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NEW JERSEY REGISTER
VOLUME 36, NUMBER 20
MONDAY, OCTOBER 18, 2004
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF MEDICAL EXAMINERS
BOARD OF MEDICAL EXAMINERS RULES

Proposed Readoption with Amendments: N.J.A.C. 13:35

Proposed Repeal: N.J.A.C. 13:35-3.5

Proposed New Rules: N.J.A.C. 13:35-3.14, 6.24 and 10.4

Proposed Repeals and New Rules: N.J.A.C. 13:35-2A.7, 2B.17 and 9.7

Authorized By: State Board of Medical Examiners, William Roeder, Executive Director.

Authority: N.J.S.A. 45:9-2 and 45:1-15.1.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2004-405.

Submit written comments by December 17, 2004 to:

William Roeder, Executive Director

State Board of Medical Examiners

PO Box 183

Trenton, NJ 08625-0183

The agency proposal follows:

Summary

Pursuant to Executive Order No. 66(1978), N.J.A.C. 13:35 is scheduled to expire on September 20, 2004. Because this notice of proposed readoption was filed prior to the expiration date, the chapter expiration date has been extended for 180 days to March 19, 2005, pursuant to N.J.S.A 52:14B-5.1c. The State Board of Medical Examiners (the Board) has reviewed the existing rules and has determined that they continue to be reasonable, necessary and effective for the purposes for which they were promulgated. The Board proposes to readopt the rules with amendments as summarized and discussed below.

The existing rules proposed for readoption have enabled the Board to have in place standards and procedures which have served to maintain principles of conduct and practice in the medical profession. The Board also believes that the proposed changes further that purpose as the amendments clarify and update the language of the rules. The Board notes that it continually reviews and revises the rules in N.J.A.C. 13:35 in order to address developments which impact the medical profession, its licensees and Board regulation of the profession.

The following summary outlines each subchapter and briefly explains the amendments which are proposed as part of this readoption.

Subchapter 1, Medical schools, colleges, externships, clerkships and post- graduate work, contains rules concerning medical training. N.J.A.C. 13:35- 1.1 outlines the requirements for externship programs and the limitations imposed on medical students as they serve as observers. N.J.A.C. 13:35-1.2, Fifth pathway, describes how an applicant who does not meet the customary requirements for educational programs may be accepted for licensure. N.J.A.C. 13:35-1.3 specifies that post-graduate training must be taken under the authority of a hospital accredited for post-graduate training. N.J.A.C. 13:35-1.4 permits the Board to grant a license to practice medicine and surgery to an applicant who has not completed the requisite post-graduate training but who furnishes proof that he or she has served in the military service as a commissioned officer and as a physician or surgeon in a medical facility.

N.J.A.C. 13:35-1.5 outlines requirements for graduate medical education programs in both medicine and podiatry. A separate proposal published on June 7, 2004, in the New Jersey Register at 36 N.J.R. 2582(a), if adopted, would amend this section to clarify that the requirement that an applicant's didactic training be completed in the jurisdiction where the medical school is authorized to confer a medical degree applies to all applicants for medical residency registration, and not, as currently written, to only those applicants who have attended more than one medical school.

Subchapter 1A contains standards for New Jersey clinical training programs which are sponsored by medical schools which are not eligible for evaluation or approved by agencies recognized by the Board. N.J.A.C. 13:35-1A.1 outlines definitions and principles which medical schools are required to follow when conducting clinical training programs. For instance, a medical school which offers or conducts a clinical training program in New Jersey must secure prior Board approval. Upon receiving such approval, the medical school is responsible for the education, clinical training program and performance of the faculty at the affiliate institution, which must have a current accredited post-graduate training program in the subject matter of the clinical training proposed for the program. The rule requires that the clinical programs as well as supervision of the student assigned to the program shall be planned and evaluated by the parent medical school and administered in close cooperation with representatives of the affiliate institution. N.J.A.C. 13:35-1A.2 specifies how the clinical program must be administered and requires the appointment of a medical director. N.J.A.C. 13:35-1A.3 requires that the faculty of the institution must possess academic credentials and experience which assures competent performance. N.J.A.C. 13:35-1A.4 outlines the educational criteria which the program must contain in order to be approved. N.J.A.C. 13:35-1A.5 specifies that the affiliate institution must be a licensed hospital which is approved by the Accreditation Council on Graduate Medical Education, the American Osteopathic Association or other groups which provide post-graduate training in subject areas of the proposed clinical training program. N.J.A.C. 13:35-1A.6 outlines the application and approval process for clinical training programs. N.J.A.C. 13:35-1A.7 specifies that a list of approved clinical training program schools and affiliates is maintained by the Board and is available upon request. N.J.A.C. 13:35-1A.8 specifies how a program that has received prior Board approval may be terminated. N.J.A.C. 13:35-1A.9 specifies that any violations of the rules contained in the subchapter may be regarded as engaging in the unlicensed practice of medicine or aiding and assisting in the unlicensed practice which will subject the violator to monetary penalties and/or other disciplinary actions. N.J.A.C. 13:35-1A.10 specifies that if any provision of a rule is declared invalid, such invalidity will not affect other provisions of the rules. N.J.A.C. 13:35-1A.11 specifies that, although the subchapter applies to all clinical training programs in the State of New Jersey, there are a number of foreign medical schools which the Board has allowed to sponsor clinical programs which are not required to meet the standards of the subchapter. The Board notes that P.L. 2003, c.133 created the "Advisory Committee on Alternatively Accredited Medical School Clinical Clerkships" within the Commission on Higher Education. This committee is not yet operational; therefore, the Board is not changing Subchapter 1A to reflect the role of the committee until such time as the committee is established.

Subchapter 2 contains rules on limited licenses for podiatry and diagnostic testing centers. N.J.A.C. 13:35-2.1 requires that an applicant for a podiatric license must have graduated from a college of podiatry approved during the entire course of the applicant's training. N.J.A.C. 13:35-2.2 requires that an applicant for licensure must have successfully completed an internship or post-graduate program which is approved by the American Podiatric Medical Association. N.J.A.C. 13:35-2.3 specifies that in instances where an applicant has not completed the requisite internship training, the Board may grant a license to practice podiatry to a person who furnishes proof that such person has fulfilled all the formal requirements established by the Podiatric Practice Act, N.J.S.A. 45:5-1 et seq., and has served at least two years in active military service. N.J.A.C. 13:35-2.4 and 2.5 are reserved. N.J.A.C. 13:35-2.6 sets forth the medical standards governing screening and diagnostic medical testing offices and determinations with respect to the validity of certain diagnostic tests. Amendments are proposed to this section which stem from an informal request during 2001 by the Radiological Society of New Jersey for modifications to current rule requirements for physician presence in some circumstances, record storage by physicians, and notification to another State agency of certain kinds of contractual arrangements. The Board is satisfied that professional practice could be facilitated by certain modifications, some applicable to screening tests and some to diagnostic tests, without harm to the public. For one subsection on diagnostic tests, the Board is initiating a more specific interpretation to prevent circumvention of the rule. A proposed amendment to N.J.A.C. 13:35-2.6 would delete paragraph (e)6, removing a requirement that a practitioner, who contracts with a licensed health care facility to perform diagnostic or screening tests on the facility premises, must provide a detailed notice to the State Department of Health and Senior Services (DOHSS). The Board has been advised that DOHSS does not presently require such notice, and that, in any event, in light of the recent enactment of P.L. 2004, c.54, which requires entities providing magnetic resonance imaging and computerized axial tomography services to obtain licenses from DOHSS, the choice of how best to address the issue lies with DOHSS. The proposed amendment to N.J.A.C. 13:35-2.6(h)2i clarifies the subparagraph, which currently requires that the office protocol required of a mammography screening office shall provide guidance on positioning of the examinee, to indicate that such guidance is to be provided to the practitioner performing the mammography. The change to subparagraph (h)2iv would delete the current requirement that verbal advice be given to the examinee in addition to the requirement for the written test report, reminding that a screening mammography is not a comprehensive examination sufficient to detect all abnormalities. Thus, the written notice would suffice. Neither change conflicts with requirements of the Federal rules implementing the Mammography Quality Standards Act, 21 CFR 900.1 et seq. N.J.A.C. 13:35-2.6(j) currently requires telephone notice to an examinee of any abnormal result on a screening test in addition to a written notice. The proposed amendment would continue the written notice requirement, but the proposed amendment would limit the additional requirement to speedily issue a notice by telephone to circumstances where immediate clinical follow-up is warranted. N.J.A.C. 13:35-2.6(k) currently requires every practitioner to maintain a complete record of diagnostic testing. The proposed amendment would allow a practitioner who has performed a diagnostic test of a patient within a licensed health care facility to entrust the reports and raw data of the test, including radiographic images, to the secured custody of that licensed health care facility as part of the facility's permanent patient records. This change should simplify recordkeeping requirements, avoiding unnecessary duplication while still providing reasonably secure and accessible record preservation. N.J.A.C. 13:35-2.6(o) deals with issuance of diagnostic test reports and currently requires a practitioner performing a diagnostic test to issue a report of test results no later than three business days from determining the result. The proposed amendment would require that the report be issued sooner, including by a preliminary verbal report, in those circumstances when immediate follow-up care is indicated. The proposed amendment to N.J.A.C. 13:35-2.6(s), presented on the initiative of the Board, would clarify that the opportunity to request a billable consultation regarding diagnostic test interpretation, from a practitioner unlicensed in this State, is intended to be available for special, occasional or emergent consultations only. A consultant or consultant entity rendering medical services interpreting diagnostic test data/records for 10 or more patients under treatment in New Jersey on an annual basis is deemed to be rendering medical services in this State and, therefore, must be licensed by the New Jersey Board of Medical Examiners. The Board has elected to adopt the standard of 10 or more New Jersey patients treated on an annual basis as this is the number recommended by the Federation of State Medical Boards of the United States in their Model Act for regulating the practice of medicine across state lines. The requirement does not apply to bioanalytic specimens sent to a clinical laboratory under the jurisdiction of the DOHSS. However, physician to physician contacts where information, which may include patient specific information, is exchanged between a licensee and a physician licensed in another state, possession of the United States or the District of Columbia would not be deemed to be rendering medical services under this subsection. N.J.A.C. 13:35-2.7 through 2.12 are reserved. N.J.A.C. 13:35-2.13 specifies those limited privileges and conditions of practice which are permitted for a graduate physician pending receipt of licensure. N.J.A.C. 13:35-2.14 is reserved.

Subchapter 2A contains rules concerning the licensure of midwives. N.J.A.C. 13:35-2A.1 defines the purpose and scope of this subchapter as relating to the licensure of and standards of practice for midwives. A proposed amendment makes a technical correction to the heading of the section so that it refers to the section as "Purpose and scope" instead of "Midwifery practice" as it is presently headed. N.J.A.C. 13:35-2A.2 defines certain words and terms used in this subchapter. A proposed amendment establishes a definition for "midwife" to mean a person licensed by the Board as a certified midwife (CM), certified nurse midwife (CNM) or certified professional midwife (CPM). N.J.A.C. 13:35- 2A.3 establishes a Midwifery Liaison Committee to the Board. N.J.A.C. 13:35- 2A.4 sets forth the application requirements for licensure. Proposed amendments change the references to the fee schedule at N.J.A.C. 13:35-6.13 since proposed amendments discussed below would restructure that section. N.J.A.C. 13:35-2A.5 outlines independent midwife practice standards. N.J.A.C. 13:35- 2A.6 specifies that prior to practice as a midwife, a licensee must enter into an affiliation with a New Jersey licensed physician and sets forth the requirements of that affiliation including clinical guidelines. N.J.A.C. 13:35-2A.7 provides that a midwife license must be renewed biennially with the payment of a renewal license fee. Proposed amendments to this section set forth the procedures for license issuance and renewal, inactive status and the reinstatement of a suspended or inactive license. The proposed amendments set forth renewal application procedures, late fees, and the consequences of an expiration of an unrenewed license. A proposed amendment codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed amendments set forth the process by which a licensee may elect to change the licensee's status from inactive to active and for the reinstatement of a license which has been automatically suspended for non-renewal. An individual seeking reinstatement of a license which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to take an examination or other requirements determined by the Board. N.J.A.C. 13:35-2A.8 addresses midwife normal antepartum management, and N.J.A.C. 13:35-2A.9 addresses management of antepartum women at increased risk. N.J.A.C. 13:35-2A.10 address normal intrapartum management, and N.J.A.C. 13:35-2A.11 addresses management of intrapartum women at increased risk. N.J.A.C. 13:35-2A.12 addresses postpartum care. N.J.A.C. 13:35-2A.13 provides that a CNM or CM may provide certain well woman care. N.J.A.C. 13:35-2A.14 specifies the requirements for a CNM to obtain prescriptive authority and other related requirements. N.J.A.C. 13:35-2A.15 concerns the requirements for licensees to perform ultrasound examinations. N.J.A.C. 13:35-2A.16 specifies the requirements for a CNMA or CM to perform colposcopies. N.J.A.C. 13:35-2A.17 specifies the requirements for a licensee to perform circumcisions.

Subchapter 2B contains requirements concerning physician assistants. N.J.A.C. 13:35-2B.1 sets forth that the rules in the subchapter which implement the provisions of the Physician Assistant Licensing Act, N.J.S.A. 45:9-27.10 et seq. N.J.A.C. 13:35-2B.2 contains definitions of terms used in the subchapter. A proposed amendment adds a definition for "designated physician assistant," a term used in proposed amendments to N.J.A.C. 13:35- 2B.15, to clarify that a designated physician assistant may not be a temporary licensee. N.J.A.C. 13:35-2B.3 sets forth the requirements which permit a licensee to engage in clinical practice. A licensee must practice under the direct supervision of a physician; limit his or her practice to that within the authorized scope of practice; wear an identification tag; comply with recordkeeping requirements; and file with the Board a notice of employment for each place of employment. A proposed amendment would clarify that employment includes full-time, part-time and per diem employment. In addition, a proposed amendment clarifies that the supervisor must be a supervising physician. Another proposed amendment makes a technical change to clarify that the licensees file their notices of employment and updated information regarding their employment and supervising physician with the Committee and not the Board as presently stated. N.J.A.C. 13:35-2B.4 sets forth the procedures and activities a licensee may perform so long as the procedures are within the training and experience of both the supervising physician and the physician assistant, are performed only when the supervising physician directs the licensee to perform the procedures, or the procedures are specified in a written protocol. A proposed amendment would make a grammatical change, and another proposed amendment would replace the term "infusion pump" with "medication delivery systems" concerning certain medical devices that the physician assistant may apply or remove since the latter term is more descriptive of the type of device and is a more inclusive term. N.J.A.C. 13:35-2B.5 sets forth the requirements an applicant must meet to be eligible for licensure. The rule also sets forth an exemption from the examination requirement for an applicant who holds a current license, certification or registration to practice as a physician assistant in a state which has standards substantially equivalent to those of New Jersey. A proposed amendment updates the name of the committee that approves physician assistant education programs and allows for the approval of the education program or examination to be made by any successor committee of the ones named in this rule.

