Chapter 4725-5 Misconduct
The employing of any solicitor or agent for the purpose of securing patients or acting as a solicitor or agent in the referring of patients is prohibited.
Engaging in the division of fees for the referral of patients, or receiving of any article of value in return for a specific referral of a patient to utilize a particular service or business is prohibited.
The receipt of fees for actual services provided in the co-management of patients with a licensed physician or with a professional corporation as defined by the Revised Code is permitted.
Co-management schedule, guidelines and visits will be determined by consultation between the licensed physician and referring optometrist. The patient will be advised of the schedule of return visits and any guidelines to be followed.
The optometrist cannot accept payment from the referral entity, a licensed physician or a corporation, for pre-surgical visits or consultations. This helps to assure the neutrality of the consultation and any subsequent referral recommendations.
The only exchange of value permitted between the optometrist and the physician shall be payment for services actually performed. Payment must come from third-party payers, self-paid from the patient, or from a pre-existing agreement between the optometrist and physician that allows for break out fees for services provided when global compensation is involved. The optometrist must document sufficient information to describe the post-operative care rendered.
Any violation of this rule constitutes "dishonest and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
R.C. 119.032 review dates: 02/07/2014 and 05/01/2019
Promulgated Under: 119.03
Statutory Authority: 4725.09
Rule Amplifies: 4725.09, 4725.19
Prior Effective Dates: 1/1/65, 6/1/99, 1/1/04
The advertising to guarantee any optometric service constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19, of the Revised Code.
The practice of optometry under any name other than the one under which the certificate of licensure is issued and registered with the exception of a legal name change constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19, of the Revised Code.
The use of the term "succeeding", "successor to", "formerly with" or other words or phrases of similar import or meaning for a period of time longer than one year after the taking over the practice, records, location, or equipment of another person constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The obtaining of any fee by fraud or misrepresentation or filing any claim forms without providing the service represented constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19, of the Revised Code.
Accepting any payment except from the holder of a certificate of licensure, a not for profit corporation or foundation or a professional corporation as defined in Chapter 1785 of the Revised Code is prohibited.
An optometrist cannot work for an unlicensed individual or an optician except in a not for profit corporation or foundation. An optometrist working in a general corporation or sole proprietorship or individual setting with an unlicensed individual cannot be paid by the hour, on a percentage basis or by splitting the examination fee paid by the patient.
The professional fee paid for services rendered, either by private pay or through a third party, must go to the optometrist. A general corporation or individual owner cannot supplement the fees of the optometrist either hourly, per patient, or in any manner.
If an optometrist leases space from a general corporation or an unlicensed individual, the optometrist shall do so on a flat rate basis. The Board may request copies of written leases from licensees working within general corporations and with individual owners. The licensee is responsible for negotiating and maintaining a proper lease relationship with unlicensed entities. The intent of this rule is to maintain the licensee's professional autonomy from the corporation or individual owner. This ensures that corporation and individual ownership objectives do not influence clinical decisions and the licensee's primary responsibilities to the patient.
For the purposes of this rule, a nonprofit corporation or foundation must be approved as so by the Ohio Secretary of State and must be primarily funded by federal grants, state grants and endowments.
The splitting, dividing or accepting payment of any fee with any person or entity other than expressly permitted constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
Rescinded eff 7-28-08
The permitting of another person to use a certificate of licensure for any purpose constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The impersonation of another holder of a certificate of licensure for any purpose constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The performance of optometric services for the public while in the employ of or while under the direct or indirect control of any person or entity of any kind other than a holder of a certificate of licensure, a corporation of holders of certificates of licensure, a not for profit charitable corporation or foundation, or a professional corporation as defined in Chapter 1785. of the Revised Code, of holders of certificates of licensure constitutes "dishonesty and unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
For the purposes of this rule, nonprofit charitable corporations or foundations that are primarily financed by federal grants, state grants and endowments, such as Prevent Blindness Ohio and low vision centers, may employ optometrists as long as no control is exerted over optometric procedures that are deemed necessary by optometrists working at these locations.
The release of confidential records regarding the treatment of a patient or physical condition of that patient is a matter within the control of the patient. The patient may request a copy of the records or waive the privilege of confidentiality for the records to be furnished to a third party.
The examining optometrist is responsible for providing a copy of the records upon a proper request either directly to the patient or to a designated third party. If records are to be sent to a third party the optometrist may require that the patient sign a record release or waiver form.
Upon retirement or termination of practice, patient records may be transferred to another optometrist for custody. A written custody agreement must be executed, signed and retained by both parties. Patients should be notified of the transfer of records and also informed that the records can be forwarded to an optometrist of their choice. A reasonable charge may be made for copying patient records. If the optometrist chooses to retain patient records, current patients must be notified of the location of their records.
