Professional Practice FAQs
Yes. The 2005 Legislature passed a law authorizing PAs to signe the Disabled Parking Permits in all practice settings and the Governer signed it into law effective July 1, 2005. Until the DOT changes its' manual however you may encounter some license offices that will not honor your signature. A technicality nuisance issue but it will be resovled in a few months.
If a physician assistant practices in a health department setting the regulations set forth in F.S. 154.04(1)(c) apply for physician assistants and nurse practitioners in these specific settings. This statute requires written protocols for PAs and ARNPs in that setting. If you practice in any other setting you DO NOT need written protocols by state law. However, please be aware that some insurance companies, hospitals, physicians or other supervisory party may include protocols at their discretion. While restrictive, it is not illegal. Remember that responsible parties, credentialing agencies, and other supervisory parties cannot do LESS than the law requires, but they may place other restrictions as part of the job limitations or requirements. Most employers will not want to put any more limitations on your practice than are required by law.
Yes. In a Florida Attorney General Advisory Legal Opinion issued by Attorney General Bill McCollum to the Secretary of the Department of Children and Families on May 30, 2008 he stated that it was his opinion as Attorney General that "a physician assistant licensed pursuant to chapter 458 or 459, Florida Statutes, may refer a patient for involuntary evaluation pursuant to section 394.463, Florida Statutes, provided that the physician assistant has experience regarding the diagnosis and treatment of mental and nervous disorders and such tasks as are within the supervising physician's scope of practice. You can read the opinion here:
Is it recommended for a surgical PA to have their own limits of liability instead of sharing limits with their practice?
Every PA should have their own malpractice coverage, regardless of their type of employment. Attorneys can go after all providers with coverage and especially those with "deep pockets". If PAs share coverage with their physicians, the limits should be the same as those of the physician. The low cost of PA malpractice insurance as compared to that of physicians reflect the fact that because we are "dependent practitioners", our liability and hence our premiums are greatly reduced. All premiums are based on actuarial studies of claims made, and the number of overall, successful claims against PAs are low.
The AAPA has an excellent article on malpractice insurance on the AAPA website. Here is a link to that:
Many group policies include blanket provisions for providers such as PAs, but again, the limits would be the same for everyone. An attorney can isolate any provider in a group coverage policy. The important thing is to make sure that you are indeed fully covered, including tail insurance provisions in and when you leave your practice.
If you had a claims only coverage it would be wise to get tail coverage when you leave the practice.
Florida law indicates you can do what your physician does within the scope of their practice providing your supervising physician allows you to do that after you have been properly trained and they feel you can do it safely under their supervision. This would include procedures that are within the scope of practice of your supervising physician provided it is not one of those procedures specifically prohibited by the PA practice act. A PA should not do anything that their physician does not do in their practice. The law is written in general terms here and both the PA and the physician should act within the standard of care for their specialty and practice. When one goes beyond that standard of care then you would be on less solid legal ground from a medicolegal aspect if problems arise. The limits of what you do in a practice setting are set by the supervising physician regardless of the specialty practice setting again taking into account those procedures specifically prohibited by statute.
You can get the required CME at the AAPA national conference held at the end of May each year, or at one of the two FAPA sponsored CME conferences offered each year. You can get CME at local FAPA sponsored meetings which are held monthly in most locations; at your local hospital; other CME conferences in your specialty provided they are accredited courses; and you can get many online courses as well. Here is a link to a page on this website to find links to various CME online:
No! NCCPA certification is NOT a board certification. Board certification implies a higher level of training and education and has been traditionally associated with physicians. That is what the general public understands. The acronym, PA-C, simply indicates that the PA has graduated from an accredited PA training program and has successfully passed the certification examination and is maintaining the certification through continued medical education requirements and has passed the recertification examination when required. In fact the acronym "PA-C" is trademarked by the NCCPA, and only those PAs fulfilling the NCCPA requirements for that designation are allowed to use it. For a PA to advertise as being "board certified" is not correct, and there could be legal ramifications if done so.
No. Statutory legislation passed and signed into law, effective July 1, 2009, deleted the mandatory cosignature of medical charts and records of physician assistants. However, a supervising physician may choose to cosign records at his/her discretion. Additionally, hospital bylaws still reserve the right to require PA cosignature at their discretion. Click here to read SB 720 in its entirety.
How do I treat patients in a clinic and nursing home with a temporary physician assistant license while awaiting approval and receipt of my permanent license?