N.J.A.C. 13:35-2B.6 provides that the Board may refuse to issue or may suspend or revoke a license for any reason set forth in N.J.S.A. 45:1-21. The rule also sets forth that prior to any license suspension or revocation the licensee shall be afforded the opportunity to be heard. N.J.A.C. 13:35-2B.7 sets forth that a biennial license renewal will not be renewed unless the applicant submits proof that he or she completed courses of continuing professional education. Any false information submitted with the renewal application may result in penalties and/or suspension or revocation of the license. The rule also allows the Board to conduct inquiries of licensees on a random basis to determine compliance with continuing education requirements. N.J.A.C. 13:35-2B.8 further provides that each applicant for a biennial license renewal shall be required to complete, during the preceding biennial period, a minimum number of continuing education credit hours. The rule allows for 15 credits to be carried over to the succeeding biennial period only if earned during the last six months of the preceding biennial period. A proposed amendment raises the minimum number of continuing education credit hours from 40 to 50 per biennial licensing period to be consistent with national standards. N.J.A.C. 13:35-2B.9 permits the Board to temporarily waive continuing education requirements on an individual basis for reasons of hardship, such as illness or disability, or other good cause. A proposed amendment clarifies that the waiver would be for a time period designated by the Committee. N.J.A.C. 13:35-2B.10 sets forth the duties and responsibilities of a supervising physician. The rule requires that a physician assistant may engage in practice only under the direct supervision of a physician. The rule requires the supervising physician in an inpatient setting to be on site and to be available through electronic communication. In an outpatient setting, the supervising physician must be constantly available through electronic communication for consultation or recall. The supervising physician must regularly review the practice of the physician assistant and must personally review all charts and patient records and counter-sign all medical orders. The rule also sets forth the supervisory ratios that must be met and that the supervising physician is responsible for the practice of the physician assistant. A proposed amendment clarifies that the supervising physician or physician designee personally reviews all charts and patient records and counter signs all medical orders as indicated in the rule. Another proposed amendment removes the requirement that a supervising physician must be a department head as well as that the supervising physician may assign his or her supervision only to attending and staff physicians since there should not be different assignment protocols between in-patient and out-patient treatment settings. An additional proposed amendment would delete the last sentence in subsection (d), which states that in all other settings in which a physician assistant is employed, the supervising physician of record shall be considered the person responsible for the practice of the physician assistant, since a supervising assistant may assign his or her supervision to a physician designee.

N.J.A.C. 13:35-2B.11 requires that licensees shall make contemporaneous, permanent entries into professional treatment records. The rule requires that the physician assistant shall sign each entry in the patient record and record the designation "PA-C" following his or her signature. A proposed amendment deletes progress notes from the list of documents that a physician assistant must maintain in the patient's records because progress notes are not a separate record but are part of other records already required to be kept under this rule. N.J.A.C. 13:35-2B.12 sets forth the conditions a physician assistant must meet before issuing prescriptions. Physician assistants may not issue prescriptions for controlled dangerous substances. A proposed amendment establishes protocols for when a physician assistant may write an order memorializing a verbal order for a controlled dangerous substance given by the supervising physician or his designee in a licensed inpatient or outpatient setting, including, but not limited to, hospital emergency departments, licensed ambulatory surgery centers and nursing homes, when the following requirements are met. The physician's controlled dangerous substance order must be written on the order sheet of the patient's chart with (1) the letters VO (meaning an order relayed to the physician assistant by the physician in person) or TO (meaning an order relayed to the physician assistant by the physician over the telephone), (2) the supervising physician's or designee's name printed, (3) the signature of the physician assistant directly under the order for the controlled dangerous substance, and (4) the supervising physician's or designee's countersignature of the controlled dangerous substance order within 48 hours of the order. N.J.A.C. 13:35-2B.13 sets forth when an individual who has filed an application for licensure but is waiting to take the next certification examination, or is waiting for the results of the examination, may apply to the Board for a temporary license to be employed under the direct supervision of a physician. N.J.A.C. 13:35- 2B.14 provides that a temporary license holder shall not issue prescriptions but may perform all of the procedures within a physician assistant's scope of practice under the direct supervision of a physician. A proposed amendment clarifies that a temporary license holder may write orders for medication, treatment or testing consistent with the provisions of N.J.A.C. 13:35- 2B.15. N.J.A.C. 13:35-2B.15 outlines the conditions that must be met before a temporary license holder can render care to a patient. A proposed amendment clarifies the types of orders that a temporary licensee may write provided that the temporary licensee is properly supervised to include both treatment and testing orders. Another proposed amendment replaces the term "licensed physician assistant with privileges in the same discipline" to "designated physician assistant" to clarify that the physician assistant who supervises a temporary license holder cannot be another temporary license holder and must be designated by the supervising physician or physician designee and because physician assistants do not have privileges. The proposed amendments also clarify the responsibilities of the supervising physician or physician designee in the event that the countersignature is of the designated physician assistant. Additional proposed amendments, make the timing and review of countersignatures of designated physician assistants by supervising physicians or physician designees to be the same as in N.J.A.C. 13:35-2B.10(b)4 which is 24 hours in an inpatient setting and 48 hours in an outpatient setting.

N.J.A.C. 13:35-2B.16 specifies that a temporary license shall expire 30 days after the temporary license holder has received notification of the successful completion of the examination or immediately upon the applicant's receipt of notification of failure to pass the examination. The rule provides that an applicant who fails an examination must cease performance of his or her duties. Unless there are extenuating circumstances, a temporary license may not be renewed. An applicant seeking to renew a temporary license based upon extenuating circumstances shall present to the Board documentation supporting the renewal request. A proposed amendment references N.J.A.C. 13:35-2B.13(a) as the provision in which an applicant would receive notification of failing to pass the examination. N.J.A.C. 13:35-2B.17 sets forth the requirements for reinstatement of a lapsed license. The Board proposes to repeal this section and to replace it with a new rule setting forth the procedures for license issuance and renewal, inactive status and the reinstatement of a suspended or inactive license. Licenses will be issued for two years and renewed biennially. The proposed amendments sets forth renewal application procedures, late fees, and the expiration of an unrenewed license. The proposed rule codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed rule set forth the process to change the licensee's status from inactive to active and for the reinstatement of a license which has been automatically suspended for non-renewal. An individual seeking reinstatement of a license which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to an examination or other requirements determined by the Board. N.J.A.C. 13:35-2B.18 sets forth the prohibition against sexual misconduct.

Subchapter 3 contains rules concerning licensing examinations, endorsements and limited exemptions from licensure. N.J.A.C. 13:35-3.1 outlines the licensing examination requirements for physicians. N.J.A.C. 13:35-3.2 specifies the requirements for the granting of a license by endorsement for a person who wishes to practice medicine and surgery in the State of New Jersey. N.J.A.C. 13:35-3.3 provides for the licensure without examination to practice podiatry in New Jersey. N.J.A.C. 13:35-3.4 is reserved. N.J.A.C. 13:35-3.5, which provides for the endorsement of certified nurse midwives, is proposed to be repealed and reserved because this section is unnecessary as the licensure of midwives is now delineated in Subchapter 2A. N.J.A.C. 13:35-3.6 provides that a person licensed in New Jersey to practice medicine and surgery may be granted a license to direct and supervise a bioanalytical laboratory without examination provided conditions outlined in the rule are met. Proposed amendments make a grammatical correction and remove the requirement that an applicant make a personal appearance before the Board as part of the licensing process since the Board no longer requires such an appearance. In addition, proposed amendments clarify the fields in which a specialty license may be granted by the Board without examination in addition to the national accrediting boards that certifying applicants in these fields because the number of specialty fields have grown and the regulation needs to be updated accordingly. A proposed technical amendment provides a corrected reference to the Bioanalytical Laboratory and Laboratory Directors Licensing Act. N.J.A.C. 13:35-3.7 provides for the limited exemption from licensure for physicians. N.J.A.C. 13:35-3.8 permits the Executive Director of the Board to admit to the licensing examination candidates who are graduates of professional schools and colleges and who have submitted the required documents for admission. N.J.A.C. 13:35-3.9 permits an applicant to postpone the taking of an examination to the next subsequent examination. N.J.A.C. 13:35- 3.10 provides for the security of the licensing examination by discouraging certain conduct in the licensing examination process which may subvert or attempt to subvert the examination. N.J.A.C. 13:35-3.11 specifies standards for licensing physicians who have graduated from medical schools which are not approved by an American national accrediting agency. N.J.A.C. 13:35-3.12 contains standards for licensure of physicians who possess post-secondary educational deficiencies. N.J.A.C. 13:35-3.13 requires a criminal history background check of all applicants for initial licensure to practice medicine and surgery in New Jersey. Proposed amendments clarify that this section operates in conjunction with P.L. 2002, c.104 (N.J.S.A. 45:1-28 et seq.), which requires that certain medical practitioners who seek licensure or any other authorization to practice by a professional or occupation board in the Division of Consumer Affairs must undergo criminal history background checks. N.J.A.C. 13:35-3.14 is a proposed new rule to include the procedures for license issuance and renewal, inactive status and the reinstatement of a suspended or inactive license. Licenses will be issued for two years and renewed biennially. The proposed new rule sets forth renewal application procedures, late fees, and the expiration of an unrenewed license. A proposed amendment codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed new rule sets forth the process to change the licensee's status from inactive to active and for the reinstatement of a license which has been automatically suspended for non-renewal. An individual seeking reinstatement of a license which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to an examination or other requirements determined by the Board.

Subchapter 4 contains rules concerning the performance of surgery. N.J.A.C. 13:35-4.1 defines what is considered a major surgical procedure. The rule specifies that a major surgical procedure may be performed by a duly qualified surgeon with an assisting physician who is a resident in/or rotating through a training program. The rule also specifies that a duly qualified registered nurse first assistant or a duly qualified physician assistant may also assist during a major surgical procedure. In addition, a duly qualified certified nurse midwife may act as a first assistant in the performance of cesarean sections. The rule further specifies that a qualified surgeon, a qualified assistant physician, a qualified resident, qualified registered nurse first assistant or qualified physician assistant must be determined by a hospital credentials committee. A proposed amendment revises the definition of major surgical procedure to include a procedure in which an opening is made into any of the three major body cavities (abdomen, chest or head), if the facility's credentials committee, in conjunction with the chair or chief of the relevant department or division, has delineated the procedure as one requiring a qualified first assistant. This change is necessary to keep in pace with technological advances in medical procedures which allow for minor procedures to be made in body cavities without the risks that would make the presence of a first assistant necessary. Another proposed amendment allows a licensed podiatric physician to act as a qualified first assistant. N.J.A.C. 13:35- 4.2 outlines the procedure for the termination of pregnancies.

Subchapter 4A contains requirements concerning the performance of surgery, special procedures and anesthesia services performed in an office setting. N.J.A.C. 13:35-4A.1 delineates the purpose of the rules contained in the subchapter. N.J.A.C. 13:35-4A.2 specifies the scope of the rules which encompass staffing and equipment requirements for practitioners and physicians who perform surgery, special procedures and administer anesthesia in an office setting. N.J.A.C. 13:35-4A.3 contains relevant definitions used in the subchapter. N.J.A.C. 13:35-4A.4 specifies that practitioners who perform surgery or special procedures and physicians who administer or supervise the administration or monitoring of anesthesia in an office must establish written policies and procedures. N.J.A.C. 13:35-4A.5 imposes a duty to report incidents which occur during surgery, special procedures or the administration of anesthesia in an office which results in death, taking a patient to a hospital for observation or treatment for 24 hours or more or complications or untoward events. N.J.A.C. 13:35-4A.6 enumerates standards for those practitioners who perform surgery and special procedures in an office setting, outlines the credentials necessary to perform such surgery and procedures, along with preprocedure counseling, standards to maintain patient records and the recovery and discharge of patients. N.J.A.C. 13:35-4A.7 enumerates standards for physicians who administer or supervise the administration of anesthesia services in an office setting, the provision of pre-anesthesia counseling and patient monitoring, and the recovery of patients after anesthesia and contains requirements on maintaining patient records and the discharge of the patient. N.J.A.C. 13:35-4A.8 specifies how general anesthesia must be administered and monitored in an office setting by those individuals authorized to do so. N.J.A.C. 13:35-4A.9 directs how regional anesthesia may be administered and monitored in an office setting and by whom. N.J.A.C. 13:35-4A.10 specifies how conscious sedation may be administered in an office setting and by whom. N.J.A.C. 13:35-4A.11 enumerates those individuals who are permitted to administer minor conduction blocks in an office setting for surgery. N.J.A.C. 13:35-4A.12 establishes the procedure for obtaining privileges to provide or supervise the administration and monitoring of general or regional anesthesia, as well as conscious sedation, in an office when the licensee does not hold privileges at a licensed hospital to do so. N.J.A.C. 13:35-4A.13 outlines the medical equipment, supplies and pharmacological agents which are required in order to provide anesthetic and recovery services as well as to treat any complications that may arise as a result of providing anesthetic and recovery services. N.J.A.C. 13:35-4A.14 outlines those safety systems and monitoring devices which must be provided in an office in which anesthesia services are provided. N.J.A.C. 13:35-4A.15 provides that a recovery area must be available in an office in which anesthesia services are provided and specifies the equipment that must be available in the recovery area. N.J.A.C. 13:35-4A.16 provides that all the equipment that is required by the rules in the subchapter is subject to inspection and maintenance. N.J.A.C. 13:35-4A.17 sets out specific dates of compliance for various provisions of the rules. N.J.A.C. 13:35-4A.18 provides that any violation of the rules shall be deemed professional misconduct.

Subchapter 5 contains rules concerning eye examinations and eyeglasses. N.J.A.C. 13:35-5.1 specifies the minimum requirements necessary in order to conduct an eye examination. The rule requires that a physician maintain a complete record of the physical examination of the patient, disclose findings and suggest an appropriate course of action to the patient. N.J.A.C. 13:35- 5.2 specifies the minimum standards and tolerances of optical lenses.

