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Ohio Laws and Rules
For purposes of this chapter the following definitions shall apply:
(A) “Certificate to prescribe” means the certificate issued by the board that authorizes the holder of the certificate to prescribe drugs and therapeutic devices in collaboration with one or more physicians or podiatrists.
(B) “Collaboration or collaborating” means in the case of a certified nurse practitioner, a clinical nurse specialist or a certified nurse-midwife, that a physician has entered into a standard care arrangement with the nurse and is continuously available to communicate with the nurse either in person, or by radio, telephone, or other form of telecommunication.
(C) “Consultation” means the discussion or communication between a nurse holding a current valid certificate to prescribe with a physician prior to initiating the prescription for a drug. The consultation relative to drug therapy shall be documented in the patient’s record and shall include the consulting physician’s name and the date the consultation took place.
(D) “Contact hour” means a minimum of fifty minutes of education. For credit hours earned on an academic quarter system, one credit hour is equivalent to ten contact hours. For credit hours earned on an academic trimester system, one credit hour is equivalent to twelve contact hours. For credit hours earned on an academic semester system, one credit hour is equivalent to fifteen contact hours.
(E) “Course of study” means an advanced level instructional program in pharmacology which consists of planned classroom and clinical study offered by either:
(1) An accredited educational institution acceptable to the board; or
(2) A continuing education course approved or accepted by an Ohio board of nursing (OBN) approver in accordance with Chapter 4723-14 of the Administrative Code.
(F) “Externship” means the practice relationship, consistent with the standard care arrangement, between a nurse who holds a current, valid externship certificate to prescribe and one or more licensed physicians during which time the nurse’s prescribing activities are reviewed and evaluated by a supervising professional for the purpose of ongoing improvement of the nurse’s competence, knowledge, and skill in pharmacokinetic principles and the application of these principles to the nurse’s area of practice. The standard care arrangement entered into between the collaborating physician and the nurse shall specify the frequency of the review needed for appropriate oversight.
(G) “Externship certificate to prescribe” means the certificate issued by the board that authorizes the holder of the certificate to prescribe drugs and therapeutic devices only when one or more supervising professionals are providing supervision in accordance with rule 4723-9-04 of the Administrative Code.
(H) “Physician” means an individual who holds a current valid license to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery issued by the Ohio state medical board.
(I) “Successful completion of an externship” means the demonstration of the required hours of an externship experience and an attestation by a supervising physician to the competence of the nurse to hold a certificate to prescribe. The information required by this paragraph shall be provided on forms developed by the board of nursing.
(J) “Supervising professional” means a physician or a nurse who is authorized by the board of nursing to prescribe and who has a standard care arrangement with the supervising physician. A holder of an externship certificate to prescribe shall not be a supervising professional.
(K) “Supervision” means the oversight of the prescribing practices of a nurse as a holder of an externship certificate to prescribe.
(1) “Direct supervision” means the supervising professional is available on site.
(2) “Indirect supervision” means the timely review by a physician of prescriptions written by and prescribing practices of a nurse holding an externship certificate to prescribe.
(L) “Types of drugs” means therapeutic drug class.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.48 to 4723.50
Prior Effective Dates: 10/1/2001, 2/1/02
(A) To be acceptable to the board, a course of study shall meet the following requirements:
(1) Be a minimum of forty-five contact hours in length and include content which ensures sufficient preparation for the safe and effective prescribing of drugs and therapeutic devices;
(2) Include content which is specific to the participant’s nursing specialty and which includes all of the following:
(a) A minimum of thirty-six hours of training, obtained from a single provider, in:
(i) Pharmacokinetic principles and clinical application; and
(ii) Principles of the use of drugs and therapeutic devices in the prevention of illness and maintenance of health;
(b) A combined six hours of training consistent with divisions (B)(3)(b) and (B)(3)(c) of section 4723.482 of the Revised Code.
