Current through all regulations passed and filed through September 16, 2024
In order to practice within the minimal standards of care when
recommending treatment with medical marijuana, a physician shall comply with
all of the following requirements:
(A)
The physician shall establish and maintain a bona fide physician-patient
relationship with the patient for the provision of medical services that is
established through an examination of the
patient by the physician either in-person
or through the use of
telehealth services that complies with this rule and for which there is
an expectation that the physician will provide care to the patient on an
ongoing basis.
(B) The physician
shall create and maintain a medical record that documents the provision of
medical services. The documentation shall include all of the following:
(1) Patient's name and date or dates of
office or telehealth visits or
treatments;
(2) A description of
the patient's current medical condition;
(3) Documented assessment of the patient's
medical history, including relevant prescription history and any history of
substance use disorder;
(4)
Documented review of any available relevant diagnostic test results;
(5) Documented review of prior treatment and
the patient's response to the treatment;
(6) Documented review of the patient's
current medication to identify possible drug interactions, including
benzodiazepines and opioids.
(7)
Documented review that standard medical treatment has been attempted or
considered. If standard medical treatment is not attempted, the physician must
document the reasons that standard medical treatment is not appropriate for
this patient;
(8) Based on evidence
or behavioral indications of addiction or drug abuse, the physician may obtain
a drug screen on the patient. It is within the physician's discretion to decide
the nature of the screen and which type of drug to be screened;
(9) The physician's performance of
an
appropriate examination relevant to the patient's current medical
condition;
(10) The physician's
diagnosis of the patient's medical condition; and
(11) If the patient has been previously
diagnosed with a qualifying medical condition as defined in section
3796.01 of the Revised Code, by
a physician licensed to practice medicine under section
4731.14
,
4731.11, or
4731.299
of the Revised
Code, the physician may confirm the diagnosis so long as the physician obtains
a copy of the medical records or a detailed written summary indicating the
diagnosis and the physician is satisfied that he or she can rely on those
records to confirm diagnosis of a qualifying condition. The practitioner shall
maintain a copy of any record or report of any physician on which the physician
relied for purposes of meeting the requirements under this paragraph.
(C) If the physician diagnoses or
confirms the diagnosis of a qualifying medical condition, as that term is
defined in section 3796.01 of the Revised Code, the
physician shall document in the medical record compliance with all of the
following actions when recommending treatment with medical marijuana:
(1) Development of a treatment plan,
including consideration of whether treatment with medical marijuana is
complementary to standard medical treatment.
(2) The review of the report concerning the
patient obtained from the drug database established and maintained by the board
of pharmacy pursuant to section
4729.75 of the Revised Code. The
report shall cover at least the twelve months immediately preceding the date of
the report.
(3) Discussion with the
patient regarding any indicators of possible abuse or diversion of controlled
substances that are reflected on the drug database report obtained from the
board of pharmacy.
(4) The
explanation of the risks and benefits of treatment with medical marijuana as it
pertains to the patient's qualifying medical condition and medical
history.
(5) The patient's consent
prior to completing a recommendation for treatment with medical marijuana. If
the patient is a minor, the physician shall obtain the consent of the patient's
parent or legal representative prior to completing a recommendation for
treatment with medical marijuana for the patient.
(6) Whether the patient needs a caregiver to
assist in the use or administration of medical marijuana. If the patient needs
a caregiver, the physician shall document the name of the caregiver designated
by the patient or the patient's legal representative.
(D) In recommending treatment with medical
marijuana, the physician or the physician's delegate shall determine from the
medical marijuana patient registry maintained by the division of marijuana control
whether the patient has an active registration for medical marijuana.
(1) If the patient is not registered or if
the patient's registration will expire within thirty days, the physician or
physician's delegate shall submit the patient's application for registration or
renewal in compliance with the requirements of section
3796.08
of the Revised
Code and the rules of the division of marijuana control
adopted under section
3796.03
of the Revised
Code.
(2) The recommendation for
treatment with medical marijuana shall include a statement from the physician
certifying the following:
(a) A bona fide
physician-patient relationship exists between the physician and
patient;
(b) The patient has been
diagnosed with at least one qualifying medical condition;
(c) Description of the qualifying medical
condition(s) and indication whether the qualifying condition is a terminal
illness for which the patient has a life expectancy of six months or
less;
(d) The physician or
physician's delegate has requested from the drug database a report of
information related to the patient that covers at least the twelve months
immediately preceding the date of the report; and
(e) The physician has informed the patient of
the risks and benefits of medical marijuana as it pertains to the patient's
qualifying medical condition and medical history.
(E) A physician who recommends
treatment with medical marijuana shall be available to provide follow-up care
and treatment to the patient, including appropriate
examinations relevant to the patient's condition to determine the efficacy of
medical marijuana in treating the patient's qualifying medical condition. If
the qualifying condition was indicated as a terminal illness in the prior six
months, the physician shall confirm whether the patient's condition continues
to be a terminal illness.
(F) The
physician shall terminate or decline to issue a new recommendation for medical
marijuana under any of the following circumstances:
(1) The patient no longer has the diagnosis
of or symptoms of the qualifying medical condition.
(2) The physician no longer has a valid
certificate to recommend medical marijuana.
(3) Based on the physician's clinical
judgement, the patient or caregiver is abusing or diverting medical
marijuana.
(4) The patient is
deceased.
(G) The
records required for the recommendation of medical marijuana may be kept with
the patient's other medical records and shall be retained for at least three
years following the last visit by
the patient.
(H) The physician
shall submit to the board an annual report describing the physician's
observations regarding the effectiveness of medical marijuana in treating
patients. The report shall not contain patient-identifying
information.
