CHAPTER 327PRACTICE OF PHYSICIAN ASSISTANTS[Prior to 8/7/02, see 645—325.6(148C) to 645—325.9(148C) and 645—325.18(148C)]645—327.1(148C)  Duties.    327.1(1)  The medical services to be provided by the physician assistant are those delegated by a supervising physician. The ultimate role of the physician assistant cannot be rigidly defined because of the variations in practice requirements due to geographic, economic, and sociologic factors. The high degree of responsibility a physician assistant may assume requires that, at the conclusion of the formal education, the physician assistant possess the knowledge, skills and abilities necessary to provide those services appropriate to the practice setting. The physician assistant’s services may be utilized in any clinical settings including, but not limited to, the office, the ambulatory clinic, the hospital, the patient’s home, extended care facilities and nursing homes. Diagnostic and therapeutic medical tasks for which the supervising physician has sufficient training or experience may be delegated to the physician assistant after a supervising physician determines the physician assistant’s proficiency and competence. The medical services to be provided by the physician assistant include, but are not limited to, the following:  a.  The initial approach to a patient of any age group in any setting to elicit a medical history and perform a physical examination.  b.  Assessment, diagnosis and treatment of medical or surgical problems and recording the findings.  c.  Order, interpret, or perform laboratory tests, X-rays or other medical procedures or studies.  d.  Performance of therapeutic procedures such as injections, immunizations, suturing and care of wounds, removal of foreign bodies, ear and eye irrigation and other clinical procedures.  e.  Performance of office surgical procedures including, but not limited to, skin biopsy, mole or wart removal, toenail removal, removal of a foreign body, arthrocentesis, incision and drainage of abscesses.  f.  Assisting in surgery.  g.  Prenatal and postnatal care and assisting a physician in obstetrical care.  h.  Care of orthopedic problems.  i.  Performing and screening the results of special medical examinations including, but not limited to, electrocardiogram or Holter monitoring, radiography, audiometric and vision screening, tonometry, and pulmonary function screening tests.  j.  Instruction and counseling of patients regarding physical and mental health on matters such as diets, disease, therapy, and normal growth and development.  k.  Function in the hospital setting by performing medical histories and physical examinations, making patient rounds, recording patient progress notes and other appropriate medical records, assisting in surgery, performing or assisting with medical procedures, providing emergency medical services and issuing, transmitting and executing patient care orders as delegated by the supervising physician.  l.  Providing services to patients requiring continuing care (i.e., home, nursing home, extended care facilities).  m.  Referring patients to specialty or subspecialty physicians, medical facilities or social agencies as indicated by the patients’ problems.  n.  Immediate evaluation, treatment and institution of procedures essential to providing an appropriate response to emergency medical problems.  o.  Order drugs and supplies in the office, and assist in keeping records and in the upkeep of equipment.  p.  Admit patients to a hospital or health care facility.  q.  Order diets, physical therapy, inhalation therapy, or other rehabilitative services as indicated by the patient’s problems.  r.  Administer any drug (a single dose).  s.  Prescribe drugs and medical devices under the following conditions:  (1)  The physician assistant shall have passed the national certifying examination conducted by the National Commission on the Certification of Physician Assistants or its successor examination approved by the board. Physician assistants with a temporary license may order drugs and medical devices only with the prior approval and direction of a supervising physician. Prior approval may include discussion of the specific medical problems with a supervising physician prior to the patient’s being seen by the physician assistant.  (2)  The physician assistant may not prescribe Schedule II controlled substances which are listed as depressants in Iowa Code chapter 124. The physician assistant may order Schedule II controlled substances which are listed as depressants in Iowa Code chapter 124 only with the prior approval and direction of a physician. Prior approval may include discussion of the specific medical problems with a supervising physician prior to the patient’s being seen by the physician assistant.  (3)  The physician assistant shall inform the board of any limitation on the prescriptive authority of the physician assistant in addition to the limitations set out in 327.1(1)“s”(2).  (4)  A physician assistant shall not prescribe substances that the supervising physician does not have the authority to prescribe except as allowed in 327.1(1)“n.”  (5)  The physician assistant may prescribe, supply and administer drugs and medical devices in all settings including, but not limited to, hospitals, health care facilities, health care institutions, clinics, offices, health maintenance organizations, and outpatient and emergency care settings except as limited by 327.1(1)“s”(2).  (6)  A physician assistant who is an authorized prescriber may request, receive, and supply sample drugs and medical devices except as limited by 327.1(1)“s”(2).  (7)  The board of physician assistants shall be the only board to regulate the practice of physician assistants relating to prescribing and supplying prescription drugs, controlled substances and medical devices.  t.  Supply properly packaged and labeled prescription drugs, controlled substances or medical devices when pharmacist services are not reasonably available or when it is in the best interests of the patient as delegated by a supervising physician.  (1)  When the physician assistant is the prescriber of the medications under 327.1(1)“s,” these medications shall be supplied for the purpose of accommodating the patient and shall not be sold for more than the cost of the drug and reasonable overhead costs as they relate to supplying prescription drugs to the patient and not at a profit to the physician or physician assistant.  (2)  When a physician assistant supplies medication on the direct order of a physician, subparagraph (1) does not apply.  (3)  A nurse or staff assistant may assist the physician assistant in supplying medications when prescriptive drug supplying authority is delegated by a supervising physician to the physician assistant under 327.1(1)“s.”  u.  When a physician assistant supplies medications as delegated by a supervising physician in a remote site, the physician assistant shall secure the regular advice and consultation of a pharmacist regarding the distribution, storage and appropriate use of presciption drugs, controlled substances, and medical devices.  v.  May, at the request of the peace officer, withdraw a specimen of blood from a patient for the purpose of determining the alcohol concentration or the presence of drugs.  w.  Direct medical personnel, health professionals and others involved in caring for patients in the execution of patient care.  x.  May authenticate medical forms by signing the form and including a supervising physician’s name.  y.  Perform other duties appropriate to a physician’s practice.  z.  Health care providers shall consider the instructions of the physician assistant to be instructions of a supervising physician if the instructions concern duties delegated to the physician assistant by the supervising physician.  327.1(2)  Emergency medicine duties.  a.  A physician assistant may be a member of the staff of an ambulance or rescue squad pursuant to Iowa Code chapter 147A.  b.  A physician assistant shall document skills, training and education equivalent to that required of a certified advanced emergency medical technician or a paramedic.  c.  A physician assistant must apply for approval of advanced care training equivalency on forms supplied by the board of physician assistants.  d.  Exceptions to this subrule include:  (1)  A physician assistant who accompanies and is responsible for a transfer patient;  (2)  A physician assistant who serves on a basic ambulance or rescue squad service; and  (3)  A physician assistant who renders aid within the physician assistant’s skills during an emergency.645—327.2(148C)  Prohibition.  No physician assistant shall be permitted to prescribe lenses, prisms or contact lenses for the aid, relief or correction of human vision. No physician assistant shall be permitted to measure the visual power and visual efficiency of the human eye, as distinguished from routine visual screening, except in the personal presence of a supervising physician at the place where these services are rendered.645—327.3(148C)  Free medical clinic.  Rescinded IAB 9/15/04, effective 8/25/04.645—327.4(148C)  Remote medical site.    327.4(1)  A physician assistant may provide medical services in a remote medical site if one of the following three conditions is met:  a.  The physician assistant has a permanent license and at least one year of practice as a physician assistant; or  b.  The physician assistant with less than one year of practice has a permanent license and meets the following criteria:  (1)  The physician assistant has practiced as a physician assistant for at least six months; and  (2)  The physician assistant and supervising physician have worked together at the same location for a period of at least three months; and  (3)  The supervising physician reviews patient care provided by the physician assistant at least weekly; and  (4)  The supervising physician signs all patient charts unless the medical record documents that direct consultation with the supervising physician occurred; or  c.  The physician assistant and supervising physician provide a written statement sent directly to the board that the physician assistant is qualified to provide the needed medical services and that the medical care will be unavailable at the remote site unless the physician assistant is allowed to practice there. In addition, for three months the supervising physician must review patient care provided by the physician assistant at least weekly and must sign all patient charts unless the medical record documents that direct consultation with the supervising physician occurred.  