Subchapter 6 enumerates general rules of practice for Board licensees. N.J.A.C. 13:35-6.1 requires that a physician with a plenary license to practice medicine and surgery shall identify and represent himself or herself in a manner which clearly indicates such plenary licensure and/or the practice specialty. The rule further requires that a licensee with a limited license must identify himself or herself for professional purposes in a manner which indicates the licensed professional by name or by using recognized and accepted abbreviations of the degree conferred by the professional institution. N.J.A.C. 13:35-6.2 outlines the manner in which a physician may issue a pronouncement of death. N.J.A.C. 13:35-6.3 specifies that licensees may not engage in sexual contact with patients with whom the licensee has a patient/ physician relationship. The rule further enumerates what the Board considers sexual misconduct by licensees and sets forth that any violation of the rule shall constitute gross or repeated malpractice or professional misconduct. An amendment is proposed to clarify the procedure by which a physician may actively terminate a patient/physician relationship and that a minimum of 30 days must pass from the rendition of the last professional service before the patient/physician relationship would be considered to be terminated. N.J.A.C. 13:35-6.4 provides for the delegation of administration of subcutaneous and intramuscular injections to a certified medical assistant. N.J.A.C. 13:35-6.5 enumerates the standards for preparation of patient records, computerized records and access to and release of information. The rule further enumerates provisions to maintain records confidential and the transfer and disposal of patient records. An amendment to subsection (c) is proposed relating to the allowable fee charged for copying x-rays and other materials within a patient record which cannot be routinely copied or duplicated on a commercial photocopy machine. The fee can not be more than the actual cost of the duplication of the materials, or the fee charged to the licensee for duplication, plus an administrative fee of the lesser of $10.00 or 10 percent of the cost of reproduction to compensate for office personnel time spent retrieving or reproducing the materials and overhead costs. In addition, a proposed amendment provides that a licensee shall not charge a patient for a copy of the patient's record when the licensee has affirmatively terminated a patient from practice in accordance with the requirements of N.J.A.C. 13:35- 6.22 or when the licensee leaves a practice that he or she was formerly a member of, or associated with, and the patient requests that his or her medical care continue to be provided by that licensee. N.J.A.C. 13:35-6.6 sets forth the joint protocols between advanced practice nurses and collaborating physicians. N.J.A.C. 13:35-6.7 is reserved. However, a separate proposal published on October 4, 2004, at 36 N.J.R. 4367(a), in the New Jersey Register, if adopted, would place a new rule at this section to establish standards so that (1) a licensee working in a setting which is neither part of a Federal Drug Administration study nor performed in a setting governed by an Institutional Review Board will know what he or she needs to do when performing a new or novel procedure and (2) patients will be protected by requiring licensees to provide them with adequate information regarding the novel nature of the procedure in order to give informed consent. N.J.A.C. 13:35-6.8 sets forth the standards for prescribing, administering or dispensing laetrile. N.J.A.C. 13:35-6.9 requires that a physician holding a plenary license to practice medicine and surgery who provides diagnostic radiological services shall upon the request of a chiropractor or podiatric physician provide diagnostic radiological services without discrimination on the basis of the classification of license provided that the diagnostic radiological service requested pertains to a skeletal area of the body. N.J.A.C. 13:35-6.10 contains standards on the use of advertising and solicitation practices. The rule defines pertinent terms, specific advertising practices that are prohibited, the advertising of fees and requirements for advertising free or discounted services and testimonials. Proposed amendments clarify that any licensee advertising certification in a specialty must possess current certification by a specialty board and that the advertising must conspicuously specify in the advertisement the specific board or certifying entity granting the certification. N.J.A.C. 13:35-6.11 prohibits the charging of excessive fees and lists factors which are taken into consideration to determine whether a fee is excessive. N.J.A.C. 13:35-6.12 is reserved. N.J.A.C. 13:35-6.13 outlines the fees that are charged by the Board. Amendments are proposed to this section to make technical changes regarding the types of fees being charged, to remove unnecessary and duplicate references, to set a reinstatement fee at $175.00 which is consistent with other licenses under the Board as well as other professional licensing boards, and to establish an inactive license fee which would be determined by the Director of Consumer Affairs by rule. N.J.A.C. 13:35-6.14 provides for the delegation of physical modalities by a physician to a licensed health care provider or an unlicensed physician aide. N.J.A.C. 13:35-6.15 sets forth the requirements for continuing medical education of licenses. N.J.A.C. 13:35-6.16 enumerates the permissible professional business practice structures in which a licensee may engage. A separate proposal published on August 2, 2004, in the New Jersey Register at 36 N.J.R. 3499(a), if adopted, would amend this section to codify the Board's long-standing informal authorization of a limited liability company (LLC) as an acceptable professional practice form. N.J.A.C. 13:35-6.17 prohibits referral fees and kickbacks. N.J.A.C. 13:35-6.18 sets forth the requirement for maintaining medical malpractice coverage. Amendments are proposed to implement recent statutory changes to N.J.S.A. 45:9-19.17 concerning mandatory medical malpractice coverage for physicians and to provide additional coverage options for physicians. Specifically, the proposed amendments identify the means by which licensees may be able to obtain the requisite coverage and include a new definition for the term "authorized" which, for the purposes of this section, means recognized by a governmental agency to offer medical malpractice insurance products. More specifically, a proposed amendment to the definition of "not available" includes the following methods by which a physician may be covered: programs relating to risk retention groups deemed eligible by the Department of Banking and Insurance (DOBI), surplus lines registered with the DOBI, self-insurance trusts, and captive insurance companies approved by the New Jersey Health Care Facilities Financing Authority in the Department of Health and Senior Services. In addition, a proposed amendment to the definition of "letter of credit" would include liability bonds and other instruments issued by a bank or saving association as a vehicle for a letter of credit. N.J.A.C. 13:35-6.19 imposes a duty upon licensees to report any changes in the names and addresses of practice locations, health care facilities or HMOs where they practice, medical malpractice insurers, or any disciplinary or criminal action taken against the licensee. Proposed amendments would amend the notification rule to be consistent with recent statutory changes to N.J.S.A. 45:9-19.16 which requires licensees to report to the Board within 10 days of any changes concerning pending or final actions by criminal authorities for violations of listed crimes and other offenses consistent with amendments in P.L. 2004, c.17. N.J.A.C. 13:35-6.20 sets forth the requirements concerning physician delegation of tasks to radiological technicians and nuclear medicine technicians. N.J.A.C. 13:35-6.21 permits licensees to perform medically recognized hair transplantation techniques. The rule requires that licensees maintain medical records which reflect the transplantation technique utilized and a history pertinent to the procedure and any complications which may have occurred and any medications prescribed. The rule requires that the licensee inform the patient of the risks and benefits associated with the technique and provide medical coverage on a 24 hour basis to all patients undergoing a hair transplantation technique. N.J.A.C. 13:35- 6.22 sets forth the requirements for the termination of the licensee-patient relationship. N.J.A.C. 13:35-6.23 requires physicians to give a patient notice that the patient has a right to have a chaperone present during a breast and pelvic examination (for a female) and during a genitalia or rectal examination (for either a male or female). N.J.A.C. 13:35-6.24 is a proposed new rule to set forth the reporting requirements for communicable diseases as required by the State Department of Health and Senior Services reporting rules at N.J.A.C. 8:57. Failure to report may be deemed to be professional misconduct and subject the licensee to penalties.

Subchapter 6A deals with the declaration of death upon the basis of neurological criteria. N.J.A.C. 13:35-6A.1 provides that the purpose of the subchapter is to implement the Declaration of Death Act, N.J.S.A. 26:6A.1 et seq. N.J.A.C. 13:35-6A.2 contains relevant definitions which are used in the subchapter. N.J.A.C. 13:35-6A.3 contains requirements for and authorizes physicians to declare death on the basis of neurological criteria. N.J.A.C. 13:35-6A.4 contains criteria for determining brain death by an attending physician and confirmation by a corroborating physician. N.J.A.C. 13:35-6A.5 contains criteria for establishing brain death and requires documentation of the methods used to make the determination. N.J.A.C. 13:35-6A.6 specifies that when objective documentation is needed to substantiate clinical findings, confirmations must be made by testing. N.J.A.C. 13:35-6A.7 provides that after all examinations and confirmatory tests have been completed and documented on the patient's chart, the attending physician and the corroborating physician may declare brain death and the attending physician must certify the death certificate.

Subchapter 7 contains requirements on the prescription, administration and dispensing of drugs. N.J.A.C. 13:35-7.1 contains definitions of relevant words and terms used in the subchapter. N.J.A.C. 13:35-7.1A sets forth the requirements, including several exceptions, that an examination of a patient's condition is required before dispensing drugs or issuing prescriptions. N.J.A.C. 13:35-7.2 outlines requirements for issuing written prescriptions for drugs. Proposed amendments would clarify that a New Jersey Prescription Blank (NJPB) may contain only one prescription for a controlled dangerous substance, but other prescriptions, other than for controlled dangerous substances, may be written on the NJPB. N.J.A.C. 13:35-7.3 concerning verbal prescriptions is reserved. N.J.A.C. 13:35-7.4 sets forth the requirement for facsimile transmitted prescriptions. N.J.A.C. 13:35-7.4A sets forth the requirements for electronically transmitted prescriptions. N.J.A.C. 13:35- 7.5 sets forth requirements for the dispensing of drugs and special limitations which are applicable to the dispensing of drugs. N.J.A.C. 13:35-7.5A sets forth the limitations on prescribing, administering and dispensing drugs for the treatment of obesity. N.J.A.C. 13:35-7.6 enumerates limitations on the prescribing, administering or dispensing of controlled substances with special provisions applicable when expressed limitations are exceeded for the management of pain. N.J.A.C. 13:35-7.7 prohibits the prescribing, administering or dispensing of controlled substances for detoxification purposes or maintenance treatment. N.J.A.C. 13:35-7.8 prohibits the prescribing, administering or dispensing of amphetamines and sympathominetic amines for purposes of dieting or weight management and sets forth limitations on the use of these medications for treatment of specific conditions unless medically necessary. N.J.A.C. 13:35-7.9 prohibits the prescribing, administering or dispensing of anabolic steroids for body building, muscle enhancement or increasing muscle strength. N.J.A.C. 13:35-7.10 sets forth that a violation of any of the rules in the subchapter may be deemed to constitute malpractice, negligence, incompetence or professional misconduct.

Subchapter 8 regulates hearing aid dispensers. N.J.A.C. 13:35-8.1 sets forth the purpose of the rules is to govern the licensing and practice of hearing aid dispensing and that they are established pursuant to N.J.S.A. 45:9A-7. N.J.A.C. 13:35-8.2 contains definitions of words and terms used in the subchapter. N.J.A.C. 13:35-8.3 sets forth the training and experience requirements an applicant must complete prior to becoming a hearing aid dispenser. The rules specify that an applicant must obtain a training permit and complete a training period with a sponsor designated by the Hearing Aid Dispensers Committee. An amendment is proposed to clarify that an applicant provide proof of successful completion of a college curriculum, rather than a county college course, in hearing aid selection and fitting approved by the Committee and/or the Commission on Higher Education as one of the training and experience options because there have been no such courses offered in this State for several years. The other options are to provide proof of (1) training with a minimum of six continuous months or interrupted training in a 24-month period or (2) a master's degree in audiology from an American Speech Language Hearing Association accredited college or university after January 1, 1993. N.J.A.C. 13:35-8.4 states that the Committee has the authority to issue and regulate training permits. N.J.A.C. 13:35-8.5 sets out when the Committee may issue a temporary license. N.J.A.C. 13:35-8.6 sets forth the requirements and restrictions of practice of temporary licensees. N.J.A.C. 13:35-8.7 establishes that every trainee and temporary licensee shall be supervised and trained by a sponsor. The rules also establish the duties and responsibilities of a sponsor. N.J.A.C. 13:35-8.8 sets forth the definition of the practice of fitting and dispensing a hearing aid. The rules set forth that the practice of fitting and dispensing a hearing aid shall include any activity which reasonably may be expected to result in the sale of a hearing aid. The rule also sets forth that hearing aid dispensing differs from those activities of a licensed audiologist. N.J.A.C. 13:35-8.9 sets forth the requirements a hearing aid dispenser licensee must follow when fitting and dispensing a deep ear canal hearing aid device to a consumer. N.J.A.C. 13:35-8.10 requires that every corporation, partnership, trust, association or unincorporated business entity operating for the purpose of filling and dispensing hearing aids shall designate a duly licensed hearing aid dispenser to act as a supervising licensee. The rule also requires all such businesses to file annually with the Committee the name and license number of the designated supervising licensee. The rule also designates the supervising licensee to be responsible for assuring that all records are maintained.

N.J.A.C. 13:35-8.11 requires every licensee to notify the Committee of any change of residence or place of practice. The rule also requires every licensee, temporary licensee or a trainee whose license or permit has expired or has been terminated to return the license or permit to the Committee and sets forth late renewal and reinstatement fees. The rule also allows a licensee to retire his or her license by surrendering the registration for any period of time in which he or she is not engaged in hearing aid dispensing. Proposed amendments to this section expand the section to include the procedures for license issuance and renewal, inactive status and the reinstatement of a suspended or inactive license. Licenses will be issued for two years and renewed biennially. The proposed amendments set forth renewal application procedures, late fees, and the expiration of an unrenewed license. A proposed amendment at subsection (d) codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed amendments set forth the requirements to change the licensee's status from inactive to active and for the reinstatement of a license which has been automatically suspended for non- renewal. An individual seeking reinstatement of a license which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to an examination or other requirements determined by the Committee. N.J.A.C. 13:35-8.12 requires that all electrical equipment that is used in testing hearing aids, including an audiometer, shall be inspected and calibrated to assure accuracy. N.J.A.C. 13:35-8.13 requires that no hearing aid shall be sold to a person who has not first been given a hearing examination unless the dispensing consists solely of make and model replacement or spare aid. The rule states that the appropriate hearing test which must precede any hearing aid fitting shall include at a minimum pure tone air conduction and bone conduction thresholds. N.J.A.C. 13:35-8.14 sets forth the forms of advertising that are deemed professional misconduct. The rule also requires that the name, license number and title designation of the supervising licensee shall appear on every advertisement, all stationary and business cards. The responsibility for the form and content of every advertisement, sign, stationary or business card shall be jointly and severally that of each licensee who is a principal, partner or officer of the firm or entity so identified as well as the supervising licensee whose name and licensee number is displayed therein. N.J.A.C. 13:35-8.15 sets forth that it shall be professional misconduct for a licensee to unilaterally terminate, without good cause, an agreement to deliver services and/or equipment to a customer without first making arrangements for the orderly continuation of said services and/or equipment delivery. The rule also states that it shall be professional misconduct for any licensee to demand or accept excessive fees for services or equipment rendered in connection with the sale or fitting of hearing aids.

N.J.A.C. 13:35-8.16 requires that in addition to the written specified data and receipt requirements set forth in the statute, a written itemization of the cost of all services and equipment shall be presented to a customer before dispensing a hearing aid. The rule also requires every licensee to retain a copy of all records including the itemization for seven years following the sale. N.J.A.C. 13:35-8.17 requires that the licensing examination shall consist of a written and practical examination. An amendment is proposed to clarify that the examination consists of two sections, namely a section concerning the fitting and dispensing of hearing aids and the other section concerning the laws and regulations governing the practice of fitting and dispensing hearing aids. Additional amendments are proposed to remove the requirement that the practical examination may be taken only after successful completion of the written examination because both the written and practical examinations are given on the same day, and, therefore, the score on the written examination would not be known prior to the applicant taking the practical examination. In addition, an amendment is proposed to clarify that re-examination for the law and regulation section may be offered at a time other than when the regularly scheduled examination is offered. N.J.A.C. 13:35-8.18 sets forth that any violation of the rules may result in disciplinary action. The notice of proposed suspension or revocation shall inform the licensed individual of the right to request a hearing. N.J.A.C. 13:35-8.19 sets forth the charges for examination and licensure and other services provided by the Board. An amendment is proposed to include an inactive license fee that would be determined by the Director of Consumer Affairs consistent with the new inactive license status proposed by amendment to N.J.A.C. 13:35-8.11. N.J.A.C. 13:35-8.20 requires that during the two years preceding application for renewal the licensee must participate in courses of continuing education. Twenty documented course hours of continuing education shall be required of each applicant as a condition of biennial license renewal. Licensees are responsible for obtaining and maintaining documentation upon completion of the required and acceptable continuing education courses. Amendments are proposed to make a technical change regarding the name of the national approval entity for continuing education courses and to clarify that college and university courses must also be approved by the Committee for a licensee to receive continuing education credit.