You may practice in your clinical setting with a temporary license but you cannot prescribe medications or give out medication samples until you receive your license and then your prescribing privileges. You can simple call in the prescriptions under your physicians' name just as we did prior to getting prescribing privileges. You should document any orders written in the nursing home setting as a verbal order from your supervising physician.
Yes, but you need to have an alternate supervising physician in case you need a physician then and your regular supervising physician is not available. The law states you must have a physician with easy availability and further that this easy availability includes the ability to communicate by way of telecommunication. We advise not to take chances and put your license in jeopardy. Get an alternate supervising physician who is easily available when your regular supervising physician is out of town.
The simple answer is yes. You can dictate for your physician, in place of the physician or for yourself. Dictation will need to be signed by you and cosigned by your supervising physician.
Where can I find information on websites that provide info on state and federally funded and medically underserved areas?
Try the Agency for Health Care Administration website, or call 1-800-342-8660. Here is a PDF link that may help as well:
No, but all hospitals require that you do so. If you go bare and carry no malpractice insurance and get sued, they still have to prove guilt. Tail coverage will not be enough to protect you if you leave a practice where you were covered, but it is still best to have the tail coverage. Facilities that allow physicians to practice bare may not have regulations in place that allow PAs to do the same. The best advice is to get the insurance, it will be cheaper in the long run.
The state statute states that PAs cannot make a final diagnosis, or interpret lab studies, x-rays, and EKGs, this is true. However, subsequent discussion/review with the supervising physician of the PA's diagnosis or test/study interpretation would allow for the physician's final corroboration.
Yes and no. The Florida Legislature recently passed and bill and it was signed into law that allows PAs to order skilled nursing care in Home Health Care Settings, and you can sign a Home Health Care Certification. But you won't get paid for it since Medicare rules do not allow it. The AAPA is working on geting these rules changed.
Yes. Under Medicare rule, a PA can own up to 99% of a clinic so long as the other 1% is owned by someone else. To find more on this, take a look at the AAPA website section Physician Assistants and Practice Ownership.
The law states that if a physician has privileges at a hospital and they supervise a PA, the PA must be allowed to have privileges as well with those privileges following the scope of practice considerations. However the guidelines and privileges must be set forth in the bylaws as well.
The Florida statutes are very specific on when PAs must submit a new "Supervision Data Form". You have thirty (30) days to submit a new "Supervision Data Form" after a change occurs in the status of a supervising physician. If you add a physician, delete a physician, add a practice setting or delete a practice setting you must submit a new "Supervision Data Form" when one of these changes occur. It is YOUR personal responsibility to do so, no one else. No excuse is acceptable. Yours' is the signature on the form and on your license. Do not take chances and delegate this to anyone else to do for you. It is just too important. A physician can be a supervising physician only if they have a license in good standing. This means they cannot have any probations or limitations on their license and be a supervising physician. The law is very specific on this issue. If a supervising physician has died and you have not removed them as a supervising physician by submitting a new form, then you are in violation of the statute and subject to disciplinary action. If a physician left the practice or moved out of state then you need to submit a new form. If a new physician is added to the group or practice and even occasionally acts as a supervising physican, you must submit an updated form. Also remember that if you are a prescribing physician assistant that you must submit the form, "Application for Changes to Licensure As A Prescribing Physician Assistant" if there are changes in your supervising physicians who supervise your prescribing of medications as well. You cannot prescribe under a new physician or setting until you have received the form back from the PA Council office indicating the changes are on file and approved, and you have in your possession a letter from the Board that you may prescribe under the new supervising physicians. Our legal counsel encourages any PA who is not absolutely certain that his or her disclosure of supervising physician(s) is up to date, immediately prepare and file the proper forms disclosing each of your current supervising physicians. There is no harm in over reporting, however, a mistaken belief that reporting is current, when it is not, will likely carry a financial penalty. The Board of Medicine can impose a fine of $250 for each omission or error on the form. If you do not delete one physician and do not add a new one, that will be two errors and subject to a $500 fine. Here is a link to the "Supervision Data Form" page on the state website: Supervision Data Form Here is a link to the "Application for Changes to Licensure As A Prescribing Physician Assistant" form page on the state website: Application for Changes to Licensure as a Prescribing Physician Assistant
Can a physician assistant who has a PhD degree with a doctorate degree be called "Doctor" in the office?
In today?s changing educational climate for physician assistants, an increasing number are earning advanced level degrees, including that of a doctorate level. The question has been brought to the Board of Medicine, Council on Physician Assistant?s attention of what is the proper legal way of presenting one?s credentials to a patient in such cases, and how does one identify themselves in advertising materials.
