Administrative Code

Virginia Administrative Code
6/27/2022

Chapter 50. Regulations Governing the Practice of Physician Assistants

Part I
General Provisions

18VAC85-50-10. Definitions.

A. The following words and terms shall have the meanings ascribed to them in § 54.1-2900 of the Code of Virginia:

"Board."

"Collaboration."

"Consultation."

"Patient care team physician."

"Patient care team podiatrist."

"Physician assistant."

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Group practice" means the practice of a group of two or more doctors of medicine, osteopathy, or podiatry licensed by the board who practice as a partnership or professional corporation.

"Institution" means a hospital, nursing home or other health care facility, community health center, public health center, industrial medicine or corporation clinic, a medical service facility, student health center, or other setting approved by the board.

"NCCPA" means the National Commission on Certification of Physician Assistants.

"Practice agreement" means a written or electronic agreement developed by one or more patient care team physicians or podiatrists and the physician assistant that defines the relationship between the physician assistant and the physicians or podiatrists, the prescriptive authority of the physician assistant, and the circumstances under which a physician or podiatrist will see and evaluate the patient.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 1.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 14, Issue 21, eff. August 5, 1998; Volume 17, Issue 21, eff. August 1, 2001; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 29, Issue 25, eff. September 26, 2013; Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-20. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 1.2, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; repealed, Virginia Register Volume 13, Issue 21, eff. August 6, 1997.

18VAC85-50-21. Current name and address.

Each licensee shall furnish the board his current name and address of record. All notices required by law or by this chapter to be given by the board to any such licensee shall be validly given when sent to the latest address of record provided or served to the licensee. Any change of name or address of record or the public address, if different from the address of record, shall be furnished to the board within 30 days of such change.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 25, Issue 23, eff. August 19, 2009; amended, Virginia Register Volume 35, Issue 12, eff. March 22, 2019.

18VAC85-50-30. Public participation guidelines.

A separate board regulation, 18VAC85-11, provides for involvement of the public in the development of all regulations of the Virginia Board of Medicine.

Statutory Authority

§§ 54.1-2400 and 54.1-2949 through 54.1-2953 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 1.3, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997.

18VAC85-50-35. Fees.

Unless otherwise provided, the following fees shall not be refundable:

1. The initial application fee for a license, payable at the time application is filed, shall be $130.

2. The biennial fee for renewal of an active license shall be $135 and for renewal of an inactive license shall be $70, payable in each odd-numbered year in the birth month of the licensee. For 2021, the fee for renewal of an active license shall be $108, and the fee for renewal of an inactive license shall be $54.

3. The additional fee for late renewal of licensure within one renewal cycle shall be $50.

4. A restricted volunteer license shall expire 12 months from the date of issuance and may be renewed without charge by receipt of a renewal application that verifies that the physician assistant continues to comply with provisions of § 54.1-2951.3 of the Code of Virginia.

5. The fee for reinstatement of a license pursuant to § 54.1-2408.2 of the Code of Virginia shall be $2,000.

6. The fee for a duplicate license shall be $5.00, and the fee for a duplicate wall certificate shall be $15.

7. The handling fee for a returned check or a dishonored credit card or debit card shall be $50.

8. The fee for a letter of good standing or verification to another jurisdiction shall be $10.

9. The fee for an application or for the biennial renewal of a restricted volunteer license shall be $35, due in the licensee's birth month. An additional fee for late renewal of licensure shall be $15 for each renewal cycle.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 18, Issue 21, eff. July 31, 2002; amended, Virginia Register Volume 22, Issue 9, eff. February 8, 2006; Volume 23, Issue 9, eff. February 7, 2007; Volume 24, Issue 11, eff. March 5, 2008; Volume 29, Issue 26, eff. September 25, 2013; Volume 32, Issue 9, eff. January 27, 2016; Volume 34, Issue 7, eff. December 27, 2017; Volume 37, Issue 13, eff. March 16, 2021.

Part II
Requirements for Practice As a Physician's Assistant

18VAC85-50-40. General requirements.

A. No person shall practice as a physician assistant in the Commonwealth of Virginia except as provided in this chapter.

B. All services rendered by a physician assistant shall be performed only in accordance with a practice agreement with one or more doctors of medicine, osteopathy, or podiatry licensed by this board to practice in the Commonwealth.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 2.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 19, Issue 18, eff. June 18, 2003; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-50. Licensure: entry requirements and application.

