Chapter 4723-8 | Advanced Practice Nurse Certification and Practice

Rule 4723-8-01 | Definitions.

• Effective: February 1, 2021
• Promulgated Under: 119.03

As used in this chapter:

(A) "Advanced practice registered nurse" means an individual who holds a current, valid license issued under Chapter 4723. of the Revised Code that authorizes the practice of nursing as an advanced practice registered nurse and is designated as any of the following:

(1) A certified registered nurse anesthetist;

(2) A clinical nurse specialist;

(3) A certified nurse-midwife;

(4) A certified nurse practitioner.

(B) "Collaboration" or "collaborating" means:

(1) In the case of a certified nurse practitioner or a clinical nurse specialist, that a podiatrist or physician has entered into a standard care arrangement with the nurse and is continuously available to communicate with the clinical nurse specialist or certified nurse practitioner either in person, or by electronic communication;

(2) In the case of 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 electronic communication.

(C) "Dentist" means an individual holding a license issued under Chapter 4715. of the Revised Code to practice dentistry, and who is practicing in Ohio.

(D) "Physician" means an individual holding a certificate issued under Chapter 4731. of the Revised Code authorizing the practice of medicine and surgery or osteopathic medicine and surgery, and who is practicing in Ohio.

(E) "Podiatrist" means an individual holding a certificate issued under Chapter 4731. of the Revised Code authorizing the practice of podiatric medicine, and who is practicing in Ohio.

(F) "Practice of nursing as an advanced practice registered nurse" means providing to individuals and groups nursing care that requires knowledge and skill obtained from advanced formal education, training and clinical experience. Such nursing care includes the care described in section 4723.43 of the Revised Code, and additionally, with respect to certified registered nurse anesthetists, sections 4723.433, 4723.434, and 4723.435 of the Revised Code.

(G) "Nursing specialty" means a specialty in practice as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner.

(H) "Standard care arrangement" means a written, formal guide for planning and evaluating a patient's health care that is developed by a collaborating physician or podiatrist and a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, and that meets the requirements of section 4723.431 of the Revised Code and this chapter.

(I) "Supervision" means that a certified registered nurse anesthetist is under the direction of a podiatrist, a dentist, or a physician.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.01, 4723.43
Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/1997, 2/1/2002, 2/1/2014

Rule 4723-8-02 | Standards of practice.

• Effective: February 1, 2021
• Promulgated Under: 119.03

(A) An advanced practice registered nurse shall provide to patients nursing care that requires knowledge and skill obtained from advanced formal education, which includes a clinical practicum, and clinical experience as specified in sections 4723.41, 4723.43, 4723.433, 4723.434, 4723.435 and 4723.482 of the Revised Code and this chapter.

(B) Except as otherwise precluded by law or rule, each advanced practice registered nurse shall practice in accordance with the following:

(1) The advanced practice registered nurse's education and clinical experience;

(2) The advanced practice registered nurse's national certification as provided in section 4723.41 of the Revised Code; and

(3) Chapter 4723. of the Revised Code and rules adopted under that chapter.

(C) Only a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist holding a current valid license as an advanced practice registered nurse may prescribe drugs. A certified registered nurse anesthetist may order drugs for use in the health care facility where the nurse practices in accordance with sections 4723.434 and 4723.435 of the Revised Code.

(D) Each certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist shall utilize and incorporate into the nurse's practice, knowledge of Chapter 4731. of the Revised Code and rules adopted under that chapter that govern the practice of the nurse's collaborating physician or podiatrist. Each certified registered nurse anesthetist shall utilize and incorporate into the nurse's practice, knowledge of Chapters 4715. and 4731. of the Revised Code and rules adopted under these chapters that govern the practice of the nurse's supervising podiatrist, dentist, or physician.

(E) Nothing in this rule precludes an advanced practice registered nurse from practicing as a registered nurse in accordance with section 4723.01 of the Revised Code and the rules of the board.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.01, 4723.43
Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/2006, 2/1/2011, 2/1/2014, 1/1/2018

Rule 4723-8-03 | Title protection.