It is understood that in a clinical medicine setting it is accepted that the public will perceive anyone identifying themselves as ?Doctor? to be interpreted as a doctor of medicine, licensed as such by the Board of Medicine, the Osteopathic Board of Medicine, or other such accepted professions as chiropractic, or dentistry.
Florida Statute 458.347(4)(e)(1) states ?a physician assistant must clearly identify to the patient that he or she is a physician assistant.? The Florida Administrative Code, Rule FAC64B8-30.0111 further delineates that a PA must identify the license under which he or she practices by:
(1) Wearing a name tag which identifies the licensee as a physician assistant (P.A.) The wearing of an article of clothing on the upper body which identifies the licensee as a physician assistant (P.A.) (2) By orally disclosing to the patient , upon the licensee?s initial in-person contact with the patient, that the licensee is a physician assistant (3) By providing, upon the licensee?s initial in-person contact with the patient, a business card or similar document which identified the licensee as a physician assistant (P.A.) (4) By placing notification in the lobby or waiting area of the location where the licensee practices, which contains a photo of the licensee and which identifies the licensee as a physician assistant (P.A.).
Florida Statue 458.305 (4) defines ?physician? as a person who is licensed to practice medicine in this state. Florida Statute 458.347 (2)(e) defines a physician assistant as a graduate of an approved program or its equivalent and meets standards by the boards and is licensed to perform medical services delegated by the supervising physician. Physician assistants practice medicine with supervision of a physician in Florida.
By statutes and rules as noted above a physician assistant in Florida must clearly identify to the patient that he or she is a physician assistant. To advertise one?s self as a ?doctor? in a clinical setting could be interpreted as a violation of Florida Statue 456.072 (1) (a) by making a ?misleading, deceptive, or fraudulent representation in or related to the practice of a licensee?s profession?, and thus be subject to disciplinary action under that same statute.
If one has earned a doctorate level degree, he or she has earned the right and privilege to present themselves as ?Doctor? in a non-clinical/practice of medicine setting. The most common place that a PA would be addressed as Dr. would be an academic setting which is where most doctoral level PAs work. If a physician assistant (P.A.) holds themselves out as ?Doctor? in a clinical setting he or she would be in violation of Florida statutes and administrative rules as referenced above.
Any person who is or has been licensed as a physician in another state or another country cannot advertise or present themselves in a clinical medicine setting in the state of Florida unless they are licensed as a physician by the Board of Medicine or Osteopathic Board of Medicine in Florida. To do so is a violation of the Florida Statutes and you will be subject to disciplinary or legal action by the appropriate Board of the Medicine and by other legal authority. In December 2009 a foreign medical graduate who is licensed by the State of Florida as a physician assistant was disciplined by the Board of Medicine for presenting himself as a physician by calling and introducing himself as ?Doctor?; allowing the staff to refer to him as ?Doctor? to the patients; using a business card with ?MD PA? on the card; and advertising on the clinic website as an ?MD?. He received a fine of $1,000; a letter of concern in his record; administrative costs of $5,567; has to do the Florida Medical Association Laws and Rules Course at a cost of $500; and has to perform 50 hours of community service.
These findings are a matter of public record and the information is available on the Department of Health website at:
In the "Professions" drop down box, click on "Physician Assistant", then click on "Search" and you will be able to review all the disciplinary actions by the Board of Medicine for cases involving physician assistants. It will be an eye opening experience. Read a few of the case files and learn from other?s experience and avoid the risk of becoming a case file yourself.
Similar rulings are on record for ARNP's as well.
PA's are allowed to give orders via telephone to nurses in a hospital setting. Since PA's are allowed to write orders in a hospital setting, they can phone those orders in as well. The same requirements apply as if you were writing the orders yourself, meaning the supervising physician usually should be in to cosign those orders within 24 hours. Check your hospital bylaws too to be sure they have no caveots to that general rule.
Can a PA perform laser treatments such as hair removal by laser treatment under indirect supervision?
Yes. The utilization of laser or light-based hair removal equipement is considered to the "practice of medicine" and, accordingly, may be performed by a physician assistant who is properly trained on the utilization of the equipment, and who supervisory physician has delegated the use of such equipment to the PA and such delegated tasks are within the supervisory's physician scope of practice.
A physician assistant may, at the supervisory physician's discretion, utilize light-based or laser hair removal equipment under "indirect supervision."