Subchapter 9 contains rules concerning the practice of acupuncture. N.J.A.C. 13:35-9.1 outlines the purpose and scope of the subchapter and states that the subchapter sets out the requirements for the practice of acupuncture and that the rules apply to individuals certified as acupuncturists, applicants for certification and guest acupuncturists. N.J.A.C. 13:35-9.2 sets out definitions for terms used in the subchapter. N.J.A.C. 13:35-9.3 sets out the credentials which an acupuncture applicant for certification must submit to the Board. N.J.A.C. 13:35-9.4 sets out examination requirements which the applicant must meet for certification. N.J.A.C. 13:35-9.5 prohibits unlicensed persons from holding themselves out as acupuncturists and delineates titles that acupuncture licensees may not use. N.J.A.C. 13:35-9.6 contains the Board's fee schedule. Amendments are proposed to make technical changes relating the name of the fees, to provide for an inactive certificate fee to be determined by the Director of Consumer Affairs and to delete subsection (b) in its entirety since the issue regarding reinstatement of a lapsed certificate is beginning proposed to be codified in N.J.A.C. 13:35-9.7. N.J.A.C. 13:35-9.7 sets out requirements, and the application process, for biennial registration certificates. The Board proposes to repeal this section and to replace it with a new rule setting forth the procedures for certificate issuance and renewal, inactive status and the reinstatement of a suspended or inactive certificate. Certificates will be issued for two years and renewed biennially. The proposed new rule sets forth renewal application procedures, late fees, and the expiration of an unrenewed certificate. The proposed new rule codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed new rule sets forth the process to change the certificate holder's status from inactive to active and for the reinstatement of a certificate which has been automatically suspended for non-renewal. An individual seeking reinstatement of a certificate which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to an examination or other requirements determined by the Committee.

N.J.A.C. 13:35-9.8 allows a licensee to perform an initial acupuncture treatment only upon presentation of a referral or diagnosis from a licensed physician. The referring or diagnosing physician must provide the licensee with a diagnosis and pre-evaluation of the patient. The rule also requires a licensee to fully explain the acupuncture procedures to be performed, inform the patient of possible complications and obtain a written consent from the patient before beginning any treatment. N.J.A.C. 13:35-9.9 specifies the equipment, devices and procedures a licensee may use in practice. A proposed technical amendment changes the term "licensees" to "certificate holders." N.J.A.C. 13:35-9.10 outlines the procedure for sterilization of equipment. A proposed technical amendment changes the term "licensee" to "certificate holder." N.J.A.C. 13:35-9.11 sets forth the requirement for the preparation of patient records, the access to and release of information, confidentiality, and the transfer and disposal of records. Proposed technical amendments change the term "licensee" to "certificate holder." N.J.A.C. 13:35-9.12 deals with guest acupuncturists practicing in New Jersey. N.J.A.C. 13:35-9.13 outlines the process of applying for, and the design of, tutorial programs, including the registration of apprentices and supervising acupuncturists. N.J.A.C. 13:35-9.14 sets out the responsibilities of supervising acupuncturists. N.J.A.C. 13:35-9.15 sets forth the responsibilities of acupuncturist apprentices. N.J.A.C. 13:35-9.16 specifies the required training of a dentist or physician who wishes to perform acupuncture. N.J.A.C. 13:35-9.17 establishes continuing education requirements for certificate holders applying for biennial certificate renewal. Proposed technical amendments are proposed to change the terms "registration" to "certificate," "two calendar years" to "biennial period" and "license" to "certificate." Appendix A is reserved.

Subchapter 10 concerns the registration and regulation of athletic trainers. N.J.A.C. 13:35-10.1 outlines the scope and purpose of Subchapter 10, which is to provide for the registration and regulation of athletic trainers in the State. The rules apply to persons who practice as athletic trainers as well as those individuals who are studying to become athletic trainers. N.J.A.C. 13:35-10.2 contains definitions of relevant words and terms used in the subchapter. N.J.A.C. 13:35-10.3 sets forth the application procedures and provides that an athletic trainer must provide proof of graduation or successful completion of a program of education, training and experience approved by the National Athletic Trainers Association Board of Certification and has passed an examination administered by the National Athletic Trainers Association Board of Certification. N.J.A.C. 13:35-10.4 specifies those activities which may be performed by an athletic trainer. The rule provides that an athletic trainer may provide pre-season, in-season and post-season conditioning programs which includes maintenance and reconditioning programs as well as bandaging, wrapping, taping, padding and splinting procedures for the prevention and management of injuries. A proposed amendment would recodify this section as N.J.A.C. 13:35-10.5. A proposed new rule at N.J.A.C. 13:35- 10.4 sets out the procedures for certificate issuance and renewal, inactive status and the reinstatement of a suspended or inactive certificate. Certificates will be issued for two years and renewed biennially. The proposed new rule sets forth renewal application procedures, late fees, and the expiration of an unrenewed certificate. The proposed new rule codifies the requirement in N.J.S.A. 45:1-7.1 which states that the Board must provide at least 60 days' notice for renewal, and in the event that less than 60 days' is provided, no monetary fine or penalty may be assessed. Additionally, the proposed new rule sets forth the requirements to change the certificate holder's status from inactive to active and for the reinstatement of a certificate which has been automatically suspended for non-renewal. An individual seeking reinstatement of a certificate which has been automatically suspended for a period of five or more years will also have to demonstrate maintained proficiency and may be required to an examination or other requirements determined by the Committee. N.J.A.C. 13:35-10.5 provides that any violation of the subchapter shall be deemed a violation of the Athletic Training Practice Act and subjects a licensee to sanctions and penalties. Technical amendments are proposed to recodify the section as N.J.A.C. 35:35- 10.6 and to correct the statutory citation to the Athletic Training Practice Act. N.J.A.C. 13:35-10.6 sets forth the fees that are charged by the Board. A technical amendment is proposed to recodify the section as N.J.A.C. 35:35- 10.7 which is presently reserved. In addition, a proposed amendment adds a reinstatement fee in the amount of $60.00 and a inactive license fee to be determined by the Director of Consumer Affairs by rule which are consistent with the proposed new rule at N.J.A.C. 13:35-10.4 which sets forth these new procedures. N.J.A.C. 13:35-10.8 is reserved.

Subchapter 11 establishes the Alternative Resolution Program. N.J.A.C. 13:35-11.1 contains definitions of relevant words and terms used in the subchapter. N.J.A.C. 13:35-11.2 creates the Impairment Review Committee which reviews matters concerning practitioners who suffer from chemical dependencies or other impairments. N.J.A.C. 13:35-11.3 sets forth the manner of operation of a professional assistance program. N.J.A.C. 13:35-11.4 sets forth the duties which the Impairment Review Committee shall perform. N.J.A.C. 13:35-11.5 outlines the process for how a professional assistance program may be approved. N.J.A.C. 13:35-11.6 authorizes the Impairment Review Committee and the professional assistance programs to accept reports from practitioners who submit information concerning their colleagues. N.J.A.C. 13:35-11.7 is reserved.

Subchapter 12 concerns the licensing and regulation of electrologists, electrologist instructors and electrologists' offices. N.J.A.C. 13:35-12.1 denotes the purpose and scope of this subchapter. N.J.A.C. 13:35-12.2 sets forth the definitions of words and terms used in the subchapter. N.J.A.C. 13:35-12.3 sets forth the street and mailing addresses of the Electrologist Advisory Committee. N.J.A.C. 13:35-12.4 requires licensees to notify the Committee when their addresses change. N.J.A.C. 13:35-12.5 sets forth the requirements for the issuance of an electrologist license without examination (the "grandfathering" provisions which expire on January 16, 2005). N.J.A.C. 13:35-12.6 establishes the electrologist licensing requirements which include the taking of an examination. N.J.A.C. 13:35-12.7 establishes the electrology instructor licensing requirements. N.J.A.C. 13:35-12.8 establishes the documentation necessary for application for an electrologist license. N.J.A.C. 13:35-12.9 establishes the documentation necessary for application for an electrology instructor license. N.J.A.C. 13:35-12.10 establishes the requirements and necessary documentation for licensing of electrologists' office premises. N.J.A.C. 13:35-12.11 establishes the infection control standards for electrologists. N.J.A.C. 13:35-12.12 requires the posting of electrologist and office licenses at electrologists' offices. N.J.A.C. 13:35-12.13 sets for the examination and re-examination requirements for applicants for electrologist licenses who are required to take the examination. N.J.A.C. 13:35-12.14 sets forth the procedures for biennial renewal, automatic suspension for licensees who do not renew within 30 days of the license expiration date, licensees to change their licenses to inactive status, reinstatement of suspended licenses, and changing inactive status licenses back to active status. N.J.A.C. 13:35-12.15 prohibits the practice of electrology, teaching electrology or using an office premises to perform electrology without the appropriate license. N.J.A.C. 13:35-12.16 sets forth the requirements for licensure by credentials by persons holding an electrology license in another State, U.S. possession or the District of Columbia. N.J.A.C. 13:35-12.17 sets forth the standards for the Board to suspend, revoke or refuse to issue a license. N.J.A.C. 13:35-12.18 sets forth the recordkeeping requirements for licensees. N.J.A.C. 13:35-12.19 sets forth the continuing education requirements, including approved programs and course, the requirements of program sponsors, and the waiver of the continuing education requirements. N.J.A.C. 13:35-12.20 prohibits sexual misconduct. N.J.A.C. 13:35-12.21 establishes the advertising and solicitation practice standards. N.J.A.C. 13:35-12.22 sets forth the Committee's fee schedule.

A separate proposal published on April 5, 2004, in the New Jersey Register at 36 N.J.R. 1721(a), if adopted, would create a new Subchapter 13 and provide for the regulation of the practice of perfusion and for the establishment of licensure standards for perfusionists

The Board has determined that the comment period for this proposal shall be 60 days; therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

The rules proposed for readoption in N.J.A.C. 13:35 affect a wide range of entities and individuals involved in the medical profession. The rules establish standards for medical schools, their internship programs, postgraduate training and clinical training programs. The rules set forth procedures for the issuance of limited licenses for podiatry, certified nurse midwives, physician assistants, hearing aid dispensers, athletic trainers, electrologists and diagnostic centers and plenary licensure for physicians and surgeons.

The rules also establish requirements for Board licensure, and exemption from licensure, licensing examinations and licensure endorsements. The rules affect all applicants who seek licensure by the Board and all licensees who are subject to Board or Committees of the Board, regulations such as physicians, surgeons, podiatrists, nurse midwives, physician assistants, hearing aid dispensers, acupuncturists and athletic trainers. The rules also regulate the performance of surgery and the administering of anesthesia in an office setting and the prescribing, administration and dispensing of drugs by licensed practitioners. The rules also provide a mechanism to rehabilitate licensees who face problems of chemical dependency or other impairments.

Through the various procedures, standards and requirements contained in the rules proposed for readoption, the Board has provided an orderly administration of its operations to ensure that qualified individuals are permitted to enter and remain practicing in the medical profession. The existing rules which the Board proposes to readopt have served to protect the public health, safety and welfare by maintaining a high level of competence and professionalism in medical practice. The readoption of the existing rules will continue to maintain the standards established and provide the public the continued protection and confidence in the medical field which is afforded by the regulations.

Several of the amendments to N.J.A.C. 13:35 that are proposed as part of this readoption are either technical in nature or simply reiterate the Board's intent by restating the regulatory provisions more clearly. For example, the proposed amendments to N.J.A.C. 13:35-2A.2 and 2B.2 add new definitions to clarify existing rules. Amendments to N.J.A.C. 13:35-2A.7, 2B.17, 8.11 and 9.7 and new rules N.J.A.C. 13:35-3.14 and 10.4 codify the reinstatement requirements for inactive licensees and those licensees whose licenses that were automatically suspended for non-renewal. Other amendments the Board proposes do not alter the scope or application of the existing rules but reflect changes which are necessary to update the regulatory provisions. For instance, amendments to N.J.A.C. 13:35-3.3 (requires criminal history background checks for initial licensure), 6.18 (requires medical malpractice coverage) and 6.19 (requires Board notification of pending and final criminal actions against licensees) are required due to recent legislative changes to related statutes.

The proposed amendment to N.J.A.C. 13:35-2.6 permit a practitioner who has performed a diagnostic test to entrust raw data, graphs and reports to the secured custody of a licensed health care facility as part of the facility's permanent record when the raw data, graphs or reports were prepared as part of a patient record for that facility. Furthermore, the rule clarifies the point when consultants are considered to be rendering medical services and must be licensed by the Board as being interpreting diagnostic test data or records for 10 or more patients under treatment in New Jersey in a year. However, the physician to physician exchange of information, which may include patient specific information, is not deemed to be rendering medical services under this section.

The proposed amendment to N.J.A.C. 13:35-2B.12 codifies an existing policy of the Board regarding the memorialization of verbal orders given by physicians for controlled dangerous substances (CDS) by physician assistants. A physician assistant may transcribe a verbal order for a CDS into the patient record that has been given by the supervising physician or a designated physician in a licensed inpatient or outpatient setting. The order shall be written on the order sheet of the patient's chart with the following information: the letters "VO," meaning a verbal order given by the physician in person, or the letters "TO," meaning that the verbal order was given by the physician over the telephone; the physician's name; the signature of the physician assistant; and the countersignature of the physician within 24 hours in an inpatient setting or within 48 hours in an outpatient setting. This policy allows patients to receive a CDS as indicated the patient's chart without the need for having a prescription filled or taking a CDS out of a controlled setting.

The repeal of N.J.A.C. 13:35-3.5 is proposed because this rule regarding the endorsement procedures of certified nurse midwives is an unnecessary rule which has been obviated by the codification of the rules licensing midwives under Subchapter 2A.

The proposed amendments to N.J.A.C. 13:35-3.6 updates the list of the various specialties and accrediting bodies for specialties that the Board will be able to accept when issuing bioanalytical laboratory specialty licenses.

