House File 2305 - Reprinted HOUSE FILE 2305 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HF 708) (As Amended and Passed by the House March 5, 2026 ) A BILL FOR An Act relating to health care decisions related to palliative 1 care, hospice programs, life-sustaining procedures, 2 out-of-hospital do-not-resuscitate orders, and durable power 3 of attorney for health care. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 HF 2305 (4) 91 lh/ko/md

H.F. 2305 Section 1. Section 135J.1, Code 2026, is amended to read as 1 follows: 2 135J.1 Definitions. 3 For the purposes of this chapter unless otherwise defined: 4 1. “Attending physician provider ” means a physician licensed 5 pursuant to chapter 148 or a physician assistant licensed 6 pursuant to chapter 148C , physician assistant, or an advanced 7 registered nurse practitioner who is licensed in this state . 8 2. “Attorney in fact” means an individual who is designated 9 by a durable power of attorney for health care as an agent 10 to make health care decisions on behalf of a patient and has 11 consented to act in that capacity. 12 3. “Close adult friend” means a friend of a patient to whom 13 all of the following apply: 14 a. The individual is at least eighteen years of age. 15 b. The individual has shown special care and concern for the 16 patient. 17 c. The individual maintains regular contact with the patient 18 and is familiar with the patient’s health, activities, and 19 beliefs. 20 d. The individual has provided an affidavit to the patient’s 21 attending provider that states that the individual is willing 22 and able to be involved in the patient’s care. 23 2. 4. “Core services” means physician services, nursing 24 services, medical social services, counseling services, 25 and volunteer services. These core services, as well as 26 others deemed necessary by the hospice in delivering safe 27 and appropriate care to its case load the hospice’s hospice 28 patients , can be provided through either direct or indirect 29 arrangement by the hospice. 30 3. 5. “Department” means the department of inspections, 31 appeals, and licensing. 32 6. “Durable power of attorney for health care” means a 33 document authorizing an attorney in fact to make health care 34 decisions for a patient if the patient is unable, in the 35 -1- HF 2305 (4) 91 lh/ko/md 1/ 15

H.F. 2305 judgment of the patient’s attending provider, to make health 1 care decisions. 2 4. 7. “Hospice patient” or “patient” means a diagnosed 3 terminally ill person an individual with an anticipated life 4 expectancy of six months or less, as certified by the attending 5 physician provider , who, alone or in conjunction with a unit of 6 care as defined in subsection 9 , has voluntarily requested and 7 received admission into the a hospice program. If the patient 8 is unable to request admission, a family member may voluntarily 9 request and receive admission on the patient’s behalf. 10 5. 8. “Hospice patient’s family” means the immediate kin of 11 the a hospice patient, including a spouse, parent, stepparent, 12 brother, sister, stepbrother, stepsister, child, or stepchild. 13 Additional relatives or individuals with significant personal 14 ties to the hospice patient may be included in the hospice 15 patient’s family. 16 6. 9. “Hospice program” means a centrally coordinated 17 program of home and inpatient care provided directly or through 18 an agreement under the direction of an identifiable hospice 19 administration providing palliative care directed at symptom 20 management and supportive medical and other health services 21 to terminally ill hospice patients and their families. A 22 licensed hospice program shall utilize a medically directed 23 interdisciplinary team and provide care to meet the physical, 24 emotional, social, spiritual, and other special needs which 25 are experienced during the final stages of illness, dying, and 26 bereavement. Hospice care shall be available twenty-four hours 27 a day, seven days a week. 28 7. 10. “Interdisciplinary team” means the hospice patient 29 and the hospice patient’s family, the attending physician 30 provider , and all of the following individuals trained to serve 31 with a licensed hospice program: 32 a. A licensed physician pursuant to chapter 148 . 33 b. A licensed registered nurse pursuant to chapter 152 . 34 c. An individual with at least a baccalaureate degree in the 35 -2- HF 2305 (4) 91 lh/ko/md 2/ 15