The provisions of Section 458.348(3), Florida Statutes, do not apply to services rendered by a physician assistant who has been properly trained and qualified to utilize laser and light-based hair removal equipment and delegated the task of providing such service as long as the delegated task is within the scope of the supervising physician's practice.
(Info provided by FAPA Legal Counsel 3/2/06)
Is their a requirement for a patient to be seen by a physician on initial evaluation or consultation?
No. But as of July 1, 2006, there is statutory requirement that states "upon initial referral of a patient by another practitioner, the physician receiving the referral must ensure that the patient is informed of the type of license held by the physician and the type of license held by any other practitioner who will be providing services to the patient. When scheduling the initial examination or consultation following such referral, the patient may decide to see the physician or any other licensed practitioner supervised by the physician and, before the initial examination or consultation, shall sign a form indicating the patient's choice of practitioner.
The supervising physician must review the medical record of the initial examination or consultation and ensure that a written report of the initial examination or consultation is furnished to the referring practitioner within ten business days following the completion of the initial examination or consultation."
Reference: FS 458.348 (5)
(5) REQUIREMENTS FOR NOTICE AND REVIEW.--Upon initial referral of a patient by another practitioner, the physician receiving the referral must ensure that the patient is informed of the type of license held by the physician and the type of license held by any other practitioner who will be providing services to the patient. When scheduling the initial examination or consultation following such referral, the patient may decide to see the physician or any other licensed practitioner supervised by the physician and, before the initial examination or consultation, shall sign a form indicating the patient's choice of practitioner. The supervising physician must review the medical record of the initial examination or consultation and ensure that a written report of the initial examination or consultation is furnished to the referring practitioner within 10 business days following the completion of the initial examination or consultation.
What are the rules in Florida pertaining to telemedicine? And according to rule, "telemedicine" includes, but is not limited to, prescribing legend drugs to patients through the following modes of communication: internet; telephone; and facsimile.
Current rule from the Board of Medicine and applying to physicians and physician assistants was effective 9/14/03 and is still current.
�In short, PAs cannot provide treatment recommendations, issue a prescription via telemedicine unless you have done a history and physical for which any drug is prescribed. You have to discuss treatment options, risks and benefits with the patient. Maintain a contemporaneous medical records in accordance with current rules. The rule does not apply in an emergency situation. And it does not apply to on-call or cross-coverage situations in which the physician has access to patient records.
�Here is the rule verbatim from the state website.
�FLORIDA ADMINISTRATIVE CODE ANNOTATED
�TITLE 64. DEPARTMENT OF HEALTH
�SUBTITLE 64B8. BOARD OF MEDICINE
�CHAPTER 64B8-9. STANDARDS OF PRACTICE FOR MEDICAL DOCTORS
�Current through the January 14, 2005 issue of the Florida Administrative Weekly.
�64B8-9.014. Standards for Telemedicine Prescribing Practice.
�(1) Prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is recognized by reasonably prudent physicians as being acceptable under similar conditions and circumstances, as well as prescribing legend drugs other than in the course of a physician's professional practice.
�(2) Physicians and physician assistants shall not provide treatment recommendations, including issuing a prescription, via electronic or other means, unless the following elements have been met:
�(a) A documented patient evaluation, including history and physical examination to establish the diagnosis for which any legend drug is prescribed.
�(b) Discussion between the physician or the physician assistant and the patient regarding treatment options and the risks and benefits of treatment.
�(c) Maintenance of contemporaneous medical records meeting the requirements of Rule 64B8-9.003, F.A.C.
�(3) The provisions of this rule are not applicable in an emergency situation. For purposes of this rule an emergency situation means those situations in which the prescribing physician or physician assistant determines that the immediate administration of the medication is necessary for the proper treatment of the patient, and that it is not reasonably possible for the prescribing physician or physician assistant to comply with the provision of this rule prior to providing such prescription.
�(4) The provisions of this rule shall not be construed to prohibit patient care in consultation with another physician who has an ongoing relationship with the patient, and who has agreed to supervise the patient's treatment, including the use of any prescribed medications, nor on-call or cross-coverage situations in which the physician has access to patient records.
�(5) For purposes of this rule, the term "telemedicine" shall include, but is not limited to, prescribing legend drugs to patients through the following modes of communication:
�(b) Telephone; and
�Specific Authority 458.309, 458.331(1)(v) FS. Law Implemented 458.331(1)(q), (t), (v) FS. History--New 9-14-03.
