Part II. Requirements for Practitioners and Patients
18VAC110-60-30. Requirements for practitioner issuing a certification.
A. Prior to issuing a certification for cannabis products for any diagnosed condition or disease, the practitioner shall meet the requirements of § 54.1-3408.3 of the Code of Virginia, shall submit an application and fee as prescribed in 18VAC110-60-20, and shall be registered with the board.
B. A practitioner issuing a certification shall:
1. Conduct an assessment and evaluation of the patient in order to develop a treatment plan for the patient, which shall include an examination of the patient and the patient's medical history, prescription history, and current medical condition;
2. Diagnose the patient;
3. Be of the opinion that the potential benefits of cannabis products would likely outweigh the health risks of such use to the qualifying patient;
4. Authorize on the written certification the use of botanical cannabis for a minor patient if the practitioner determines such use is consistent with the standard of care to dispense botanical cannabis to a minor. If not specifically included on the initial written certification, authorization for botanical cannabis may be communicated verbally or in writing to the pharmacist at the time of dispensing;
5. Explain proper administration and the potential risks and benefits of the cannabis product to the qualifying patient and, if the qualifying patient lacks legal capacity, to a parent or legal guardian prior to issuing the written certification;
6. Be available or ensure that another practitioner, as defined in § 54.1-3408.3 of the Code of Virginia, is available to provide follow-up care and treatment to the qualifying patient, including physical examinations, to determine the efficacy of cannabis products for treating the diagnosed condition or disease;
7. Comply with generally accepted standards of medical practice, except to the extent such standards would counsel against certifying a qualifying patient for cannabis products;
8. Maintain medical records in accordance with 18VAC85-20-26 for all patients for whom the practitioner has issued a certification; and
9. Access or direct the practitioner's delegate to access the Virginia Prescription Monitoring Program of the Department of Health Professions for the purpose of determining which, if any, covered substances have been dispensed to the patient.
C. The practitioner shall use his professional judgment to determine the manner and frequency of patient care and evaluation, which may include the use of telemedicine, provided that the use of telemedicine:
1. Includes the delivery of patient care through real-time interactive audio-visual technology;
2. Conforms to the standard of care expected for in-person care; and
3. Transmits information in a manner that protects patient confidentiality.
D. A practitioner shall not delegate the responsibility of diagnosing a patient or determining whether a patient should be issued a certification. Employees under the direct supervision of the practitioner may assist with preparing a certification, so long as the final certification is approved and signed by the practitioner before it is issued to the patient.
E. The practitioner shall provide instructions for the use of cannabis products to the patient, parent, or guardian, as applicable, and shall also securely transmit such instructions to the permitted pharmaceutical processor.
F. Upon request, a practitioner shall make a copy of medical records available to an agent of the Board of Medicine or Board of Pharmacy for the purpose of enabling the board to ensure compliance with the law and regulations or to investigate a possible violation.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-40. Prohibited practices for practitioners.
A. A practitioner who issues certifications shall not:
1. Directly or indirectly accept, solicit, or receive anything of value from any person associated with a pharmaceutical processor or provider of paraphernalia, excluding information on products or educational materials on the benefits and risks of cannabis products;
2. Offer a discount or any other thing of value to a qualifying patient, parent, guardian, or registered agent based on the patient's agreement or decision to use a particular pharmaceutical processor or cannabis product;
3. Examine a qualifying patient for purposes of diagnosing the condition or disease at a location where cannabis products are dispensed or produced; or
4. Directly or indirectly benefit from a patient obtaining a certification. Such prohibition shall not prohibit a practitioner from charging an appropriate fee for the patient visit.
B. A practitioner who issues certifications, and such practitioner's coworker, employee, spouse, parent, or child, shall not have a direct or indirect financial interest in a pharmaceutical processor, a cannabis dispensing facility, or any other entity that may benefit from a qualifying patient's acquisition, purchase, or use of cannabis products, including any formal or informal agreement whereby a pharmaceutical processor or other person provides compensation if the practitioner issues a certification for a qualifying patient or steers a qualifying patient to a specific pharmaceutical processor or cannabis product.
C. A practitioner shall not issue a certification for himself or for family members, employees, or coworkers.
D. A practitioner shall not provide product samples containing cannabis other than those approved by the U.S. Food and Drug Administration.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-50. Registration of a patient, parent, legal guardian, or registered agent.
A. A qualifying patient for whom a practitioner has issued a certification shall register with the board in accordance with this section. If the qualifying patient is a minor or an incapacitated adult, the qualifying patient's parent or legal guardian shall register with the board in accordance with this section. For a registration application to be considered complete, the following items shall be submitted:
1. A copy of the certification issued by a registered practitioner;
2. Proof of residency of the qualifying patient and proof of residency of a parent or legal guardian, if applicable, such as a government-issued identification card or tax receipt or proof of temporary residency, if applicable, such as a current academic identification card from a Virginia institution of higher learning, rental agreement, utility bill, or attestation on a form prescribed by the board that contains information sufficient to document temporary residency in Virginia;
3. Proof of identity of the qualifying patient and, if the patient is a minor, proof of identity of the parent or legal guardian in the form of a government-issued identification card;
4. Proof of the qualifying patient's age in the form of a birth certificate or other government-issued identification;
5. Payment of the appropriate fees; and
6. Such other information as the board may require to determine the applicant's suitability for registration or to protect public health and safety.
B. A patient, or the patient's parent or legal guardian, may choose a registered agent to receive cannabis products on behalf of the patient. An individual may serve as a registered agent for no more than two registered patients. For a registration application to be approved, the following shall be submitted:
1. The name, address, birthdate, and registration number of each registered patient for whom the individual intends to act as a registered agent;
2. Proof of identity in the form of a copy of a government-issued identification card;
3. Payment of the applicable fee; and
4. Such other information as the board may require to determine the applicant's suitability for registration or to protect public health and safety.
