MINUTESOF THE MEETING OF THE BOARD OF MEDICAL EXAMINERS

OF THE STATE OF NORTH CAROLINA

October 12 - 16, 1983Radisson Plaza Hotel

Raleigh, North Carolina

Cal 1 to Order

The Board of medi cal Examiners of the State of North Carol ina convened at 8:00p. m. , Thursday, October 12, 1983, at the Radi sson Plaza Hotel in Ra le i gh, NorthCarolina, for the purpose of interviewing candidates for I i cense by endorsementof credentials and conducting other business.

Board members present at thi s meeting included: Loui s T. Kermon, M. D. , Presi-dent; Frank Noble Sul 1 ivan, M. D. , Secretary; Charles H. Duckett, M. D. ; ThomasE. Fi tz, M. D. ; Jack A. Koontz, M. D. ; A. T. Pagter, J r. , M. D. ; Rose Pul 1 y, M. D. ;and Martha Kirkland Walston.

Staff members present at this meeting included: Bryant D. Paris, Jr. , Execu-ti ve Secretary; Betty Joe Bari ck, Assi stant Executi ve Secretary; Lee A. Denneyand Don Pi ttman, Investigators; and Sibyl Lamoreaux, Secretary.

Reinstatement of Licenses Suspended for Rai lure to Register

The Board adopted a motion that the licenses of the following physiciansbe reinstated as these physicians have now registered.

Edward Castello Loughlin, Jr.Phillip Charles GalleArthur Rogers Summerlin, IIIHewlette Collier ConnellHoward Linward RussellNed Brooks Armstrong

Physisician Assistant Subcommittee Report

The Chairman of the Physician Assistant Subcommittee reported on recommenda-tions made by this Subcommittees The Board adopted a motion that the followingrecommendations be approved.

Physician Assistant Applications Approved by the Board

Barden, Lucy Pinson, PA — Mary Alexander, M AD. , GreensboroBeech, Joyce Wagner, PA — Ronald LE Garber, M. D. , GreensboroBoaz, Thomas DeLeon, PA - Rose Fari as, M. D. , Fair BluffBrimm, Daniel Ashley, PA — Cyril A. Allen, M. D.Dalton, Christine B. , PA - Donald 0. Castell, M. D.Eades, Lauren Elizabeth, PA - Richard P. Polisson, M. D. , DurhamFurlong, Thomas Alan, PA — James M. Lee, M. D. , GreensboroGaskell, Perry Craig, Jr. , PA - James N. Davis, M. D. , DurhamHerman, Margaret Charity, PA - Paul A. Fleming, M. D. , RaleighHoffman, Margaret A. , PA — John A. Henderson, M. D. , AshevilleHollingsworth, Karen H. , PA - William C. Meyers, M. D. , DurhamJohnson, Adrena Elaine, PA - Mary Emma Louise Vernon, M. D. , DurhamKing, Mary Estelle, PA - Robert L. Bloomfield, M. D. , Winston-Salem,Leggett, Jerry Curtis, PA - Christine Chiosi, M. D. , Collettsvi!leMcLeod, Donald Clyde, PA - John Caleb Pease, M. D. , WhitevilleMinton, Dean Lincoln, PA — Maureen Aaron Elliott, M. D. , Winston-SalemOsman, Robert E. PA - Khin Mae Hla, M. D. , DurhamRich, Forrest Ross, PA - William E. Garrett, Jr. , M. D. , DurhamSanderson, Shirley Gray, PA — Daniel Gottovi, M. D. , Wil mingtonSethi, Hemlata, PA — E. Ted Chandler, M. D. , Winston-SalemStark, Gregg Alan, PA - Donald 0. Castell, M. D. , Winston-SalemVaillancourt, Anne Therase, PA - John T. Garbutt, Jr. , M. D. , Durham

Willia, Linda Lee, PA - Patricia J. Zekan, M. D. , Winston-SalemWitaszek, Jeremy Michael, PA - E. Stanley Willett, M. D. , AshevilleZimmerman, Diane Ruth, PA - Paul E. Klotman, M. D. , Durham

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Ph sisicianksistant A plications Approved with Stipulations

Chabon, Stephen Jeffrey, PA — James A. Maul tsby„M,D. , GreensboroStenberg, Edwin S. , I I I, PA — Gregory G. Hol thusen, M. D. , Winston-Salem

Physician Assistant Applications Approved by the Board i f and when CertainCredentials are Submi tted or Certain Condi tions are Met

Arce, Joseph Michael, PA — Inad B. Atassi „M.D. , Fayettevi1 leColey, I rene, PA — Michael Rosner, M. D. , Chapel Hi I I

Donnel ly, Wi I 1 i am James, I I I, PA — John W. Gainey, Jr. , M. D. , Morehead Ci tyMcKinney, Brenda W. , PA - Adrian M. Gri ffin, M. D. , Mt. AiryProf fi tt, Valerie Staples, PA - Kathryn Sweeney, M. D. , DurhamQuattro, Cynthia L. , PA — Hugh Fi tzpatri ck, M. D, , Hi gh PointWi I I iams, Ann Godfrey, PA — James W. Rackley, M. D. , Winston-SalemKauffman, Gary D. , PA — F. E. Blalock, M. D. , Andrews

Physician Assistant Applications which were not Approved by the Board at this Time

Moore, Carol Ann, PA — David E. Garces, M. D. , Whitevi1 leJon Langston, PA — Bernard L. Langston, N ~ D. , Supply

Physician Assistant Applications for Approval of Extension of Duties Approvedby the Board

Coni gl io, David Martin, PA — David F. Paul son, M. D. , Durham

Lloyd, Dougl as Davi d, PA — John F. Nunroe, M. D. , Whi tevi I leWol insky, Sidney, PA - Morton Nel tzer, N. D. . Fayettevi I leFoster, Ernest R. , PA - Morton Mel tzer, N. D. , Fayettevi I leHenderson, Davi d B. , PA - Charles T. Adkins, M. D. , Fayettevi 1 leEads, Donald, PA - Charles T. Adkins, M. D. „Fayettevi I leHol I ingsworth, Robert, PA — Otto F. Rogers, M. D. , Fayettevi 1 leRapal je, James J. , PA - Mark Steinman, M. D. , Fayettevi 1 le

Physician Assistant Applications for Approval of Chanqes in PrimarySupervising Physicians Approved by the Board

Dufour, Claude, PA - David Garces, M. D, , Whi tevi lieEvans, Shannon D. , PA — Hemen I' Joshi, M. D. , Whiteville

Physician Assistant Applications for Administrative Approval of Changesin Primary Supervising Physicians Approved by the Board

H. D. Pete rson, M. D.Phi I i p Jerome Karam, M D.Lorraine Sharon, M. DE

Nahesh A. Varia, M. D.Mahesh A. Varia, M. D.John Miles Harrelson, M. D.Allan MD Johnstone, M. D.John Stanford Noell, M. D.Hugh Duane Peterson, N. D.Mary Fennell Lyles, M. D.E. Ted Chandler, M. DE

Marian Elaine Cranford„ PA

John J, Triplett, Jr. . PA

Daniel E. Mattingly, PA

Carol B. Kirschenbaum„ PA

Charles E. Kober, PA

Max Anderson Isbell, PA

Alice Susan Horne, PA

Frank John Oktavec„ Jr. , PA

Sandra Reimers Herzoq, PA

Martha Ann Kilby, PA

Gale Lynn Harkness, PA

Physician Assistant Ap lications Requiring Additional Follow"u~

Bradshaw, Johnnie Mack, PA Applicant - Daniel R. Brandon, M. D.Stowe, Jasper Carl, III, PA Applicant - David I. Gross, M. D. , Gastonia

Revised Physician Assistant Application

The Board adopted a motion that the physician assistant application formbe revised as attached to these Mi'nutes.