H.F. 2305 field of social work providing medical-social services. 1 d. Trained hospice volunteers Volunteer services . 2 e. As deemed appropriate by the hospice, physician 3 assistants, providers of special services including but not 4 limited to a spiritual counselor, a pharmacist pharmacists , or 5 professionals in the fields of mental health may be included 6 on the interdisciplinary team. 7 8. 11. “Palliative care” means specialized medical care 8 directed at managing symptoms experienced by the hospice 9 provided to a patient , as well as addressing related needs 10 of the patient and family as they experience the stress of 11 the dying process who has been diagnosed by the patient’s 12 attending provider with a serious illness. Palliative care is 13 stress and symptom management care, based on the needs of the 14 patient rather than the patient’s diagnosis, provided by an 15 interdisciplinary team . The intent of palliative care is to 16 enhance the quality of life for the hospice patient and family 17 unit , and is not treatment directed at cure of the terminal 18 illness . Palliative care may be provided at any stage of a 19 patient’s serious illness, regardless of the patient’s age, and 20 may be provided in conjunction with curative treatment for the 21 serious illness. 22 12. “Serious illness” means a health condition that carries 23 a high risk of mortality and either negatively impacts a 24 person’s daily functioning or quality of life, or excessively 25 strains the person’s caregivers. 26 13. “Terminal condition” means the same as defined in 27 section 144A.2. 28 9. 14. “Unit of care” means the a hospice patient and the 29 hospice patient’s family within a hospice program. 30 10. 15. “Volunteer services” means the services provided by 31 individuals who have successfully completed a training program 32 developed by a licensed hospice program. 33 Sec. 2. Section 135J.3, Code 2026, is amended to read as 34 follows: 35 -3- HF 2305 (4) 91 lh/ko/md 3/ 15

H.F. 2305 135J.3 Basic requirements. 1 A licensed hospice program shall include: 2 1. A planned program of hospice care, the medical components 3 of which shall be under the direction of an attending physician 4 provider . 5 2. Centrally administered, coordinated hospice core 6 services provided in home, outpatient, or institutional 7 settings. 8 3. A mechanism that assures the rights of the patient and 9 family a unit of care . 10 4. Palliative care Symptom management provided to a hospice 11 patient and family unit of care under the direction of an 12 attending physician provider . 13 5. An interdisciplinary team which develops, implements, 14 and evaluates the hospice plan of care for the patient and 15 family a unit of care . 16 6. Bereavement services. 17 7. Accessible hospice care twenty-four hours a day, seven 18 days a week in all settings. 19 8. An ongoing system of quality assurance and utilization 20 review. 21 Sec. 3. NEW SECTION . 135J.3A Patient incapable of making a 22 treatment decision. 23 A patient who has a terminal condition, and who is comatose, 24 incompetent, or otherwise physically or mentally incapable 25 of communication, and who has not expressed their desire 26 for palliative care or a hospice program, may be placed in 27 a hospice program by any of the following individuals, who 28 shall be guided by the express or implied intentions of the 29 patient, in the following order of priority if no individual 30 in the previous priority is reasonably available, willing, and 31 competent to make the decision: 32 1. The patient’s attorney in fact. 33 2. The guardian of the patient appointed pursuant to chapter 34 633. If the patient has appointed more than one guardian with 35 -4- HF 2305 (4) 91 lh/ko/md 4/ 15

H.F. 2305 equal responsibilities, the decision agreed to by a majority 1 of the guardians. If no majority consensus is achieved by the 2 guardians, a court order shall be required. 3 3. The patient’s spouse. 4 4. An adult child of the patient or, if the patient 5 has more than one adult child, the decision agreed to by a 6 majority of the adult children who are reasonably available for 7 consultation with the patient’s attending provider. 8 5. A parent of the patient, or if the patient has more than 9 one parent, the decision agreed to by both parents if both 10 are reasonably available for consultation with the patient’s 11 attending provider. 12 6. An adult sibling of the patient, or if the patient has 13 more than one sibling, the decision agreed to by a majority 14 of the adult siblings who are reasonably available for 15 consultation with the patient’s attending provider. 16 7. The decision agreed to by a majority of the patient’s 17 relatives, including but not limited to grandchildren, 18 grandparents, aunts, uncles, nieces, nephews, stepchildren, 19 stepparents, and stepsiblings who are at least eighteen years 20 of age and reasonably available for consultation with the 21 patient’s attending provider. 22 8. A close adult friend. 23 Sec. 4. Section 144A.2, Code 2026, is amended to read as 24 follows: 25 144A.2 Definitions. 26 Except as otherwise provided, as used in this chapter : 27 1. “Adult” means an individual eighteen years of age or 28 older. 29 2. “Advanced registered nurse practitioner” means the same as 30 defined in section 152.1. 31 2. 3. “Attending physician provider ” means the physician 32 selected by, or assigned to, the patient who has primary 33 responsibility for the treatment and care of the patient same 34 as defined in section 135J.1 . 35 -5- HF 2305 (4) 91 lh/ko/md 5/ 15