• Effective: February 1, 2021
• Promulgated Under: 119.03

(A) Only a person who holds a current valid license to practice as an advanced practice registered nurse issued in accordance with sections 4723.41, 4723.42 and 4723.482 of the Revised Code and this chapter may use the following titles or initials if designated to do so:

(1) Certified nurse-midwife, or A.P.R.N.-C.N.M., if the individual is authorized to practice in accordance with division (A) of section 4723.43 of the Revised Code;

(2) Clinical nurse specialist, or A.P.R.N.-C.N.S., if the individual is authorized to practice in accordance with division (D) of section 4723.43 of the Revised Code;

(3) Certified nurse practitioner, or A.P.R.N.-C.N.P., if the individual is authorized to practice under division (C) of section 4723.43 of the Revised Code;

(4) Certified registered nurse anesthetist or A.P.R.N.-C.R.N.A., if the individual is authorized to practice in accordance with division (B) of sections 4723.43, 4723.433, 4723.434, and 4723.435 of the Revised Code; or

(5) Advanced practice registered nurse or A.P.R.N. if the individual is authorized to practice under division (A) to division (D) of section 4723.43 of the Revised Code.

(B) Only a person who holds a current valid advanced practice registered nurse license issued in accordance with sections 4723.41, 4723.42 and 4723.482 of the Revised Code and this chapter to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall:

(1) Practice in accordance with section 4723.43, 4723.433, 4723.434, or 4723.435 of the Revised Code, as applicable, and this chapter as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist;

(2) Hold themselves out as being a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, or advanced practice registered nurse;

(3) Use any title or initials implying that the person is a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, or advanced practice registered nurse authorized to practice in accordance with section 4723.03 of the Revised Code and paragraph (A) of this rule.

(C) At all times when an advanced practice registered nurse is providing direct care to a patient within the nurse's respective scope of practice, each certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall display and identify the applicable title and designation as set forth in this rule.

(D) No person who is not authorized to do so shall knowingly prescribe or personally furnish drugs or therapeutic devices without holding a current valid license to practice nursing as an advanced practice registered nurse issued under Chapter 4723. of the Revised Code and being designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner according to section 4723.42 of the Revised Code.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.44
Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2004, 4/1/2006

Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist.

• Effective: February 1, 2022
• Promulgated Under: 119.03

(A) Prior to engaging in practice, a standard care arrangement shall be entered into with each physician or podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist collaborates.

(1) The standard care arrangement shall be revised to reflect the addition or deletion of a physician or podiatrist with whom the nurse collaborates within that employment setting. Under these circumstances, a new standard care arrangement is not necessary.

(2) A new standard care arrangement shall be executed when the nurse is:

(a) Employed at a different or additional organization or practice; and

(b) Engages in practice with a collaborating physician or podiatrist outside of the primary employing organization.

(B) Except as provided in paragraph (C) of this rule, a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist engaged in the practice of the nurse's specialty, shall enter into a written standard care arrangement with one or more collaborating physicians or podiatrists whose practice is the same or similar to the nurse's practice.

(C) In accordance with division (A)(2)(c) of section 4723.431 of the Revised Code, a clinical nurse specialist certified as a psychiatric-mental health CNS by the American nurses credentialing center or a certified nurse practitioner who is certified as a psychiatric-mental health NP by the American nurses credentialing center, may enter into a standard care arrangement with a physician, but not a podiatrist, if the collaborating physician is practicing in one of the following specialties:

(1) Psychiatry;

(2) Pediatrics;

(3) Primary care of family practice.

(D) The standard care arrangement shall include at least:

(1) The signatures of each nurse, and each collaborating physician, or the physician's designated representative, or each podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist primarily collaborates indicating review of and agreement to abide by the terms of the standard care arrangement. For purposes of this rule, a physician's designated representative means a physician who serves as the department or unit director or chair, within the same institution, organization or facility department or unit, and within the same practice specialty, that the nurse practices, and with respect to whom the physician has executed a legal authorization to enter collaborating agreements on the physician's behalf;

(2) The date when the arrangement is initially executed;

(3) The date of the most recent review of the arrangement;

(4) The complete name, specialty and practice area, business address, and business phone number or number at which the individual can be reached at any time for:

(a) Each collaborating physician or podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist primarily collaborates and who is a party to the standard care arrangement, unless a physician's designated representative has entered the standard care arrangement on the physician's behalf; and

(b) Each certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist who is a party to the standard care arrangement;

(5) A statement of services offered by the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist consistent with section 4723.43 of the Revised Code and this chapter, including a description of the scope of prescriptive practice and authorization to enter consult agreements for patients, if applicable;

(6) A plan for incorporation of new technology or procedures consistent with the applicable scope of practice as set forth in section 4723.43 of the Revised Code and this chapter;

(7) Quality assurance provisions, including at least:

(a) When modification is made to the body of the standard care arrangement, reapproval of the standard care arrangement is required;

(b) Criteria for referral of a patient by the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist to a collaborating physician or podiatrist, including, for the certified nurse-midwife, a plan for referral of breech or face presentation or any other abnormal condition identified as such in the standard care arrangement;