327.4(2)  The supervising physician must visit a remote site or communicate with the physician assistant at the remote site via electronic communications to provide additional medical direction, medical services and consultation at least every two weeks. For purposes of this rule, communication may consist of, but shall not be limited to, in-person meetings, two-way interactive communication directly between the supervising physician and the physician assistant via the telephone, secure messaging, electronic mail, or chart review. At least one supervising physician must meet in person with the physician assistant at the remote medical site at least once every six months to evaluate and discuss the medical facilities, resources, and medical services provided at the remote medical site.Related ARC(s): 1909C, 2436C, 4300C645—327.5(147)  Identification as a physician assistant.  The physician assistant shall be identified as a physician assistant to patients and to the public.645—327.6(147)  Prescription requirements.    327.6(1)  Each written outpatient prescription drug order issued by a physician assistant shall contain the following:  a.  The date of issuance.  b.  The name and address of the patient for whom the drug is prescribed.  c.  The name, strength, and quantity of the drug, medicine, or device prescribed and directions for use.  d.  When delegated prescribing occurs, the supervising physician’s name shall be used, recorded, or otherwise indicated in connection with each individual prescription so that the individual who dispenses or administers the prescription knows under whose delegated authority the physician assistant is prescribing. Notification may include, but is not limited to, including the physician’s name on the prescription, including the physician’s name in the memo section of an electronic prescription, or providing the physician’s name by telephone or other electronic means. If, in an electronic prescription record, the record does not include a dedicated field for the name of the supervising physician, a memo or comment field may be used to record the supervising physician’s name by entering the code “SP01” and then the supervising physician’s name prior to any other comment in the memo or comment field.  e.  The physician assistant’s name and the practice address.  f.  The signature of the physician assistant followed by the initials “PA.”  g.  The Drug Enforcement Administration (DEA) number of the physician assistant if the prescription is for a controlled substance.All other prescriptions shall comply with paragraph “d.”  327.6(2)  Each oral prescription drug order issued by a physician assistant shall include the same information required for a written prescription, except for the written signature of the physician assistant and the address of the practitioners.  327.6(3)  Prior to prescribing an opioid, a physician assistant shall review the patient’s information contained in the prescription monitoring program database, unless the patient is receiving inpatient hospice care or long-term residential facility patient care.Related ARC(s): 9217B, 9844B, 4299C645—327.7(147)  Supplying—requirements for containers, labeling, and records.    327.7(1)    Containers.  A prescription drug shall be supplied in a container which meets the requirements of the Poison Prevention Packaging Act of 1970, 15 U.S.C. §§1471-1476 (1976), which relate to childproof closure, unless otherwise requested by the patient. The containers must also meet the requirements of Section 502G of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §§301 et seq.(1976), which pertain to light resistance and moisture resistance needs of the drug supplied.  327.7(2)    Labeling.  A label bearing the following information shall be affixed to a container in which a prescription drug is supplied:  a.  The name and practice address of the supervising physician and physician assistant.  b.  The name of the patient.  c.  The date supplied.  d.  The directions for administering the prescription drug and any cautionary statement deemed appropriate by the physician assistant.  e.  The name, strength and quantity of the prescription drug in the container.  f.  When supplying Schedule II, III, or IV controlled substances, the federal transfer warning statement must appear on the label as follows: “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.”  327.7(3)    Samples.  Prescription sample drugs will be provided without additional charge to the patient. Prescription sample drugs supplied in the original container or package shall be deemed to conform to labeling and packaging requirements.  327.7(4)    Records.  A record of prescription drugs supplied by the physician assistant to a patient shall be kept which contains the label information required by paragraphs 327.7(2)“b” to “e.” Noting such information on the patient’s chart or record is sufficient.645—327.8(148C)  Sharing information.  When the board receives a complaint alleging that inadequate supervision by a physician assistant’s supervising physician may have occurred, the board shall forward a copy of that complaint to the board of medicine. Any response to the complaint, filed with the board by the physician assistant, will also be shared with the board of medicine.Related ARC(s): 3642CThese rules are intended to implement Iowa Code section 147.107 and chapters 148C and 272C.Related ARC(s): 9217B, 9844B, 1909C, 2436C, 3642C, 4299C, 4300C