153

October, 1984, Board Iee t i n g

The Board adopted a motion that, i f reservations can be arranged, theOctober, 1984, meeting be held at the Grove Park Inn, Ashevi l le, NorthCarol ina. The Board adopted a further motion that, i f these reservationscannot be confirmed, the Board meet at the Marriott in Ralei gh. TheBoard also adopted a motion that the October, 1984, meeting be held duringthe same time period as the October, 1983, meeting.

Emergency Medical Services

Emergency Medical Services Applications Approved by the Board

EMT-I Applications Approved by the Board

Durham: 1, Wake: 8, Craven: 12, Orange: 4, Cumberland: 2, Iredell: 28, Forsyth: 3,Pitt: 13, Cabarrus: 1, Mecklenburg: 1, Buncombe: 5

EMT-P Applications Approved by the Board

Orange: 1, Henderson: 1, Alamance: 1, Iredell: 5, Catawba: 5, Forsyth: 1,Surry: 15

Ml CN Appl ications Approved by the Board

Yadkin: 1, Onslow: 3, Orange: 1, Davie: 1, I redel I: 1, Davidson: 1

Bee Sting Certification Applications

Bee Sting Certi fication Applications approved by the Board

388

Bee Sting Certification Applications Not Approved by the Board at this Time

Kermi t Tal ley, Jr.Nine Appl ications Lacking Appl icants' Social Securi ty Numbers

Bee Sting Certification Form Wording Revision

The Board adopted a motion that the wording on this form be changedfrom "under my supervision" to "by me. "

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Nurse Practi ti oner Joint Subcommi t tee Report

The Chai rman of the Joint Subcommi ttee reported on thi s meeting.

Nurse Practitioner Program Approved by the Board

Cha r 1 es ton, South Ca ro I i na, Coun ty Hea 1 th Depa r tmen t Pedi a t r i c NursePracti tioner Program.

Nurse Practitioner Applications Approved by the Board

A. JarJ. S.D. NatJ. B.L. S.M. H.S. D.T. J.F. W.R. C.E. EasJ. T.

rahi, M. D. , Winston-Salem, NC — K. F. Cornatzer, NP

8 I a i r, M. D. , Wa 1 I ace, NC - E. J. DeVane, NP

haniel, M. D. , Goldsboro, NC - L. A. Franklin, NP

Holt, M. D. , Pi ttsboro, NC — J. K. Goins, NP

Ki lby, M. D. , N. Wi lkesboro, NC — N. N. Hayes, NP

Bertl ing, M. D. , Greensboro, NC - S. T. Jami son, NP

Condie, M. D. , Shelby, NC — C. R. Langston, NP

Mearns, M. D. , Hi ckory, NC — P. H. McDowel 1, NP

Henderson, M. D. , Chapel Hi I 1, NC — K. B. Phi lbrick, NP

Turner, M. D. , Greenvi I le, NC - N. J. Randal I, NP

ley, M. D. , Durham, NC — R. Rudner, NP

Dees, M. D. , Burgaw, NC - S. E. Warrick, NP

Nurse Practitioner Requests for Extensions of Duties Approved by the Board

Charles F. Murray, M. D. , Asheville, NC — Margaret Carroll, NP;Catherine B. Johnson, NP; Beverly L. Smith, NP; Kay Taylor, NP; CynthiaVan Deusen, NP; Kathleen C. Griffin, NP

Nurse Practitioner Applications Approved by the Board if and when CertainCredentials are Submitted or Certain Conditions are Met

R. L. Spencer, M. D. , Winston-Salem, NC — J. L. Gilley, NP

D. T. Moore, M. D. , Durham, NC - P. S. Holden, NP

E. Easley, M. D. , Durham, NC - C. M. Latta, NP

L. M. Cutchin, Tarboro, NC — S. J. Stroud, NP

S. L. McCormack, M. D. , Tryon, NC - B. S. Trumble, NP

W. S. Berkey, M. D. , Skyland, NC - D. L. Underwood, NP

Certified Nurse Midwife A plication riot Considered at this Meetinq

R. C. Crawford, M. D. , High Point, NC — G,. D. Watkins, CNM

Re uest for Approval ot Extension of Duties Approved by the Board if andwhen Certain Credentials are Submitted or Certain Conditions are Met

Charles F. Murray, Jr. , M. D. , Asheville, NC — Denise Gohmann Vish, NP

Nurse Practitioner Applications-. for Chariges in Primary SupervisingPhysicians Ap roved by, the Board

Mel inda C. Paul, M. D.Kenneth Lee, M. D.Carol Klein, M. D.Alan Spanos, M. D.

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Ange la Carter Martin, NP

Patricia Miller Bradshaw, NP

Glenda Oldham Hargraves, NP

Nancy Mary Tanguay, NP

MICN Training Programs

The Board adopted a motion that theand regulatory requirements mandateapprove MICN programs and, that, ifact in a consultant capacity to EMS

Joint Subcommi ttee be noti f i ed statutorythe Office of Emergency Services tothe Joint Subcommi t tee wi shes, i t mayin the consideration of MICN programs.

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Of f i cers for the Joint Subcommi t tee

The Board adopted a motion that, as the Board of Medical Examiners has thestatutory responsibi 1 i ty to approve the medical acts performed in the stateof North Carol ina, the Chairman of the Joint Subcommi ttee wi 1 1 be appointedby the President of the Board of Medical Examiners ~

New Nurse Practitioner Application Form

The Chai rman of the Joint Subcommi ttee reported to the Board of MedicalExaminers that the Joint Subcommi ttee tabled di scuss ion of a new nurse prac-t i t i oner app 1 i ca t i on form.

Physician and Nurse Representatives Recommended as Representatives to theCert i, fied Nurse Mi dwi fery Subcommi t tee

The. Execut i ve Secretary reported to the. Board of Med i ca 1 Examiners thatRobert Brame, M. D, , and Hui tt Everett Mattox, M, D. , are the physician nomineesfor the new commi ttee, He stated that he furni shed Mi ss Kuba of the Boardof Nursing the names of ihe physician nominees shor tly after the August, 1983,meeting of the Board of Medical Examiners. Mr. Pari s indicated that a fewdays prior to the October. 1983, meeting of the Board he received from MissKuba the names of Linda Glenn, R. N. , and Elizabeth Dickson, R. N. . the nursenominees to the new commi t tee. The Executi ve Secretary then reported to theBoard that, when he contacted the physician nominees to request their at-tendance at the October, 1983,. meeting, the physicians informed him that theywere unable to make arranqements to attend this meetinq on such short notice.

Joel Greqg Puleo, M. D. , Durham, North Carolina

The Board adopted a motion that no decision be made on Dr. Puleo's licensureapplication at this time.

Reza Nilforooshan, M. D. , Cleveland, Ohio

The Board adopted a motion that Dr. Nilforooshan's licensure application re-mains incomplete as his application for permanent resident status in the UnitedStates does not constitute immigrant status which would result in his receivingan alien registration receipt card.

Question in the Licensure Application Form Regarding the Use of Alcohol

The Board reviewed a suggested revision in the application form concerningthe excessive use of, or dependence upon, alcohol. The Board adopted amotion that the Executive Secretary's suggestions regarding omission of theword "alcohol'' from Question 15 on the application form and the addition ofQuestion 14 A to the application form inquiring: "Have you ever used toexcess or been dependent upon alcohol" ? be approved and implemented.

Report on Hearing to Revise Wording in the Regulation Regardinq BiennialRegistration Fee for Physicians

The Board reviewed a report of a hearing held on August 31, 1983, at 4:00p. m. , at the North Carolina Medical Society Auditorium, Raleigh, North Caro-lina, in accordance with requirements of the North Carolina AdministrativeProcedures Act, to receive oral or written statements from the public relevantto the Board of Medical Examiners' proposal to amend regulation 21 NCAC 32F .0003regarding biennial registration fee for physicians as follows:

.0003 FEEEach physician shall pay a registration fee of twenty-five dollars ($25. 00)to the Board.