(c) A process for the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist to obtain consultation from a physician or podiatrist; and

(d) A process for chart review in accordance with rule 4723-8-05 of the Administrative Code if the nurse's practice includes any direct patient care;

(8) A plan for coverage of patients in instances of emergency or planned absences of either the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist, or the collaborating physician or podiatrist;

(9) A process for resolution of disagreements regarding matters of patient management; and

(10) Regarding the prescribing component of the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner's practice, the following quality assurance provisions shall include at least:

(a) Provisions to ensure timely direct, personal evaluation of the patient with a collaborating physician or the physician's designee when indicated;

(b) Prescribing parameters for drugs or therapeutic devices when indicated;

(c) Provisions for the use of schedule II controlled substances;

(d) If the nurse is prescribing to minors, as defined in division (A) of section 3719.061 of the Revised Code, provisions for complying with section 3719.061 of the Revised Code when prescribing an opioid analgesic to a minor; and

(e) Provisions for obtaining and reviewing OARRS reports, and engaging in physician consultation and patient care consistent with section 4723.487 of the Revised Code and rule 4723-9-12 of the Administrative Code.

(11) Quality assurance standards consistent with rule 4723-8-05 of the Administrative Code.

(E) The most current copy of the standard care arrangement, and any legal authorization signed by a physician according to paragraph (D)(1) of this rule, shall be retained on file by the nurse's employer. Upon request of the board, the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall immediately provide a copy of the standard care arrangement to the board.

(F) Copies of previously effective standard care arrangements shall be retained by the nurse for three years and provided to the board upon request.

(G) When a hospital negotiates a standard care arrangement in accordance with division (E) of section 4723.431 of the Revised Code and this chapter, the standard care arrangement shall be developed in accordance with paragraph (D) of this rule. Review and approval of the standard care arrangement shall be in accordance with the policies and procedures of the hospital governing body and the bylaws, policies, and procedures of the hospital medical staff.

(H) A certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall notify the board of the identity of a collaborating physician or podiatrist not later than thirty days after engaging in practice.

(I) A certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist shall notify the board of any change in the name and business address of a collaborating physician or podiatrist not later than thirty days after the change takes effect, except as provided in division (D) of section 4723.431 of the Revised Code.

Last updated February 1, 2022 at 8:55 AM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.431
Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/1997, 2/1/2006, 2/1/2011, 2/1/2014, 2/1/2016, 1/1/2018

Rule 4723-8-05 | Quality assurance standards.

• Effective: February 1, 2021
• Promulgated Under: 119.03

(A) An advanced practice registered nurse shall comply with all continuing education requirements for registered nurse license renewal and advanced practice registered nurse license renewal set forth in division (C) of section 4723.24 of the Revised Code and national certification requirements set forth in sections 4723.41 and 4723.42 of the Revised Code and this chapter.

(B) Each certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist who is a party to a standard care arrangement shall comply with all quality assurance provisions of the standard care arrangement in accordance with this chapter. Failure to provide, enter into, or to practice in accordance with a standard care arrangement may result in disciplinary action in accordance with section 4723.28 of the Revised Code.

(C) Each practicing certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist who is a party to a standard care arrangement shall participate in a quality assurance process and shall immediately provide documentation satisfactory to the board of such participation upon request of the board. The quality assurance process shall include at a minimum:

(1) Periodic random chart review which includes prescribing patterns and schedule II prescribing, if indicated, at least annually by a collaborating physician, podiatrist, , or a designated member of a quality assurance committee, composed of at least one physician, of the institution, organization, or agency where the nurse has practiced;

(2) An opportunity for the advanced practice registered nurse and the collaborating physician to discuss feedback or issues subsequent to the chart review; and

(3) A process for patient evaluation of care.

(D) Documentation of participation in an ongoing, systematic quality assurance process at an institution, organization, or agency shall satisfy the requirements of paragraph (C) of this rule, provided there is a plan to utilize the results of the quality assurance process to maintain or improve care delivery.

(E) The board may audit, review or investigate, at any time, whether an advanced practice registered nurse has complied with the quality assurance standards set forth in this rule.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.41, 4723.431
Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2014, 1/1/2018

Rule 4723-8-06 | National certifying organizations.

• Effective: February 1, 2021
• Promulgated Under: 119.03

[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]

(A) To be approved by the board, a national certifying organization shall meet all of the requirements set forth in division (A) of section 4723.46 of the Revised Code.