An optometrist departing from a practice at a leased location may transfer records to another optometrist for custody. The optometrist may allow copies of patient prescriptions to remain at the leased location but is prohibited from releasing full patient records to any non-licensed individual, unless the patient provides written authorization to the optometrist.
The failure to timely release patient records upon a proper request or to notify current patients of a change of location where their records are maintained constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
All patient records must be maintained by the examining optometrist for seven years unless released to another optometrist for custody. Patient records include examinations, furnishing legend therapeutic agents and for whom optical accessories have been dispensed. Records may be maintained as paper or electronic files. If records are maintained electronically, a backup file will be maintained off site. The computer will also be keyed to record the time and date of any records transactions or alterations.
The failure to keep for a period of at least seven years a complete record of all patients examined or furnished legend therapeutic agents and of all patients for whom optical accessories have been adapted constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The failure clearly to show to the public both the name of the holder of a certificate of licensure and the fact that the holder is an optometrist constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The use of the words "eye specialist", "contact lens specialist", optometric eye specialist", "expert", "certified" or any other words of similar import of proficiency, skill, knowledge, or methods of practice constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
An optometrist shall notify the optometry board office within seventy-two hours of the occurrence of any instance of a clinically significant drug-induced side effect in a patient resulting from the optometrist administering, employing, applying, or furnishing such topical ocular or therapeutic pharmaceutical agent to or for the patient.
A report form, which will be provided by the optometry board to the reporting optometrist, shall be completed and forwarded to the optometry board office within ten days of receipt to provide the required information to comply with section 4725.31 of the Revised Code. The report form will include, but is not limited to, the presenting problem, diagnosis, agent administered, benefits achieved, problems encountered, and the action taken on the part of the administering optometrist to alleviate the patient problem. This report will not include the name or any other identifying information on the patient. This report will not be filed in the reporting optometrist's file but in a separate file designated by the board to retain this information for a period of two years.
A clinically significant drug-induced side effect means an unexpected reaction by a person resulting from topical ocular or therapeutic pharmaceutical agents administered by an optometrist which occurs within twenty four hours after the drug is administered and requires either referral to a medical doctor for treatment or hospitalization of the individual.
Failure to comply with all or part of this reporting procedure constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
Each optometrist who holds a current licensure certificate shall notify the board of the primary address where the optometrist is in practice and wherein the certificate of licensure is displayed.
The holder of a licensure certificate shall notify the board of any change of address of primary practice wherein the certificate is displayed. The license holder will take whatever steps are necessary to see that patients are informed of the new location of the optometrist or the location of the patient's records.
Prescriptions written for therapeutic pharmaceutical agents shall contain the optometrist's name, address of the location wherein their therapeutic certificate is displayed and the identification number of the therapeutic pharmaceutical agents certificate the optometrist holds.
Failure to place the required information on prescriptions for therapeutic pharmaceutical agents or to notify the board of address change within thirty days constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
The name or all names of optometrists practicing at a location must be prominently displayed to the public. The minimum requirement is the licensee's name and O.D., or optometrist or doctor of optometry.
If optometrists are employed by another optometrist, the minimum requirement is to display the name of the employing optometrist responsible for the administration of examinations at each such location with the names of examining optometrists posted at the entrances to exam rooms.
The provisions outlined in the above two paragraphs are not required if an optometrist is in practice at a health maintenance organization, public health clinic, clinic affiliated with a school of optometry, a hospital, licensed health care facility, or as a consultant to industry or an educational facility. In these locations the optometrist will wear an identifying name plate when in direct patient contact and give the patient a prescription with the required identifying information.
An optometrist has the responsibility to establish and maintain a safe and hygienic office adequately equipped to provide full optometric services within the scope of the licensure of the practitioner. The board requires the following minimum equipment needed to provide a full scope examination which shall include, but not be limited to, tonometer, slit lamp, and instrumentation to examine the retina and to perform visual fields. All optometric examination locations shall be equipped with adequate hand washing facilities on location for use by optometrists and patients.
Failure to display identity to the public or to maintain a safe and hygienic office adequately equipped constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
Each optometrist who conducts an eye examination for a patient shall be responsible for providing the patient with certain information prior to and during the course of the examination to permit the patient to make informed decisions.
(A) The usual and customary fees for an eye examination will be defined for the patient, which will include the cost of an examination for spectacles or for contact lenses. The professional fees for a contact lens examination will include all procedures, tests and fitting requirements that are customarily required in a standard examination to obtain all information needed to produce a valid contact lens prescription.
(B) No licensed optometrist will conduct a spectacle examination and write on the spectacle prescription "approved for contact lens" or any other similar wording.