The proposed amendments to N.J.A.C. 13:35-6.5 limits the fees that a licensee may charge for the reproduction of x-rays and other material within a patient record which cannot be routinely copied or duplicated on a commercial photocopy machine. Under the proposed amendment, a licensee could charge no more than the actual cost of duplication plus an administrative fee of the lesser of $10.00 or 10 percent of the cost or reproduction. Presently, the rule limits the fee for duplicating the patient record to the lesser of $1.00 per page or $100.00 for the entire record, but the present rule does not take x- rays and similar records into account.

The proposed amendments to N.J.A.C. 13:35-6.10 clarify the standards for advertising a licensee's certification in a specialty. This proposed amendment will give the public better information about the licensee's specialty certification.

Proposed new rule N.J.A.C. 13:35-6.24 requires licensees to adhere to Department of Health and Senior Services rules regarding the reporting of communicable diseases and allows for the Board to discipline licensees for professional misconduct if they fail to report such diseases as required.

The proposed amendments to N.J.A.C. 13:35-7.2 clarify the requirements for issuing written prescriptions for controlled dangerous substances (CDS) and will eliminate the confusion as to whether a prescription containing a CDS may contain other non-CDS prescriptions on the same New Jersey Prescription Blank (NJPB) by explicitly allowing other non-CDS prescriptions on a NJPB.

Economic Impact

The readoption of the existing rules in N.J.A.C. 13:35 and the proposed amendments, repeal and new rules impose economic costs, as follows:

As noted above, N.J.A.C. 13:35-6.5 limits the fees that a physician may charge for duplication of a patient's record. Proposed amendments would also limit the fees that a licensee may charge for non-standard materials, such as x-rays, contained in the patient record.

N.J.A.C. 13:35-6.13 sets forth the fees charged by the Board for applications, examinations, biennial licensure, endorsement, duplicate licenses, name changes, replacement of certificates, late renewal and reinstatement fees for various categories of licensees including physicians, surgeons, podiatrists, midwives, physician assistants, and bio-analytical laboratory directors.

N.J.A.C. 13:35-8.19 contains the fee schedule for the Hearing Aid Dispensers Examination Committee which sets forth applicable fees for applications, temporary licenses, training permits, examinations, initial and biennial registration, duplicate certificates, tutorial programs, late renewal and reinstatement fees.

N.J.A.C. 13:35-10.6, proposed to be recodified as 10.7, contains the fee schedule of the Athletic Training Advisory Committee which contains charges for temporary licensure, initial and biennial licensure, endorsement, late renewal and reinstatement fees.

N.J.A.C. 13:35-12.22 contains the fee schedule of the Electrologists Advisory Committee which contains charges for application, initial and biennial licensure for electrologists, electrologist instructors and office premises and endorsement, late renewal, duplicate certificate, continuing education sponsor, license verification and reinstatement fees.

N.J.A.C. 13:35-6.11 may impose economic consequences on licensees because the rule prohibits the charging of excessive fees which may affect the amount of income derived from the professional practice if the Board determines that a licensee has over-charged patients.

N.J.A.C. 13:35-6.16 details permissible professional practice structures. The rule may have economic consequences because it requires licensees who have a significant beneficial interest in any of the practice structures listed to terminate their employment or professional affiliation once the licensee becomes aware that the practice structure no longer complies with the provisions of the rule.

N.J.A.C. 13:35-6.17 regulates the collection of professional fees and prohibits referring a patient to a health care service where the practitioner has a significant beneficial interest. The rule also prohibits the giving or receipt of gifts, fees, commissions, rebates, bonuses or other forms of compensation.

N.J.A.C. 13:35-8.20, 9.17 and 12.19 require that hearing aid dispensers, acupuncturists and electrologists, respectively, biennially comply with continuing education requirements which impose costs on these licensees to attend continuing education courses as a prerequisite to license renewal.

Although the rules mentioned above have an economic impact upon licensees, the costs imposed pursuant to the fee schedules are necessary to defer the expenses of the Board and the respective Committees to oversee the regulation of licensees. As for the other rules which impose economic consequences, the Board believes the cost upon the licensees is outweighed by the benefit to the public in assuring that fees charged by licensees are reasonable and that a licensee's professional judgment is not influenced by some other financial interest.

Federal Standards Statement

A Federal standards analysis is not required because the rules proposed for readoption and the proposed amendments and new rules are not subject to any Federal standards or requirements.

Jobs Impact

The Board does not expect that the rules proposed for readoption and amendments, repeal and new rules will result in the creation or loss of jobs in the State.

Agriculture Industry Impact

The Board believes that the rules proposed for readoption and amendments, repeal and new rules will not affect the agriculture industry in the State.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., requires that the Board provide a description of the types and an estimate of the number of small businesses to which the rules apply. If, for purposes of the Act, the approximately 36,900 licensees of the Board and Committees under the Board are considered "small businesses," then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping and other compliance requirements including the kind of professional services likely to be needed to comply with the requirements of N.J.A.C. 13:35.

The rules which the Board proposes for readoption with amendments and proposed new rules will continue to impose a number of reporting, recordkeeping and compliance requirements upon licensees. Most of the rules contained in N.J.A.C. 13:35 fall within the category of compliance requirements. See the discussion in the Summary above. Subchapter 1 sets forth compliance requirements for externship programs and postgraduate and graduate training. Subchapter 1A sets forth compliance standards for clinical training programs which include administration requirements, makeup of faculty, program eligibility and facilities of the medical school. Subchapter 2 contains compliance requirements for podiatrist and the establishment of screening and diagnostic testing offices. Subchapter 2A establishes compliance requirements for midwife practice. Subchapter 2B contains the practice, scope and eligibility requirements for physician assistants. Subchapter 3 establishes examination, endorsement and exemption requirements. Subchapter 4 contains compliance requirements for qualified first assistants. Subchapter 4A contains compliance requirements for the establishment of offices that perform surgery, anesthesia and special procedures. Subchapter 5 sets forth requirements for conducting eye examinations and standards for optical lenses. Subchapter 6 contains diverse regulations which set forth compliance requirements for the identification of medical practices, the pronouncement of death, the prohibition of sexual misconduct, delegation of injections and physical modalities, advertising and solicitation practices, the establishment of professional business structures and the prohibition of kickbacks and referral fees. Subchapter 6A sets forth compliance requirements for physicians to declare death based on neurological criteria. Subchapter 7 contains compliance requirements for prescribing, administering and dispensing drugs. Subchapters 8, 9 and 10 establish compliance requirements for the practices of hearing aid dispensing, acupuncture and athletic trainers, respectively. Subchapter 11 contains compliance standards for the administration of the Alternative Resolution Program. Subchapter 12 establishes compliance standards for the practice of electrology.

Several rules in N.J.A.C. 13:35 contain recordkeeping requirements. N.J.A.C. 13:35-2.6(k) requires practitioners performing diagnostic tests to retain raw data, graphs and reports arising out of a diagnostic test administration. N.J.A.C. 13:35-2B.11 requires that physician assistants maintain patient records of treatment and services provided. N.J.A.C. 13:35- 4A.7(h) requires physicians who administer or supervise the administration or monitoring of anesthesia services in an office to prepare patients records. N.J.A.C. 13:35-4A.16 requires that records be maintained for service and maintenance performed on anesthesia equipment. N.J.A.C. 13:35-5.1 requires physicians to prepare records of eye examinations of patients. N.J.A.C. 13:35-6.5 requires Board licensees to maintain patient treatment records, bills and claim forms. N.J.A.C. 13:35-8.16 requires hearing aid dispensers to keep records which are maintained for the purpose of fitting or dispensing hearing aids. N.J.A.C. 13:35-9.11 requires acupuncturists to maintain treatment and billing records. N.J.A.C. 13:35-10.4(f) requires athletic trainers to create and maintain treatment records. N.J.A.C. 13:35-12.18 requires electrologists to maintain treatment and billing records.

Several rules in N.J.A.C. 13:35 impose reporting requirements on licensees. N.J.A.C. 13:35-4A.5 imposes a duty to report to the Executive Director of the Board any incident related to surgery, special procedures on the administration of anesthesia within an office which results in a patient's death, transport of the patient to a hospital for observation or treatment for more than 24 hours, or a complication or untoward event. N.J.A.C. 13:35-6.19 requires licensees to report to the Board any changes in names and addresses of practice locations, medical malpractice insurers, health care facility or HMO with which the licensee has an affiliation, changes in practitioners with whom a licensee is associated in practice, and any type of criminal or disciplinary action taken against the licensee. N.J.A.C. 13:35-11.3(a)2 requires that a professional assistance program must report to the Impairment Review Committee any referral which suggests that a licensee has a chemical dependency or other impairment.

The costs of compliance with the rules proposed for readoption with amendments, repeal and new rules are discussed in the Economic Impact statement above.

With regard to professional services that may be required to comply with the rules, a licensee may find it necessary to consult with an attorney or accountant in order to establish a professional practice structure in compliance with N.J.A.C. 13:35-6.16. The cost of such service would vary widely dependent upon the professional engaged and the complexity of the structure established.

The Board believes that because the requirements mentioned above and contained in the rules proposed for readoption are the minimum necessary for the protection of the public health, safety and welfare, all the rules in N.J.A.C. 13:35 must be uniformly applied. No exemption is therefore provided based on business size as to do so would frustrate the protections intended by the rules.

Smart Growth Impact

The Board does not believe that the rules proposed for readoption with amendments, repeals and new rules will have any impact upon the achievement of smart growth or upon the implementation of the State Development and Redevelopment Plan.

Full text of the proposed readoption may be found in the New Jersey Administrative Code at N.J.A.C. 13:35.

Full text of the proposed repeals may be found in the New Jersey Administrative Code at N.J.A.C. 13:35-2A.7, 2B.17, 3.5 and 9.7.

Full text of the proposed amendments follows :

<< NJ ADC 13:35-2.6 >>

13:35-2.6 Medical standards governing screening and diagnostic medical testing offices; determinations with respect to the validity of certain diagnostic tests

(a)-(d) (No change.)

(e) Any practitioner designated to be responsible for the management of a diagnostic or screening office not licensed by the Department of Health and Senior Services (DOHSS) shall:

1.-3. (No change.)

4. Verify, through a documented review of credentials, upon hiring and on at least an annual basis, that:

i.-ii. (No change.)

iii. All personnel, other than physicians, operating ultrasound equipment are certified by the American Registry of Diagnostic Medical Sonographers or by the American Registry of Radiologic Technologists, or demonstrate technical training to perform ultrasounds and are not otherwise precluded by any requirements of the Department of Environmental Protection; <<+and+>>

5. Implement on an ongoing basis a quality assurance program as required by (f) below<<+.+>><<-; and->>

6. Ensure that, when entering into a contract for the provision of diagnostic or screening test to be provided by a mobile entity for or on the premises of any licensed health care facility, notice is given by the health care facility to the Department of Health and Senior Services of the name of the testing entity and the identity of the practitioner(s) designated to be responsible for the provision of the diagnostic or screening tests.<<-->>

(f)-(g) (No change.)

(h) In addition to the obligations set forth in (e) through (g) above, any practitioner designated to be responsible for the management of a screening office at which mammography is offered shall:

1. (No change.)

2. Establish a written protocol in compliance with the requirements of the Mammography Quality Standards Act, 42 U.S.C. 263(b) et seq., and 21 CFR 900.1 et seq., which <<+protocol+>> shall <<+also+>> include:

i. Guidance <<+to the performer of the test+>> with respect to appropriate positioning preparatory to the test;

ii.-iii. (No change.)

iv. Procedures for providing in lay language <<-both verbal and->> written advice at the time of testing, and on the testing report, that a screening mammography is not a comprehensive examination nor sufficient to detect all abnormalities and that examinees should seek a complex examination from a physician; and

3. (No change.)

(i) (No change.)

(j) A practitioner designated to be responsible for the management of a screening office not licensed by the Department of Health and Senior Services (DOHSS) shall ensure that reports with respect to screening tests which yield abnormal results are prepared in writing, include clear direction as to necessary follow-up, and are issued within three business days from the date of receipt of the report by the testing entity.

1.-2. (No change.)

3. When an abnormality has been discovered<<-,->> and no referring or treating practitioner is identified by the examinee, the written notice of abnormality which shall be provided to the examinee shall contain a clear advisory concerning the need to seek follow-up medical consultation as well as appropriate referral information;

4. In the circumstances set forth in (j)3 above <<+and where immediate clinical follow-up is warranted+>>, efforts shall be made additionally to personally contact the examinee by telephone to confirm that the examinee was made aware of the need to follow up, which efforts shall be documented in the examinee record. When efforts to contact the examinee have been unsuccessful over a period not to exceed 10 days, a letter shall be forwarded to the examinee's address of record by certified mail, return receipt requested, with a copy maintained in the chart, advising of the abnormality and the need for follow-up and referral; and

5. (No change.)

(k) Any practitioner performing a diagnostic test in any location, whether or not licensed by the Department of Health and Senior Services<<+,+>> shall retain raw data or graphs arising out of a diagnostic test administration and shall prepare and retain a comprehensive report, on professional letterhead bearing the practitioner's full name and title or degree ("Dr." alone is insufficient) and office name, address and telephone number. <<+(However, raw data, graphs and reports, for example, but not limited to, radiographic images, which have been prepared as part of the patient record for a licensed health care facility such as a hospital or nursing home, may be entrusted by the preparing/interpreting practitioner to the secured custody of the licensed health care facility as part of the facility's permanent records.)+>> The report shall include at least the following:

1.-9. (No change.)

(l)-(n) (No change.)

(o) A practitioner performing a diagnostic test in all locations, whether or not licensed by the DOHSS, shall promptly issue the results of the test, by preliminary verbal report when <<-necessary->> <<+immediate follow-up care is indicated+>> and no later than three business days <<+in any event+>> from the date of receipt of the report by the testing entity, to the referring practitioner and upon request to the patient or other authorized person, to the extent authorized by N.J.A.C. 13:35-6.5. An interpretation delayed pending receipt of additional material shall be issued as soon as possible thereafter. All abnormalities shall be clearly identified for the attention of a physician or other treating practitioner.

(p)-(r) (No change.)

(s) A practitioner who transmits diagnostic test data/records<<+, other than bioanalytical specimens to a clinical laboratory under the jurisdiction of the Department of Health and Senior Services pursuant to N.J.S.A. 45:9-42.27 et seq.,+>> for interpretation by a consultant who is not a licensee of the Board shall assure that advance written consent for such interpretation service by such consultant has been obtained from the patient/third party payor. <<+ Utilization of the provisions in this subsection shall be consistent with the requirements of (n) above. This subsection is intended to be available for special, occasional or emergent consultations only. A consultant or consultant entity rendering medical services interpreting diagnostic test data/records, whether in or out of this State, by means of any media, for 10 or more patients under treatment in New Jersey on an annual basis is deemed to be rendering medical services in this State and requires licensure by the Board. However, the exchange of information, which may include patient specific information, between a licensee and a physician licensed in another state, a possession of the United States or the District of Columbia shall not be deemed to be rendering medical services.+>>

<< NJ ADC 13:35-2A.1 >>

13:35-2A.1 <<-Midwifery practice->> <<+Purpose and scope+>>

(No change in text.)