(B) Annually at a time specified by the board, each national nursing certifying organization approved by the board for the prior year shall submit a "Verification Form Organizations Certifying Advanced Practice Registered Nurses: Certified Nurse Midwives (CNMs), Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs)," attesting that the organization has met and continues to meet all the requirements contained in section 4723.46 of the Revised Code. The board shall verify compliance of each national nursing certifying organization with the criteria contained in section 4723.46 of the Revised Code. No later than January thirtieth of each year, the board shall publish a list of approved national certifying organizations that meet these requirements. The board may approve additional national nursing certifying organizations or discontinue approval of a national nursing certifying organization based on criteria in section 4723.46 of the Revised Code. At the discretion of the board, it may discontinue approval of a national certifying organization for failure of the organization to return to the board the form indicating compliance with the requirements of section 4723.46 of the Revised Code.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.46
Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2011

Rule 4723-8-08 | Advanced practice registered nurse license renewal; notification of national recertification.

• Effective: February 1, 2021
• Promulgated Under: 119.03

[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]

(A) To renew a current valid license to practice as an advanced practice registered nurse, a licensee shall:

(1) Submit a "Certified Registered Nurse Anesthetist Renewal Application," "Certified Nurse Midwife Renewal Application," "Certified Nurse Practitioner Renewal Application," and/or "Clinical Nurse Specialist Renewal Application," that includes:

(a) Except as provided in paragraph (A)(2) of this rule, documentation satisfactory to the board that the licensee has maintained certification in the nursing specialty with a national certifying organization as required by division (B) of section 4723.42 of the Revised Code;

(b) Documentation satisfactory to the board of completion of continuing education required by division (C)(2) of section 4723.24 of the Revised Code and rule 4723-8-10 of the Administrative Code;

(c) A list of the names and business addresses of the holder's current collaborating physicians and podiatrists, if the nurse is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner; and

(d) The renewal fee set forth in division (A)(8) of section 4723.08 of the Revised Code. If a completed renewal application is not renewed on-line by September fifteenth of odd numbered years, in order to renew the applicant shall pay a late processing fee of fifty dollars in accordance with division (A)(10) of section 4723.08 of the Revised Code. The late processing fee is in addition to the renewal fee specified in division (A)(8) of section 4723.08 of the Revised Code, and is in addition to any late processing fee imposed with respect to renewal of the applicant's registered nurse license; and

(2) A clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013, is not required to provide documentation of having maintained certification in the holder's specialty, but shall submit documentation satisfactory to the board of completion of continuing education in compliance with paragraph (E) of rule 4723-8-10 of the Administrative Code.

(B) A renewed advanced practice registered nurse license is subject to renewal in odd-numbered years. When an advanced practice registered nurse license is first issued by the board on or after July first of an odd numbered year, that license shall be current through the thirty-first of October of the next odd-numbered year.

(C) The board shall provide access to an on-line application to each holder of a current valid advanced practice registered nurse license for renewal of the license, except when the board is aware that an individual is ineligible for renewal for any reason, including those reasons specified in section 4723.24 of the Revised Code.

(D) Within thirty days of recertification by the applicable national certifying organization, an advanced practice registered nurse shall request that the national certifying organization provide, directly to the board, satisfactory documentation of recertification to the board. This requirement does not apply to a clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013.

(E) An advanced practice registered nurse who fails to maintain certification or recertification by the applicable national certifying organization approved by the Board according to section 4723.46 of the Revised Code, may be subject to disciplinary action in accordance with section 4723.28 of the Revised Code. This requirement does not apply to a clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013.

(F) A clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013, who fails to complete the continuing nursing education required by division (B) of section 4723.42 of the Revised Code and rule 4723-8-10 of the Administrative Code, may be subject to disciplinary action in accordance with section 4723.28 of the Revised Code.

(G) A holder of a current valid advanced practice registered nurse license who does not intend to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist in Ohio may request that the license be placed on inactive status at any time, by submitting a written statement to the board or electronic request asking that the certificate be placed on inactive status.

(H) While on inactive status a nurse shall not represent or imply to the public that the nurse is authorized to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist or use the titles or designations established by section 4723.03 of the Revised Code and rule 4723-8-03 of the Administrative Code.

(I) An inactive or lapsed advanced practice registered nurse license may be reactivated or reinstated by:

(1) Submitting an "Advanced Practice Registered Nurse Reactivation and Reinstatement Application"; and

(2) Payment of the applicable fees set forth in section 4723.08 of the Revised Code.

