RSA 328-D:3-b · Physician Assistant Scope of Practice

328-D:3-b Physician Assistant Scope of Practice. – [Paragraph I effective until January 1, 2027; see also paragraph I set out below.]

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I.

(a) Except as provided in RSA 328-D:15, III and RSA 328-D:16, II, physician associates with fewer than 8,000 hours of post-graduate clinical practice hours practicing without at least one licensed New Hampshire physician in the group, practice, or health system shall enter into a written collaboration agreement with a New Hampshire licensed physician. The physician signing the collaboration agreement shall practice in a similar area of medicine as the physician associate. The physician associate shall provide proof of clinical hours worked upon request of the board of medicine.

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(b)

Any New Hampshire licensed physician associate with more than 8,000 post-graduate clinical practice hours who intends to practice medicine in a setting without at least one licensed New Hampshire physician in the group, practice, or health system shall apply to the board of medicine for a waiver of the collaboration agreement requirement. Within 90 days of enactment of this subparagraph, the board shall adopt rules pursuant to RSA 541-A which set forth the requirements the physician associate must meet for the board to grant the waiver. The rules shall include creating a waiver application form on which the physician associate shall provide the physician associate's name, license number, physical location of the practice, mailing address, phone number, primary area of medical practice, and proof of required post-graduate clinical practice hours. The rules shall require the board to confirm the physician associate's license is in good standing. The board may delay or deny approval of the waiver if the physician associate's license is not in good standing or if the board is aware of action against the physician associate's license. The board shall also adopt rules that outline the conditions under which a physician associate who is denied a waiver may reapply. Any New Hampshire licensed physician associate with more than 8,000 post-graduate clinical practice hours who intends to practice medicine in a setting without at least one licensed New Hampshire physician in the group, practice, or health system may not do so without first obtaining a waiver through the waiver process created by the board of medicine in this subparagraph. [Paragraph I effective January 1, 2027; see also paragraph I set out above.]

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I.

Except as provided in RSA 328-D:15, III and RSA 328-D:16, II, physician associates with fewer than 8,000 hours of post-graduate clinical practice hours practicing without at least one licensed New Hampshire physician in the group, practice, or health system shall enter into a written collaboration agreement with a New Hampshire licensed physician. The physician signing the collaboration agreement shall practice in a similar area of medicine as the physician associate. The physician associate shall provide proof of clinical hours worked upon request of the board of medicine.

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II.

A collaboration agreement shall include all of the following:

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(a)

Processes for collaboration and consultation with the appropriate physician and other health care professional as indicated based on the patient's condition; the physician associate's education, training, and experience, and the applicable standards of care.

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(b)

An acknowledgment that the physician associate's scope of practice shall be limited to medical care that is within the physician associate's education, training, and experience as outlined in paragraphs VII-XVIII.

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(c)

A statement that although collaboration occurs between the physician associate and physicians and other health care professionals, a physician shall be accessible for consultation in person, by telephone, or electronic means at all times when a physician associate is practicing.

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(d)

The signatures of the physician associate and the participating physician. No other signatures shall be required.

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III.

The collaboration agreement shall be updated as necessary.

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IV.

In the event of the unanticipated unavailability of a participating physician practicing as a sole practitioner due to serious illness or death, a physician associate may continue to practice for not more than a 30-day period without entering into a new collaboration agreement with another participating physician.

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V.

The collaboration agreement shall be kept on file at the practice and made available to the board upon request. The board shall not request or require any modifications to the collaboration agreement.

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VI.

A participating physician shall not be required to submit a written acceptance of collaboration to the board.

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VII.

Physician associates may provide any legal medical service for which they have been prepared by their education, training, and experience and are competent to perform. Medical and surgical services provided by physician associates include, but are not limited to:

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(a)

Obtaining and performing comprehensive health histories and physical examinations;

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(b)

Evaluating, diagnosing, managing, and providing medical treatment;

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(c)

Ordering, performing, and interpreting diagnostic studies and therapeutic procedures;

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(d)

Educating patients on health promotion and disease prevention;

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(e)

Providing consultation upon request;

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(f)

Writing medical orders;

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VIII.

Physician associates may provide services in healthcare facilities or programs including but not limited to hospitals, nursing facilities, assisted living facilities, and hospices.

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IX.

Physician associates may obtain informed consent.

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X.

Physician associates may supervise, delegate, and assign therapeutic and diagnostic measures to licensed or unlicensed personnel.

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XI.

Consistent with the scope of practice, physician associates may certify the health or disability of a patient as required by any local, state, or federal program.

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XII.

Physician associates may authenticate any document with their signature, certification, stamp, verification, affidavit, or endorsement if it may be so authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of a physician.

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XIII.

A physician associate may prescribe, dispense, order, administer, and procure drugs and medical devices. Physician associates may plan and initiate a therapeutic regimen that includes ordering and prescribing non pharmacological interventions, including but not limited to durable medical equipment, nutrition, blood and blood products, and diagnostic support services including but not limited to home healthcare, hospice, and physical and occupational therapy. A physician associate licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine, a subsequent evaluation shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. All prescribing shall be in compliance with all federal and state laws and regulations.

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XIV.

The prescribing and dispensing of drugs shall:

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(a)

Comply with the requirements of RSA 318, and federal and state regulations;

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(b)

Occur when pharmacy services are not reasonably available, or when it is in the best interests of the patient, or when it is an emergency; and

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(c)

Include any medications that may be dispensed by a physician.

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XV.

Physician associates may request, receive, and sign for professional samples, and may distribute professional samples to patients.

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XVI.

Physician associates who prescribe and/or dispense controlled substances shall register with the United States Drug Enforcement Administration and any applicable state controlled substance regulatory authority.

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XVII.

Physician associates shall collaborate with, consult with, and/or refer to the appropriate member(s) of the healthcare team as indicated by the patient's condition, the education, experience, and competencies of the physician associate, and the standard of care. The degree of collaboration should be outlined in the collaboration agreement. Physician associates are solely responsible for the care they provide.

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XVIII.

The scope of practice of a physician associate shall be determined at the practice level based on the education, training, and experience of the physician associate. Practice settings may include, but are not limited to, a physician employer setting, group practice setting, independent private practice setting, or in a health care facility setting governed by a system of credentialing and/or granting of privileges.

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XIX.

Physician associates shall collaborate with, consult with, and/or refer to a physician or the appropriate member of the health care team as indicated by the patient's condition, the education, experience, and competencies of the physician associate, and the standard of care. Physician associates may only practice medicine when a physician or other appropriate member of the health care team is available for consultation in person or by electronic means. Physician associates are solely responsible for the care they provide.

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XX.

Physician associates shall comply with all internal policies regarding scope of practice as set forth by the physician associate's employer. Source. 2022, 148:5, eff. Aug. 6, 2022. 2024, 264:5, 7, eff. July 26, 2024; 264:6, eff. Jan. 1, 2027. 2025, 105:1-3, eff. June 17, 2025; 105:7, 8, eff. Jan. 1, 2027; 134:2, eff. Aug. 23, 2025.

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