18VAC85-50-57. Discontinuation of employment.
If for any reason the assistant discontinues working in the
employment and under the supervision of a licensed practitioner,
assistant or the employing practitioner shall so inform the board. A a
new practice agreement shall be submitted to the board and approved by the
board entered into in order for the assistant either to be
reemployed by the same practitioner or to accept new employment with another
18VAC85-50-101. Requirements for a practice agreement.
A. Prior to initiation of practice, a physician assistant and
his supervising physician shall
submit enter into a written or
electronic practice agreement which that spells out the roles
and functions of the assistant. Any such practice agreement shall take into
account such factors as the physician assistant's level of competence, the
number of patients, the types of illness treated by the physician, the nature
of the treatment, special procedures, and the nature of the physician
availability in ensuring direct physician involvement at an early stage and
regularly thereafter. The practice agreement shall also provide an evaluation
process for the physician assistant's performance, including a requirement
specifying the time period, proportionate to the acuity of care and practice
setting, within which the supervising physician shall review the record of
services rendered by the physician assistant. The practice agreement may
include requirements for periodic site visits by supervising licensees who
supervise and direct assistants who provide services at a location other than
where the licensee regularly practices.
B. The board may require information regarding the level of
supervision, (i.e., "direct," "personal,"
,") with which the supervising physician
plans to supervise the physician assistant for selected tasks. The board may
also require the supervising physician to document the assistant's competence
in performing such tasks.
C. If the role of the assistant includes prescribing for drugs
and devices, the written practice agreement shall include
: 1. Those those
schedules and categories of drugs and devices that are within the scope of
practice and proficiency of the supervising physician ; and 2. Requirements for periodic site visits by supervising
licensees who supervise and direct assistants who provide services at a
location other than where the licensee regularly practices.
D. If the initial practice agreement did not include
prescriptive authority, there shall be an addendum to the practice
agreement for prescriptive authority
shall be submitted.
E. If there are any changes in supervision, authorization, or
scope of practice, a revised practice agreement shall be
into at the time of the change.
18VAC85-50-110. Responsibilities of the supervisor.
The supervising physician shall:
1. Review the clinical course and treatment plan for any patient who presents for the same acute complaint twice in a single episode of care and has failed to improve as expected. The supervising physician shall be involved with any patient with a continuing illness as noted in the written or electronic practice agreement for the evaluation process.
2. Be responsible for all invasive procedures.
a. Under general supervision, a physician assistant may insert a nasogastric tube, bladder catheter, needle, or peripheral intravenous catheter, but not a flow-directed catheter, and may perform minor suturing, venipuncture, and subcutaneous intramuscular or intravenous injection.
b. All other invasive procedures not listed
subdivision 2 a of this section must be performed under direct supervision
unless, after directly supervising the performance of a specific invasive
procedure three times or more, the supervising physician attests to the
competence of the physician assistant to perform the specific procedure without
direct supervision by certifying to the board in writing the number of times
the specific procedure has been performed and that the physician assistant is
competent to perform the specific procedure. After such certification has been
accepted and approved by the board, the physician assistant may perform the
procedure under general supervision.
3. Be responsible for all prescriptions issued by the assistant and attest to the competence of the assistant to prescribe drugs and devices.
18VAC85-50-115. Responsibilities of the physician assistant.
A. The physician assistant shall not render independent health care and shall:
1. Perform only those medical care services that are within the scope of the practice and proficiency of the supervising physician as prescribed in the physician assistant's practice agreement. When a physician assistant is to be supervised by an alternate supervising physician outside the scope of specialty of the supervising physician, then the physician assistant's functions shall be limited to those areas not requiring specialized clinical judgment, unless a separate practice agreement for that alternate supervising physician is approved and on file with the board.
2. Prescribe only those drugs and devices as allowed in Part V (18VAC85-50-130 et seq.) of this chapter.
3. Wear during the course of performing his duties identification showing clearly that he is a physician assistant.
B. If, due to illness, vacation, or unexpected absence, the
supervising physician or alternate supervising physician is unable to supervise
the activities of his assistant, such supervising physician may temporarily
delegate the responsibility to another doctor of medicine, osteopathic medicine,
The supervising physician so delegating his responsibility
shall report such arrangement for coverage, with the reason therefor, to the
board office in writing, subject to the following provisions: 1. For planned absence, such notification shall be received
at the board office at least one month prior to the absence of both the
supervising and alternate supervising physicians; 2. For sudden illness or other unexpected absence that
necessitates temporary coverage, the board office shall be notified as promptly
as possible, but in no event later than one week; and 3. Temporary coverage may not exceed four weeks unless
special permission is granted by the board.
C. With respect to assistants employed by institutions, the following additional regulations shall apply:
1. No assistant may render care to a patient unless the physician responsible for that patient has signed the practice agreement to act as supervising physician for that assistant. The board shall make available appropriate forms for physicians to join the practice agreement for an assistant employed by an institution.
2. Any such practice agreement as described in subdivision 1 of this subsection shall delineate the duties which said physician authorizes the assistant to perform.
3. The assistant shall, as soon as circumstances may dictate, report an acute or significant finding or change in clinical status to the supervising physician concerning the examination of the patient. The assistant shall also record his findings in appropriate institutional records.
D. Practice by a physician assistant in a hospital, including an emergency department, shall be in accordance with § 54.1-2952 of the Code of Virginia.