The Board adopted a motion made by Dr. Pagter that this regulation change beapproved by the Board of Medical Examiners and filed in accordance withthe Administrative Procedures Act.

Proposed Budget for the North Carolina Board of Medical Fxaminers

The Board reviewed a proposed budget for 1983-1984 and adopted a motion thatthis proposed budget be approved with whatever modifications may be required asa result of Board action.

Interviews for Li cense by Endorsement of Credentials

The fol lowing physicians appl ied for 1 i cense by endorsement of credentials,appeared for personal interviews before the Board, a subcommi ttee of theBoard, an indi vi dual Board member, or the Executi ve Secretary, andobtained licensure October 15, 1983.

Davi d AbernathyCarol AdamsKenneth AlonsoDean AssimosJames BainCharles BaleMitchel BaumanEldon BeardRobert BechtoldRobert Becker, JrDavid BectonStephen BeeseRaja BhatLawrence BirisLewis BissellLewis Bolin, Jr.James BrowneHilton BruchJohn CanonJune ChangChristine ChiosiMary Chri stenburCynthia ChuaDonald Cook, Jr.Bruce CorselloWilliam CrawfordJohn CrouchThomas DaviesJames Davis, Jr.Arthur DeutschRonald DietrickPeter Di xonWilliam DodsonRobe r t Dough, J r.James DunningtonMichael FarrellKirk FaustDavi d FayNorene FlemingWilton Gay, Jr.Cosmos GeorgePazhayidathe Geo rge

Ri chard GibsonJohn Gi lmoreClarence Gowen, Jr.Gregory GrantCharles GreenbergWilliam GriffinKathy GrossRoberta HallDaniel HarroLawrence HopkinsDavid HowellJeffrey HuntJames JewellTink Johnson, IIIDavid KavjianJohn KeaGeorge Kernodle, Jr.Kenneth KleinRubin KleinSteven KovachChristopher KusLars LarsenJames LeeKenneth LeeKenneth S.LeeJames LewisJames LisakLarry LitscherSusan LodewijksDavid MasseyDaniel MatthewsJohn MayKeith MeadorJeffrey MenasheRichard Moon

Herman Morgan, Jr.Abdu I Muhammad

Thomas MundorfJohn Murphy, Jr.Frances NorrisJerome Nymberg, lllKeith Olbrantz

Mahendra PatelNatu PatelHubert Patterson, I I I

Peter Peraul tJohn PetittJoseph PetrozzaKatherine PierceLeo P revos tBema rd Ram

Norman Rami rezDavi d RaperTadur ReddyAlton RidgwayMare Ri voGeorge RozakisRoger RussellJeffrey RymuzaBarbara SamuelsSally SandersBruce Schi rmerJugalkishor ShahGlyndon Shaver, Jr.Anthony SintetosPeter Smi thJohn SorgeRoger TaylorBasil TheodotouJonathan TillMing-Sound TsaoScott TuckerMurray UrquhartRobert VaughanJoes VogtMonica WalkerPaul WalkerRobert Walkup, Jr.Roger WarrenAcquenetta WheelerNettie WhiteStephen WilkinsonMary WitgesJerry WithrowJoseph Yankes, Jr.

Temporary LicensesGeorge Klein Brian Sudderth. exp, 9/27/88 Wi 1 1 imam Wil 1 iams, I I I, exp, 2/]/85Jerry Dean Peters Jani fer C. Roberts Frederick H. Shipkey, Jr.Steven Crawshaw - extended through 12/3]/84 Ronald Wi 1 I iams — extendedLetters of Intent

E ri c L. HansenDonald MacPhersonAl an B. Munro

Donald F. PottsPaul H. White

John Allen Dyer

Ap 1icants for License by Examination

The Board licensed the following physicians who submitted the requiredcredentials and successfully passed the North Carolina Examination forLicensure (FLEX).

Reese Hunter C 1 a rklan CrockerKenneth FreemanManning Goldsmith, lllThomas Graham

Samy I skandarVincent KoppKatherine LenskiRitva Linnoi laSamir Nazam

Betsy PhillipsSandra SasserPeter TavesVictor VillagraLynn Wesson

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Fees for FLEX Examination and License by Endorsement

The Board reviewed a memorandum from theincreasing the FLEX fee to a maximum ofmended that the incoming President, wi threquired, take this legislative questionpackage of fee increases to be presenteda 1 so recommended that these proposed i nclicense by endorsement fees so that thethe level in effect in other states, suc

Executi ve Secretary regarding$300.00 ~ D r. Ke rmon recom-whatever consul tants may beunder advisement and develop ato the legi sl ature. Dr. Kermon

reases include both FLEX andlatter fee may be increased toh as South Carolina.

Status of Hearin s and Pending Charges

The Board reviewed information regarding this matter. The Board of MedicalExaminers adopted a motion that Dr. Dalton be added to the list ofphysicians for whom a hearing officer has been suggested and that he benotified when a date, place, and hearing officer have been selected. Dr.Koontz volunteered to serve as hearing officer on hearings for which ahearing officer has been suggested.

Roger Neal Goodlin M. D. , Fayetteville, North Carolina

The Board of Medical Examiners of the State of North Carolina held ahearing concerning additional charges preferred against Roger NealGoodlin, M. D. , at 1:15 p. m. , Friday, October 14, 1983, at the RadissonPlaza Hotel, Raleigh, North Carolina, at which hearing Dr. Goodlin didnot appear but was represented by counsel. The Board unanimously adopteda motion that it finds these charges to be true and orders that thelicense to practice medicine in the state of North Carolina issued toDr. Goodlin be revoked.

Edwin Si ms Mize, Jr. , M. D ~ , Black Mountain, North Carolina

The Board of Medical Examiners of the State of North Carolina held a hearingconcerning charges preferred against Edwin Sims Mize, Jr. , M. D. , onFriday, October 14, 1983, at 4:00 p. m. , at the Radisson Plaza Hotel,Raleigh, North Carolina, at which hearing Dr. Mize appeared and was re-presented by counsel. The Board unanimously adopted a motion that it findsthe charges to be true and orders that the license to practice medicineissued to Edwin Sims Mize, Jr. , M. D. , be revoked.

William Nye Corpening, M. D. , Granite Falls, North Carolina

The Board adopted a motion that Dr. Corpening be issued a temporary licensefor a period of six months.

Report on Hearings Held on October 13, 1983

Dr. Koontz reported to the Board that the hearings scheduled for this datewere held and further stated he acted as Hearing Officer. Dry Koontzalso informed the Board that findings of fact and orders must be sent tothe respondents prior to presenting this information to the Board of MedicalExaminers. Dr. Pagter volunteered to serve as Hearing Officer for futurehearings as might be necessary.

Jeffrey R. MacDonald, M. D.

The Board reviewed a report that Dr. MacDonald surrendered his license topractice medicine in the state of North Carolina on October 12, 1983. TheBoard adopted a motion that this report be accepted as information.

Thomas Janney Rober ts, M. D. , Leesbui"g, Vi rgini a

The Board adopted a motion that. the proper procedures be insti tutedto prefer charqes aqainst Dr. Roberts, that he be so notified in writing,and that he be further noti fied he will be given a hearing on the chargespreferred agai'nst him, The Board adopted a further ration that thepossibility be discussed with the Board's attorney of including thishearing with the other hearings to be held before a hearing officer.

Lawrence Nelson Farrell, M. D. , Fort Collins, Colorado

The Board adopted a motion that the charges preferred against him bythe Board of Medical Examiners be wi thdrawn.

Ri chard D. Hamer, M. D. , Charlotte, North Carol dna

The Board adopted a motion that Dr. Hamer's temporary license be extended forone year.