H.F. 2305 3. 4. “Attending physician assistant” means the physician 1 assistant selected by, or assigned to, the patient who has 2 primary responsibility for the treatment and care of the 3 patient “Attorney in fact” means the same as defined in section 4 135J.1 . 5 5. “Close adult friend” means the same as defined in section 6 135J.1. 7 4. 6. “Declaration” means a document executed in accordance 8 with the requirements of section 144A.3 . 9 5. 7. “Department” means the department of health and human 10 services. 11 8. “Durable power of attorney for health care” means the same 12 as defined in section 135J.1. 13 6. 9. “Emergency medical care provider” means emergency 14 medical care provider as defined in section 147A.1 . 15 7. 10. “Health care provider” means a person, including an 16 emergency medical care provider, who is licensed, certified, or 17 otherwise authorized or permitted by the law of this state to 18 administer health care in the ordinary course of business or in 19 the practice of a profession. 20 8. 11. “Hospital” means hospital as defined in section 21 135B.1 . 22 9. 12. a. “Life-sustaining procedure” means any medical 23 procedure, treatment, or intervention, including resuscitation, 24 which meets both of the following requirements: 25 (1) Utilizes mechanical or artificial means to sustain, 26 restore, or supplant a spontaneous vital function. 27 (2) When applied to a patient in a terminal condition, would 28 serve only to prolong the dying process. 29 b. “Life-sustaining procedure” does not include the 30 provision of nutrition or hydration except when required 31 to be provided parenterally or through intubation, or the 32 administration of medication or performance of any medical 33 procedure deemed necessary to provide comfort care or to 34 alleviate pain. 35 -6- HF 2305 (4) 91 lh/ko/md 6/ 15

H.F. 2305 10. 13. “Out-of-hospital do-not-resuscitate order” means 1 a written order signed by a physician an attending provider , 2 executed in accordance with the requirements of section 3 144A.7A and issued consistent with this chapter , that directs 4 the withholding or withdrawal of resuscitation when an adult 5 patient in a terminal condition is outside the hospital. 6 11. 14. “Physician” means a person licensed to practice 7 medicine and surgery or osteopathic medicine and surgery in 8 this state. 9 12. 15. “Physician assistant” means a person licensed to 10 practice as a physician assistant in this state. 11 13. 16. “Qualified patient” means a patient who has 12 executed a declaration or an out-of-hospital do-not-resuscitate 13 order in accordance with this chapter and who has been 14 determined by the attending physician to be in a terminal 15 condition. 16 14. 17. “Resuscitation” means any medical intervention that 17 utilizes mechanical or artificial means to sustain, restore, 18 or supplant a spontaneous vital function, including but not 19 limited to chest compression, defibrillation, intubation, and 20 emergency drugs intended to alter cardiac function or otherwise 21 to sustain life. 22 15. 18. “Terminal condition” means an incurable or 23 irreversible condition that, without the administration 24 of life-sustaining procedures, will, in the opinion of 25 the attending physician provider , result in death within 26 a relatively short period of time or a state of permanent 27 unconsciousness from which, to a reasonable degree of medical 28 certainty, there can be no recovery. 29 Sec. 5. Section 144A.3, subsections 3 and 5, Code 2026, are 30 amended to read as follows: 31 3. It is the responsibility of the declarant to provide 32 the declarant’s attending physician or health care provider 33 with the declaration. An attending physician or health care 34 provider may presume, in the absence of actual notice to the 35 -7- HF 2305 (4) 91 lh/ko/md 7/ 15