<< NJ ADC 13:35-2A.2 >>

13:35-2A.2 Definitions

The following words and terms, when used in this subchapter, shall have the following meaning, unless the context clearly indicates otherwise: ...

<<+"Midwife" means a person licensed by the Board as a certified midwife (CM), certified nurse midwife (CNM) or certified professional midwife (CPM).+>>

<< NJ ADC 13:35-2A.4 >>

13:35-2A.4 Application for licensure

(a) An applicant for licensure as a midwife shall submit to the Committee:

1.-6. (No change.)

7. The application fee pursuant to N.J.A.C. 13:35-6.13<<-(a)6i->>.

(b) Once the applicant has been approved, he or she shall submit the initial license fee pursuant to N.J.A.C. 13:35-6.13<<-(a)6iv->>.

<< NJ ADC 13:35-2A.7 >>

<<+13:35-2A.7 Licensure; biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status+>>

<<+(a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a completed renewal application and the renewal fee as set forth in N.J.A.C. 13:35-6.13 prior to the expiration date of the license.+>>

<<+(b) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(c) If a licensee does not renew the license prior to its expiration date, the licensee may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-6.13. During this 30-day period, the license shall be valid, and the licensee shall not be deemed to be practicing without a license.+>>

<<+(d) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice and shall be subject to the penalties prescribed by N.J.S.A. 45:9-22 for practicing without a license.+>>

<<+(e) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-6.13; and+>>

<<+2. Submission of an affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer.+>>

<<+(f) In addition to the fulfilling the requirements set forth in (e) above, a licensee whose license has been automatically suspended for more than five years who wishes to return to practice shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<<+(g) Renewal applications shall provide the licensee with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-6.13 and shall not engage in practice.+>>

<<+(h) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee; and+>>

<<+2. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(i) In addition to the fulfilling the requirements set forth in (h) above, a licensee who has been on inactive status for more than five years who wishes to return to practice shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

SUBCHAPTER 2B. LIMITED LICENSES: PHYSICIAN ASSISTANTS

\

<< NJ ADC 13:35-2B.2 >>

13:35-2B.2 Definitions

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicated otherwise: ...

<<+"Designated physician assistant" means a physician assistant, other than a temporary license holder, who is assigned by a supervising physician or a physician designee to supervise a temporary license holder.+>> ...

<< NJ ADC 13:35-2B.3 >>

13:35-2B.3 Practice requirements

(a) (No change.)

(b) The licensee shall file with the <<-Board->> <<+Committee+>> a notice of employment for each <<+full-time, part-time or per diem+>> place of employment, on forms provided by the Committee, within 10 days after the date on which employment commences. Furthermore, the licensee shall report to the <<-Board->> <<+Committee+>> any change in employment <<+and/+>> or <<-supervisor->> <<+supervising physician+>> within 10 days of the change.

<< NJ ADC 13:35-2B.4 >>

13:35-2B.4 Scope of practice

(a) A licensee who has complied with the provisions of N.J.A.C. 13:35-2B.3 may perform the following procedures on a discretionary and routine basis:

1. Approaching a patient to elicit a detailed and accurate history, perform an appropriate physical examination, identify problems, record information<<+,+>> <<-and->> interpret and present information to the supervising physician, determine and implement therapeutic plans jointly with the supervising physician and compile and record pertinent narrative case summaries;

2.-9. (No change.)

10. Applying and removing medical and surgical appliances and devices such as splints, casts, immobilizers, traction, monitors and <<-infusion pumps->> <<+medication delivery systems+>>;

11.-13. (No change.)

(b) (No change.)

<< NJ ADC 13:35-2B.5 >>

13:35-2B.5 Eligibility for licensure

(a) An applicant for licensure shall submit to the Board, with the completed application form and the required fee, evidence that the applicant:

1.-2. (No change.)

3. Has successfully completed an education program for physician assistants which is approved by the <<-Committee on Allied Health Education and->> Accreditation <<+Review Commission on Education for the Physician Assistant, Inc. (ARC-PA)+>>, or its successor; and

4. Has passed the examination administered by the National Commission on Certification of Physician Assistants (NCCPA)<<+, or its successor+>>, except as set forth in (b) below.

(b) (No change.)

<< NJ ADC 13:35-2B.8 >>

13:35-2B.8 Credit-hour requirements

(a) Each applicant for a biennial license renewal shall be required to complete, during the preceding biennial period, a minimum of <<-40->> <<+ 50+>> continuing education credit hours in category I courses approved by the American Medical Association, the American Academy of Physician Assistants, the American Academy of Family Physicians, the American Osteopathic Association or the Accreditation Council on Continuing Medical Education. The Board reserves the right to review and approve continuing education courses offered by entities other than those set forth above.

(b) (No change.)

<< NJ ADC 13:35-2B.9 >>

13:35-2B.9 Waiver of continuing education requirement

(a) The Board may, in its discretion, temporarily waive continuing education requirements on an individual basis for <<+a period of time designated by the Committee for+>> reasons of hardship, such as illness or disability, or other good cause.

(b) (No change.)

<< NJ ADC 13:35-2B.10 >>

13:35-2B.10 Supervision

(a) (No change.)

(b) The physician assistant shall not render care unless the following conditions are met:

1.-3. (No change.)

4. The supervising physician <<+or physician designee+>> personally reviews all charts and patient records and countersigns all medical orders as follows:

i.-ii. (No change.)

5. (No change.)

(c) (No change.)

(d) A supervising physician <<-who is a department head->> may assign physician assistants under his or her supervision to <<-attending and staff physicians->> <<+a physician designee+>>, who shall be responsible for the practice of the physician assistant during the assignment. <<-In all other settings in which a physician assistant is employed, the supervising physician of record shall be considered to be the person responsible for the practice of the physician assistant.->>

<< NJ ADC 13:35-2B.11 >>

13:35-2B.11 Recordkeeping

(a) Licensees shall make contemporaneous, permanent entries into professional treatment records which shall accurately reflect the treatment or services rendered. To the extent applicable, professional treatment records shall reflect:

1.-4. (No change.)

<<-5. Progress notes;->>

Recodify existing 6.-8. as <<+5.-7.+>> (No change in text.)

(b)-(d) (No change.)

<< NJ ADC 13:35-2B.12 >>

13:35-2B.12 Requirements for issuing prescriptions for medications<<+; memorialization of verbal orders for CDS given by physicians+>>

(a) A physician assistant may issue prescriptions only in accordance with the following conditions:

1.-2. (No change.)

<<+3. A physician assistant shall not initiate an order for controlled dangerous substances. However, a physician assistant may memorialize an order for a controlled dangerous substance when the order has been verbally given by the supervising physician or physician designee in a licensed inpatient or outpatient setting, including, but not limited to, hospital emergency departments, licensed ambulatory surgery centers and nursing homes, when the following requirements are met. The controlled dangerous substance order shall be written on the order sheet of the patient's chart with:+>>

<<+i. The letters VO (meaning an order relayed to the physician assistant by the physician in person) or TO (meaning an order relayed to the physician assistant by the physician over the telephone);+>>

<<+ii. The supervising physician's or physician designee's name printed;+>>

<<+iii. The signature of the physician assistant directly under the order for the controlled dangerous substance; and+>>

<<+iv. The supervising physician's or the physician designee's countersignature of the controlled dangerous substance order within 24 hours in the inpatient setting and within 48 hours of the order in the outpatient setting.+>>

<< NJ ADC 13:35-2B.14 >>

13:35-2B.14 Temporary licensure; scope of practice

(a) A temporary license holder who has complied with the practice requirements set forth in N.J.A.C. 13:35-2B.3 may perform all of the procedures within the scope of practice of a physician assistant, as set forth in N.J.A.C. 13:35-2B.4(a) and (b) and subject to the limitations therein, except that a temporary license holder shall not issue prescriptions. <<+A temporary license holder may write orders for medication, treatment, or testing consistent with the provisions of N.J.A.C. 13:35-2B.15.+>>

(b) (No change.)

<< NJ ADC 13:35-2B.15 >>

13:35-2B.15 Supervision of temporary license holder

(a) A temporary license holder shall not render care unless the following conditions are met:

1. In any setting, the supervising physician, <<-or->> physician designee or a <<-licensed->> <<+designated+>> physician assistant <<-with privileges in the same discipline->>:

i. (No change.)

ii. Countersigns, immediately after its entry in the chart, any order for medication<<+, treatment, or testing+>> written by the temporary license holder.

2. <<-The->> <<+In the event that the countersignature in (a)1 above is that of a designated physician assistant, the+>> supervising physician or physician designee<<+, within the appropriate conditions set in N.J.A.C. 13:35-2B.10(b)4, shall+>>:

i. Personally review<<-s->> all charts and patient records <<-within 24 hours of->> <<+and+>> the temporary license holder's entry in the chart and record; and

ii. Countersign<<-s->> any order for medication<<+, treatment, or testing+>> written by the temporary licensee <<-and countersigned by a licensed physician assistant->>.

<< NJ ADC 13:35-2B.16 >>

13:35-2B.16 Expiration of temporary license; renewal

(a) A temporary license shall expire 30 days after the temporary license holder has received notification of successful completion of the examination or immediately upon the applicant's receipt of notification of failure to pass the examination <<+referenced in N.J.A.C. 13:35-2B.13(a)+>>.

(b)-(c) (No change.)

<< NJ ADC 13:35-2B.17 >>

<<+13:35-2B.17 Licensure; biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status+>>

<<+(a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a renewal application and the renewal fee set forth in N.J.A.C. 13:35-6.13 prior to the expiration date of the license.+>>

<<+(b) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(c) If a licensee does not renew the license prior to its expiration date, the licensee may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-6.13. During this 30-day period, the license shall be valid, and the licensee shall not be deemed to be practicing without a license.+>>

<<+(d) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice and shall be subject to the penalties prescribed by N.J.S.A. 45:9-22 for practicing without a license.+>>

<<+(e) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-6.13;+>>

<<+2. Completion of the Board-approved continuing education units required for each biennial registration period for which the licensee was suspended; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer.+>>

<<+(f) In addition to the fulfilling the requirements set forth in (e) above, a licensee whose license has been automatically suspended for more than five years who wishes to return to practice shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<<+(g) Renewal applications shall provide the licensee with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-6.13 and shall not engage in practice.+>>

<<+(h) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee;+>>

<<+2. The completion of the Board-approved continuing education units required for each biennial registration period for which the licensee was on inactive status; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(i) In addition to the fulfilling the requirements set forth in (h) above, a licensee who has been on inactive status for more than five years who wishes to return to the practice of medicine shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<< NJ ADC 13:35-3.5 >>

13:35-3.5 <<+(Reserved)+>>

<< NJ ADC 13:35-3.6 >>

13:35-3.6 Bioanalytical laboratory director license, plenary or specialty, granted to physicians

(a) The Board shall grant to any person licensed in this State to practice medicine and surgery a plenary license to direct and supervise a registered bioanalytical laboratory, without examination, provided that:

1. (No change.)

2. Such person<<-,->> is certified in <<-anatomical->> <<+ anatomic+>> pathology or is Board-eligible, and can demonstrate to the satisfaction of the Board<<-, following a personal appearance,->> appropriate training, including completion of a residency program in pathology in a laboratory or laboratories acceptable to the Board, and not less than three full years of post graduate general bioanalytical laboratory experience in a laboratory or laboratories acceptable to the Board.

(b) The Board shall grant to any person licensed in the State to practice medicine and surgery, a specialty license in one or more of the following <<- fields->>: toxicological chemistry, microbiology <<+(including bacteriology, parasitology, virology and mycology)+>>, cytogenetics, biochemical genetics, clinical chemistry <<+(including urinalysis, endocrinology and toxicology), andrology, diagnostic laboratory immunology, embryology, hematology (including flow cytometry), serology+>> and <<-such other specialties as may be hereafter authorized by law->> <<+molecular diagnostics+>>, without examination, provided that such person is certified by a national accrediting board in one of the above specialties, which board requires a doctorate degree plus experience, such as the American Board of Pathology, the American Osteopathic Board of Pathology, the American Board of Medical Microbiology, the American Board of Clinical Chemistry, the American Board of Bioanalysis<<+, the American Board of Histocompatibility and Immunogenetics, the American Board of Molecular Genetics+>> and the American Society of Cytogenetics, or any other national accrediting board recognized by the <<+State+>> Board of Medical Examiners. The specialty license shall authorize the licensee to perform and supervise only those tests which are within the scope of the specific specialty license issued by the Board.

(c) Nothing herein shall be construed to waive registration and fees required by the Bioanalytical Laboratory <<-Director->> <<+and Laboratory Directors+>> Licensing Act, as amended <<+(N.J.S.A. 45:9-42.1 et seq.)+>>.

(d) (No change.)

<< NJ ADC 13:35-3.13 >>

13:35-3.13 Criminal history record information

<<-The Board shall require a criminal history record check by the Division of State Police of all applicants for initial licensure to practice medicine and surgery in this State. Such criminal history record checks shall be obtained, processed and maintained in accordance with the procedures established by the Division of State Police pursuant to P.L. 1994, c.60 (N.J.S.A. 53:1-20.5 et seq.) and N.J.A.C. 13:59. Such criminal history records shall be disseminated in strict accordance with the limitations established by the Division of State Police pursuant to N.J.A.C. 13:59-1.6 and are not public records within the meaning of the Right to Know Law, P.L. 1963, c.73 (N.J.S.A. 47:1A-1 et seq.).->> <<+An applicant for initial licensure in the State by the Board shall submit his or her name, address and fingerprints for purposes of a criminal history background check to be conducted by the State of New Jersey pursuant to P.L. 2002, c.104 (N.J.S.A. 45:1-28 et seq.) to determine whether criminal history record information exists which may be considered by the Board in determining whether the applicant shall be licensed in the State.+>> Fees for criminal history record checks shall be paid by applicants for licensure in conformity with P.L. 1994, c.60 (N.J.S.A. 53:1-7)<<+, P.L. 2002, c.104 (N.J.S.A. 45:1-31)+>> and N.J.A.C. 13:59-1.3 and 1.4. In addition to its use in evaluating an application for initial licensure, the Board may obtain criminal history record information from the Division of State Police for any other purpose authorized by statute or regulation.

