
				examination, may request review of the results of the examination by the
				Washington state board of osteopathic medicine and surgery.
(a) The board will not modify examination
				results unless the candidate presents clear and convincing evidence of error in
				the examination content or procedure, or bias, prejudice, or discrimination in
				the examination process.
(b) The
				board will not consider any challenges to examination scores unless the total
				of the potentially revised score would result in issuance of a
				license.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-350 - Examination conduct

Current through Register Vol. 24-14, July 15, 2024
Any applicant who fails to follow written or oral
				  instructions relative to the conduct of the examination, is observed talking or
				  attempting to give or receive information, or use unauthorized materials during
				  any portion of the examination will be terminated from the examination and not
				  permitted to complete it.
Statutory Authority:
					 RCW
					 18.57.005 and
					 18.130.175. 91-10-043 (Order
					 159B), § 246-853-350, filed 4/25/91, effective
					 5/26/91.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-400 - Brief adjudicative proceedings-Denials based on failure to meet education, experience, or examination prerequisites for licensure (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 18.57.005 and
					 chapter
					 18.57 RCW. 92-20-001
					 (Order 303B), § 246-853-400, filed 9/23/92, effective
					 10/24/92.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-500 - Adjudicative proceedings

Current through Register Vol. 24-14, July 15, 2024
The board adopts the model procedural rules for adjudicative
				  proceedings as adopted by the department of health and contained in chapter
				  246-11 WAC, including subsequent amendments.
Statutory Authority:
					 RCW
					 18.57.005 and
					 18.130.050. 94-15-068, §
					 246-853-500, filed 7/19/94, effective
					 8/19/94.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-600 - 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 osteopathic
				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 osteopathic physician and the person. The fact that a
				person is not actively receiving treatment or professional services is not the
				sole determining factor.
(b)
				"Osteopathic physician" means a person licensed to practice osteopathic
				medicine and surgery under chapter 18.57 RCW.
(c) "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, guardians and
				proxies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-610 - Abuse

Current through Register Vol. 24-14, July 15, 2024
(1) An osteopathic
				physician commits unprofessional conduct if the osteopathic physician abuses a
				patient or key third party. "Osteopathic physician," "patient" and "key third
				party" are defined in WAC
				246-853-600. An osteopathic
				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;
(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 246-853 - Osteopathic physicians and surgeons › Section 246-853-630 - 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 section, laser, light, radiofrequency, and plasma (LLRP)
				devices are medical devices that:
(a) Use a
				laser, noncoherent light, intense pulsed light, radio-frequency, or plasma to
				topically penetrate skin and alter human tissue, or use high frequency
				ultrasound or other technologies to deliver energy to or through the skin;
				and
(b) Are classified by the
				federal Food and Drug Administration as prescriptive devices.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-640 - Nonsurgical medical cosmetic procedures

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
				this rule is to set forth the duties and responsibilities of an osteopathic
				physician who delegates the injection of medications 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
				osteopathic medicine under
				RCW
				18.57.001(4).
(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
				246-853-630;
(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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-655 - Administration of deep sedation and general anesthesia by osteopathic physicians in dental offices

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
				  this section is to govern the administration of deep sedation and general
				  anesthesia by osteopathic physicians in dental offices. The board establishes
				  these standards to promote effective perioperative communication and
				  appropriately timed interventions, and mitigate adverse events and
				  outcomes.
(2) The definitions in
				  this subsection apply throughout this section unless the context clearly
				  requires otherwise.
(a) "Administering
				  osteopathic physician" means an individual licensed under chapter 18.57 RCW,
				  who has successfully completed an accredited anesthesiology residency, who
				  administers deep sedation or general anesthesia to a patient in a dental
				  office.
(b) "Deep sedation" has the
				  same meaning as in WAC 246-853-650.
(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 246-853-650.
(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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-660 - Intent and scope

Current through Register Vol. 24-14, July 15, 2024
WAC 246-853-660 through 246-853-790 govern the prescribing
					 of opioids in the treatment of pain.
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-660, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-661 - Exclusions

Current through Register Vol. 24-14, July 15, 2024
WAC
					 246-853-660 through
					 246-853-790 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
				  premedications;
(4) The treatment
				  of patients who have been admitted to any of the following facilities for more
				  than 24 hours:
(a) Acute 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-663