H.F. 2305 contrary, that the declaration complies with this chapter and 1 is valid. 2 5. A declaration executed pursuant to this chapter may, but 3 need not, be in the following form: 4 DECLARATION 5 If I should have an incurable or irreversible condition that 6 will result either in death within a relatively short period 7 of time or a state of permanent unconsciousness from which, 8 to a reasonable degree of medical certainty, there can be no 9 recovery, it is my desire that my life not be prolonged by 10 the administration of life-sustaining procedures. If I am 11 unable to participate in my health care decisions, I direct 12 my attending physician provider to withhold or withdraw 13 life-sustaining procedures that merely prolong the dying 14 process and are not necessary to my comfort or freedom from 15 pain. 16 Sec. 6. Section 144A.4, Code 2026, is amended to read as 17 follows: 18 144A.4 Revocation of declaration. 19 1. A declaration may be revoked at any time and in any 20 manner by which the declarant is able to communicate the 21 declarant’s intent to revoke, without regard to mental or 22 physical condition. A revocation is only effective as to the 23 attending physician or attending physician assistant provider 24 upon communication to such physician or physician assistant 25 attending provider by the declarant or by another to whom the 26 revocation was communicated. 27 2. The attending physician or attending physician assistant 28 provider shall make the revocation a part of the declarant’s 29 medical record. 30 Sec. 7. Section 144A.5, Code 2026, is amended to read as 31 follows: 32 144A.5 Determination of terminal condition. 33 When an attending physician provider who has been provided 34 with a declaration determines that the declarant is in a 35 -8- HF 2305 (4) 91 lh/ko/md 8/ 15

H.F. 2305 terminal condition, this decision must be confirmed by another 1 physician , advanced registered nurse practitioner, or physician 2 assistant . The attending physician provider must record that 3 determination in the declarant’s medical record. 4 Sec. 8. Section 144A.6, subsection 2, Code 2026, is amended 5 to read as follows: 6 2. The declaration of a qualified patient known to the 7 attending physician provider to be pregnant shall not be in 8 effect as long as the fetus could develop to the point of live 9 birth with continued application of life-sustaining procedures. 10 However, the provisions of this subsection do not impair any 11 existing rights or responsibilities that any person may have 12 in regard to the withholding or withdrawal of life-sustaining 13 procedures. 14 Sec. 9. Section 144A.7, subsections 1 and 2, Code 2026, are 15 amended to read as follows: 16 1. Life-sustaining procedures may be withheld or withdrawn 17 from a patient who is in a terminal condition and who is 18 comatose, incompetent, or otherwise physically or mentally 19 incapable of communication , and who has not made a declaration 20 in accordance with this chapter section 144A.3 if there is 21 consultation and written agreement for the withholding or the 22 withdrawal of life-sustaining procedures between the attending 23 physician provider, another physician, physician assistant, 24 or advanced registered nurse practitioner, and any of the 25 following individuals, who shall be guided by the express or 26 implied intentions of the patient, in the following order 27 of priority if no individual in a prior class the previous 28 priority is reasonably available, willing, and competent to act 29 make a decision : 30 a. The attorney in fact designated to make treatment 31 decisions for the patient should such person be diagnosed as 32 suffering from a terminal condition, if the designation is in 33 writing and complies with chapter 144B . 34 b. The guardian of the person of the patient if one has been 35 -9- HF 2305 (4) 91 lh/ko/md 9/ 15

H.F. 2305 appointed , provided pursuant to chapter 633, or the guardian 1 of the patient who has obtained court approval is obtained in 2 accordance with section 232D.401, subsection 4 , paragraph “a” , 3 or section 633.635, subsection 3 , paragraph “b” , subparagraph 4 (1) . This paragraph does not require the appointment of a 5 guardian in order for a treatment decision to be made under 6 this section . 7 c. The patient’s spouse. 8 d. An adult child of the patient or, if the patient 9 has more than one adult child, the decision agreed to by a 10 majority of the adult children who are reasonably available for 11 consultation with the patient’s attending provider . 12 e. A parent of the patient, or parents if both the patient 13 has more than one parent, the decision agreed to by both 14 parents if both are reasonably available for consultation with 15 the patient’s attending provider . 16 f. An adult sibling of the patient or, if the patient 17 has more than one adult sibling, the decision agreed to by a 18 majority of the adult siblings who are reasonably available for 19 consultation with the patient’s attending provider . 20 g. The decision agreed to by a majority of the patient’s 21 adult relatives, including but not limited to grandchildren, 22 grandparents, aunts, uncles, nieces, nephews, stepchildren, 23 stepparents, and stepsiblings who are reasonably available for 24 consultation with the patient’s attending provider. 25 h. A close adult friend. 26 2. When a decision is made pursuant to this section to 27 withhold or withdraw life-sustaining procedures, there shall 28 be a witness present at the time of the consultation with the 29 patient’s attending provider when that the decision is made. 30 Sec. 10. Section 144A.7A, subsections 1 and 3, Code 2026, 31 are amended to read as follows: 32 1. If an attending physician or attending physician 33 assistant provider issues an out-of-hospital do-not-resuscitate 34 order for an adult patient under this section , the physician 35 -10- HF 2305 (4) 91 lh/ko/md 10/ 15

