I support the amendment to 18VAC 85-50-110.  PAs are trained to provide team-based care and to recognize their limitations within their scope of practice.  The nature of collaborative team practice is to determine when the needs of a patient exceed the knowledge and skillset of a provider and to seek further opinion.  This could occur on an initial visit with a patient or at a later follow-up.  The prescribed content of the current legislative language is not reflective of patient needs.  For example, significant improvement in a patient's condition may not be expected and continued care on subsequent follow-up by a PA may not be out of line with the training and scope of the PA.  A dictated determination for follow-up with a physician could be appropriately determined at the practice level to meet the practice and patient needs, but it should not be dictated at a legislative level.