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-663, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-664

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-664, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-665

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-665, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-666

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-666, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-667

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-667, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-668

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-668, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-669

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-669, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-670

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-670, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-671

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-671, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-672

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-672, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-673

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						18.57.285,
						18.57A.090,
						18.57.005,
						18.57A.020. 11-10-062, §
						246-853-673, filed 5/2/11, effective
						7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-675 - Patient notification, secure storage, and disposal

Current through Register Vol. 24-14, July 15, 2024
(1) The osteopathic physician shall discuss
				  with 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, type of patient, and phase of treatment. The osteo-pathic 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-680 - Use of alternative modalities for pain treatment

Current through Register Vol. 24-14, July 15, 2024
The osteopathic physician shall consider multimodal
					 pharmacologic and nonpharmacologic therapy for pain rather than defaulting to
					 the use of opioid therapy alone whenever reasonable, evidence-based, clinically
					 appropriate alternatives exist. An osteopathic physician may combine opioids
					 with other medications and treatments including, but not limited to,
					 acetaminophen, acupuncture, chiropractic, cognitive behavior therapy,
					 nonsteroidal anti-inflammatory drugs (NSAIDs), osteopathic manipulative
					 treatment, physical therapy, massage, or sleep hygiene.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-853-685 - 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, an osteopathic physician licensed to prescribe opioids shall
				  complete a one-time continuing education requirement regarding best practices
				  in the prescribing of opioids and the current opioid prescribing rules in this
				  chapter. The continuing education must be at least one hour in
				  length.
(2) The osteopathic
				  physician shall complete the onetime continuing education requirement described
				  in subsection (1) of this section by the end of the osteopathic 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 continuing education requirements.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-853-690 - 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 osteopathic 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 date, type, dosage and quantity
				  prescribed.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-853-695 - Treatment plan-Acute nonoperative pain

Current through Register Vol. 24-14, July 15, 2024
The osteopathic 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 osteopathic
				  physician shall consider prescribing nonopioid analgesics as the first line of
				  pain control in patients in accordance with the provisions of WAC 246-853-680,
				  unless not clinically appropriate.
(2) The osteopathic physician, or their
				  designee, shall conduct queries of the PMP in accordance with the provisions of
				  WAC 246-853-790 to identify any Schedule II-V medications or drugs of concern
				  received by the patient and document their review and any concerns.
(3) If the osteopathic 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) A three-day supply or less will
				  often be sufficient.
(b) More than
				  a seven-day supply will rarely be needed.
(c) The osteopathic physician shall not
				  prescribe beyond a seven-day supply without clinical documentation in the
				  patient record to justify the need for such a quantity.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-ACUTE NONOPERATIVE PAIN AND ACUTE PERIOPERATIVE PAIN › Section 246-853-700 - Treatment plan-Acute perioperative pain

Current through Register Vol. 24-14, July 15, 2024
The osteopathic 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 osteopathic
				  physician shall consider prescribing nonopioid analgesics as the first line of
				  pain control in patients in accordance with the provisions of WAC 246-853-680,
				  unless not clinically appropriate.
(2) The osteopathic physician, or their
				  designee, shall conduct queries of the PMP in accordance with the provisions of
				  WAC 246-853-790 to identify any Schedule II-V medications or drugs of concern
				  received by the patient and document in the patient record their review and any
				  concerns.
(3) If the osteopathic
				  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.
(a) A
				  three-day supply or less will often be sufficient.
(b) More than a fourteen-day supply will
				  rarely be needed for perioperative pain.
(c) The osteopathic 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 osteopathic physician may refer
				  to clinical practice guidelines.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-SUBACUTE PAIN › Section 246-853-705 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
The osteopathic 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
				  opioids for subacute pain, the osteopathic 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 taking, including date,
				  type, dosage, and quantity prescribed;
(d) Conduct, or cause their designee to
				  conduct, a query of the PMP in accordance with the provisions of WAC
				  246-853-790 to identify any Schedule II-V medications or drugs of concern
				  received by the patient and document the review for any concerns;
(e) Screen and document the patient's
				  potential for high-risk behavior and adverse events related to opioid therapy.
				  If the osteopathic 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; and
(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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-SUBACUTE PAIN › Section 246-853-710 - Treatment plan-Subacute pain