(J) An advanced practice registered nurse who is a service member or veteran, as defined in rule 4723-2-01 of the Administrative Code, or who is the spouse or surviving spouse of a service member or veteran, may be eligible for a waiver of the late application fee and the reinstatement fee according to rule 4723-2-03 of the Administrative Code.

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.24, 4723.47, 4723.42
Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2016

Rule 4723-8-09 | Advanced practice registered nurse license for a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist practicing in another jurisdiction.

• Effective: January 1, 2018
• Promulgated Under: 119.03

[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist who is practicing in another jurisdiction may apply for an advanced practice registered nurse license to practice in Ohio if the nurse meets the requirements for licensure set forth in section 4723.41 of the Revised Code and this chapter. An applicant from another jurisdiction shall:

(A) Submit a completed "Advanced Practice Registered Nurse License Application,"; and

(B) Submit the applicable fee.

Last updated September 11, 2023 at 11:11 AM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.41
Five Year Review Date: 10/15/2025
Prior Effective Dates: 4/1/1997

Rule 4723-8-10 | Continuing education requirements.

• Effective: January 1, 2018
• Promulgated Under: 119.03

(A) Each advanced practice registered nurse who obtains continuing nursing education in the nurse's area of practice for the purpose of obtaining or maintaining a national certification may use those continuing education hours to satisfy the continuing education requirements for renewal of a license to practice as a registered nurse and advanced practice registered nurse set forth in this rule, section 4723.24 of the Revised Code and Chapter 4723-14 of the Administrative Code, if the continuing education meets the requirements of Chapter 4723-14 of the Administrative Code.

(B) An advanced practice registered nurse who holds an active license shall complete continuing nursing education as follows in order to renew the license:

(1) Twenty-four contact hours of continuing nursing education;

(2) For advanced practice registered nurses designated as a clinical nurse specialist, certified nurse-midwife or certified nurse practitioner, at least twelve hours of the education must be in advanced pharmacology and must have been provided by an accredited institution recognized by the board, including any provider referenced in paragraph (E) of rule 4723-9-01 of the Administrative Code;

(3) For the first period of renewal immediately following the initial issuance of the advanced practice registered nurse license by the board, a licensee is not required to complete any contact hours of continuing education;

(4) For purposes of fulfilling the twenty-four hours of continuing education required for renewal, an advanced practice registered nurse may satisfy up to eight hours by providing health care services as a volunteer if the following requirements are met:

(a) The licensee provides the health care services to an indigent and uninsured person as defined in section 2305.234 of the Revised Code;

(b) The health care provided is advanced practice registered nursing, as defined in division (P) of section 4723.01 of the Revised Code and is within the designated specialty scope of practice of the advanced practice registered nurse providing the services as set forth in section 4723.43 of the Revised Code;

(c) The health care services provided are provided as a volunteer, as that term is defined in section 2305.234 of the Revised Code;

(d) The licensee satisfies the requirements of section 2305.234 of the Revised Code to qualify for the immunity from liability granted under that section;

(e) One hour of continuing education may be awarded for each sixty minutes documented as spent providing health care services as a volunteer;

(f) The advanced practice registered nurse obtains, and maintains for a period of six years following the date the health care services are provided, a signed statement from a person at the health care facility or location where the health care services were performed indicating:

(i) The date and time period the licensee performed the health care services;

(ii) That the recipient of the health care services was indigent and uninsured as defined in section 2305.234 of the Revised Code; and

(iii) That the licensee provided the health care services as a volunteer as defined in section 2305.234 of the Revised Code.

(C) An advanced practice registered nurse who earns more than the number of hours required by this rule during a single renewal period cannot apply the extra hours to meet future renewal period continuing education requirements.

(D) The waiver option discussed in rule 4723-14-03 of the Administrative Code, for purposes of registered nurse or licensed practical nurse continuing nursing education, does not apply to the advanced practice registered nurse continuing education requirements set forth in this rule.

(E) A clinical nurse specialist, originally issued a certificate of authority on or before December 31, 2000 in accordance with division (C) of section 4723.41 of the Revised Code, as that division existed prior to March 20, 2013, who is not certified by a national nursing certifying organization approved by the board shall obtain twelve contact hours of continuing nursing education in addition to the twenty-four hours required every two years for renewal of a license to practice nursing as a registered nurse and the twenty-four hours required for renewal of a license to practice as an advanced practice registered nurse. For the purposes of complying with this rule:

(1) The additional hours shall be in programs that are targeted to advanced practice registered nurses in the nurse's area of practice or in relevant programs from other health care disciplines;

(2) The continuing education activity must meet the requirements of Chapter 4723-14 of the Administrative Code; and

(3) The clinical nurse specialist cannot use the waiver option contained in rule 4723-14-03 of the Administrative Code for the additional twelve contact hours of continuing nursing education required by this paragraph.