Robert Leslie, M. D. , Application for Licensure Reinstatement

The Board adopted a motion that Dr. Leslie's request for reinstatementof his North Carolina medical license not be approved at this time.

Melvin Walter Webb, M. D. , Burnsville, North Carolina

The Board adopted a motion that Dr. Webb's license to practice medicinein the state of North Carolina be revoked.

Flex Exami'nation

There was a motion made to hold this examination once a year in June andthat a hearing be held to change the regulations. The Board adopteda moti'on that this motion be tabled,

Elton Kessel, M. D, , Chapel Hill ~North Carolina

The Board reviewed a request from this physician that he be. issued an un-restricted medical license. The Board adopted a motion that Dr, Kesselbe granted approval to practice medicine in Chapel Hill, North Caroling,rather than just at the University of North Carolina, but that thispractice be limited to preventive medicine and public health.

Temporary Licenses

The Board adopted a motion that a letter be sent out with each temporarylicense issued to house staff physicians stating that the license istemporary until such time as the physician furnishes the Board with apermanent North Carolina practice site and further stating that no housestaff physician without a definite North Carolina practice site willbe issued a full North Carolina medical license.

Donald Lew Bedney, M. D. , Fletcher, North Carolina

The Board adopted a motion that Dr, Bedney's temporary license not beextended.

Specialty Board Licensure Requirements

The Executive Secretary reported to the Board that he has received onlyone. response to inquiries he sent to all specialty boards. TheOB/Gyn Specialty Board responded that it will not accept temporary licensureas meeting its requirements to take the 08/Gyn Specialty Board examination.

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North Carolina Medical Society Executive Council Meeting Report

Dr. Sul 1 i van reported to Board members on this meeting.

1. The Executi ve Counci I agreed to support 1egi s1 at i on to enact a 1 I

revision of fees.

2. The Executive Council agreed to support legislation to requireone year postgraduate training prior to taking the FLEX examinationin North Carolina.

3. The Executive Council supported funding in the amount of $3, 000for printing medical-legal codes in book form to be presentedto each physician who receives a license in North Carolina andrequested the Board of Medical Examiners to distribute thesebooks and urge newly-licensed physicians to familarize themselveswith this information.

4. The Executive Council announced that George E. Moore who iscurrently on the staff of North Carolina State University willbe the new Executive Director of the North Carolina MedicalSociety and indicated that there will be a transition periodof six months prior to the new Executive Director's replacingMr. Hilliard.

August, 1984, Board Meeting

The Board adopted a motion that, if reservations can be confirmed at theRadisson in Raleigh, the Board meet there in August, 1984; and, ifreservations cannot be confi rmed at the Radisson, the Board meet at theSheraton Highwoods in Raleigh.

Southern Bell Request for an Opinion Regarding Physician Assistants' Advertising

The Board adopted a motion that physician assistants should not advertiseindependently.

Federation Transition Task Force

The Execut. i ve Seccomponents: (I)to test an indivi(2) Patient Mana

ability to practithat FLEX will stexamination shoul

retary reported to the Board that FLEX will have twoHiqh Impact Disease Processes and Problems designed

dual's ability to practice in a supervised setting andgement Problems which would better measure the individual'sce in an unsupervised setting. Mr. Paris also reportedill consist of a three day examination and the newd be finalized and in use in June, 1985.

Adjournment

As there was no further business to be considered by the Board of MedicalExaminers at this time, the President declared the meeting adjourned at 12:45p. m. , Sunday, October 16, 1983.

Frank No

BOARD OF MEDICAL EXAMINERS OF THE STATE OF NORTH CAROLINA

FNS:BDPjr;sl

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j' REQUIRED APPLICATION FOBl"1S AND ATTACHNENTS

I' APPLICATION FOR APPROVAL AS PHYSICIAN ASSISTANT

A. Completed application form. (All forms must be typewritten. )

B. Photocopy of certificate of completion of approved PA program. (Not applicable,if previously approved in N. C. and certificate already on file at Board's office. )

C. Three original letters of recommendation or character reference letters, addressedto the N. C. Board of Medical Examiners, preferably from last three employers as PA.(If previously approved, only one letter is required, a job evaluation in letter form,from most recent primary supervising physician. )

D. Fee of $50. 00 made payable to N. C. Board of Medical Examiners.

II. ADDITIONAL PRACTICE SITES — If applying for approval of additional practice sites underthe supervision of currently approved primary supervising physician, submit:

A. Letter of request signed by PA and primary supervising physician.

B. FORM 3 regarding address and supervision at new site.

C. Signatures of back-up supervising physicians, if new back-up supervi. sion isbeing added.

D. NO FEE REQUIRED.

CHANGE OF PRIMARY SUPERVISING PHYSICIAN ONLY — If applying for approval of a change ofprimary supervising physician, when that i.s the ONLY change being made in PA employment,submit the following information PRIOR TO the change occurring: (Contact the Board'soffice for correct forms. )

A. Information form regarding PA and supervising physicians.

B. Statement of Certification of Understanding and Compliance signed by primarysupervising physician and PA.

C. One current letter of recommendation, if letters on file in Board's office areolder than two (2) years. (Letters must be addressed to the N. C. Board of MedicalExaminers and bear original signatures. )

D. Fee of $50. 00 made payable to N. C. Board of Medical Examiners.t IV. ADDITIONAL SETTING UNDER ADDITIONAL PRIMARY SUPERVISING PHYSICIAN If applying forapproval of an addi. tional practice setting under the supervision of an additional primarysupervising physician (other than the primary physician already approved), submit:

A. Completed application form. (All forms must be typewritten. )

B. Letter from EACH primary supervising physician acknowledging to the Board that he isfamiliar with the PA's proposed practice arrangements with each physician.

C. Fee of $50. 00 made payable to N. C. Board of Medical Examiners.

V. ADDITIONAL BACK-UP SUPERVISING PHYSICIANS FOR APPROVED PRACTICE SITE — If adding new

back-up supervising physicians, contact the Board's office for correct form for thenew back-up physician to sign. Signatures of back-up physicians should be on file inthe Board's office before supervision of the PA occurs. (No fee require -)No fee re uired. )

VI. ANNUAZ. REGISTRATION — DUE JULY 1 — Notices will be mailed around June l to PAto PA at address

of practice site. If ANY changes have occurred in practice situation, no yotif Board'soffice.

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APPLICATION FOR APPROVAL OF PHYSICIAN ASSISTANT

Submit all material to: N. C. Board of Medical ExaminersSuite 214, 222 N. Person StreetRaleigh, North Carolina 27601(919) 833-5321

MEETING DATES AND DEADLINES

Completed application forms WITH ALL RE UIRED ATTACHMENTS must be received inthe office of the Board of Medical Examiners 15 DAYS PRIOR to the meetings:

December 2, 1983 (deadline Nov. 17)

January 19, 1984 (deadline Jan. 4)

March 15, 1984 (deadline Feb. 29)

May 3, 1984 (deadl ine April 18)

June 8, 1984 (deadline May 24)

August 9, 1984 (deadline July 25)

Instructions for Completing Application Forms

All applications must be typewritten.2. All addresses given must include PHYSICAL LOCATIONS (street, city,

zip code) as well as mailing address, if different.3. FORM 1 is to be completed by the PA applicant.4. FORM 2 is to be completed by the PRIMARY supervising physician.5. ALL physicians listed on FORM 2 (primary and back-up) must sign

FORM 4. If there are no back-up supervising physicians, FORM 4and FORM 5 must be signed by the primary supervising physicianand the PA applicant.

MATERIAL TO RETAIN ON FILE AT PA PRACTICE SITE

Material to keep on file in PA practice site in additionto standing orders and medical reference materials:

3.4.5.

6.7.