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The osteopathic 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 osteopathic
				  physician shall reevaluate the patient who does not follow the expected course
				  of recovery. If significant and documented improvement in function or pain
				  control has not occurred, the osteopathic physician shall reconsider the
				  continued use of opioids or whether tapering or discontinuing opioids is
				  clinically indicated. The osteopathic 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 osteopathic 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. The osteopathic physician shall not prescribe beyond a fourteen-day
				  supply of opioids without clinical documentation to justify the need for such a
				  quantity during the subacute phase.
(4) If the osteopathic physician elects to
				  prescribe a combination of opioids with a medication listed in WAC 246-853-775
				  or prescribes opioids to a patient known to be receiving a medication listed in
				  WAC 246-853-775 from another practitioner, the osteopathic physician shall
				  prescribe in accordance with WAC 246-853-775.
(5) If the osteopathic physician elects to
				  treat a patient with opioids beyond the six- to twelve-week subacute phase, the
				  osteopathic 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 246-853-715 through 246-853-760 shall apply.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-715 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
(1) For the purposes of this section, "risk
				  assessment tool" means professionally developed, clinically accepted
				  questionnaires appropriate for identifying a patient's level of risk for
				  substance abuse or misuse.
(2) The
				  osteopathic 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 pain, the efficacy of medications tried; and
(vii) Medication allergies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-720 - Treatment plan

Current through Register Vol. 24-14, July 15, 2024
(1) When the
				  patient enters the chronic pain phase, the osteopathic 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-725 - Written agreement for treatment

Current through Register Vol. 24-14, July 15, 2024
The osteopathic physician shall use a written agreement for
					 treatment with the patient who requires long-term opioid therapy for chronic
					 pain that outlines the patient's responsibilities. This written agreement for
					 treatment must include:
(1) The
				  patient's agreement to provide biological samples for biological specimen
				  testing when requested by the osteopathic 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 or renewals;
(3) Reasons for which opioid therapy may be
				  discontinued including, but not limited to, the patient's violation of an
				  agreement;
(4) The requirement that
				  all chronic opioid prescriptions are provided by a single prescriber, single
				  clinic, or a multi-disciplinary 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 osteopathic
				  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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-730 - Periodic review

Current through Register Vol. 24-14, July 15, 2024
(1) The osteopathic
				  physician shall periodically review the course of treatment for chronic pain.
				  The osteopathic physician shall base the frequency of visits, biological
				  testing, and PMP queries, in accordance with the provisions of WAC 246-853-790
				  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 or aberrant behavior; and
(e) More frequently at the osteopathic
				  physician's discretion.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-735 - Consultation-Recommendations and requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  osteopathic 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. The management of 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. Unless the consultation is exempted under
				  WAC 246-853-740 or 246-853-745, an osteopathic physician who prescribes a
				  dosage amount that meets or exceeds the mandatory consultation threshold must
				  comply with the pain management specialist consultation requirements described
				  in WAC 246-853-750. 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 consultation between the pain
				  management specialist and the osteopathic physician;
(c) An audio-visual evaluation conducted by
				  the pain management specialist remotely, where the patient is present with
				  either the osteopathic physician or with a licensed health care practitioner
				  designated by the osteopathic 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-740 - Consultation-Exemptions for exigent and special circumstances

Current through Register Vol. 24-14, July 15, 2024
An osteopathic physician is not required to consult with a
					 pain management specialist as defined in WAC 246-853-750 when the osteopathic
					 physician has documented adherence to all standards of practice as defined in
					 WAC 246-853-715 through 246-853-760, 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 osteopathic physician documents
				  reasonable attempts to obtain a consultation with a pain management specialist
				  and the circumstances justifying prescribing above one hundred twenty
				  milligrams MED per day without first obtaining a consultation; or
(4) The osteopathic 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-745 - Consultation-Exemptions for the osteopathic physician