The law was changed on July 1, 2006. Here is the current law on supervision:
FS 458.348 (4)
(4) SUPERVISORY RELATIONSHIPS IN MEDICAL OFFICE SETTINGS.--A physician who supervises an advanced registered nurse practitioner or physician assistant at a medical office other than the physician's primary practice location, where the advanced registered nurse practitioner or physician assistant is not under the onsite supervision of a supervising physician, must comply with the standards set forth in this subsection. For the purpose of this subsection, a physician's "primary practice location" means the address reflected on the physician's profile published pursuant to s. 456.041.
(a) A physician who is engaged in providing primary health care services may not supervise more than four offices in addition to the physician's primary practice location. For the purpose of this subsection, "primary health care" means health care services that are commonly provided to patients without referral from another practitioner, including obstetrical and gynecological services, and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.
(b) A physician who is engaged in providing specialty health care services may not supervise more than two offices in addition to the physician's primary practice location. For the purpose of this subsection, "specialty health care" means health care services that are commonly provided to patients with a referral from another practitioner and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.
(c) A physician who supervises an advanced registered nurse practitioner or physician assistant at a medical office other than the physician's primary practice location, where the advanced registered nurse practitioner or physician assistant is not under the onsite supervision of a supervising physician and the services offered at the office are primarily dermatologic or skin care services, which include aesthetic skin care services other than plastic surgery, must comply with the standards listed in subparagraphs 1.-4. Notwithstanding s. 458.347(4)(e)8., a physician supervising a physician assistant pursuant to this paragraph may not be required to review and cosign charts or medical records prepared by such physician assistant.
1. The physician shall submit to the board the addresses of all offices where he or she is supervising an advanced registered nurse practitioner or a physician's assistant which are not the physician's primary practice location.
2. The physician must be board certified or board eligible in dermatology or plastic surgery as recognized by the board pursuant to s. 458.3312.
3. All such offices that are not the physician's primary place of practice must be within 25 miles of the physician's primary place of practice or in a county that is contiguous to the county of the physician's primary place of practice. However, the distance between any of the offices may not exceed 75 miles.
4. The physician may supervise only one office other than the physician's primary place of practice except that until July 1, 2011, the physician may supervise up to two medical offices other than the physician's primary place of practice if the addresses of the offices are submitted to the board before July 1, 2006. Effective July 1, 2011, the physician may supervise only one office other than the physician's primary place of practice, regardless of when the addresses of the offices were submitted to the board.
(d) A physician who supervises an office in addition to the physician's primary practice location must conspicuously post in each of the physician's offices a current schedule of the regular hours when the physician is present in that office and the hours when the office is open while the physician is not present.
(e) This subsection does not apply to health care services provided in facilities licensed under chapter 395 or in conjunction with a college of medicine, a college of nursing, an accredited graduate medical program, or a nursing education program; offices where the only service being performed is hair removal by an advanced registered nurse practitioner or physician assistant; not-for-profit, family-planning clinics that are not licensed pursuant to chapter 390; rural and federally qualified health centers; health care services provided in a nursing home licensed under part II of chapter 400, an assisted living facility licensed under 1part III of chapter 400, a continuing care facility licensed under chapter 651, or a retirement community consisting of independent living units and a licensed nursing home or assisted living facility; anesthesia services provided in accordance with law; health care services provided in a designated rural health clinic; health care services provided to persons enrolled in a program designed to maintain elderly persons and persons with disabilities in a home or community-based setting; university primary care student health centers; school health clinics; or health care services provided in federal, state, or local government facilities.
The rule states that all providers have to identify themselves. This can be done with a name badge or by verbally identifying their medical degree. A badge is not REQUIRED, but it's a good idea. Some simply have their name and insignia embroidered on their labcoat.
F.A.C. 64B8-30.0111 more specifically states the following:
All persons licensed pursuant to Section 458.347, F.S., and not exempt pursuant to Section 456.072(1)(t), F.S., shall identify the license under which he or she practices in one of the following manners:
(1) The wearing of a name tag which identifies the licensee as a physician assistant (P.A.);
(2) The wearing of an article of clothing on the upper body which identifies the licensee as a physician assistant (P.A.);
(3) By orally disclosing to the patient, upon the licensee?s initial in-person contact with the patient, that the licensee is a physician assistant;
(4) By providing, upon the licensee?s initial in-person contact with the patient, a business card or similar document which identifies the licensee as a physician assistant (P.A.);
(5) By placing notification in the lobby or waiting area of the location where the licensee practices, which contains a photo of the licensee and which identifies the licensee as a physician assistant (P.A.).