<< NJ ADC 13:35-3.14 >>

<<+13:35-3.14 Biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status+>>

<<+(a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a renewal application and the renewal fee set forth in N.J.A.C. 13:35-6.13 prior to the expiration date of the license.+>>

<<+(b) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(c) If a licensee does not renew the license prior to its expiration date, the licensee may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-6.13. During this 30-day period, the license shall be valid, and the licensee shall not be deemed to be practicing without a license.+>>

<<+(d) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice.+>>

<<+(e) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-6.13;+>>

<<+2. Completion of the continuing education units required for each biennial registration period for which the licensee was suspended, if appropriate; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer.+>>

<<+(f) In addition to the fulfilling the requirements set forth in (e) above, a licensee whose license has been automatically suspended for more than five years who wishes to return to have his or her license reinstated shall reapply for licensure and, in accordance with N.J.S.A. 45:5-9b or 45:9- 6.1, whichever is appropriate, shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<<+(g) Renewal applications shall provide the licensee with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-6.13 and shall not engage in practice.+>>

<<+(h) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee;+>>

<<+2. The completion of the continuing education units required for each biennial registration period for which the licensee was on inactive status, if appropriate; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(i) In addition to the fulfilling the requirements set forth in (h) above, a licensee who has been on inactive status for more than five years who wishes to return to practice shall reapply for licensure and, consistent with N.J.S.A. 45:5-9b or 45:9-6.1, whichever is appropriate, shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<< NJ ADC 13:35-4.1 >>

13:35-4.1 Major surgery; qualified first assistant

(a) A major surgical procedure is one with a substantial hazard to the life, health or welfare of the patient. By way of example, but not limitation, <<- a->> major surgical procedure<<+s+>> include<<-s->>:

<<+1. A procedure performed where the anatomic locality, the condition, the difficulty or the length of time required to operate would constitute a direct hazard to the life of the patient; and+>>

<<-1.->><<+2.+>> A procedure in which an opening is made into any of the three major body cavities (abdomen, chest or head), <<-exclusive of endoscopic approaches which explore existing channels and involve no transverse of a body wall (for example, bronchoscopy, colonoscopy) or are exclusively diagnostic (for example, laparoscopy, colposcopy). With respect to non-diagnostic endoscopic procedures requiring the transverse of a body wall, a duly qualified first assistant shall be immediately available on the premises of the health care facility;->> <<+if the facility's credentials committee, in conjunction with the chair or chief of the relevant department or division, has delineated the procedure as one requiring a qualified first assistant.+>>

<<-2. A procedure performing a major amputation;->>

<<-3. A procedure performed where the locality, the condition, the difficulty or the length of time required to operate would constitute a direct hazard to the life of the patient.->>

(b) (No change.)

(c) In addition to those individuals listed in (b) above who may act as qualified first assistants, in a health care facility licensed by the Department of Health and Senior Services, a duly qualified registered nurse first assistant (RNFA) <<-or->><<+,+>> a duly qualified physician assistant <<+or a licensed podiatric physician+>> may so act. A duly qualified certified nurse midwife (CNM) may also act as a qualified first assistant in the performance of cesarean sections. For purposes of this subsection, a licensed CNM shall be deemed to be "duly qualified" provided that the CNM has taken and passed a 30-hour didactic training course that includes anatomy, physiology, surgical technique (including wound closure), and direct observation of cesarean sections. Following the completion of the course, a CNM shall serve and be supervised as a second assistant on 10 cesarean sections and complete a supervised preceptorship as a first assistant in 20 cesarean sections.

(d)-(g) (No change.)

<< NJ ADC 13:35-6.3 >>

13:35-6.3 Sexual misconduct

(a)-(b) (No change.)

(c) A licensee shall not engage in sexual contact with a patient with whom he or she has a patient-physician relationship. The patient-physician relationship is considered ongoing for purposes of this section in all contexts other than the provision of psychiatric or psychotherapeutic services, unless: actively terminated, by way of written notice to the patient <<-and->> <<+pursuant to N.J.A.C. 13:35-6.22,+>> documentation in the patient record <<+and a minimum of 30 days has passed from the rendition of the last professional service+>>; or the last professional service was rendered more than one year ago.

1. (No change.)

(d)-(l) (No change.)

APPENDIX

(No change.)

<< NJ ADC 13:35-6.5 >>

13:35-6.5 Preparation of patient records, computerized records, access to or release of information; confidentiality, transfer or disposal of records

(a)-(b) (No change.)

(c) Licensees shall provide access to professional treatment records to a patient or an authorized representative in accordance with the following:

1.-3. (No change.)

4. Licensees may require a record request to be in writing and may charge a fee for <<-he->><<+:+>>

<<+i. The+>> reproduction of records, which shall be no greater than $1.00 per page or $100.00 for the entire record, whichever is less. (If the record requested is less than 10 pages, the licensee may charge up to $10.00 to cover postage and the miscellaneous costs associated with retrieval of the record.) If the licensee is electing to provide a summary in lieu of the actual record, the charge for the summary shall not exceed the cost that would be charged for the actual record<<+; and/or+>>

<<+ii. The reproduction of x-rays or any other material within a patient record which cannot be routinely copied or duplicated on a commercial photocopy machine, which shall be no more than the actual cost of the duplication of the materials, or the fee charged to the licensee for duplication, plus an administrative fee of the lesser of $10.00 or 10 percent of the cost of reproduction to compensate for office personnel time spent retrieving or reproducing the materials and overhead costs.+>>

<<+5. Licensees shall not charge a patient for a copy of the patient's record when:+>>

<<+i. The licensee has affirmatively terminated a patient from practice in accordance with the requirements of N.J.A.C. 13:35-6.22; or+>>

<<+ii. The licensee leaves a practice that he or she was formerly a member of, or associated with, and the patient requests that his or her medical care continue to be provided by that licensee.+>>

Recodify existing 5.-6. as <<+6.-7.+>> (No change in text.)

(d)-(h) (No change.)

<< NJ ADC 13:35-6.10 >>

13:35-6.10 Advertising and solicitation practices

(a)-(l) (No change.)

(m) Any licensee advertising <<-Board->> <<+board+>> certification in a specialty shall possess <<+current+>> certification by a <<+specialty board or+>> certifying <<-agency. A list of certifying agencies->> <<+ entity. Specialty boards+>> recognized by the American Board of Medical Specialties <<+(ABMS)+>>, the American Osteopathic Association <<+ (AOA)+>>, and/or the American Podiatric Medicine Association <<+(APMA)+>> shall be <<+approved by the Board and included in a list+>> maintained by the Board. <<+A licensee advertising board certification shall conspicuously specify in the advertisement the specific specialty board or certifying entity granting the certification (for example, the American Board of Psychiatry and Neurology, the American Board of Radiology, etc.), the national organization recognizing such specialty board or certifying entity (for example, ABMS, AOA, APMA, etc.), if any, and, if not included in the name of the specialty board or certifying entity itself, the field of medical or surgical specialty in which the certification was conferred.+>>

(n)-(o) (No change.)

<< NJ ADC 13:35-6.13 >>

13:35-6.13 Fee schedule

(a) The following fees shall be charged by the Board of Medical Examiners:

1. Medicine and Surgery (M.D. or D.O. license)
i. (No change.)
ii. Initial license fee
(1)-(2) (No change.)
iii.-v. (No change.)
vi. Biennial license 340.00
vii. Biennial license for licensee over 65 without 125.00
health care facility or HMO affiliation
viii. (No change.)
2. Podiatry (license)
i.-ii. (No change.)
iii. Initial license fee
(1)-(2) (No change.)
iv. (No change.)
v. Biennial license $230.00
vi. Biennial license for licensee over 65 without 85.00
health care facility or HMO affiliation
vii. (No change.)
3. Bioanalytical laboratory directorship, plenary or
specialty license
i. (No change.)
ii. Examination 350.00
iii. (No change.)
iv. Initial license fee
(1)-(2) (No change.)
v. Biennial license $230.00
4. Midwifery (license)
i. (No change.)
ii. Examination 50.00
iii. Endorsement 50.00
iv. Initial license fee
(1)-(2) (No change.)
v. Biennial license $230.00
vi. Biennial prescriptive authorization
(Certified Nurse Midwife) 50.00
5. (No change in text.)
6. General
i.-iv. (No change.)
v. Reinstatement fee 175.00
vi. Inactive license fee (to be determined by
Director by regulation)

<< NJ ADC 13:35-6.18 >>

13:35-6.18 Medical malpractice coverage; letter of credit

(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

<<+"Authorized" means recognized by a governmental agency to offer medical malpractice insurance products.+>>

"Covered" means ongoing maintenance of insurance in the sum of $1 million per occurrence and $3 million dollars per policy year, with extended reporting endorsement coverage for claims made ("tail coverage") issued by a carrier <<+or other entity+>> authorized to write medical malpractice policies.

"Letter of credit" means a non-assignable, non-transferable, unexpired, continuous irrevocable obligation<<+, liability bond or other instrument+>> issued by a bank or saving association authorized to do business in this State, payable to the physician or podiatrist as the beneficiary within 30 days after a demand for payment and the presentation of a final judgment or settlement in a medical malpractice action.

"Maintaining a professional practice with responsibility for patient care" means the furnishing of professional services to patients in New Jersey, including, but not limited to, the testing for, or diagnosis of, or the offering or furnishing of treatment, preventative medical care or consultation relating to human disease or dysfunction or physical condition, including the prescribing, administering or dispensing of products, devices or drugs at a place, such as an office (even if located in a home), hospital or clinic, or through a business entity, such as a laboratory or mobile van service.

"Not available" means that a physician or podiatrist is unable to purchase medical malpractice insurance coverage from a carrier authorized to write medical malpractice insurance, including through programs relating to <<- high->> risk retention groups <<+deemed eligible by the Department of Banking and Insurance, surplus lines registered with the Department of Banking and Insurance, self-insurance trusts or captive insurance companies approved by the New Jersey Health Care Facilities Financing Authority in the Department of Health and Senior Services+>>. "Not available" for purposes of this section does not mean "not affordable."

(b)-(e) (No change.)

<< NJ ADC 13:35-6.19 >>

13:35-6.19 Duty to report changes in status

(a)-(b) (No change.)

(c) A licensee shall provide notice to the Board in writing <<+within 10 days+>> of any changes in circumstances which would alter the response last provided by the licensee to questions on the biennial renewal form eliciting information pertaining to pending or finalized actions, including those predicated on a no contest or nolo contendere plea or other consensual or voluntary agreement, or a surrender or resignation of license or of privileges or a consent to limitations on practice which occurred in the face of an investigation or of pending action. Reporting of the following actions is required:

1. <<-Actions->> <<+Pending or final actions+>> by criminal authorities for violations of law or regulation<<+, or any arrest or conviction for any criminal or quasi-criminal offense pursuant to the laws of the United States, this State or another state, including, but not limited to:+>>

<<+i. Criminal homicide pursuant to N.J.S.A. 2C:11-2;+>>

<<+ii. Aggravated assault pursuant to N.J.S.A. 2C:12-1;+>>

<<+iii. Sexual assault, criminal sexual contact or lewdness pursuant to N.J.S.A. 2C:14-2 through 2C:14-4; or+>>

<<+iv. An offense involving any controlled dangerous substance or controlled substance analog as set forth in N.J.S.A. 2C:35-1 et seq.+>>;

2.-8. (No change.)

(d) A licensee, who is not already known to the Board's Impairment Review Committee through participation in the Alternative Resolution Program, shall provide notice to the Board in writing <<+within 21 days+>> of any changes in circumstances which would alter the response last provided by the licensee to questions on the biennial renewal form pertaining to medical conditions and use of chemical substances which in any way impair or limit the licensee's ability to practice with reasonable skill and safety. Licensees shall provide notice to the Board of any hospitalization, in-patient treatment or participation in supervised rehabilitation programs relating to these medical conditions. Licensees shall notify the Board of any leave of absence taken from a health care facility or health maintenance organization for reasons related to these medical conditions. (Parental leaves need not be reported.) Any notices received by the Board pursuant to this subsection shall be retained by the Board in a confidential manner and shall not be deemed to be public records within the meaning of N.J.S.A. 47:1A-1 et seq.

(e)-(f) (No change.)

(g) Failure by a licensee to provide the Board with notice of any information required pursuant to this section within <<-21 days->> <<+the required time period+>> of the change or the event necessitating the filing of the notice may be deemed professional misconduct within the meaning of N.J.S.A. 45:1-21(e).

<< NJ ADC 13:35-6.24 >>

<<+13:35-6.24 Reporting of communicable diseases by licensees+>>

<<+(a) A licensee shall report a case of a communicable disease in accordance with Department of Health and Senior Services regulations at N.J.A.C. 8:57-1.+>>

<<+(b) A licensee shall report a case of Acquired Immunodeficiency Syndrome (AIDS) and infection with Human Immunodeficiency Virus (HIV) in accordance with Department of Health and Senior Services regulations at N.J.A.C. 8:57- 2.+>>

<<+(c) Failure to report pursuant to the requirements of this section shall constitute professional misconduct subjecting the licensee to disciplinary action by the Board.+>>

<< NJ ADC 13:35-7.2 >>

13:35-7.2 Requirements for issuing written prescriptions for medicines

(a)-(g) (No change.)

(h) Each prescription for a controlled substance shall be written on a separate NJPB.

<<+1. An NJPB that contains prescriptions for two or more controlled substances shall be invalid.+>>

<<+2. An NJPB that contains a prescription for only one controlled substance and contains other prescription(s) other than another controlled substance shall be valid.+>>

<< NJ ADC 13:35-8.3 >>

13:35-8.3 Training and experience requirements

(a) An applicant for licensure as a hearing aid dispenser shall submit one of the following to the Committee:

1. (No change.)

2. Proof of successful completion of a <<-county->> college <<- course->> <<+curriculum+>> in hearing aid selection and fitting approved by the Committee and/or the Commission on Higher Education; or

3. (No change.)

(b)-(f) (No change.)

<< NJ ADC 13:35-8.11 >>

13:35-8.11 Notification to the Committee; <<-suspension of license for failure to renew->> <<+biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status+>>

(a)-(b) (No change.)

<<-(c) Every licensee who does not respond to the computerized notice for renewal of his or her registration prior to the renewal deadline but who files a renewal application within 60 days after the expiration of the biennial registration period shall be assessed a late fee of $25.00. Thereafter, licensees who seek to renew their registrations shall be assessed a reinstatement fee of $100.00.->>

<<-1. A licensee may petition for license reinstatement by making written application to the Committee.->>

<<-2. The Committee may require payment for any missed registration period caused by his or her failure to renew.->>

<<-3. The Committee may make reasonable inquiry to evaluate his or her qualifications for continued licensure.->>

<<-(d) A licensee may retire his or her licensure by surrendering the registration for any period of time when he or she is not engaged in hearing aid dispensing. Prior to reinstatement of the license, the Committee may make reasonable inquiry to evaluate his or her qualifications for continued licensure.->>

<<+(c) All licenses issued by the Committee shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a renewal application and the renewal fee set forth in N.J.A.C. 13:35-8.19 prior to the expiration date of the license.+>>

<<+(d) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(e) If a licensee does not renew the license prior to its expiration date, the licensee may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-8.19. During this 30-day period, the license shall be valid, and the licensee shall not be deemed to be practicing without a license.+>>

<<+(f) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice.+>>

<<+(g) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to (f) above may be reinstated by the Committee upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-8.19;+>>

<<+2. Completion of the continuing education units required for each biennial registration period for which the licensee was suspended; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer.+>>

<<+(h) In addition to the fulfilling the requirements set forth in (g) above, a licensee whose license has been automatically suspended for more than five years who wishes to return to the dispensing of hearing aids shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Committee that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Committee prior to reinstatement of his or her license.+>>

<<+(i) Renewal applications shall provide the licensee with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-8.19 and shall not engage in the dispensing of hearing aids.+>>

<<+(j) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Committee upon completion of the following:+>>

<<+1. Payment of the reinstatement fee;+>>

<<+2. The completion of the continuing education units required for each biennial registration period for which the licensee was on inactive status; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(k) In addition to the fulfilling the requirements set forth in (j) above, a licensee who has been on inactive status for more than five years who wishes to return to the dispensing of hearing aids shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Committee that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Committee prior to reinstatement of his or her license.+>>

<< NJ ADC 13:35-8.17 >>

13:35-8.17 Licensing examination

(a) (No change.)