(C) In conducting a standard eye examination the use of dilating agents or topical ocular pharmaceutical agents will be included in the usual and customary fee and not identified as a separate or additional cost. This in no way limits or prohibits the charge of an additional fee to a patient for extended tests or procedures which require the use of these agents and are deemed necessary as a result of the standard eye examination. The use of dilating agents or topical ocular pharmaceutical agents in conducting an eye examination will be at the professional judgment of the examining optometrist.
(D) In advertising the price of an eye examination for contact lenses, the advertisement will include full information on the usual and customary fees normally required to provide the patient with a valid prescription and any requirements on the part of the patient. This in no way prohibits charging additional fees required for extended tests, procedures or visits found necessary as the result of the standard examination. Any additional tests or procedures performed will be included in the patient's medical records.
Failure to disclose the required information on providing professional services to the patient or in advertising eye examinations constitutes "dishonesty or unprofessional conduct" as that phrase is used in section 4725.19 of the Revised Code.
(1) "Delegation" means the transfer of authority for the performance of a selected optometric activity or task from a licensed optometrist authorized to perform the activity or task to ancillary personnel who do not have the authority to perform the activity or task independently. Delegation to ancillary personnel shall be performed under direct, general or administrative supervision. Ancillary personnel need not be employees of the responsible licensed optometrist.
(2) "Direct supervision" means the responsible licensee must be on the premises both while the procedure is being performed by the ancillary personnel and to interpret the data upon completion of the task.
(3) "General supervision" means that the licensee assumes responsibility for the activities and tasks performed by ancillary personnel, but need not be present while they are performed. The licensee must be available for consultation and direction except if involved in a personal emergency which makes them temporarily unavailable.
(4) "Administrative supervision" means supervision to an extent that the responsible licensee need not be present, but must give proper instruction on procedures and assumes responsibility for the actions of ancillary personnel. The licensee shall not be required to be available for immediate contact.
(5) "Ancillary personnel" means any person or persons working under the direct, general or administrative supervision of a licensed practitioner. Ancillary personnel may be delegated to perform ministerial duties, tasks and functions as assigned to them by the licensed practitioner.
(B) Ancillary personnel may not, under any circumstances, be delegated diagnosis or treatment duties, refractions or interpretation of testing that requires optometric judgement.
(C) Ancillary personnel may administer dilation and therapeutic drops into the eyes per the responsible practitioner's instructions and may instruct patients on the proper protocol on self administration of topical ocular pharmaceutical agents. These tasks must be performed under the direct supervision of a licensed practitioner.
(D) Ancillary personnel may perform ministerial duties, tasks and functions assigned to them by and performed under the general supervision of a licensed practitioner. This includes obtaining demographic information that allows the office to better serve the patients. Tasks and functions that may be performed shall include, but not be limited to, data gathering, preliminary testing, performing prescribed vision therapy and low vision therapy, delivery of eyeglasses, selection of frames and adjustments of frames. Ancillary personnel shall not alter, or change in any manner, a patient's prescription without express, written instructions by the licensed practitioner.
(E) Ancillary personnel may perform tasks and duties assigned to them under the administrative supervision of a licensed practitioner including, but not limited to, sorting and cataloguing of patient records, while maintaining confidentiality. Ancillary personnel may respond to other healthcare professionals concerning patient records.
(F) Ancillary personnel must demonstrate skill and ability prior to being delegated to do assigned tasks. A written policy must outline what procedures can be done and by whom. This policy must also state that no professional judgments or interpretation of data are allowed in any situation.
(G) Direct supervision is required when delegation of ancillary personnel occurs in a health care facility or other institutions offering health care except for routine administration of topical agents, delivery of eyeglasses, selection of frames, adjustment of frames and instruction to patients on insertion, removal and wearing regimen of contact lenses.
(H) If in the performance of any delegated task the ancillary personnel becomes aware that the patient has a problem that limits the patient's ability to respond, the task will be immediately stopped. The supervising practitioner will be advised of the situation before continuing.
(A) Accepted and prevailing standards of care presuppose a professional relationship between a patient and optometrist when the optometrist is prescribing controlled substances. By definition, an optometrist may never have such a relationship with himself or herself. Thus, an optometrist may not self-prescribe or self-administer controlled substances.
(B) Accepted and prevailing standards of care require that an optometrist maintain detached professional judgment when utilizing controlled substances in the treatment of family members. An optometrist shall utilize controlled substances when treating a family member only in an ocular emergency situation which shall be documented in the patient's record.
(C) For purposes of this rule, "family member" means a spouse, parent, child, sibling or other individual in relation to whom an optometrist's personal or emotional involvement may render that optometrist unable to exercise detached professional judgment in reaching diagnostic or therapeutic decisions.
Failure to comply with all or part of this rule constitutes a violation of divisions B)(3), (B)(9) and/or (B)(13) of section 4725.19 of the Revised Code.