Current through Register Vol. 51, No. 19, September 20, 2024
A. Before a physician may delegate medical
acts and before a physician assistant may perform medical acts, the physician
assistant and primary supervising physician shall file with the Board:
(1) A delegation agreement on the
Board-approved form; and
(2) The
required fee as specified in Regulation .16 of this chapter.
B. The delegation agreement shall
include the following information:
(1) The
primary supervising physician's Maryland license number;
(2) A description of the supervising
physician's qualifications to supervise a physician assistant;
(3) The physician assistant's Maryland
license number;
(4) The location
and settings where the physician assistant will practice;
(5) The scope of the primary and alternate
physicians' practices;
(6) The
delegated medical acts which the physician assistant will perform, including:
(a) Core duties; and
(b) Any advanced duties;
(7) A description of the continuous
supervision mechanisms that the primary supervising physician will
use;
(8) A description of how the
physician assistant's performance will be evaluated; and
(9) Any other information deemed necessary by
the Board to carry out the provisions of Health Occupations Article, Title 15,
Annotated Code of Maryland.
C. The primary supervising physician shall
make the following attestations as a part of the delegation agreement:
(1) All medical acts to be delegated to the
physician assistant are within the scope of practice of the primary or
alternate supervising physician and appropriate to the physician assistant's
education, training, and level of competence;
(2) The primary supervising physician will
utilize the mechanisms of continuous supervision as described in the delegation
agreement;
(3) The primary
supervising physician will accept responsibility for any care given by the
physician assistant;
(4) The
primary supervising physician will respond in a timely manner when contacted by
the physician assistant;
(5) The
primary supervising physician may not supervise more than four physician
assistants at any one time, except as permitted in a:
(a) Hospital;
(b) Correctional facility;
(c) Detention center; or
(d) Public health facility; and
(6) The following statement: The
primary supervising physician and the physician assistant attest that:
(a) They will establish a plan for the types
of cases that require a physician plan of care or require that the patient
initially or periodically be seen by the supervising physician; and
(b) The patient will be provided access to
the supervising physician on request.
D. Except as provided in §E of this
regulation, if a delegation agreement includes delegation of one or more
advanced duties, the delegation agreement shall include the following
additional information and documentation:
(1)
In a special facility:
(a) A description of
the advanced duty and the education, training, and experience that qualifies
the physician assistant to perform the advanced duty; and
(b) A copy of the approved delineation of
duties from the governing board of the health care facility stating that the
physician assistant has been approved by the facility to perform the advanced
duty; or
(2) In a
setting other than a special facility:
(a) A
description of the advanced duties to be delegated;
(b) Documentation of the specialized
education, training, or experience received by the physician assistant in order
to perform the advanced duties;
(c)
The level of supervision that the primary supervising physician will use when
the physician assistant is performing the advanced duty; and
(d) Documentation described in of Regulation
.06F of this chapter if the delegation agreement includes a request for a
temporary practice letter allowing the physician assistant to perform an
advanced duty before approval by the Board.
E. If a delegation agreement includes the
delegation of general anesthesia or neuroaxial anesthesia, the delegation
agreement shall include all of the information specified in §D(2) of this
regulation.
F. A physician assistant
who has filed a delegation agreement with the Board for approval to perform the
advanced duty of nonfluoroscopic X-ray procedures using a mini C-arm or similar
low-level radiation machine shall present the Board with evidence of completion
of a course on those procedures. The required course shall include:
(1) Didactic instruction of at least 8 hours
on the following subject matters:
(a)
Principles of radiography;
(b)
Image acquisition;
(c) Principles
of exposure;
(d) Image
evaluation;
(e) Radiation
safety;
(f) Equipment overview;
and
(g) Documentation;
and
(2) Clinical
instruction, which shall:
(a) Include
anterior-posterior and lateral radiographic studies of extremities, not
including the head, on at least 20 separate patients; and
(b) Be under the direct supervision of the
delegating physician or radiologist.