(3) Include a process for interaction of the participants with instructional personnel;
(4) Include a process for evaluating the participants’ learning of the content required by this rule which includes:
(a) Successful completion of case studies or written assignments;
(b) Successful completion of a comprehensive written examination; and
(c) A mechanism to assure the security of the evaluation process;
(5) Be faculty-directed and obtained either from:
(a) An accredited educational institution acceptable to the board; or
(b) A continuing education program in pharmacology which has been submitted individually for approval to an Ohio board of nursing approver and approved or accepted in accordance with Chapter 4723-14 of the Administrative Code.
Effective: 04/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.482
Prior Effective Dates: 10/1/2001, 2/1/02, 2/1/03
(A) To be eligible for a certificate to prescribe, an applicant shall complete, within the three years immediately preceding the application, a course of study, as defined in rule 4723-9-01 of the Administrative Code, that meets the requirements of rule 4723-9-02 of the Administrative Code.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.482
Prior Effective Dates: 10/1/2001, 2/1/03
(A) In order to participate in an externship as defined in paragraph (F) of rule 4723-9-01 of the Administrative Code a nurse shall:
(1) Meet the requirements set forth in section 4723.482 of the Revised Code; and
(2) Hold a current, valid externship certificate to prescribe issued by the board.
(B) The externship shall consist of not less than one thousand five hundred hours and not more than one thousand eight hundred hours during which the nurse’s prescribing practices shall be supervised as follows:
(1) For a minimum of five hundred hours, direct supervision, as defined in paragraph (K)(1) of rule 4723-9-01 of the Administrative Code, shall be provided by a supervising professional. A physician shall determine whether a nurse may act as a supervising professional. When the supervising professional is a nurse, the nurse shall provide no more than two hundred of the five hundred hours of supervision; and
(2) For the remaining hours, indirect supervision, as defined in paragraph (K)(2) of rule 4723-9-01 of the Administrative Code, shall be provided by a physician.
(C) A nurse who holds current valid authority to prescribe drugs and therapeutic devices from another jurisdiction, or who has been employed by the United States government and authorized to prescribe in conjunction with that employment, may satisfy up to one thousand hours of the indirect supervision requirement of the externship as follows:
(1) By submitting documentation acceptable to the board from a physician that the nurse’s prescriptive practice has been overseen or supervised by a physician in the other jurisdiction or a physician employed by the United States government; and
(2) By verifying that the oversight or supervision occurred within the three years immediately preceding or subsequent to the application for prescriptive authority.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.48, 4723.482, 4723.484
Prior Effective Dates: 2/1/2002, 2/1/2003, 2/1/2006
(A) To obtain an externship certificate to prescribe a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, who meets the qualifications set forth in sections 4723.431 and 4723.482 of the Revised Code and this chapter, shall submit:
(1) A completed application on a form specified by the board which includes evidence of having successfully completed the advanced pharmacology course as set forth in rule 4723-9-03 of the Administrative Code;
(2) Evidence of holding both a current, valid license to practice nursing as a registered nurse and a current, valid certificate of authority issued under section 4723.41 of the Revised Code to practice as a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist;
(3) Documentation of a collaborative practice with a supervising physician who has agreed to the practice agreement; and
(4) An application fee of fifty dollars.
(B) The externship certificate to prescribe shall be considered current for one year following issuance of the certificate by the board unless the certificate is suspended or revoked by the board.