General information regarding submitting applica-tions (this page)

Regulations regarding physician assistants (Sub-chapter 32D)

Approved FormularyPhotocopy of submitted applicationCopy of correspondence sent and received regarding

approval processStatement of ApprovalInformation regarding dispensing of drugs (May beobtained from N. C. Board of Pharmacy, P.O. Box H,Carrboro, NC 27510, (919) 942-4454

A PA APPLICANT MAY FUNCTION BEFORE APPROVAL BY THE BOARD OF

MEDICAL EXAMINERS IN THE SAME MANNER HE FUNCTIONED AS A STUDENT,

BUT ACCORDING TO LAW MAY NOT BE IDENTIFIED AS A PHYSICIAN ASSIS-TANT. (See G. S. 90-18.1)

(Forms Revised 10/15/83)

SUBCHAPTER 32D —APPROVAL OF ASSISTANT TO PHYSICIAN

.000I DEFINITIONS —The term "board" as used herein refers to the Board of Medtcal Exammers of the State of North CarolinaThe term "secretary" as used herem refers to the Executive Secretary of the Board ol Medical Examiners of the State of North CarolinaThe term "assistant to a physician" as herem used refers to auxihary, paramedical personnel who are lunctiomng in a dependent relationship

with a physician hcensed by the board and who are performing tasks or combinations of tasks traditionally performed by (he physic»an himself Ex-amples of such tasks would include history taking, physical examination, and treatment, such as the application of a cast The regulations are notmtended to cover or tn any way pre)udice the activities of assistants not engaged in direct patient contact or the performance ol' assistants « ith taskswel)Mefined by statute or recognized custom of medical practice.

The term "applicant" as herein used refers to the assistant upon whose behall' an application is submittedThe term "supervision" is defined by the North Carolina Board of Medical Examiners as incorporating physician backup io assistants to physi-

cians performmg medical acts in the following ways(I) Contmuous availabihty of direct communications by radio, telephone or telecommunications,(2) The backup physician shall be available on a regularly scheduled basis for

(a) referra)s,(b) review of their practice between conferences incoiporating

(i) consultation,(ii) chart review and co-signing records to document accountability

(A) daily chart revie» except for situations that might be given individual consideration,(B) prescnbtng within that practice setting, standing orders and drug protocol lor interval bet»een confercttccs to be

part of this regular review and documentation,(»i) continuing education,

(3) A predetermined plan for emergency services

.0002 APPLICATION I Ok APPROVAL —Application tor approval ol an assistant must be made upon forms supplied by the hoard and must besubmitted by the physician with whom the assistant »ill work and «ho will assume responsibility lor the assistant's performance

Application forms submitted to the board must be completed in every detail Every supporting document required b) the application form mustbe submitted with each application

If for any reason an assistant discontinue~ working at the direction ot or under the supervision of the physician who subinitted the. ipplicationunder «hich the assitant ts approved. such assistant shall so inform the hoard and his approval shall terminate until such tiinc as a nc» .ipplication tssubmitted by the same or another physician and it ts approved by the hoard

When the proposed medical lunctions of an assistant to a physician shall include the prescrtbing ol drugs, the supervising (backup) physician andthe assistant shall review the lormulary approved by thc board, and shall acknowledge in the application to thc board that they arc familiar with theformulary and that such formulary «ill be a part of and incorporated in the approved standing orders Clianges in the formulary are to be approvedby the board In regard to changes, thc approved tormulary may include any over-the counter or non-prescnption drug

Prescnptions, except controlled substances, may upon spectlic orders ol'(he supervising physician given betore the prescription is issued bc «rit-ten and issued b) such assistant tor the use by patients of drugs «hich are not included in for formulary Such prescriptions shall be signed by theassistant with a notation thereon that the same was issued upon the specific order of the supervising physician For example Mary Sn»th, P A, onorder of John Poe, M D However, no prescription shall be written or issued by such assistant lor any drugs which arc spccttted as controlledsubstances under the Federal Controlled Substances Act

Assistants io physician~ who are approved to prescribe drugs as herein provided ~hall be assigned a number which shalt appear on all prescriptionsissued by such assistant The names and numbers of such assistants shall he recorded and transmitted to the North (.arulina Board of Pharmacy

.0003 Rk QUIRLMLNlb I Ok APPkOVAI —Before heing approved by ihe board to perform as an assistant to a ph&stctan. an applicant shall(I) be of good moral character and have sattsltcd the requirements of 2l N( AC 32D 0004 h«cot.(2) give evidence that he has su«cssl'»ll& completed, i iraining program recognized by the board under 2) NC AC 320 0003 hereof,

Initial approval may be denied for any ol the reasons set torth in I NC A(. 32D 0006, Paragraph (I), hcrcot, as grounds for termination of ap-proval, as well as for lailure to satisly the board of thc qualifications cited in Paragraph (l) of this Rule

in hearings held pursuant to this Rule, the board shall admii .ind hear evidence in the same manner and form as prescribed by la» tor civil ac-tions

.0004 MORAI E.klARACTI. R —Every applicant shall bc of goo(i moral iharacter, and the applicant shall have thc burden ot prosing that hc tspossessed oi' good moral character

All information turnished to the hoard b3 an applic, int and all ans»crs and questions upon (orms turnished by thc board shall bc dec»icdmaterial and such forms and information shall bc and become a permanent i«ord of thc board

All investigations in rcl'ercnce to the moral character ol' an applicant may be inlormal, but shall be thorough, »ith the oh)ect ol ascertaining thetruth Neither the hearsay rule nor any other technical rulc of ciidcnce need bc obscricd

Every applicant may be required to appear before thc board to hc cxamincd ahout any matter pertaining to hts moral character

.0005 REQUIRI MENTS FOR RLC.O(&NI I'ION Ol TRAININ(i PROCRAMN —Application for i ccognition of a training program by thc boardshall be made by letter and supporting documents trom the director of the program and must demonstrate to the satist'action of the board that suchprogram fulfills the requirements sct forth in the second through thc cighih paragrapli of this Rule (All physician assistant programs approicd bythe American Medical Assoctaiion Council on Medical Education are recognized by thc board )

The (raimng program must be sponsored by a college or uiiivci sity with appropriate arrangements for the clinical training of' its students, such asa hospital maintaining a teaching program There must he evidence that the program has education as its pnmary orientation and ob)ective

The program must be under the supervision of a qualified director, who has at hts disposal the resources of competent personnel adequately train-ed in the administration and operation ot educational programs

Adequate space, light and modern equipment must be provided for all necessary ieaching function~ A library, containing up-to-date textbooks,scientific periodicals, and reference material pertaining to clinical medicine, its underlying scientific disciplines. and its specialties, shall bc readilyaccessible to student~ and faculty

The curnculum inust provide adequate instruction in the basic sciences underlying the medical practice to provide the traincc with an understand-ing of the nature of disease processes and symptoms, abnormal test~, drug actions, etc This must be combined»ith instruction, observation andparticipation in hisiory taking, physical examination, therapeutic procedures, etc This should be in suflicient depth to cnablc the graduate to in-tegrate and organize histoncal and physical t indings 1 he didactic instruction shall folio» a planned and progressive outline and shall include an ap-propriate mixture of classroom lectures, textbook assignments, discussions, demonstrations. and similar activities instruction ~hall include prac-

t)cal mstruction and chnical experience under quahfied supervision suff)«tent to provide understanding of a skill in performing those clinical func-tions which the assistant may be asked to perform There must be sufficient evaluative procedures to assure adequate evidence of iompetenceAlthough the student may concentrate his effort and his interest m a particular spec)alty of medicine, the program must insure that he possesses abroad general understanding of medical practice and therapeutic techniques

Although some vanation may be possible for the mdividual student, dependent on aptitude, previous education, and expenence, the curriculumshall be designed to require two or more academic years for completion

