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 18 years of age 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.
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 26, 2019; Volume 41, Issue 11, eff. February 27, 2025.
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 the patient's legally authorized representative of the patient's medical diagnoses, prognosis, and prescribed treatment or plan of care in understandable terms. No practitioner shall 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. 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 the patient's 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.
3. 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, no practitioner shall terminate the relationship or make the practitioner's 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; amended, Virginia Register Volume 41, Issue 11, eff. February 27, 2025.
18VAC85-20-29. Practitioner responsibility.
A. No practitioner shall:
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; or
3. Exploit the practitioner-patient relationship for personal gain.
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 by 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 26, 2019; Volume 38, Issue 10, eff. February 2, 2022; Volume 41, Issue 11, eff. February 27, 2025.
18VAC85-20-30. Advertising ethics.
No licensee of the board shall 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 responsible and accountable for the content of the advertisement shall be documented and maintained by the practice for at least two years.
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; Volume 41, Issue 11, eff. February 27, 2025.
18VAC85-20-40. (Repealed.)
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; repealed, Virginia Register Volume 41, Issue 11, eff. February 27, 2025.
18VAC85-20-50. (Repealed.)
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; repealed, Virginia Register Volume 41, Issue 11, eff. February 27, 2025.
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. (Repealed.)
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; repealed, Virginia Register Volume 41, Issue 11, eff. February 27, 2025.
18VAC85-20-90. (Repealed.)
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 26, 2019; repealed, Virginia Register Volume 41, Issue 11, eff. February 27, 2025.
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.