Last updated September 11, 2023 at 11:11 AM

Supplemental Information

Authorized By: 4723.07, 4745.04
Amplifies: 4723.41, 4723.24, 4723.42
Five Year Review Date: 10/15/2025
Prior Effective Dates: 2/1/2006

Rule 4723-8-11 | Youth concussion assessment and clearance.

• Effective: February 1, 2021
• Promulgated Under: 119.03

(A) For purposes of this rule:

(1) "Interscholastic athletics" means an athletic activity, that is an interscholastic extracurricular activity as defined in section 3313.535 of the Revised Code, that a school or school district sponsors or participates in and that includes participants from more than one school or school district.

(2) "Youth" means an individual between the ages of four and nineteen who participated in youth sports organization or interscholastic athletics and was removed from practice or competition under division (D) of section 3707.511 of the Revised Code or division (D) of section 3313.539 of the Revised Code, based on exhibiting signs, symptoms or behaviors consistent with having sustained a concussion or head injury while participating in practice or competition.

(3) "Youth sports organization" has the same meaning as in section 3707.51 of the Revised Code and means a public or nonpublic entity that organizes an athletic activity in which the athletes are not more than nineteen years of age and are required to pay a fee to participate in the athletic activity or whose cost to participate is sponsored by a business or nonprofit organization.

(4) "Consensus Statement" means the "Consensus Statement on Concussion in Sport - the 5th International Conference on Concussion in Sport held in Berlin, October 2016."

(B) An advanced practice registered nurse clinical nurse specialist or certified nurse practitioner may assess and clear a youth to return to practice or competition if all of the following requirements are met:

(1) The advanced practice registered nurse's practice must include care and treatment of patients aged four through nineteen years of age and the nurse must collaborate with a physician whose practice includes this age group;

(2) The advanced practice registered nurse has completed education and training in the detection of concussion, its clinical features, assessment techniques, and the principles of safe return to play protocols consistent with the "Consensus Statement";

(3) The advanced practice registered nurse has maintained competency and completed continuing education in the detection of concussion, its clinical features, assessment techniques, and the principles of safe return to play protocols consistent with the "Consensus Statement"; and

(4) The nurse uses the medical clearance return to play after suspected concussion form located at: http://www.nursing.ohio.gov/forms.htm (2019).

Supplemental Information

Authorized By: 3313.539, 3707.511, 3707.521, 4723.07
Amplifies: 3313.539, 3707.511,3707.521, 4723.43
Five Year Review Date: 10/15/2025
Prior Effective Dates: 9/17/2015

Rule 4723-8-12 | Consult agreements for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist.

• Effective: February 1, 2022
• Promulgated Under: 119.03

(A) For purposes of this rule and rule 4723-8-13 of the Administrative Code, practitioner means an advanced practice registered nurse licensed under Chapter 4723. of the Revised Code and practicing in Ohio as a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist.

(B) Requirements of a consult agreement

(1) A consult agreement shall include all of the following:

(a) Identification of the practitioner(s) and pharmacist(s) authorized to enter the agreement. They may include:

(i) Individual names of the practitioner(s) and pharmacists;

(ii) Practitioner or pharmacist practice groups;

(iii) Identification based on institutional credentialing or privileging; or

(iv) If multiple practitioners are entering the consult agreement, identification of the primary practitioner for the patient.

(b) A description of the patient's consent to drug therapy management pursuant to the consult agreement in compliance with paragraph (E) of rule 4729:1-06-01 of the Administrative Code.

(c) The specific diagnoses and diseases being managed under the agreement, including whether each disease is primary or comorbid.

(d) A description of the drugs or drug categories managed as part of the agreement.

(e) A description of the procedures, decision criteria, and plan the managing pharmacist is to follow in acting under a consult agreement. Such a description should provide a reasonable set of parameters for the activities a managing pharmacist is allowed to perform under a consult agreement.

(f) A description of the types of tests permitted pursuant to section 4729.39 of the Revised Code that may be ordered and evaluated by the managing pharmacist as long as the tests relate directly to the management of drug therapy. This may include specific tests or categories of testing that may be ordered and evaluated.

(g) A description of how the managing pharmacist shall maintain a record of each action taken for each patient whose drug therapy is managed under the agreement. All prescribing, administering, and dispensing of drugs shall be documented using positive identification pursuant to paragraph (N) of rule 4729-5-01 of the Administrative Code.