H.F. 2305 attending provider shall use the form prescribed pursuant to 1 subsection 2 , include a copy of the order in the patient’s 2 medical record, and provide a copy to the patient or an 3 individual authorized to act on the patient’s behalf. 4 3. The out-of-hospital do-not-resuscitate order form shall 5 include all of the following: 6 a. The patient’s name. 7 b. The patient’s date of birth. 8 c. The name of the individual authorized to act on the 9 patient’s behalf, if applicable. 10 d. A statement that the patient is in a terminal condition. 11 e. The physician’s or physician assistant’s attending 12 provider’s signature. 13 f. The date the form is signed. 14 g. A concise statement of the nature and scope of the order. 15 h. Any other information necessary to provide clear and 16 reliable instructions to a health care provider. 17 Sec. 11. NEW SECTION . 144A.7B Procedure in absence of 18 out-of-hospital do-not-resuscitate order. 19 1. Resuscitation may be withheld or withdrawn from a patient 20 who has a terminal illness, and who is comatose, incompetent, 21 or otherwise physically or mentally incapable of communication, 22 and who has not executed an out-of-hospital do-not-resuscitate 23 order, if there is consultation and written agreement for 24 the withholding or the withdrawal of resuscitation between 25 the attending provider and another physician, physician 26 assistant, or advanced registered nurse practitioner and any 27 of the following individuals, who shall be guided by the 28 express or implied intentions of the patient, in the following 29 order of priority if no individual in the previous priority 30 is reasonably available, willing, and competent to make a 31 decision. 32 a. The patient’s attorney in fact. 33 b. The guardian of the patient appointed pursuant to chapter 34 633. If the patient is appointed more than one guardian with 35 -11- HF 2305 (4) 91 lh/ko/md 11/ 15

H.F. 2305 equal responsibilities, the decision agreed to by a majority of 1 the guardians. If no consensus is achieved by the guardians, a 2 court order shall be required. 3 c. The patient’s spouse. 4 d. An adult child of the patient or, if the patient 5 has more than one adult child, the decision agreed to by a 6 majority of the adult children who are reasonably available for 7 consultation with the patient’s attending provider. 8 e. A parent of the patient or, if the patient has more 9 than one parent, the decision agreed to by both of the parents 10 if both are reasonably available for consultation with the 11 patient’s attending provider. 12 f. An adult sibling of the patient or, if the patient 13 has more than one adult sibling, the decision agreed to by a 14 majority of the adult siblings who are reasonably available for 15 consultation with the patient’s attending provider. 16 g. The decision agreed to by a majority of the patient’s 17 adult relatives, including but not limited to grandchildren, 18 grandparents, aunts, uncles, nieces, nephews, stepchildren, 19 stepparents, and stepsiblings who are reasonably available for 20 consultation with the patient’s attending provider. 21 h. A close adult friend. 22 2. When a decision is made pursuant to this section to 23 withhold or withdraw resuscitation, a witness shall be present 24 at the time of the consultation with the patient’s attending 25 provider when the decision is made. 26 Sec. 12. Section 144A.8, subsection 1, Code 2026, is amended 27 to read as follows: 28 1. An attending physician provider who is unwilling to 29 comply with the requirements of section 144A.5 , or who is 30 unwilling to comply with the declaration of a qualified 31 patient in accordance with section 144A.6 or an out-of-hospital 32 do-not-resuscitate order pursuant to section 144A.7A , or who is 33 unwilling to comply with the provisions of section 144A.7 or 34 144A.7A shall take all reasonable steps to effect the transfer 35 -12- HF 2305 (4) 91 lh/ko/md 12/ 15

