Part II. Standards of Professional Conduct
18VAC85-20-25. Treating and prescribing for self or family.
A. Treating or prescribing shall be based on a bona fide practitioner-patient relationship, and prescribing shall meet the criteria set forth in § 54.1-3303 of the Code of Virginia.
B. A practitioner shall not prescribe a controlled substance to himself or a family member, other than Schedule VI as defined in § 54.1-3455 of the Code of Virginia, unless the prescribing occurs in an emergency situation or in isolated settings where there is no other qualified practitioner available to the patient, or it is for a single episode of an acute illness through one prescribed course of medication.
C. When treating or prescribing for self or family, the practitioner shall maintain a patient record documenting compliance with statutory criteria for a bona fide practitioner-patient relationship.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-26. Patient records.
A. Practitioners shall comply with the provisions of § 32.1-127.1:03 of the Code of Virginia related to the confidentiality and disclosure of patient records.
B. Practitioners shall provide patient records to another practitioner or to the patient or the patient's personal representative in a timely manner in accordance with provisions of § 32.1-127.1:03 of the Code of Virginia.
C. Practitioners shall properly manage patient records and shall maintain timely, accurate, legible, and complete patient records.
D. Practitioners shall maintain a patient record for a minimum of six years following the last patient encounter with the following exceptions:
1. Records of a minor child, including immunizations, shall be maintained until the child reaches the age of 18 or becomes emancipated, with a minimum time for record retention of six years from the last patient encounter regardless of the age of the child;
2. Records that have previously been transferred to another practitioner or health care provider or provided to the patient or the patient's personal representative; or
3. Records that are required by contractual obligation or federal law to be maintained for a longer period of time.
E. Practitioners shall post information or in some manner inform all patients concerning the timeframe for record retention and destruction. Patient records shall only be destroyed in a manner that protects patient confidentiality, such as by incineration or shredding.
F. When a practitioner is closing, selling, or relocating his practice, he shall meet the requirements of § 54.1-2405 of the Code of Virginia for giving notice that copies of records can be sent to any like-regulated provider of the patient's choice or provided to the patient.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005; amended Virginia Register Volume 35, Issue 24, eff. September 16, 2019.
18VAC85-20-27. Confidentiality.
A. A practitioner shall not willfully or negligently breach the confidentiality between a practitioner and a patient. A breach of confidentiality that is required or permitted by applicable law or beyond the control of the practitioner shall not be considered negligent or willful.
B. Unauthorized use or disclosure of confidential information received from the Prescription Monitoring Program shall be grounds for disciplinary action.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005; amended, Virginia Register Volume 26, Issue 22, eff. August 4, 2010.
18VAC85-20-28. Practitioner-patient communication; termination of relationship.
A. Communication with patients.
1. Except as provided in § 32.1-127.1:03 F of the Code of Virginia, a practitioner shall accurately inform a patient or his legally authorized representative of his medical diagnoses, prognosis and prescribed treatment or plan of care. A practitioner shall not deliberately make a false or misleading statement regarding the practitioner's skill or the efficacy or value of a medication, treatment, or procedure prescribed or directed by the practitioner in the treatment of any disease or condition.
2. A practitioner shall present information relating to the patient's care to a patient or his legally authorized representative in understandable terms and encourage participation in the decisions regarding the patient's care.
3. Before surgery or any invasive procedure is performed, informed consent shall be obtained from the patient in accordance with the policies of the health care entity. Practitioners shall inform patients of the risks, benefits, and alternatives of the recommended surgery or invasive procedure that a reasonably prudent practitioner in similar practice in Virginia would tell a patient.
a. In the instance of a minor or a patient who is incapable of making an informed decision on his own behalf or is incapable of communicating such a decision due to a physical or mental disorder, the legally authorized person available to give consent shall be informed and the consent documented.
b. An exception to the requirement for consent prior to performance of surgery or an invasive procedure may be made in an emergency situation when a delay in obtaining consent would likely result in imminent harm to the patient.
c. For the purposes of this provision, "invasive procedure" means any diagnostic or therapeutic procedure performed on a patient that is not part of routine, general care and for which the usual practice within the health care entity is to document specific informed consent from the patient or surrogate decision maker prior to proceeding.
4. Practitioners shall adhere to requirements of § 32.1-162.18 of the Code of Virginia for obtaining informed consent from patients prior to involving them as subjects in human research with the exception of retrospective chart reviews.
B. Termination of the practitioner/patient relationship.
1. The practitioner or the patient may terminate the relationship. In either case, the practitioner shall make a copy of the patient record available, except in situations where denial of access is allowed by law.
2. Except as provided in § 54.1-2962.2 of the Code of Virginia, a practitioner shall not terminate the relationship or make his services unavailable without documented notice to the patient that allows for a reasonable time to obtain the services of another practitioner.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-29. Practitioner responsibility.