C. A qualifying patient shall not be issued a written certification by more than one practitioner during a given time period.
D. Patients, parents, legal guardians, and registered agents issued a registration shall carry their registrations with them whenever they are in possession of cannabis products.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-60. Denial of a qualifying patient, parent, legal guardian, or registered agent registration application.
A. The board may deny an application or renewal of the registration of a qualifying patient, parent, legal guardian, or registered agent if the applicant:
1. Does not meet the requirements set forth in law or regulation or fails to provide complete information on the application form;
2. Does not provide acceptable proof of identity, residency or temporary residency, or age of the patient to the board;
3. Provides false, misleading, or incorrect information to the board;
4. Has had a qualifying registration of a qualifying patient, parent, legal guardian, or registered agent denied, suspended, or revoked by the board in the previous six months;
5. Has a certification issued by a practitioner who is not authorized to certify patients for cannabis products; or
6. Has a prior conviction of a violation of any law pertaining to controlled substances.
B. If the board denies an application or renewal of a qualifying patient, parent, legal guardian, or registered agent applicant, the board shall provide the applicant with notice of the grounds for the denial and shall inform the applicant of the right to request a hearing pursuant to § 2.2-4019 of the Code of Virginia.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-70. Reporting requirements for practitioners, patients, parents, legal guardians, or registered agents.
A. A practitioner shall report to the board, on a form prescribed by the board, the death of a registered patient or a change in status involving a registered patient for whom the practitioner has issued a certification if such change affects the patient's continued eligibility to use cannabis products or the practitioner's inability to continue treating the patient. A practitioner shall report such death, change of status, or inability to continue treatment not more than 15 days after the practitioner becomes aware of such fact.
B. A patient, parent, or legal guardian who has been issued a registration shall notify the board of any change in the information provided to the board not later than 15 days after such change. The patient, parent, or legal guardian shall report changes that include a change in name, address, contact information, medical status of the patient, or change of the certifying practitioner. The patient, parent, or legal guardian shall report such changes on a form prescribed by the board.
C. A registered agent who has been issued a registration shall notify the board of any change in the information provided to the board not later than 15 days after such change, to include a change in the identifying information of the patient for whom he is serving as a registered agent.
D. If a patient, parent, legal guardian, or registered agent notifies the board of any change that results in information on the registration of the patient, parent, legal guardian, or registered agent being inaccurate, the board shall issue a replacement registration. Upon receipt of a new registration, the qualifying patient, parent, legal guardian, or registered agent shall destroy in a nonrecoverable manner the registration that was replaced.
E. If a patient, parent, legal guardian, or registered agent becomes aware of the loss, theft, or destruction of the registration of such patient, parent, legal guardian, or registered agent, the registrant shall notify the board not later than five business days after becoming aware of the loss, theft, or destruction, and submit the fee for a replacement registration. The board shall inactivate the initial registration upon receiving such notice and issue a replacement registration upon receiving the applicable fee, provided the applicant continues to satisfy the requirements of law and regulation.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-80. Proper storage and disposal of cannabis products by patients, parents, legal guardians, or registered agents.
A. A registered patient, parent, legal guardian, or registered agent shall exercise reasonable caution to transport and store cannabis products in a manner to prevent theft, loss, or access by unauthorized persons.
B. A registered patient, parent, legal guardian, or registered agent shall dispose of all usable cannabis products in possession of the registered patient, parent, legal guardian, or registered agent no later than 10 calendar days after the expiration of the patient's registration if such registration is not renewed, or sooner should the patient no longer wish to possess cannabis products. A registered patient, parent, legal guardian, or registered agent shall complete such disposal by one of the following methods:
1. By removing the product from the original container and mixing it with an undesirable substance such as used coffee grounds, dirt, or kitty litter. The mixture shall be placed in a sealable bag, empty can, or other container to prevent the drug from leaking or breaking out of a garbage bag.
2. By transferring it to law enforcement via a medication drop-box or drug take-back event if permissible under state and federal law.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.
18VAC110-60-90. Revocation or suspension of a qualifying patient, parent, legal guardian, or registered agent registration.
The board may revoke or suspend the registration of a registrant (i.e., a patient, parent, legal guardian, or registered agent) under the following circumstances:
1. The patient's practitioner notifies the board that the practitioner is withdrawing the written certification submitted on behalf of the patient, and 30 days after the practitioner's withdrawal of the written certification, the patient has not obtained a valid written certification from a different practitioner;
2. The registrant provided false, misleading, or incorrect information to the board;
3. The registrant is no longer a resident of Virginia or is no longer temporarily residing in Virginia;
4. The registrant obtained more than a 90-day supply of cannabis products in a 90-day period;
5. The registrant provided or sold cannabis products to any person, including another registrant;
6. The registrant permitted another person to use the registration of the registrant, except as required for a registered agent to act on behalf of a patient;
7. The registrant tampered, falsified, altered, modified, or allowed another person to tamper, falsify, alter, or modify the registration of the registrant;
8. The registration of the registrant was lost, stolen, or destroyed, and the registrant failed to notify the board or notified the board of such incident more than five business days after becoming aware that the registration was lost, stolen, or destroyed;
9. The registrant failed to notify the board of a change in registration information or notified the board of such change more than 15 days after the change; or
10. The patient, parent, or legal guardian violated any federal or state law or regulation.
Statutory Authority
§§ 54.1-3442.6 and 54.1-3447 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019; amended, Virginia Register Volume 37, Issue 1, eff. September 30, 2020; Volume 37, Issue 25, eff. September 1, 2021.