The program must have a faculty competent to teach thc didactic and clinical mater)al which iompnses the curr)culum The laiulty shall includeat least one )nstru«tor who )s a graduate of medicine, hcensed to practice )n the location of the school, and whose training and exper)enie enable himto properly superv)sc progress and teaching in chnical sub)ects He shall be )n attendance for suff)ci«nt time to insure proper exposure ol' the stud«ntto clinical teaching and practice The program may util)zc instructors other than physicians, but suit)c)ent exposure to clinical medicine must beprovided to insure understanding of the patient, his problem, and the diagnostic and therapeutii responses to this problem

The program must, through appropriate entrance requirem«nts, insure that candidates accepted lor training possess ( I) abihty to usc sir)iten andspoken language in elfective communication v:ith physicians, pat)ents, and others, (2) qua(i()iation skills to insure proper calcu(at)on and inicr-pretation of tests, (3) behavioral characteristiis oi honesty and dependability, and (4) high ethical and moral standards in ord«r to sat cgudr J Ihc in-terest of patients and others

To retain its recognition by the board, a recognized progiam shall(a) make available to the board yearly summaries of case loads and cduiational aitiiities done b) cliniial affiliates, iniluding volume ot outpa-

tient visits, number of inpatients, and the operating budget,(b) maintain a satisfaitory rciord ol the entrance qualilications and evaluations of all work done by caih student, )ihiih shall bc availablc io thc

board, and(c) notify the board in wr)t)ng ol any ma)or ihang«s )n the iurriculum or a change )n Ihc Jireitorship of the program

Rc ognit)on ol a program may be withdrav n v h«11, In the opinion ol' thc board, the program tails to maintain the cduiational standards J«sirib-cd above When a program has not been in operation for a p«r)od ol tv o ionseiut)vc yedis. reiogn)(ion»)ll automatiidllv b««ithdrd»nWithdrav al of reiognition from a program»ill in no wa) affect the status of an assistant v ho grdJudtcd lrom suih program whil« it »ds r«iognIz«dand who has been approved by the hoard

.0006 TkRMINATION OI APPRO% AI. —The aPProval ol an Bss)stan) shall b« terminated by the board wh«n, alter duc notii«and hear)ng ii) di-cordanie «ith the proiis)ons ol this Rule. it shall tind(I) that thc assistant has held himself oui or p«rmiit«d another to r«present l)im as a licensed phys)i)an,(2) that the assistant hai )n laii pcrlormcd oth«r«)se than at thc Jireiiion ol or under the supervision ol a phys)i)Bi) liienscd by thc bodi J,(3) that thc appl)«ant has been rcquircd to pcr(0rm, or h,» pcrlormcd, a m«d)«al task or tasks, function or lunct)ons lor v hiih Ihc applll, ,)lli )i

not approicd or (or which th«appliidnt is not qual)l)«J by train»ig to p«rl'orm inilu ding prescribing or d)spcnsing ol drugs not inilud«d )nthe approved formulary,that the assistant is an habitual us«r ol intoiiiants or drugs to suih extent that hc is unable to p«rform ds an assistant to the ph) siii. iii,that the assistant has been ionviited in an& court, state or l«dcral, ol any lelony or other «rim)nal ollensc involvlllg mori)I iurpitud«,that the assistant has been adludicatcd a rn«nial iniomp«tent or «hose mental iondition renders him unahlc io sal'ely pcrforni as an ass)stan)to a physiiian, or

(7) that Ihe assistant lids lailcd to iomply with Bni Ol th«provisions ol 2l NC AC 32D NX)7 hcrcolBefore the board shall terminate Bpproi al granted by )110 dli Bsslsidl)i, II '» III glie to the assistant and to th«phs siiidn to «horn hc )i .)pproi «J d

wnt ten notice Indicating Ihe g«iicr il naiur«ot ihc ih irg«i, Bi«Usa)Ion, 01 iOU)pl lint preferred against him Bnd state thai the assistd»t v ill h«giici)an opportunity io hc heard coni«ming suih ihdrgcs or ioinplaints at a Iinic .ind plaic stated in suih not)i«, oi io b« iliircait«r lixed by th«bo)rd,and shall hold d public h«illllg «1th») a riasonable tim« I olio«ing suih h«dring, Ihc board shall Jcterin)n«on these rcguldt)ons «he(her thi dp-proial ol the assistant shall h« t«ri»indt«J

In hear)ngs held pursuani t0 this Rulc. th«boar J shall admit .inil li«ai «1)denie in the sam«manner and lorm as pr«sir)bed by la» tor i)nil, «-tions

.QQQ7 MkTHOI) OI Pl RI ORMANC I -- Ali asS)s)B))t inUSI iliarly Iilcllilti hlfllsi'lt, ls dli ass)stall( to a phyilild)1, a phys)iian ass)i)ant, Oi hs someOther apprOpridtC J«S)gnat)on, in 0) J«r t0)i)sur« tl)at h«)s nOt mistaken tOr d l)i«i»ed physi«)an Thii mdV h«ai«Ompliih«J, IOr «i,imp(«, hs th«wearing of an appropriat«nani« tdg

Thc ass)stan) must gencrdlli tunition iii rc,ison. ihl«proiiniity to th«phys)iidn Il h« is to pcrlorm duties d«d) (rom the rcsponsihlc phys)i)an,sUI.'h physiiian musi il«.irly spesif& io thc hoard thOsc iiriumsiani«s «hi«h «oulJ )ust)I& th)i aition and thc «rittcn poliiics «stahlish«J to prot«itthc pat)cnt

The Bs»stan) rn)ist h«pi«par«J IO J«monsir iiC upon r«qu«si iO, I m«nih«i Ot ih«bod)J Or iO i)th«r pci sons dcsignateJ bv Ih«hoard, his dbllli) )0perlorm th))s« tdsks .»sli'll«il IO hln1 bv his I«spoils)hi« t)hyii«)an

.000g I I I S —I e«ol t)ii& dollars (gsq (X)) must h«P iiJ,)t th« t)i))i of thi, )PPliiat))»i lor dPProi )I I i« loi dniiudl r«gistr ii)0n, Ju« lul) I, )s I«ndollars (I I0 (g))

,Q009 I ()RMS —1h« lol(0«)iig lorn)s O)ai b«s«iurid lrom thi Ollii«ol Ihc Board ol M«dii. il I:xdm)n«rs r«garJIOB dpprOi. )l loi .Iss)i)anti IOphysicians(I) Riilcs and R«gul, ))u)l)s I))l .)II Assistant io I I his)ilail,(2) Appliiution lor Approi, il .» .)ii As. istdnt to .i I'his)i)du,(3) I.ormulary,(4) Statement ot APP)oidl, UPO)1 hclllg BPPIo)«J,(5) Not)i« ol R«glstratlon,(6) ( «rtitiiat«OI R«g)s)r. llu)&), llp0)) r«glsl«rulg

APPROVED FORMULARYFOR THE WRITING OF PRESCRIPTIONS BY PERSONS APPROVED

TO PRESCRIBE DRUGS UNDER THE PROVISIONS G S 90.18 I a 9018 2

No controlled substances (Schedule 2. 2N. 3, 3N, 4. 5) defmed by the Federal Controlled Substances Act may be pre-scribed

No parenteral preparations (except Insuhnl may be prescr)bed

Any pure form or combination of the following generic classes of drugs may be prescribed, unless the drug or class ofdrug is listed as excluded from the formularv No drugs or classes of drugs that are excluded may be prescribed.