Current through Register Vol. 24-14, July 15, 2024
An osteopathic physician is exempt from the consultation
					 requirement in WAC 246-853-735 if one or more of the following qualifications
					 are met:
(1) The osteopathic physician
				  is a pain management specialist under WAC 246-853-750;
(2) The osteopathic physician has
				  successfully completed every four years a minimum of twelve continuing
				  education hours on chronic pain management approved by the profession's
				  continuing education accrediting organizations. At least two of these hours
				  must be in substance use disorders;
(3) The osteopathic physician is a pain
				  management practitioner working in a multidisciplinary chronic pain treatment
				  center or a multidisciplinary academic research facility; or
(4) The osteopathic physician has a minimum
				  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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-750 - Pain management specialist

Current through Register Vol. 24-14, July 15, 2024
(1) A pain
				  management specialist shall meet one or more of the following qualifications:
(a) An osteopathic physician shall be 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, rehabilitation medicine,
				  neurology, rheumatology, or anesthesiology;
(b) Have a subspecialty certificate in pain
				  medicine by an ABMS-approved board;
(c) Have a certification of added
				  qualification in pain management by the AOA;
(d) Be credentialed in pain management by an
				  entity approved by the board; or
(e) Have a minimum of three years of clinical
				  experience in a chronic pain management care setting including:
(i) Successful completion of a minimum of at
				  least 18 continuing education hours in pain management during the past three
				  years for an osteopathic physician; and
(ii) At least 30 percent of the osteopathic
				  physician's current practice is the direct provision of pain management care or
				  in a multidisciplinary pain clinic.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-755 - Tapering requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The
				  osteopathic 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 is unsatisfactory.
(2) The osteopathic physician shall consider
				  tapering, changing, discontinuing treatment, or referral for a substance use
				  disorder evaluation when:
(a) The patient
				  requests;
(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 or doses; or
(h) 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT › Section 246-853-760 - Patients with chronic pain, including those on high doses, establishing a relationship with a new practitioner

Current through Register Vol. 24-14, July 15, 2024
(1)
				  When a patient receiving chronic opioid pain medications changes to a new
				  practitioner, it is normally appropriate for the new practitioner to initially
				  maintain the patient's current opioid doses. Over time, the practitioner may
				  evaluate if any tapering or other adjustments in the treatment plan can or
				  should be done.
(2) An osteopathic
				  physician's treatment of a new high-dose chronic pain patient is exempt from
				  the mandatory consultation requirements of WAC 246-853-735 and the tapering
				  requirements of WAC 246-853-755 if:
(a) The
				  patient was previously being treated with a dosage of opioids in excess of one
				  hundred twenty milligrams 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 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 dose in excess of one hundred twenty milligrams MED.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-853-765 - Special populations-Patients twenty-five years of age or under, pregnant patient, 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 osteopathic physician shall
				  treat pain in a manner equal to that of an adult but must account for the
				  weight of the patient and reduce the dosage prescribed accordingly.
(2) Pregnant patients. The osteopathic
				  physician shall not discontinue the use of MAT opioids, such as methadone or
				  buprenorphine, by a pregnant patient without oversight by the MAT prescribing
				  practitioner. The osteopathic 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 osteopathic 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 246-853 - Osteopathic physicians and surgeons › OPIOID PRESCRIBING-SPECIAL POPULATIONS › Section 246-853-770 - 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 osteopathic physician knows is being treated with opioids for
				  chronic pain, such as for emergency or urgent care, the osteopathic physician
				  shall review the PMP to identify any Schedule II-V or drugs of concern received
				  by the patient and document in the patient record their review and any
				  concerns.
(2) An osteopathic
				  physician providing episodic care to a patient who the osteopathic physician
				  knows is being treated with opioids for chronic pain should provide additional
				  opioids to be equal to the severity of the acute pain. If opioids are provided,
				  the osteopathic 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 osteopathic physician providing
				  episodic care shall report known violations of the patient's written agreement
				  to the patient's treatment practitioner who provided the agreement for
				  treatment, when reasonable.
(4) The
				  osteopathic physician providing episodic care shall coordinate care with the
				  patient's chronic pain treatment practitioner if that person is known to the
				  osteopathic physician providing episodic care, when reasonable.
(5) For the purposes of this section,
				  "episodic care" means medical care provided by a practitioner other than the
				  designated primary practitioner in the acute care setting; for example, urgent
				  care or emergency department.