I am not able to find the wording of the 2007 legislation that refers to informed consent. Could you help me find this?
SB1508 that was passed in 2007 can be found HERE. It mentions which statute was corrected and how it should now be worded. As noted on this page from the STATE STATUTE WEBSITE, this bill was passed into law by the Governor in 2007.
YES, a PA can order PT under present Florida law, since it is a duty that can be delegated by a supervising physician and is not restricted in our Administrative Codes. This issue came under review in 1998 by the Board of Physical Therapy. They passed down the ruling in detail, which we have loaded to the website here:
Yes. Under Medicare guidelines though, a PA can only own up to 99% of the practice with at least 1% being owned by someone else (not necessarily a physician). The AAPA has a great piece that explains Practice Ownership for PAs in more detail:
PAs can take Xrays if they have a Basic Xray Machine Operator certificate. That certificate requires passing a state administered exam, and the certificate must be maintained. The information regarding the requirements is below and the DOH website, that has a link to get the book to study for the exam, is below that.
(In follow up to above question... found on Dept of Health FAQ Page) Who needs to be certified by the Department of Health to work with x-rays in Florida?
Per Section 468.302, Florida Statutes (F.S.), an individual must be a licensed practitioner or a certificate holder to administer x-ray or other types ionizing radiation to humans in the State of Florida. According to s. 468.301, F.S., ?Licensed practitioner? means a person who is licensed or otherwise authorized by law to practice medicine, podiatric medicine, chiropody, osteopathic medicine, naturopathy, or chiropractic medicine in this state. Categories of certification include Basic X-ray Machine Operator, Basic X-ray Machine Operator-Podiatric Medicine, General Radiographer, Nuclear Medicine, and Radiation Therapy certification. Please note that Ultrasound and MRI are not certified in Florida; however, some facilities may require additional licensing through a national registry.
Is there a place on the FAPA website that I can get information on Bloodborne Pathogen Exposure Protocol?
Yes, in fact Past President Ron Pace has a website dedicated to bloodborne pathogen exposure information (http://www.needlestickexposure.com/) which includes a free downloadable text entitled "Bloodborne Pathogen Exposure Protocol".
Yes. As you can see on the FHSAA form loaded to our website below, it specifically identifies "licensed physician assistant" as a qualified person to perform this exam and sign the form.
Yes. This form can be found on the DOH site at the following link:
DOH School Entry Health Exam
To the best of our knowledge, Non-physician providers can not perform IME's or Impairment Ratings since PA's can not sit for and take the American Board of Independent Medical Examiners (ABIME) examination. PAs are, however, able to perform the initial evaluation and physical so long as the supervising physician sees the patient and completes the paperwork including the final diagnosis and impairment ratings. There are only provisions for a medical doctor to perform these independently, as noted in the Certified Independent Medical Examiner (CIME) Handbook:
Yes. PAs may supervise basic machine operators and certified technicians if the physician is not physically present on the premises. You cannot however take x-rays yourself as a PA unless you have a separate license as an x-ray technician unless your supervising physician takes x-rays and delegates that duty to you as well.
Yes. Florida Statute 768.13, entitled the "Good Samaritan Act," states the following:
Good Samaritan Act; immunity from civil liability.?
(1) This act shall be known and cited as the "Good Samaritan Act."
(2)(a) Any person, including those licensed to practice medicine, who gratuitously and in good faith renders emergency care or treatment either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to s. 381.00315, a state of emergency which has been declared pursuant to s. 252.36 or at the scene of an emergency outside of a hospital, doctor's office, or other place having proper medical equipment, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.
(b)1. Any hospital licensed under chapter 395, any employee of such hospital working in a clinical area within the facility and providing patient care, and any person licensed to practice medicine who in good faith renders medical care or treatment necessitated by a sudden, unexpected situation or occurrence resulting in a serious medical condition demanding immediate medical attention, for which the patient enters the hospital through its emergency room or trauma center, or necessitated by a public health emergency declared pursuant to s. 381.00315 shall not be held liable for any civil damages as a result of such medical care or treatment unless such damages result from providing, or failing to provide, medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another.
2. The immunity provided by this paragraph does not apply to damages as a result of any act or omission of providing medical care or treatment:
a. Which occurs after the patient is stabilized and is capable of receiving medical treatment as a nonemergency patient, unless surgery is required as a result of the emergency within a reasonable time after the patient is stabilized, in which case the immunity provided by this paragraph applies to any act or omission of providing medical care or treatment which occurs prior to the stabilization of the patient following the surgery; or
b. Unrelated to the original medical emergency.