AiVTIHISTAMINFS

AI&&TI INFI CTIV E AGENTS

Drugs excluded under &h&x genenc catetoryAmebscides

—Carbarsome—fh&ndohvdroxyqu&n—F.metine—Glvcohiarxol

Chloramphenirol

OxanllinM&ni&rvcl&ne

Pedistnc TetrarvrlineClindsmyc&nPlsxmodindex

—Amodiaqu&ne—Chloroqu&ne—Hvdri&xvrhloroquine—Pr&maquine—Pvnmethamine

A VTI VKOPI. ASTI(' A( FNTS

All agents sre excluded uniler thir genenc cstegorv

AUTONOhlIC DRllGV

BLOOD FORMATI()N AND ('OAGULATION

Drugs excluded under this genenc categorvA ni i coag u lan t x

('ARDIOVASCUI. AR l)Rt'GS

CFNTRAL NKRVoti&& SY&&Tk:M DRUGS

Drugs excluded under this genenc csiegorvPxyrhotherapeuti& agentxAnt&deprevranixTrsnqu&l&rerxBensci v zineL&th&um

Resp&rctory 'StimulantsCerehral xt&mulantxSedat&ve» and hypnoticx

DIAGNOSTIC AGFNT i

FLKCTROLYTIC. CAI.ORIC AND WATER BAI.ANCE

ENZYh1KS

EXPECTORANTS AND COUGH PREPARATIONS

KYF KAR VOSF. AVD THROAT PRFPARATIONS

Drugs excluded under th&s genenc iategorvAnv preparation contmmng an excluded drug

(,ASTROINTKt&TINAI. DRUGS

klOR81OVFs AND SiYNTHk:TI(' i(JBSTITLJTKS

Drugs e&&eluded under this genenc categorvPara& hvroid hormones snd xvntheticxP&iuitary hormones snd vynthei&rs

OX YTO('ICh

All agent x sn excluded under th&s genenc categorv

R &&I)l()A('Tl t F A(IFNTS

All agents are excluded under th&r genenc categorv

SKIV AVD MU('OU i MFMBRANF PREPARATIONS

l)rugs exrlurled under &h&x genenc categorvAnv preparation conta&n&ng an excluded drug

SPAS%1OLYTIC AGENTS

V I T A Xl I V h

OTHER CRITERIA:

According to N. C. General Statute 90-18 I and 90-18.2, written standing orders must be used.

A prescription may not indicate a refill.

Every prescription must be entered on the patient's chart. A second prescription for the same medication may beauthorized by telephone and must be entered on the patient's chart and countersigned by the physician within 72hours.

Amount of drug can be no more than 100 dosage units or a one month supply

Rev. 8/81

( Re pl i n ted 10/1 5/83)

N. C. GENERAL STATUTES REGARDING PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS

Q 80-18 Practicing without license; practicing defined, penalties —No person shall practice medicine or surgery, or any of the branches thereof, nor in anycase prescnbe for the cure of diseases unless he shall have been first licensed and registered so to do in the manner provided in this Article, and if any personshall practice medicine or surgery without being duly hcensed and registered, as prosnded in this Article, he shall not be allowed to maintain any action tocollect any fee for such services The person so practicing without hcense shall be guilty of a misdemeanor, and upon conviction thereof shall be fined not lessthan fifty dollars ($50 00) nor more than one hundred dollars ($100 00), or impnsoned at the discretion of the court for each and every offense

Any person shall be regarded as practicing medicine or surgery within the meaning of this Article who shall diagnose or attempt to diagnose, treat or attemptto treat, operate or attempt to operate on, or prese nbe for or administer to, or profess to treat any human ailment, physical or mental, or any physical inlury to ordeformity of another person Provided, that the following cases shall not come within the definition above recited

(13) Any act, task or function performed by an assistant to a person licensed as a physician by the Board of Medical Examiners when

a Such assistant is approved by and annually registered with the assistant to a physician, except that no more than two assistants may be currentlyregistered for any physician, andb Such act, task or function is performed at the direction or under the supervision of such physician, in accordance with rules and regulationspromulgated by the Board, andc The serwces of the assistant are hmited to assisting the physician in the particular field or fields for which the assistant has been trained, approvedand registered,

Provided that this subdwi sion shall not limit or prevent any physician from delegating to a qualified person any acts, tasks or functions which are otherwisepermitted by law or established by custom(14) The practice of nursing by a registered nurse engaged in the practice of nursing and the performance of acts otherwise constituting medical practice

by a registered nurse when performed in accordance with rules and regulations developed by a loint subcommittee of the Board of Medical Examinersand the Board of Nursing and adopted by both boards

() 90-lg. l. Limitabons on physician assistants. —(a) Anyperson who is approved under the provisions of G S 90-(g (l3)to perform medical acts, tasks or functions as an assistant to aphysician may use the title "physician assistant "

Any otherperson who uses the title ln any form or holds out to be a physi-cian assistant or io be so approved, shall be deemed to be inviolation of this Article

(b) Physician assistants are authorized to wrue prescnpuonsfor drugs under the following conditions

(l) The Board of Medica( Examiners has adoptedregulations govermng the approval of individualphysician assistants io write prescnptlons with suchlimitations as the Board may determine to be in thebest interest of patient health and safety,

(2) The physician assistant has current approval fromthe Board,

(3) The Board of Medical Examiners has assigned anidentification number to the physician assistantwhich is shown on the wntten prescnption, and

(4) The supervising physician has provided to the physi-cian assistant wnt ten instructions about indicationsand contralndications for prescribing drugs and awritten pohcy for penodic review by the physician ofthe drugs prescnbed

(c) Physician assistants are authonzed to compound anddispense drugs under the followmg conditions

(1) The function is performed under the supervision of alicensed pharmacist, and

(2) Rules and regulations of the North Carolina Boardof Pharmacy governing this function are comphedwith

(d) Physician assistants are authonzed to order medicauons,tests and treatments ln hospitals, chmcs, nursmg homes andother health facihties under the following conditions

(l) The Board of Medical Examiners has adoptedregulations govermng the approval of individualphysician assistants to order medications, tests andtreatments with such hmitations as the Board maydetermine to be in the best interest of patient healthand safety,

(2) The physician assistant has current approval fromthe Board,

(3) The supervising physician has provided to the physi-cian assistant wntten instructions about ordenngmedlcatlons, tests and treatments, and when ap-propriate, specific oral or written instructions for anindividual patient, with provision for review bv thephysitnan of the order within a reasonable time, asdetermined by the Board, after the medication. testor treatment is ordered, and

(4) The hospital or other health facility has adopted awritten policy, approved by the medica( staff afterconsultation with the nursing administration, aboutordenng medicatlons. tests and treatments, in-cluding procedures for venf ication of the physicianassistants' orders by nurses and other facilityemployees and such other procedures as are in theinterest of patient health and safety

(e) Any prescription wntten by a physician assistant or ordergiven by a physician assistant for medications, tests ortreatments shall be deemed io have been authorized by thephysician approved by the Board as the supervisor of the physi-cian assistant and such supervising physician shall be responsi-ble for authonzing such prescription or order

(f) Any registered nurse or licensed practical nurse whoreceives an order from a physician assistant for medications,tests or treatments is authonzed to perform that order ln thesame manner as if it were received from a licensed physician

f) 90-18.2 Limitations on nurse practiboners. —(a) Anynurse approved under the provisions ot G S 90-(8 ((4) to per-form medical acts, tasks or tunctions may use the litle "nursepractitioner "

Any other person who uses the title in any formor holds out io be a nurse practitioner or to be so approved,shall be deemed to be in violation ot this Anicle

(b) Nurse practitioners are authonzed io wnte prescriptionsfor drugs under ihe following conditions

(l) The Board of Vledtcal Examiners and Board of Nur-sing have adopted regulations developed by a )ointsubcommittee governing the approval of' individualnurse practitioners io write prescriptions with suchlimitations as the boards may determine to be in ihebest interest of patient health and safety,

(2) The nurse practitioner has current approval from theboards.