(C) An externship certificate to prescribe may be extended for an additional year if the nurse submits evidence satisfactory to the board of continued participation in an externship as set forth in rule 4723-9-04 of the Administrative Code.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.48, 4723.482, 4723.484
Prior Effective Dates: 2/1/2002
(A) To obtain a certificate to prescribe a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, who meets the qualifications set forth in section 4723.482 of the Revised Code and this chapter shall:
(1) Submit a completed application on a form specified by the board which includes, but is not limited to:
(a) Evidence of having successfully completed the advanced pharmacology course of study as set forth in rule 4723-9-03 of the Administrative Code; or
(b) Evidence of having held authority to prescribe as an advanced practice nurse under section 4723.56 of the Revised Code on May 17, 2000;
(2) Submit evidence of holding both a current, valid license to practice nursing as as registered nurse and a current, valid certificate of authority issued under section 4723.41 of the Revised Code to practice as a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist;
(3) Submit evidence of either:
(a) Having completed the externship required by rule 4723-9-04 of the Administrative Code which includes a statement from a supervising physician attesting to the applicant’s successful completion of the externship; or
(b) Having held authority to practice as an advanced practice nurse under section 4723.56 of the Revised Code on May 17, 2000; and
(4) Submit an application fee of fifty dollars. If through no fault of the board, an applicant for a certificate to prescribe is not determined eligible for a certificate to prescribe within one year from receipt of the application, the application shall be considered void and the fee forfeited. The application shall state the circumstances under which this forfeiture may occur.
(B) An initial certificate to prescribe is considered current until the next scheduled renewal period for registered nurse licensure. However, when a certificate to prescribe is issued by the board on or after the first of April of an odd numbered year, that certificate to prescribe shall be current through the thirty-first of August of the next odd numbered year.
(C) A certificate to prescribe shall be considered inactive or lapsed in accordance with section 4723.47 of the Revised Code when a license to practice as a registered nurse or a certificate of authority is inactive or expires due to failure to renew. The certificate to prescribe shall remain inactive or lapsed until the license to practice as a registered nurse and the certificate of authority are reactivated or reinstated.
(D) A certificate to prescribe shall be automatically revoked in accordance with section 4723.47 of the Revised Code if the nurse’s certificate of authority is revoked under section 4723.28 and 4723.281 of the Revised Code.
(E) A certificate to prescribe shall be automatically suspended in accordance with section 4723.47 of the Revised Code if the nurse’s certificate of authority is suspended under section 4723.28 or 4723.281 of the Revised Code.
(F) In accordance with section 4723.47 of the Revised Code, if a restriction is placed on a nurse’s certificate of authority under section 4723.28 of the Revised Code, the same restriction shall be automatically placed on the nurse’s certificate to prescribe. The restriction shall remain on the certificate to prescribe as long as the certificate of authority remains restricted.
(G) The holder of an inactive, lapsed, revoked, or suspended certificate to prescribe shall immediately return the certificate to the board.
(H) A holder of a current valid certificate to prescribe who does not intend to prescribe drugs or therapeutic devices in Ohio may request that the certificate to prescribe be placed on inactive status:
(1) At time of renewal, by checking the appropriate box on the certificate to prescribe renewal application that indicates the holder wishes to be placed on inactive status; or
(2) At any other time, by submitting to the board a written statement requesting inactive status, and the holder’s current certificate to prescribe.
(I) While on inactive status, a nurse shall not represent or imply to the public that the nurse is authorized to prescribe drugs or therapeutic devices.
(J) An inactive or lapsed certificate to prescribe may be reactivated or reinstated pursuant to a written request which shall be accompanied by:
(1) A completed certificate to prescribe renewal application on a form specified by the board; and
(2) Payment of the renewal fee of fifty dollars.
(K) If the certificate to prescribe has lapsed or been placed on inactive status for three years or longer, the nurse seeking to reinstate or reactivate the certificate shall first obtain an externship certificate to prescribe and shall meet all requirements of externship including completion of the pharmacology course in accordance with rule 4723-9-03 of the Administrative Code.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.48, 4723.482
Prior Effective Dates: 2/1/2002
(A) To renew a certificate to prescribe, a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist who meets the qualifications set forth in sections 4723.24 and 4723.485 of the Revised Code shall submit:
(1) A completed renewal application on a form specified by the board;
(2) Evidence of having completed during the previous two years at least twelve hours of additional continuing education in advanced pharmacology as provided in section 4723.485 of the Revised Code, or, if the certificate has been held for less than a full renewal period, at least six hours of approved continuing education in pharmacology as provided in section 4723.485 of the Revised Code; and
(3) A renewal fee of fifty dollars and all other applicable fees.