3. For purposes of this paragraph, "reckless disregard" as it applies to a given health care provider rendering emergency medical services shall be such conduct which a health care provider knew or should have known, at the time such services were rendered, would be likely to result in injury so as to affect the life or health of another, taking into account the following to the extent they may be present;
a. The extent or serious nature of the circumstances prevailing.
b. The lack of time or ability to obtain appropriate consultation.
c. The lack of a prior patient-physician relationship.
d. The inability to obtain an appropriate medical history of the patient.
e. The time constraints imposed by coexisting emergencies.
4. Every emergency care facility granted immunity under this paragraph shall accept and treat all emergency care patients within the operational capacity of such facility without regard to ability to pay, including patients transferred from another emergency care facility or other health care provider pursuant to Pub. L. No. 99-272, s. 9121. The failure of an emergency care facility to comply with this subparagraph constitutes grounds for the department to initiate disciplinary action against the facility pursuant to chapter 395.
(c) Any person who is licensed to practice medicine, while acting as a staff member or with professional clinical privileges at a nonprofit medical facility, other than a hospital licensed under chapter 395, or while performing health screening services, shall not be held liable for any civil damages as a result of care or treatment provided gratuitously in such capacity as a result of any act or failure to act in such capacity in providing or arranging further medical treatment, if such person acts as a reasonably prudent person licensed to practice medicine would have acted under the same or similar circumstances.
(3) Any person, including those licensed to practice veterinary medicine, who gratuitously and in good faith renders emergency care or treatment to an injured animal at the scene of an emergency on or adjacent to a roadway shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.
A physician may not supervise more than four currently licensed physician assistants at any one time. Note that this does not limit the number of PAs a physician may have listed for potential supervision, so long as no more than four are being supervised at a time.
It has been determined that a PA can order medications for an inpatient if delegated by his/her supervising physician. This has been clarified multiple times by the attorney from the Board of Medicine, most recently during a meeting held June 30, 2010. To read more about this meeting, go to June 2010 Article. Additionally, Senior Assistant Attorney General and Board of Medicine General Counsel Ed Tellechea sent this letter on August 25, 2010 to reaffirm PA right to order controlled substances in a hospital setting if delegated by a physician:
Yes. PAs can take the 120 hour course and become risk managers. In 2011, the FAPA Legal and Government Counsel confirmed this opinion based on the argument that a PA is, in fact, a health care professional, and thus can become a risk manager by the same protocols as physicians and nurses.
If a PA works for two specialists (s.a. Internal Med and Cardiology), can he/she do an H&P on a patient (under the Internal Medicine service) and then subsequently do a consult (under the Cardiology service) on the same patient on the same day?
No! This is often referred to as "Double Dipping" and is not allowed by PAs OR physicians (even if they are board certified in two specialties). In such a billing scenario, the highest specialty would take precedence.
If there is a specialized PA training program for lapband deflation OR If training provided as part of a PA program provides knowledge and experience to support compentency OR If this would even fall under a PA's approved scope of services.
Here is the protocol regarding Physician Assistant performance of the procedure from the University of California San Franciso Medical Center:
There does not appear to be a formal training, but, as is often the case in medicine, it is a "see one, do one" learning experience under direct physician supervision until the PA is felt to be competent to perform the procedure under indirect supervision.
The knowledge a PA receives during their training would provide the basis for the specialized training, but there is not specific training for this procedure provided during PA training that would suffice as competency.
Regarding scope of practice, Florida Administrative code states:
64B8-30.012 Physician Assistant Performance.
(1) A supervising physician shall delegate only tasks and procedures to the physician assistant which are within the supervising physician?s scope of practice. The physician assistant may work in any setting that is within the scope of practice of the supervising physician?s practice. The supervising physician?s scope of practice shall be defined for the purpose of this section as ?those tasks and procedures which the supervising physician is qualified by training or experience to perform.?
(2) The decision to permit the physician assistant to perform a task or procedure under direct or indirect supervision is made by the supervising physician based on reasonable medical judgment regarding the probability of morbidity and mortality to the patient. Furthermore, the supervising physician must be certain that the physician assistant is knowledgeable and skilled in performing the tasks and procedures assigned.
Therefore, as long as the procedure is within the scope of practice of the supervising physician, delegating to a "knowledgeable and skilled" PA, as determined by the supervising physician, would be deemed to be within the scope of practice of the PA.