A. The applicant seeking licensure as a physician assistant shall submit:

1. A completed application and fee as prescribed by the board.

2. Documentation of successful completion of an educational program as prescribed in § 54.1-2951.1 of the Code of Virginia.

3. Documentation of passage of the certifying examination administered by the National Commission on Certification of Physician Assistants.

4. If licensed or certified in any other jurisdiction, verification that there has been no disciplinary action taken or pending in that jurisdiction.

B. The board may issue a license by endorsement to an applicant for licensure if the applicant (i) is the spouse of an active duty member of the Armed Forces of the United States or the Commonwealth, (ii) holds current certification from the National Commission on Certification of Physician Assistants, and (iii) holds a license as a physician assistant that is in good standing, or that is eligible for reinstatement if lapsed, under the laws of another state.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 2.2, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 14, Issue 21, eff. August 5, 1998; Volume 36, Issue 1, eff. October 2, 2019; Volume 38, Issue 13, eff. April 1, 2022.

18VAC85-50-55. Provisional licensure.

Pending the outcome of the next examination administered by the NCCPA, an applicant who has met all other requirements of 18VAC85-50-50 at the time his initial application is submitted may be granted provisional licensure by the board. The provisional licensure shall be valid until the applicant takes the next subsequent NCCPA examination and its results are reported, but this period of validity shall not exceed 30 days following the reporting of the examination scores, after which the provisional license shall be invalid.

Statutory Authority

§§ 54.1-2400 and 54.1-2949 through 54.1-2953 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 21, eff. August 6, 1997; amended, Virginia Register Volume 14, Issue 21, eff. August 5, 1998.

18VAC85-50-56. Renewal of license.

A. Every licensed physician assistant intending to continue to practice shall biennially renew the license in each odd numbered year in the licensee's birth month by:

1. Returning the renewal form and fee as prescribed by the board; and

2. Verifying compliance with continuing medical education standards established by the NCCPA.

B. Any physician assistant who allows his NCCPA certification to lapse shall be considered not licensed by the board. Any such assistant who proposes to resume his practice shall make a new application for licensure.

Statutory Authority

§ 54.1-2400 and Chapter 29 (§ 54.1-2900 et seq.) of Title 54.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 21, eff. August 6, 1997; amended, Virginia Register Volume 18, Issue 21, eff. July 31, 2002.

18VAC85-50-57. Discontinuation of employment.

If for any reason the physician assistant discontinues working with a patient care team physician or podiatrist, a new practice agreement shall be entered into in order for the physician assistant either to be reemployed by the same practitioner or to accept new employment with another patient care team physician or podiatrist.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 21, eff. August 6, 1997; amended, Virginia Register Volume 14, Issue 21, eff. August 5, 1998; Volume 29, Issue 25, eff. September 26, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 37, Issue 13, eff. March 16, 2021.

18VAC85-50-58. Inactive licensure.

A. A physician assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required fee, be issued an inactive license.

1. The holder of an inactive license shall not be required to maintain certification by the NCCPA.

2. An inactive licensee shall not be entitled to practice as a physician assistant in Virginia.

B. An inactive licensee may reactivate his license upon submission of:

1. The required application;

2. Payment of the difference between the current renewal fee for inactive licensure and the renewal fee for active licensure for the biennium in which the license is being reactivated; and

3. Documentation of having maintained certification or having been recertified by the NCCPA.

C. The board reserves the right to deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-2915 of the Code of Virginia or any provisions of this chapter.

Statutory Authority

§§ 54.1-2400 and 54.1-2912.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 17, Issue 13, eff. April 11, 2001; amended, Virginia Register Volume 24, Issue 1, eff. October 17, 2007.

18VAC85-50-59. Registration for voluntary practice by out-of-state licensees.

Any physician assistant who does not hold a license to practice in Virginia and who seeks registration to practice under subdivision 27 of § 54.1-2901 of the Code of Virginia on a voluntary basis under the auspices of a publicly supported, all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people shall:

1. File a complete application for registration on a form provided by the board at least five business days prior to engaging in such practice. An incomplete application will not be considered;

2. Provide a complete record of professional licensure in each state in which he has held a license and a copy of any current license;

3. Provide the name of the nonprofit organization, the dates and location of the voluntary provision of services;

4. Pay a registration fee of $10; and

5. Provide a notarized statement from a representative of the nonprofit organization attesting to its compliance with provisions of subdivision 27 of § 54.1-2901 of the Code of Virginia.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 19, Issue 18, eff. June 18, 2003; amended, Virginia Register Volume 24, Issue 24, eff. September 3, 2008.