(B) A renewed certificate to prescribe shall be current until the next scheduled renewal period for registered nurse licensure.
(C) The board shall provide to each holder of a current, valid certificate to prescribe who is eligible to renew that certificate, an application for renewal of a certificate to prescribe. Failure of the holder to receive an application for renewal from the board does not excuse the holder from the requirements of Chapter 4723. of the Revised Code and this chapter.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.485
Prior Effective Dates: 2/1/2002
(A) In accordance with section 3719.81 of the Revised Code, a A nurse who holds a current, valid certificate to prescribe issued by the board may personally furnish to a patient a sample of a drug or therapeutic device included among the types of drugs and devices set forth in the formulary established in rule 4723-9-10 of the Administrative Code, subject to all of the following:
(1) The amount of the sample furnished shall not exceed a seventy-two-hour supply, except when the minimum available quantity of the sample is packaged in an amount that is greater than a seventy-two-hour supply, in which case the nurse may furnish the sample in the packaged amount;
(2) Samples may not be sold as set forth in section 4729.01 of the Revised Code;
(3) Samples of controlled substances may not be personally furnished;
(4) Where the directions for use by a particular patient are different from the directions on or in the sample container, the nurse shall also provide, in written format, the following:
(a) The name of the prescribing nurse;
(b) The name of the patient; and
(c) Directions for use of the drug or therapeutic device; and
(5) The nurse shall maintain a written record of all drugs and devices personally furnished by the nurse.
(B) A nurse who holds a current, valid certificate to prescribe issued by the board may personally furnish to a patient a complete or partial supply of a drug or therapeutic device included in the types of drugs and devices listed on the formulary established in rule 4723-9-10 of the Administrative Code, subject to all of the following:
(1) Those drugs that may be personally furnished: are limited to those set forth in section 4723.481 of the Revised Code;
(2) The nurse shall affix to the container a label showing:
(a) The name and address of the prescribing nurse;
(b) The name of the patient for whom the drug is intended;
(c) Name and strength of the drug;
(d) Directions for use; and
(e) Date furnished;
(3) The nurse shall maintain a written record of all drugs and devices personally furnished by the nurse; and
(4) The nurse may personally furnish the drug or device only in the locations set forth in section 4723.481 of the Revised Code.
(C) A nurse who personally furnishes a drug or therapeutic device shall do so only in accordance with this rule and any other applicable state or federal laws or rules relative to personally furnishing drugs and therapeutic devices, including, but not limited to, rules adopted by the Ohio board of pharmacy.
Effective: 02/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.481
Prior Effective Dates: 2/1/2002
(A) A nurse who holds a current valid certificate to prescribe may prescribe a drug or therapeutic device provided the prescription is in accordance with:
(1) The nurse’s standard care arrangement;
(2) The scope of practice in the nurse’s specialty area;
(3) The requirements of the formulary as set forth in section 4723.50 of the Revised Code; and
(4) The requirements of this chapter.
(B) The nurse’s prescriptive authority shall not exceed the prescriptive authority of the collaborating physician, including but not limited to, any restrictions imposed on the physician’s practice by action of the United States drug enforcement administration or the state medical board.
(C) A nurse who holds a current valid certificate to prescribe shall prescribe in a valid prescriber-patient relationship. This includes, but is not limited to:
(1) Obtaining a thorough history of the patient;
(2) Conducting a physical examination of the patient;
(3) Rendering a diagnosis;
(4) Prescribing medication, ruling out the existence of any recognized contraindications;
(5) Consulting with the collaborating physician when necessary; and
(6) Properly documenting these steps in the patient’s medical records.
(D) Except in an emergency situation, a nurse holding a current, valid certificate to prescribe shall not prescribe for a family member or other individual for whom the nurse’s personal or emotional involvement may render the nurse unable to exercise detached professional judgment in making diagnostic or therapeutic decisions.