(b) The written examination shall <<-contain sections->> <<+consist of two sections, one section+>> relating to theory and knowledge about fitting and dispensing hearing aids and <<+the other section testing+>> knowledge relating to the laws and regulations governing the practice of fitting and dispensing hearing aids.

1. In order to pass the licensing examination the candidate shall attain a <<+passing score as determined by the examining agency on the written section of the examination relating to theory and knowledge about fitting and dispensing hearing aids and a+>> score of 70 <<-percent->> or greater on <<-each section->> <<+the written section of the examination relating to laws and regulations+>>.

2. Candidates who fail all or any section of the written examination shall be required to sit for the entire <<-written->> <<+licensing+>> examination during the next regularly scheduled examination with one exception: candidates failing only the law and regulation section may be admitted to a <<-make-up->> <<+re-+>>examination for this section only.

(c) <<-A candidate will only be permitted to take the practical examination if he or she has successfully passed the written examination.->> In order to pass the practical examination, a candidate shall attain a passing grade on each part of the practical examination. A candidate shall be eligible to re-take the part(s) failed for one additional examination. No passing credit shall be carried over to a third examination and the candidate failing two exam sessions shall be required to take all sections of the examination.

(d) All examinations and re-examinations will be offered only during the regularly scheduled examination session <<+except for the re-examination of the law and regulation section+>>.

<< NJ ADC 13:35-8.19 >>

13:35-8.19 Fee schedule

(a) The fee schedule for the Hearing Aid Dispensers Examining Committee of the State Board of Medical Examiners, in the Division of Consumer Affairs in the Department of Law and Public Safety, shall be as follows:

1.-10. (No change.)

11. Inactive license fee ..................... (to be determined by the

Director by regulation) Recodify existing 11.-12. as <<+12.-13.+>> (No change in text.)

(b)-(c) (No change.)

<< NJ ADC 13:35-8.20 >>

13:35-8.20 License renewal; continuing education requirement

(a)-(b) (No change.)

(c) The number of creditable course hours and course contents must be accepted and approved by the National Institute for Hearing Instruments Studies (NIHIS), the educational arm of the <<-National Hearing Aid Society (NHAS)->> <<+ International Hearing Society (IHS)+>>, and the Committee <<-except for courses completed through an accredited college or university->>. A <<+ licensee who completes a three or more credit+>> course in hearing aid dispensing <<-creditable by the institution toward three or more credits completed->> at an accredited college or university shall <<+upon the approval of the Committee+>> receive credit for 10 continuing education course hours.

(d)-(e) (No change.)

SUBCHAPTER 9. ACUPUNCTURE

<< NJ ADC 13:35-9.6 >>

13:35-9.6 Fee schedule<<+; refunds+>>

(a) The Board shall charge the following fees:

1.-3. (No change.)
4. Initial Certification Fee:
i. If paid during the first year of a biennial $230.00 renewal period
ii. If paid during the second year of a biennial $115.00 renewal period
5. Biennial Certification $230.00
6. Duplicate or replacement of biennial certificate $ 25.00
7. Late Fee (biennial certification) $ 50.00
8. Inactive Certificate Fee (to be determined by Director by regulation)
9.-10. (No change.)
11. Preparation of certification papers for $ 25.00 applicants to other states

<<-(b) If a license lapses due to nonpayment of the biennial registration fee, it may be reinstated within five years, provided that the pertinent delinquency fee and all past due registration fees are submitted with the application.->>

<<-(c)->><<+(b)+>> (No change in text.)

<<-(d)->><<+(c)+>> After the 14-day period in <<-(c)->><<+ (b)+>> above, an applicant who fails to sit for an examination for which payment has been submitted may, one time only, have the fee credited toward the next scheduled examination. The fee will be entirely forfeited if the applicant fails to sit for the succeeding examination.

<<-(e)->><<+(d)+>> (No change in text.)

<< NJ ADC 13:35-9.7 >>

<<+13:35-9.7 Biennial certificate renewal; certificate suspension; reinstatement of suspended certificate; inactive status; return from inactive status; display of certificate+>>

<<+(a) All certificates to practice acupuncture issued by the Board shall be issued for a two-year biennial certification period. A certificate holder who seeks renewal of the certificate shall submit a renewal application and the renewal fee set forth in N.J.A.C. 13:35-9.6 prior to the expiration date of the certificate.+>>

<<+(b) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(c) If a certificate holder does not renew the certificate prior to its expiration date, the certificate holder may renew the certificate within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-9.6. During this 30-day period, the certificate shall be valid, and the certificate holder shall not be deemed to be engaged in unauthorized practice.+>>

<<+(d) A certificate that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended certificate shall be deemed to be engaged in unauthorized practice.+>>

<<+(e) A certificate holder whose certificate has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-9.6;+>>

<<+2. Completion of the continuing education units required for each biennial registration period for which the certificate holder was suspended; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period of suspended certificate which includes the name, address, and telephone number of each employer.+>>

<<+(f) In addition to the fulfilling the requirements set forth in (e) above, a certificate holder whose certificate has been automatically suspended for more than five years who wishes to return to have his or her certificate reinstated shall reapply for certification and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her certificate.+>>

<<+(g) Renewal applications shall provide the certificate holder with the option of either active or inactive status. A certificate holder electing inactive status shall pay the inactive certificate fee set forth in N.J.A.C. 13:35-9.6 and shall not engage in the practice of acupuncture.+>>

<<+(h) A certificate holder who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee;+>>

<<+2. The completion of the continuing education units required for each biennial certification period for which the certificate holder was on inactive status; and+>>

<<+3. Submission of an affidavit of employment listing each job held during the period the certificate holder was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(i) In addition to the fulfilling the requirements set forth in (h) above, a certificate holder who has been on inactive status for more than five years who wishes to return to practice shall reapply for certification and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her certificate.+>>

<<+(j) The certificate shall be posted in a conspicuous location in the office of the acupuncturist. If the acupuncturist has more than one office, he or she shall obtain from the Board duplicate certificates for each location.+>>

<< NJ ADC 13:35-9.9 >>

13:35-9.9 Accepted equipment and devices; procedures

(a) <<-Licensees->> <<+Certificate holders+>> may use any of the following to effect the stimulation of acupuncture points and channels: needles, moxa, cupping, thermal methods, herbal applications, magnetic stimulation, gwa-sha scraping techniques, acupatches, acuform, teishin (pressure needles), manual acutotement (defined as stimulation by an instrument that does not pierce the skin), acupressure, electroacupuncture (whether utilizing electrodes on the surface of the skin or current applied to inserted needles), laser bio-stimulation in accordance with relevant Federal law including United States Food and Drug Administration rules and regulations, and ultrasonic stimulation of acupuncture points and channels.

(b)-(c) (No change.)

<< NJ ADC 13:35-9.10 >>

13:35-9.10 Precautionary and sterilization procedures

(a)-(e) (No change.)

(f) If a <<-licensee->> <<+certificate holder+>> learns that a patient has a blood-borne infectious disease, the <<-licensee->> <<+certificate holder+>> shall use only disposable needles in treating the patient.

(g) (No change.)

<< NJ ADC 13:35-9.11 >>

13:35-9.11 Preparation of patient records; computerized records; access to or release of information; confidentiality, transfer or disposal of records

(a) The following words and terms, as used in this section, shall have the following meanings unless the context clearly indicates otherwise:

1. (No change.)

2. "Patient" means any person who is the recipient of a professional service rendered by a <<-licensee->> <<+certificate holder+>> for purposes of treatment.

(b) Acupuncturists shall prepare contemporaneous, permanent professional treatment records. Acupuncturists shall also maintain records relating to billings made to patients and third-party carriers for professional services. All treatment records, bills and claim forms shall accurately reflect the treatment or services rendered. Treatment records shall be maintained for a period of seven years from the date of the most recent entry.

1. (No change.)

2. Corrections and/or additions may be made to an existing record, provided that each change is clearly identified as such, dated and initialed by the <<-licensee->> <<+certificate holder+>>;

3. (No change.)

(c) Acupuncturists shall provide access to professional treatment records to a patient or an authorized representative in accordance with the following:

1.-2. (No change.)

3. Acupuncturist may require that a record request be in writing and may charge a fee for the reproduction of records, which shall be no greater than $1.00 per page or $100.00 for the entire record, whichever is less. If the <<-licensee->> <<+certificate holder+>> elects to provide a summary in lieu of the actual record, the charge for the summary shall not exceed the cost that would be charged for the actual record.

4. (No change.)

5. The acupuncturist shall not refuse to provide a professional treatment record on the grounds that the patient owes the <<-licensee->> <<+ certificate holder+>> an unpaid balance if the record is needed by another health care professional for the purpose of rendering care.

(d)-(e) (No change.)

(f) If an acupuncturist ceases to engage in practice or it is anticipated that he or she will remain out of practice for more than three months, the acupuncturist or designee shall:

1. Establish a procedure by which patients can obtain a copy of the treatment records or acquiesce in the transfer of those records to another <<- licensee->> <<+certificate holder+>> who is assuming responsibilities of the practice. However, an acupuncturist shall not charge a patient, pursuant to (c)3 above, for a copy of the records<<-,->> when the records will be used for purposes of continuing treatment or care.

2.-3. (No change.)

<< NJ ADC 13:35-9.17 >>

13:35-9.17 Continuing professional education requirements

(a) The provisions of this section shall apply to all acupuncturists applying for biennial <<-registration->> <<+certificate+>> renewal except those seeking renewal for the first time.

(b) No <<-registration->> <<+certificate+>> renewal shall be issued by the Board unless the acupuncturist confirms on his or her renewal application that during the <<-two calendar years->> <<+biennial period+>> preceding application for renewal the acupuncturist participated in courses or activities of continuing education of the type and number of credits specified in this section. Evidence of 20 documented hours of continuing education is a mandatory requirement for <<-license->> <<+certificate+>> renewal, except for initial renewal.

1.-2. (No change.)

(c) Credit for continuing professional education shall be granted as follows for each two-year period:

1.-2. (No change.)

3. Successful completion of graduate course work taken beyond that required for professional <<-license->> <<+certificate+>>; one hour per credit hour; and

4. (No change.)

(d) (No change.)

(e) Credits taken in excess of the 20 required for biennial <<- registration->> <<+certificate+>> renewal shall not be carried over for use in subsequent renewal periods.

(f) (No change.)

SUBCHAPTER 10. ATHLETIC TRAINERS

<< NJ ADC 13:35-10.4 >>

<<+13:35-10.4 Licensure; biennial license renewal; license suspension; reinstatement of suspended license; inactive status; return from inactive status+>>

<<+(a) All licenses issued by the Board shall be issued for a two-year biennial licensure period. A licensee who seeks renewal of the license shall submit a completed renewal application and the renewal fee as set forth in N.J.A.C. 13:35-10.7 prior to the expiration date of the license.+>>

<<+(b) The Board shall send a notice of renewal to each licensee at the address registered with the Board at least 60 days prior to the expiration of the license. If the notice to renew is not sent at least 60 days prior to the expiration date, no monetary penalties or fines shall apply to the holder for failure to renew.+>>

<<+(c) If a licensee does not renew the license prior to its expiration date, the licensee may renew the license within 30 days of its expiration by submitting a renewal application, a renewal fee and a late fee, as set forth in N.J.A.C. 13:35-10.7. During this 30-day period, the license shall be valid, and the licensee shall not be deemed to be practicing without a license.+>>

<<+(d) A license that is not renewed within 30 days of its expiration shall be automatically suspended. An individual who continues to practice with a suspended license shall be deemed to be engaged in unlicensed practice and shall be subject to penalties for practicing without a license.+>>

<<+(e) A licensee whose license has been automatically suspended for five years or less for failure to renew pursuant to (d) above may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee and all past delinquent biennial renewal fees pursuant to N.J.A.C. 13:35-10.7; and+>>

<<+2. Submission of an affidavit of employment listing each job held during the period of suspended license which includes the name, address, and telephone number of each employer.+>>

<<+(f) In addition to the fulfilling the requirements set forth in (e) above, a licensee whose license has been automatically suspended for more than five years who wishes to return to practice shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while suspended may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<<+(g) Renewal applications shall provide the licensee with the option of either active or inactive status. A licensee electing inactive status shall pay the inactive license fee set forth in N.J.A.C. 13:35-10.7 and shall not engage in practice.+>>

<<+(h) A licensee who elected inactive status and has been on inactive status for five years or less may be reinstated by the Board upon completion of the following:+>>

<<+1. Payment of the reinstatement fee; and+>>

<<+2. Submission of an affidavit of employment listing each job held during the period the licensee was on inactive status which includes the name, address, and telephone number of each employer.+>>

<<+(i) In addition to the fulfilling the requirements set forth in (h) above, a licensee who has been on inactive status for more than five years who wishes to return to the practice of medicine shall reapply for licensure and shall demonstrate that he or she has maintained proficiency. An applicant who fails to demonstrate to the satisfaction of the Board that he or she has maintained proficiency while on inactive status may be subject to an examination or other requirements as determined by the Board prior to reinstatement of his or her license.+>>

<< NJ ADC 13:35-10.4 >>

<< NJ ADC 13:35-10.5 >>

13:35-<<-10.4->><<+10.5+>> (No change in text.)

<< NJ ADC 13:35-10.5 >>

<< NJ ADC 13:35-10.6 >>

13:35-<<-10.5->><<+10.6+>> Violations

Without limiting the prosecution of any practices which may be unlawful under any other state or Federal law, a violation of this subchapter shall be deemed to be a violation of the Athletic Training Licensure Act, N.J.S.A. <<-45:37- 35->> <<+45:9-37.35+>> et seq., and shall be subject to the sanctions and penalties of N.J.S.A. 45:1-1 et seq.

<< NJ ADC 13:35-10.6 >>

<< NJ ADC 13:35-10.7 >>

13:35-<<-10.6->><<+10.7+>> Fees

(a) The following fees shall be charged by the Board for athletic trainer licensure:

1.-5. (No change.)
6. Reinstatement fee ................................................ $60.00
7. Inactive license fee ........................... (to be determined by the Director by regulation)



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