A. A practitioner shall not:
1. Knowingly allow subordinates to jeopardize patient safety or provide patient care outside of the subordinate's scope of practice or area of responsibility. Practitioners shall delegate patient care only to subordinates who are properly trained and supervised;
2. Engage in an egregious pattern of disruptive behavior or an interaction in a health care setting that interferes with patient care or could reasonably be expected to adversely impact the quality of care rendered to a patient;
3. Exploit the practitioner and patient relationship for personal gain; or
4. Engage in conversion therapy with a person younger than 18 years of age.
B. Advocating for patient safety or improvement in patient care within a health care entity shall not constitute disruptive behavior provided the practitioner does not engage in behavior prohibited in subdivision A 2 of this section.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005; amended Virginia Register Volume 35, Issue 24, eff. September 16, 2019; Volume 38, Issue 10, eff. February 2, 2022.
18VAC85-20-30. Advertising ethics.
A. Any statement specifying a fee, whether standard, discounted or free, for professional services which does not include the cost of all related procedures, services and products which, to a substantial likelihood, will be necessary for the completion of the advertised service as it would be understood by an ordinarily prudent person shall be deemed to be deceptive or misleading, or both. Where reasonable disclosure of all relevant variables and considerations is made, a statement of a range of prices for specifically described services shall not be deemed to be deceptive or misleading.
B. Advertising a discounted or free service, examination, or treatment and charging for any additional service, examination, or treatment that is performed as a result of and within 72 hours of the initial office visit in response to such advertisement is unprofessional conduct unless such professional services rendered are as a result of a bonafide emergency. This provision may not be waived by agreement of the patient and the practitioner.
C. Advertisements of discounts shall disclose the full fee that has been discounted. The practitioner shall maintain documented evidence to substantiate the discounted fees and shall make such information available to a consumer upon request.
D. A licensee shall disclose the complete name of the specialty board that conferred the certification when using or authorizing the use of the term "board certified" or any similar words or phrase calculated to convey the same meaning in any advertising for his practice.
E. A licensee of the board shall not advertise information that is false, misleading, or deceptive. For an advertisement for a single practitioner, it shall be presumed that the practitioner is responsible and accountable for the validity and truthfulness of its content. For an advertisement for a practice in which there is more than one practitioner, the name of the practitioner or practitioners responsible and accountable for the content of the advertisement shall be documented and maintained by the practice for at least two years.
F. Documentation, scientific and otherwise, supporting claims made in an advertisement shall be maintained and available for the board's review for at least two years.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.3, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 14, Issue 21, eff. August 5, 1998; Volume 20, Issue 10, eff. February 25, 2004; Volume 21, Issue 20, eff. July 13, 2005; Volume 22, Issue 1, eff. October 19, 2005; Volume 23, Issue 20, eff. August 25, 2007.
18VAC85-20-40. Vitamins, minerals and food supplements.
A. The recommendation or direction for the use of vitamins, minerals or food supplements and the rationale for that recommendation shall be documented by the practitioner. The recommendation or direction shall be based upon a reasonable expectation that such use will result in a favorable patient outcome, including preventive practices, and that a greater benefit will be achieved than that which can be expected without such use.
B. Vitamins, minerals, or food supplements, or a combination of the three, shall not be sold, dispensed, recommended, prescribed, or suggested in doses that would be contraindicated based on the individual patient's overall medical condition and medications.
C. The practitioner shall conform to the standards of his particular branch of the healing arts in the therapeutic application of vitamins, minerals or food supplement therapy.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.4, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-50. Anabolic steroids.
A practitioner shall not sell, prescribe, or administer anabolic steroids to any patient for other than accepted therapeutic purposes.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.5, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-60. (Repealed.)
Historical Notes
Derived from VR465-02-1, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; repealed, Virginia Register Volume 14, Issue 21, eff. August 5, 1998.
18VAC85-20-80. Solicitation or remuneration in exchange for referral.
A practitioner shall not knowingly and willfully solicit or receive any remuneration, directly or indirectly, in return for referring an individual to a facility or institution as defined in § 37.2-100 of the Code of Virginia, or hospital as defined in § 32.1-123 of the Code of Virginia.
Remuneration shall be defined as compensation, received in cash or in kind, but shall not include any payments, business arrangements, or payment practices allowed by 42 USC § 1320a-7b(b), as amended, or any regulations promulgated thereto.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.8, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 11, Issue 25, eff. October 4, 1995; Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-90. Pharmacotherapy for weight loss.
A. A practitioner shall not prescribe amphetamine, Schedule II, for the purpose of weight reduction or control.
B. A practitioner shall not prescribe controlled substances, Schedules III through VI, for the purpose of weight reduction or control in the treatment of obesity, unless the following conditions are met:
1. An appropriate history and physical examination are performed and recorded at the time of initiation of pharmacotherapy for obesity by the prescribing physician, and the physician reviews the results of laboratory work, as indicated, including testing for thyroid function;
2. If the drug to be prescribed could adversely affect cardiac function, the physician shall review the results of an electrocardiogram performed and interpreted within 90 days of initial prescribing for treatment of obesity;
3. A diet and exercise program for weight loss is prescribed and recorded;
4. The patient is seen within the first 30 days following initiation of pharmacotherapy for weight loss by the prescribing physician or a licensed practitioner with prescriptive authority working under the supervision of the prescribing physician, at which time a recording shall be made of blood pressure, pulse, and any other tests as may be necessary for monitoring potential adverse effects of drug therapy;
5. The treating physician shall direct the follow-up care, including the intervals for patient visits and the continuation of or any subsequent changes in pharmacotherapy. Continuation of prescribing for treatment of obesity shall occur only if the patient has continued progress toward achieving or maintaining a target weight and has no significant adverse effects from the prescribed program.