(E) A nurse holding a current valid certificate to prescribe a controlled substance shall apply for, and obtain, the United States drug enforcement administration registration prior to prescribing any controlled substances.
(F) A nurse holding a current valid certificate to prescribe shall not prescribe any drug or device to perform or induce an abortion.
(G) All drugs and therapeutic devices shall be prescribed in accordance with the standard care arrangement and Chapter 4723. of the Revised Code and rules of the board.
(H) A nurse holding a current valid certificate to prescribe may prescribe drugs for purposes other than food and drug administration (FDA) indications when both of the following apply:
(1) The prescribing is in accordance with provisions of the formulary established pursuant to section 4723.50 of the Revised Code; and
(2) The prescribing is consistent with the standard care arrangement required by section 4723.431 of the Revised Code.
(I) A nurse holding a current valid certificate to prescribe shall satisfy all requirements for prescribing set forth in rule 4729-5-30 of the Administrative Code, and shall include the nurse’s prescriber number on each prescription.
Effective: 04/01/2006
R.C. 119.032 review dates: 10/14/2005 and 10/01/2010
Promulgated Under: 119.03
Statutory Authority: 4723.50
Rule Amplifies: 4723.481
Prior Effective Dates: 2/1/2002, 2/1/03
(A) The formulary, as established by the committee on prescriptive governance, shall be available on the Ohio board of nursing web site.
(B) The committee on prescriptive governance shall review the formulary for additions or deletions at least once a year.
(C) The committee on prescriptive governance shall establish a formulary and may exclude subtypes or individual drugs within the following types of drugs:
(1) Nutrients and nutritional agents;
(2) Hematological agents;
(3) Endocrine and metabolic agents;
(4) Cardiovascular agents;
(5) Renal and genitourinary agents;
(6) Respiratory agents;
(7) Central nervous system agents;
(8) Gastrointestinal agents;
(9) Anti-infective and systemic agents;
(10) Biologic/immunologic agents;
(11) Dermatologic agents;
(12) Opthalmic and otic agents;
(13) Antineoplastic agents; and
(14) Diagnostic aids.
(D) A nurse with a current valid certificate to prescribe may prescribe a schedule II controlled substance only in situations where all of the following apply:
(1) A patient has a terminal condition;
(2) The nurse’s collaborating physician initially prescribed the substance for the patient; and
(3) The prescription is for a quantity that does not exceed the amount necessary for the patient’s use in a single, twenty-four hour period.
(E) A nurse holding a current valid certificate to prescribe may prescribe any drug or therapeutic device in any form and route of administration which is included on the formulary and as agreed to by the collaborating physician in the standard care arrangement. The ability to prescribe the drug or therapeutic device must be within the nurse’s scope of practice.
(F) Drugs approved by the FDA subsequent to the date of the adoption of these rules shall not be prescribed until reviewed and approved by the committee on prescriptive governance.
(G) For purposes of interpreting the formulary, the following definitions shall apply:
(1) “Physician consultation” means a nurse holding a current, valid certificate to prescribe may initiate the medication after direct communication with the collaborating physician regarding a particular patient and documenting the consultation in the patient record. Once the medication is initially authorized by the collaborating physician, a nurse holding a current valid certificate to prescribe may continue, modify, or discontinue the medication without further consultation.
(2) “Physician initiation” means the collaborating physician is required to have personally examined and evaluated the patient before therapy is initiated in accordance with rule 4731-11-09 of the Administrative Code. Following discussion with the collaborating physician, the initial order or prescription may be written by an advanced practice nurse holding a current valid certificate to prescribe. Once therapy has been initiated, the advanced practice nurse may continue, modify, or discontinue the medication without further consultation.
Effective: 02/01/2008
R.C. 119.032 review dates: 10/01/2010
Promulgated Under: 119.03
Statutory Authority: RC 4723.50
Rule Amplifies: RC 4723.49, 4723.491, 4723.492
Prior Effective Dates: 2/1/02, 2/1/03, 2/1/06