H.F. 2305 of the patient to another physician provider . 1 Sec. 13. Section 144B.1, Code 2026, is amended to read as 2 follows: 3 144B.1 Definitions. 4 For purposes of this chapter , unless the context otherwise 5 requires: 6 1. “Attending provider” means the same as defined in section 7 135J.1. 8 1. 2. “Attorney in fact” means an individual who is 9 designated by a durable power of attorney for health care as an 10 agent to make health care decisions on behalf of a principal 11 and has consented to act in that capacity. 12 2. 3. “Designee” means a person named in a declaration 13 under chapter 144C . 14 3. 4. “Durable power of attorney for health care” means a 15 document authorizing an attorney in fact to make health care 16 decisions for the principal if the principal is unable, in the 17 judgment of the attending physician or attending physician 18 assistant provider , to make health care decisions. 19 4. 5. “Health care” means any care, treatment, service, 20 or procedure to maintain, diagnose, or treat an individual’s 21 physical or mental condition. “Health care” does not include 22 the provision of nutrition or hydration except when they are 23 required to be provided parenterally or through intubation. 24 5. 6. “Health care decision” means the consent, refusal of 25 consent, or withdrawal of consent to health care. 26 6. 7. “Health care provider” means a person who is 27 licensed, certified, or otherwise authorized or permitted by 28 the law laws of this state to administer health care in the 29 ordinary course of business or in the practice of a profession. 30 7. 8. “Principal” means a person age eighteen or older who 31 has executed a durable power of attorney for health care. 32 Sec. 14. Section 144B.5, subsection 1, Code 2026, is amended 33 to read as follows: 34 1. A durable power of attorney for health care executed 35 -13- HF 2305 (4) 91 lh/ko/md 13/ 15

H.F. 2305 pursuant to this chapter may, but need not, be in the following 1 form: 2 I hereby designate ........ as my attorney in fact (my 3 agent) and give to my agent the power to make health care 4 decisions for me. This power exists only when I am unable, in 5 the judgment of my attending physician or attending physician 6 assistant provider , to make those health care decisions. The 7 attorney in fact must act consistently with my desires as 8 stated in this document or otherwise made known. 9 Except as otherwise specified in this document, this document 10 gives my agent the power, where otherwise consistent with the 11 law laws of this state, to consent to my physician or physician 12 assistant attending provider not giving health care or stopping 13 health care which is necessary to keep me alive. 14 This document gives my agent power to make health care 15 decisions on my behalf, including to consent, to refuse to 16 consent, or to withdraw consent to the provision of any care, 17 treatment, service, or procedure to maintain, diagnose, or 18 treat a physical or mental condition. This power is subject 19 to any statement of my desires and any limitations included in 20 this document. 21 My agent has the right to examine my medical records and to 22 consent to disclosure of such records. 23 Sec. 15. Section 144B.6, subsection 1, Code 2026, is amended 24 to read as follows: 25 1. Unless the district court sitting in equity specifically 26 finds that the attorney in fact is acting in a manner contrary 27 to the wishes of the principal or the durable power of attorney 28 for health care provides otherwise, an attorney in fact who 29 is known to the health care provider to be available and 30 willing to make health care decisions has priority over any 31 other person, including a guardian appointed pursuant to 32 chapter 633 , to act for the principal in all matters of health 33 care decisions. The attorney in fact has authority to make 34 a particular health care decision only if the principal is 35 -14- HF 2305 (4) 91 lh/ko/md 14/ 15

H.F. 2305 unable, in the judgment of the attending physician or attending 1 physician assistant provider , to make the health care decision. 2 If the principal objects to a decision to withhold or withdraw 3 health care, the principal shall be presumed to be able to make 4 a decision. 5 Sec. 16. Section 144C.2, subsection 16, Code 2026, is 6 amended to read as follows: 7 16. “Licensed hospice program” means a licensed hospice 8 program as defined described in section 135J.1 . 9 Sec. 17. Section 633.635, Code 2026, is amended by adding 10 the following new subsection: 11 NEW SUBSECTION . 6. Notwithstanding subsection 2 or 3, a 12 guardian may make a decision for a protected person pursuant to 13 sections 135J.3A, 144A.7, and 144A.7B without court approval. 14 -15- HF 2305 (4) 91 lh/ko/md 15/ 15