18VAC85-50-60. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 2.3, eff. February 1, 1989; amended Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; repealed, Virginia Register Volume 13, Issue 21, eff. August 6, 1997.

18VAC85-50-61. Restricted volunteer license.

A. A physician assistant who held an unrestricted license issued by the Virginia Board of Medicine or by a board in another state as a licensee in good standing at the time the license expired or became inactive may be issued a restricted volunteer license to practice without compensation in a clinic that is organized in whole or in part for the delivery of health care services without charge in accordance with § 54.1-106 of the Code of Virginia.

B. To be issued a restricted volunteer license, a physician assistant shall submit an application to the board that documents compliance with requirements of § 54.1-2928.1 of the Code of Virginia and the application fee prescribed in 18VAC85-50-35.

C. The licensee who intends to continue practicing with a restricted volunteer license shall renew biennially during his birth month, meet the continued competency requirements prescribed in subsection D of this section, and pay to the board the renewal fee prescribed in 18VAC85-50-35.

D. The holder of a restricted volunteer license shall not be required to attest to hours of continuing education for the first renewal of such a license. For each renewal thereafter, the licensee shall attest to obtaining 50 hours of continuing education during the biennial renewal period with at least 25 hours in Type 1 and no more than 25 hours in Type 2 as acceptable to the NCCPA.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 24, Issue 11, eff. March 5, 2008.

Part III
Examination [Repealed]

18VAC85-50-70. (Repealed.)

Historical Notes

Derived from VR465-05-1 §§ 3.1 to 3.4 eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; repealed, Virginia Register Volume 13, Issue 21, eff. August 6, 1997.

Part IV
Practice Requirements

18VAC85-50-101. Requirements for a practice agreement.

A. Prior to initiation of practice, a physician assistant and one or more patient care team physicians or podiatrists shall enter into a written or electronic practice agreement that spells out the roles and functions of the assistant and is consistent with provisions of § 54.1-2952 of the Code of Virginia.

1. Any such practice agreement shall take into account such factors as the physician assistant's level of competence, the number of patients, the types of illness treated by the physicians or podiatrists, the nature of the treatment, special procedures, and the nature of the physicians' or podiatrists' availability in ensuring direct physician or podiatrist involvement at an early stage and regularly thereafter.

2. The practice agreement shall also provide an evaluation process for the physician assistant's performance, including a requirement specifying the time period, proportionate to the acuity of care and practice setting, within which the physicians or podiatrists shall review the record of services rendered by the physician assistant.

3. The practice agreement may include requirements for periodic site visits by licensees who supervise and direct the patient care team physicians or podiatrists to collaborate and consult with physician assistants who provide services at a location other than where the physicians or podiatrists regularly practice.

B. The board may require information regarding the degree of collaboration and consultation by the patient care team physicians or podiatrists. The board may also require a patient care team physician or podiatrist to document the physician assistant's competence in performing such tasks.

C. If the role of the physician assistant includes prescribing drugs and devices, the written practice agreement shall include those schedules and categories of drugs and devices that are within the scope of practice and proficiency of the patient care team physicians or podiatrists.

D. If the initial practice agreement did not include prescriptive authority, there shall be an addendum to the practice agreement for prescriptive authority.

E. If there are any changes in consultation and collaboration, authorization, or scope of practice, a revised practice agreement shall be entered into at the time of the change.

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 17, Issue 21, eff. August 1, 2001; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-110. Responsibilities of the patient care team physician or podiatrist.

A patient care team physician or podiatrist shall:

1. Review the clinical course and treatment plan for any patient who presents for the same acute complaint twice in a single episode of care and has failed to improve as expected. A physician or podiatrist shall be involved with any patient with a continuing illness as noted in the written or electronic practice agreement for the evaluation process.

2.

Be available at all times to collaborate and consult with the physician assistant.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 4.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 33, Issue 19, eff. June 29, 2017; Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-115. Responsibilities of the physician assistant.