(h) A description of how communication between a managing pharmacist and practitioner acting under a consult agreement shall take place at regular intervals specified by the practitioner who authorized the agreement. The agreement may include a requirement that the managing pharmacist send a consult report to each consulting practitioner.

(i) A provision that allows a practitioner to override a decision made by the managing pharmacist when appropriate.

(j) An appropriate quality assurance mechanism to ensure that managing pharmacists only act within the scope authorized by the consult agreement.

(k) A description of a continuous quality improvement (CQI) program used to evaluate effectiveness of patient care and ensure positive patient outcomes. The CQI program shall be implemented pursuant to the agreement.

(l) The training and experience criteria for managing pharmacists. The criteria may include privileging or credentialing, board certification, continuing education or any other training requirements. The agreement shall include a process to verify that the managing pharmacists meet the specified criteria.

(m) A statement that the practitioner(s) and pharmacists shall meet minimal standards of care at all times.

(n) An effective date and expiration date.

(o) Any other requirements contained in rules 4729:1-6-01, 4729:1-6-02 and 4729:1-6-03 of the Administrative Code.

(2) Institutional or ambulatory outpatient facilities may implement a consult agreement and meet the requirements of paragraphs (A)(1)(c) to (A)(1)(f) of this rule through institutional credentialing standards or policies. Such standards or policies shall be referenced as part of the consult agreement and available to an agent of the board upon request.

(3) The consult agreement shall be signed by the primary practitioner and one of the following:

(a) The terminal distributor's responsible person, which may include the responsible person's designee if the designee meets the qualifications of the responsible person pursuant to Chapter 4729. of the Revised Code; or

(b) A managing pharmacist licensed pursuant to Chapter 4729. of the Revised Code.

(4) All amendments to a consult agreement shall be signed and dated by the primary practitioner and one of the following:

(a) The terminal distributor's responsible person, which may include the responsible person's designee if the designee meets the qualifications of the responsible person pursuant to Chapter 4729. of the Revised Code; or

(b) A managing pharmacist licensed pursuant to Chapter 4729. of the Revised Code.

(c) Amendments to the consult agreement are required when the scope of the managing pharmacist's permitted procedures expands past what was contemplated in the original agreement.

(5) A consult agreement shall be valid for a period not to exceed two years.

(6) A practitioner may enter a consult agreement with an Ohio licensed pharmacist if the physician or podiatrist with whom the practitioner collaborates, with respect to patient(s) that are the proposed subjects of consult agreements, has authorized in the standard care agreement that the practitioner may enter consult agreements for those patient(s).

(C) Recordkeeping. The primary practitioner, practitioner group or institution as defined in agency 4729 of the Administrative Code shall maintain a copy of the original consult agreement, all amendments made to the agreement, and a record of actions made in consultation with the managing pharmacist regarding each patient's drug therapy. The records shall be maintained in such a manner that they are readily retrievable for at least three years from the date of the last action taken under the agreement. Consult agreements shall be considered confidential patient records.

(D) Managing drug therapy.

(1) For purposes of implementing the management of a patient's drug therapy by an authorized managing pharmacist acting pursuant to a consult agreement, the primary practitioner must:

(a) Provide the managing pharmacist with access to the patient's medical record;

(b) Establish the managing pharmacist's prescriptive authority as one or both of the following:

(i) A prescriber authorized to issue a drug order in writing, orally, by a manually signed drug order sent via facsimile or by an electronic prescribing system for drugs or combinations or mixtures of drugs to be used by a particular patient as authorized by the consult agreement. For all prescriptions issued by a pharmacist pursuant to this paragraph, the pharmacist shall comply with rules 4729-5-30 and 4729-5-13 of the Administrative Code; and or

(ii) With respect to non-controlled dangerous drugs only, an agent of the consulting practitioner(s). As an agent of the consulting practitioner(s), a pharmacist is authorized to issue a drug order, on behalf of the consulting practitioner(s), in writing, orally, by a manually signed drug order sent via facsimile or by an electronic prescribing system for drugs or combinations or mixtures of drugs to be used by a particular patient as authorized by the consult agreement;

(c) Specifically authorize the managing pharmacist's ability to:

(i) Change the duration of treatment for the current drug therapy; adjust a drug's strength, dose, dosage form, frequency of administration, route of administration, discontinue a drug, or to prescribe new drugs; and or

(ii) Order tests related to the drug therapy being managed and to evaluate those results; and

(d) Identify the extent to which, and to whom, the managing pharmacist may delegate drug therapy management to other authorized pharmacists under the agreement.