C. If specifically authorized in his practice agreement with a supervising or patient care team physician, a physician assistant or nurse practitioner may perform the physical examination, review tests, and prescribe Schedules III through VI controlled substances for treatment of obesity, as specified in subsection B of this section.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.9, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 13, Issue 5, eff. December 25, 1996; Volume 22, Issue 1, eff. October 19, 2005; Volume 31, Issue 20, eff. July 16, 2015; Volume 35, Issue 24, eff. September 16, 2019.
18VAC85-20-91. Practice and supervision of laser hair removal.
A. A doctor of medicine or osteopathic medicine may perform or supervise the performance of laser hair removal upon completion of training in the following:
1. Skin physiology and histology;
2. Skin type and appropriate patient selection;
3. Laser safety;
4. Operation of laser device to be used;
5. Recognition of potential complications and response to any actual complication resulting from a laser hair removal treatment; and
6. A minimum number of 10 proctored patient cases with demonstrated competency in treating various skin types.
B. Doctors of medicine or osteopathic medicine who have been performing laser hair removal prior to August 7, 2019, are not required to complete training specified in subsection A of this section.
C. A doctor who delegates the practice of laser hair removal and provides supervision to a person other than a licensed physician assistant or licensed nurse practitioner shall ensure that such person has completed the training required in subsection A of this section.
D. A doctor who performs laser hair removal or who supervises others in the practice shall receive ongoing training as necessary to maintain competency in new techniques and laser devices. The doctor shall ensure that persons the doctor supervises also receive ongoing training to maintain competency.
E. A doctor may delegate laser hair removal to a properly trained person under the doctor's direction and supervision. Direction and supervision shall mean that the doctor is readily available at the time laser hair removal is being performed. The supervising doctor is not required to be physically present but is required to see and evaluate a patient for whom the treatment has resulted in complications prior to the continuance of laser hair removal treatment.
F. Prescribing of medication shall be in accordance with § 54.1-3303 of the Code of Virginia.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 35, Issue 23, eff. August 7, 2019.
18VAC85-20-100. Sexual contact.
A. For purposes of § 54.1-2915 A 12 and A 19 of the Code of Virginia and this section, sexual contact includes, but is not limited to, sexual behavior or verbal or physical behavior that:
1. May reasonably be interpreted as intended for the sexual arousal or gratification of the practitioner, the patient, or both; or
2. May reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it.
B. Sexual contact with a patient.
1. The determination of when a person is a patient for purposes of § 54.1-2915 A 19 of the Code of Virginia is made on a case-by-case basis with consideration given to the nature, extent, and context of the professional relationship between the practitioner and the person. The fact that a person is not actively receiving treatment or professional services from a practitioner is not determinative of this issue. A person is presumed to remain a patient until the patient-practitioner relationship is terminated.
2. The consent to, initiation of, or participation in sexual behavior or involvement with a practitioner by a patient does not change the nature of the conduct nor negate the statutory prohibition.
C. Sexual contact between a practitioner and a former patient after termination of the practitioner-patient relationship may still constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge, or influence of emotions derived from the professional relationship.
D. Sexual contact between a practitioner and a key third party shall constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge or influence derived from the professional relationship or if the contact has had or is likely to have an adverse effect on patient care. For purposes of this section, key third party of a patient means spouse or partner, parent or child, guardian, or legal representative of the patient.
E. Sexual contact between a medical supervisor and a medical trainee shall constitute unprofessional conduct if the sexual contact is a result of the exploitation of trust, knowledge or influence derived from the professional relationship or if the contact has had or is likely to have an adverse effect on patient care.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from VR465-02-1 § 1.10, eff. October 4, 1995; amended, Virginia Register Volume 21, Issue 20, eff. July 13, 2005; Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-105. Refusal to provide information.
A practitioner shall not willfully refuse to provide information or records as requested or required by the board or its representative pursuant to an investigation or to the enforcement of a statute or regulation.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 14, Issue 21, eff. August 5, 1998; amended, Virginia Register Volume 22, Issue 1, eff. October 19, 2005.
18VAC85-20-110. (Repealed.)
Historical Notes
Derived from VR465-02-1 § 2.1, eff. January 18, 1989; amended, Virginia Register Volume 6, Issue 4, eff. December 20, 1989; Volume 6, Issue 8, eff. February 14, 1990; Volume 6, Issue 26, eff. October 24, 1990; Volume 7, Issue 26, eff. October 23, 1991; Volume 10, Issue 9, eff. February 23, 1994; Volume 10, Issue 24, eff. September 21, 1994; Volume 11, Issue 25, eff. October 4, 1995; Volume 13, Issue 3, eff. November 27, 1996; repealed, Virginia Register Volume 14, Issue 21, eff. August 5, 1998.