(3) The Board of Vledtca( Examiners has assigned anidenufication number io the nurse practitionerwhich is shown on the wntten prescnption. and

(4) The supervising physician has provided to the nursepractitioner»rttten instructions about indicationsand contraindicatlons for prescribing drugs and awritten policy for periodic review bv the physician ofthe drugs prescribed

(c) Nurse practitioners are authorized io compound anddispense drugs under the following conditions

(1) The lunction is performed under the supervision of alicensed pharmacist, and

(2) Rules and regulations of the North Carolina Boardof Pharmacy governing this function are compliedwith

(d) Nurse practitioners are authonzed to order medications,tests and treatments in hospitals, chmcs, nursmg homes andother health fact(tttes under the following conditions

(I) The Board of Medical Examiners and Board of Nur-sing have adopted regulations developed by a )ointsubcommittee governing the approval of individualnurse practitioners to order medlcatlons, tests andtreatments with such limitations as the boards maydetermine to be in the best interest of patient healthand safety,

(2} The nurse practitioner has current approval from theboards,

(3) The supervising physician has provided to the nursepractitioner wntten instrucnons about ordenngmedications. tests and treatments, and when ap-propnate, specific oral or wntten instructions for anindividual patient, with provision for review by thephysituan of the order within a reasonable time, asdetermined by the Board, after the medication, testor treatment is ordered, and

(4) The hospital or health facility has adopted a wnttenpohcy, approved by the medical staff after consulta-tion wuh the nursing administration, about ordenngmedications, tests and treatments, mcludlng pro-cedures for venfication of the nurse practitioners'orders by nurses and other facility employees andsuch other procedures as are in the interest of patienthealth and safety

(e) Any prescnption written by a nurse practitioner or ordergiven by a nurse practitioner for medicaiions, tests ortreatments shall be deemed to have been authonzed by thephysician approved by the boards as the supervisor of the nursepractitioner and such supervlsmg physician shall be responsiblefor authonzing such prescnptlon or order

(f) Any registered nurse or hcensed practical nurse whoreceives an order from a nurse practitioner for medlcations,tests or treatments ls authonzcd to perform that order in thesame manner as if it were received from a licensed physician

APPLICATION FOR APPROVAL. OF; AN .ASSISTANT TO A PHYSICIANBY THE BOARD OF MEDICAL EXAMINERS OF THE STATE OF NORTH CAROL INA

.FORI'1 1

Name of PA applicant:

I-. ~ctice address:street city zip code

Residence address:street city zip code

Birthplace: Birthdate:

Education: (Give location, attendance dates, number of years at each school, degrees,diplomas, or certificates earned. )

High School

College

PA ProgramAttach photocopy of certificate of completion of PA program.

Previous Occupations: (Include name and address of employer, dates of employment and briefjob description. Use reverse side of this form, if necessary. )

Also required are letters of recommendation and $50 fee. (See direction page for details. )

Circle the answer to the following questions. If you answer "yes" to any of the questions,attach a detailed explanation.

YES NO 1. Have you ever been charged with violation of a federal, state, or locallaw other than minor traffic violations?

YES NO 2. Have you ever had any difficulty with a medical licensing board?

YES NO 3. Have you ever personally used or consumed any controlled substanceother than those prescribed by a physician or dentist?

YES NO 4. Have you ever used alcohol to excess that has affected your abilityto perform medical acts as a physician assistant?

YES NO 5. Have you ever had or been requested to have a psychiatric evaluationor therapy?

YES NO 6. Have you ever or are you now being sued regarding malpractice?

YES NO 7. Are you aware of any investigation conducted of you by any governmentalagency?

I hereby certify that I have read carefully and do understand the regulationsfor an assistant to a physician and the formulary adopted by the North Carolina Board ofMedical Examiners and agree to comply with same.

Date PA Applicant

'SUPERVISING PHYSiCIANS FORM 2

I. PRIMARY SUPERVISING PHYSICIAN (To be completed by physician who assumes fulladministrative and ~supervisory responsibility)

A. Full name

8. Physician's specialty NC Medical License g

C. Name of physician's practice

D. Address of physician's practice (street, city, zip code)

E. Type of practice (family practice, surgery, etc. )

F. Telephone (offi ce) (home)

p pof other physician assistants and/or nurse practitioners?If yes, list names below.

noyesG. Does rimar h sician named above have rimar re onsibility for the supervision

H. Do other physician assistants and/or nurse practitioners under the primary super-vision of other~ physicians work in this practice site? ~es noIf yes, list names below.

II. BACK-UP SUPERVISING PHYSICIANS (To be completed with information regarding allphysicians who will serve as back-up for the primary physician's supervision of thePA. If more than three, provide information on separate sheet; if none, completeFORM 5. )

A. Full Name

Office Address

Telephone (office) (home)

Specialty

B. Full Name

NC Medical License b

Office Address

Telephone (office (home)

Spec i a 1 ty NC Medical License 4

C. Full Name

Office Address

Telephone (office) (home)

Specialty NC Medical License 8

UTILIZATION OF PA FORM 5

I. PRACTICE LOCATIONS

List ALL locations where PA will function, including name of practice, physicallocation (street, city, zip) and mailing address, if different.

I I . SUPERVISION

A. "If the PA is to perform duties away from the responsible physician, thephysician must clearly specify to the Board those circumstances which wouldjustify this action and the written policies established to protect thepatient. " (See regulation .0007, paragraph 2. )

1. Mill the PA perform medical acts when the responsible physician is noton site? ~es no

If yes, describe situations in which this might occur and the back-upsupervisory arrangements.

2. Indicate standing orders on file in PA practice site covering most commonlyencountered problems. (See G. S. 90-18.1) Check appropriate blank below:

a. Published volume (give name)

b. Individually designed standing orders

B. Chart review and countersigning by the supervising physician is required within24 HOURS of PA/patient contact, unless request for specific consideration isreceived, giving full explanation of circumstances. (See regulation .0001(2)(b)(11)(A).

CERTIFICATION OF UNDERSTANDING AND COMPLIANCE FORM 4

Each of the undersigned has read this application and certifies that theinformation herein is correct to the best of his/her knowledge.

Each of the undersigned further certifies that he/she has read carefullyand understands the statutes and regulations regarding physician assistantsand the Approved Formulary adopted by the Board of Medical Examiners. Suchstatutes, regulations and formulary will be fully complied with by the under-signed.

EACH UNDERSIGNED PHYSICIAN ACCEPTS RESPONSIBILITY FOR THE APPLICANT'S CONDUCTAS A PHYSICIAN ASSISTANT UNDER HIS/HER SUPERVISION AND UNDERSTANDS THAT CONDUCTWHICH VIOLATES THE LAWS AND REGULATIONS GOVERNING PHYSICIAN ASSISTANTS MAY SUB-JECT THE SUPERVISING PHYSICIAN TO SANCTIONS INCLUDING SUSPENSION OR REVOCATIONOF THE PHYSICIAN'S LICENSE TO PRACTICE MEDICINE IN NORTH CAROLINA.

Date Primary Supervising Physician, M. D.

Date Back-up Supervising PhysicianM. D.

Date Back-up Supervising Physician, M. D.

Date Back-up Supervising PhysicianM. D.

Date PA Applicant

(All physicians listed on FORM 2 must sign this form. Use additional page ifnecessary. If there will be no back-up supervising physicians, the primarysupervising physician and the PA applicant must sign this form and FORM 5. )

NO BACK-UP SUPERVISING PHYSICIANS- FORN 5

Since there will be no additional or back-up supervising physicians in this

practice, the physician assistant will not perform medical acts unless the

primary supervising physician is available for supervision as outlined in

the application.

Date Primary Supervising PhysicianM. D.

Date PA Applicant

(DO NOT SIGN THIS FORM, FORM 5, IF BACK-UP SUPERVISING PHYSICIANS ARE LISTED

ON FORM 2 AND HAVE SIGNED FORM 4.