The law regarding the FECA form states the form must be signed by a "physician". The legal definition of who that means is below. Apparently, PAs can't sign the form.
(2) ?physician? includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law. The term ?physician? includes chiropractors only to the extent that their reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist, and subject to regulation by the Secretary...
Do initial office visit Medicare patients have to have the physician see them? And then PA's can see for follow up visits alone under appropriate supervision guidelines?
There is no Medicare regulation requiring the physician to EVER see the patient except in Nursing Homes. What you are thinking of is in regard to ?incident to? billing. This is to allow the practice to bill under the doctor?s number for 100% reimbursement rather than the 85% reimbursement when a PA sees the patient. ?Incident to? is only for office visits and requires the physician to see all new patients and all established patients with new complaints. You are able to see new patients without the physician seeing them as well but the reimbursement will be $15 ? 20 less for the visit depending on the coding. It is generally worth the lower reimbursement to improve the efficiency of the practice.
My job duties include seeing residents/patients in the nursing home, SNF and ambulatory health clinic as well. Must I add EVERY potential physician who works in each facility as my supervising physician, or does that rule not apply to this setting?
If a new physician is added to the group or practice and even occasionally acts as a supervising physician, you MUST submit an updated supervision data form adding that physician. As in the question regarding Supervision Data Forms above, these rules still apply.
Is it required that physician's report all of the controlled substances they prescribe to a controlled substance monitoring database (If one exist?), or is it optional use?
As per state law that became effective in late 2011, it is required that ALL controlled substances be entered by the person who DISPENSES the medications (i.e. the pharmacists). All the info is accessible via the state website, which is known as E-FORSCE. Any prescribing Florida licensed medical provider can register for access to this E-FORSCE database by going to the website and filling out the request.
Here's the link to Florida E-FORSCE:
es. There is no problem with PAs in the state of Florida being allowed to treat patients and sign the forms for Worker's Compensation, so long as proper physician supervision, as per Florida law, is occurring. PAs can sign a patient's return to work approval, so long as this specific delegated authority has been granted by the supervising physician.
HOWEVER, please be aware PAs cannot make the MMI decision or determine % of impairment. This must be done under the doctor?s signature. PAs can't sign the DWC 25 form for MMI (Maximum Medical Improvement). PAs can fill out and sign the form for the initial and all follow-up visits, order treatment, tests, referrals and determine work status prior to MMI. The DWC 25 that gives the MMI date and the impairment rating must be signed by the physician.
Here is the form and instructions:
Here is the Florida Worker's Compensation Rules and Forms website:
According to the verbiage in the FAC 64B15-6.010, the generic name of "central line" does not define the route of access. What is the DOH's interpretation of "central line"'?
PICC's (peripherally inserted central catheters) and CVC's (central
venous catheters) are essentially both considered "central lines" only
because both catheters end up centrally in the superior vena cava
(SVC). Although there are indications for use of one over the other,
the main difference is the site of insertion which explains why CVC's
are considered to be invasive and are routinely done by only
PA's and ARNP's. This is because CVC's (which includes triple/quad
lumen catheters, dialysis and PA catheters) are inserted centrally
meaning that they are placed directly in the greater vessels of the
neck, chest, or groin (i.e.the internal jugular, subclavian, or femoral
veins) and advanced to the SVC. Anatomically speaking, CVC's are deemed
to be riskier in terms of complications because of the type of vein
they are inserted in and lie in and because of the greater vessels and
structures that surround them in immediate proximity. PICC's on the
other hand are inserted peripherally through a peripheral vein in the
arm and then advanced centrally and for this reason are considered to
be less or not invasive. Physicians, PA's and ARNP's as well as
specialty trained nurses can be trained to do PICC's. At my hospital,
the PA's are allowed to do all of the above as long as the supervising
physician(s) is/are in the hospital though they do not have to be
"directly" supervising i.e. in the room.
As far as the use of ultrasound vs fluoroscopy..both PICC's and
CVC's can be done via ultrasound and fluoroscopic guidance however for
CVC's this is not necessary and is per preference of the practitioner
doing the procedure. Regardless and in my practice, a chest x-ray is
always be done post subclavian and internal jugular central line
placement to confirm and document proper placement as well as to make
sure that that complications i.e. a pneumo/hemothorax did not arise.
Yes, but Medicare pays only under certain circumstances. See links below regarding telemedicine reimbursement.