(E) Review of consult agreements. Upon the request of the board, the practitioner shall immediately provide a copy of the consult agreement, amendments, and any related policies or documentation pursuant to this rule and section 4729.39 of the Revised Code. The board may prohibit the execution of a consult agreement, or subsequently void a consult agreement, if the board finds any of the following:

(1) The agreement does not meet the requirements set forth in section 4729.39 of the Revised Code or Chapter 4723. of the Administrative Code; or

(2) The consult agreement, if executed, would present a danger to patient safety.

Last updated February 1, 2022 at 8:55 AM

Supplemental Information

Authorized By: 4729.39, 4723.07, 4723.50
Amplifies: 4723.481, 4723.43, 4723.431
Five Year Review Date: 10/16/2026

Rule 4723-8-13 | Standards for managing drug therapy according to a consult agreement.

• Effective: February 1, 2022
• Promulgated Under: 119.03

(A) A practitioner may elect to manage the drug therapy of an established patient by entering into a consult agreement with a pharmacist. The agreement is subject to but not limited by the following standards:

(1) The primary practitioner must ensure that the managing pharmacist has access to the patient's medical record, the medical record is accurate, and that while transferring the medical record, the primary practitioner ensures the confidentiality of the medical record.

(2) The practitioner must have an ongoing practitioner-patient relationship with the patient whose drug therapy is being managed, including an initial assessment and diagnosis by the practitioner prior to the commencement of the consult agreement.

(3) With the exception of inpatient management of patient care at an institutional facility as defined in agency 4729 of the Administrative Code, the practitioner, prior to a pharmacist managing the patient's drug therapy, shall communicate the content of the proposed consult agreement to each patient whose drug therapy is managed under the agreement, in such a manner that the patient or the patient's representative understands the scope and role of the managing pharmacist, which includes the following:

(a) That a pharmacist may be utilized in the management of the patient's care;

(b) That the patient or an individual authorized to act on behalf of a patient has the right to elect to participate in and to withdraw from the consult agreement; and

(c) Consent may be obtained as part of the patient's initial consent to treatment.

(4) The diagnosis by the practitioner must be within the practitioner's scope of practice.

(5) The practitioner shall meet the minimal and prevailing standards of care.

(6) The practitioner must ensure that the pharmacist managing the patient's drug therapy has the requisite training and experience related to the particular diagnosis for which the drug therapy is prescribed. Practitioners practicing at institutional or ambulatory outpatient facilities may meet this requirement through institutional credentialing standards or policies.

(7) The practitioner shall review the records of all services provided to the patient under the consult agreement.

(B) Quality assurance mechanisms. The following quality assurance mechanisms shall be implemented to verify information contained within the consult agreement, and ensure the managing pharmacist's actions are authorized and meet the standards listed in paragraphs (A) and (B) of this rule:

(1) Verification of ongoing practitioner-patient relationship. A practitioner-patient relationship can be established by detailing criteria set forth in paragraph (A)(2) of this rule within the consult agreement.

(2) Verification that practitioner diagnosis is within the practitioner's scope of practice. Establishing that a diagnosis is within the practitioner scope of practice may be established by detailing the criteria set forth in paragraph (A)(4) of this rule within the consult agreement.

(3) Verification that the pharmacist's training and experience is related to the drug therapy. Establishing that a pharmacist's requisite training and experience with a particular drug therapy is related to the diagnosis for which the drug therapy is prescribed may be established by detailing the criteria set forth n paragraph (A)(6) of this rule within the consult agreement.

(C) Continuous quality improvement program. The following should be included in the development of a continuous quality improvement program in order to evaluate the effectiveness of patient care and ensure positive patient outcome:

(1) Notifications to the primary practitioner. The managing pharmacist must notify the primary practitioner of the following situations regarding any pharmacist authorized to manage drug therapy under the agreement:

(a) A pharmacist has had their pharmacist license revoked, suspended, or denied by the state board of pharmacy;

(b) If prescribing controlled substances, a pharmacist has failed to renew their controlled substance prescriber registration;

(c) If prescribing controlled substances, a pharmacist fails to obtain or maintain a valid D.E.A. registration;

(D) Overriding decisions of managing pharmacist. Any authorized practitioner identified under the consult agreement may override any decision, change, modification, evaluation or other action by any pharmacist acting pursuant to the consult agreement or under the direction of the managing pharmacist, that was made with respect to the management of the patient's drug therapy under the consult agreement.

Last updated February 1, 2022 at 8:55 AM

Supplemental Information

Authorized By: 4729.39, 4723.07, 4723.50
Amplifies: 4723.481, 4723.43, 4723.431
Five Year Review Date: 10/16/2026