A. The physician assistant shall not render independent health care and shall:

1. Perform only those medical care services that are within the scope of the practice and proficiency of the patient care team physicians or podiatrists as prescribed in the physician assistant's practice agreement. When a physician assistant is working outside the scope of specialty of the patient care team physicians or podiatrists, then the physician assistant's functions shall be limited to those areas not requiring specialized clinical judgment, unless a separate practice agreement has been executed for an alternate patient care team physician or podiatrist.

2. Prescribe only those drugs and devices as allowed in Part V (18VAC85-50-130 et seq.) of this chapter.

3. Wear during the course of performing his duties identification showing clearly that he is a physician assistant.

B. If, due to illness, vacation, or unexpected absence, a patient care team physician or podiatrist or alternate physician or podiatrist is unable to supervise the activities of his physician assistant, such patient care team physician or podiatrist may temporarily delegate the responsibility to another doctor of medicine, osteopathic medicine, or podiatry.

Temporary coverage may not exceed four weeks unless special permission is granted by the board.

C. With respect to physician assistants employed by institutions, the following additional regulations shall apply:

1. No physician assistant may render care to a patient unless the physician or podiatrist responsible for that patient is available for collaboration and consultation with that physician assistant.

2. Any such practice agreement as described in subdivision 1 of this subsection shall delineate the duties which said patient care team physician or podiatrist authorizes the physician assistant to perform.

D. Practice by a physician assistant in a hospital, including an emergency department, shall be in accordance with § 54.1-2952 of the Code of Virginia.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 21, eff. August 6, 1997; amended, Virginia Register Volume 14, Issue 21, eff. August 5, 1998; Volume 16, Issue 21, eff. August 2, 2000; Volume 18, Issue 21, eff. July 31, 2002; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 29, Issue 25, eff. September 26, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 34, Issue 25, eff. September 20, 2018; Volume 35, Issue 23, eff. August 22, 2019; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-116. Volunteer restricted license for certain physician assistants.

The issuance of a volunteer restricted license and the practice of a physician assistant under such a license shall be in accordance with the provisions of § 54.1-2951.3 of the Code of Virginia.

Statutory Authority

§§ 54.1-2400 and 54.1-2949 through 54.1-2953 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 14, Issue 21, eff. August 5, 1998.

18VAC85-50-117. Authorization to use fluoroscopy.

A physician assistant working under a practice agreement with a licensed doctor of medicine or osteopathy specializing in the field of radiology is authorized to use fluoroscopy for guidance of diagnostic and therapeutic procedures provided such activity is specified in his protocol and he has met the following qualifications:

1. Completion of at least 40 hours of structured didactic educational instruction and at least 40 hours of supervised clinical experience as set forth in the Fluoroscopy Educational Framework for the Physician Assistant created by the American Academy of Physician Assistants (AAPA) and the American Society of Radiologic Technologists (ASRT); and

2. Successful passage of the American Registry of Radiologic Technologists (ARRT) Fluoroscopy Examination.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 31, Issue 9, eff. February 13, 2015; amended, Virginia Register Volume 37, Issue 13, eff. March 16, 2021.

18VAC85-50-120. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 5.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; repealed, Virginia Register Volume 13, Issue 21, eff. August 6, 1997.

Part V
Prescriptive Authority

18VAC85-50-130. Qualifications for approval of prescriptive authority.

An applicant for prescriptive authority shall meet the following requirements:

1. Hold a current, unrestricted license as a physician assistant in the Commonwealth;

2. Maintain a practice agreement acceptable to the board as prescribed in 18VAC85-50-101 and § 54.1-2952.1 of the Code of Virginia; and

3. Submit evidence of successful completion of a minimum of 35 hours of acceptable training to the board in pharmacology.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 5.2, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 17, Issue 21, eff. August 1, 2001; Volume 29, Issue 20, eff. July 3, 2013; Volume 35, Issue 23, eff. August 22, 2019.

18VAC85-50-140. Approved drugs and devices.

A. The approved drugs and devices which the physician assistant with prescriptive authority may prescribe, administer, or dispense manufacturer's professional samples shall be in accordance with provisions of § 54.1-2952.1 of the Code of Virginia:

B. The physician assistant may prescribe only those categories of drugs and devices included in the practice agreement. The patient care team physician or podiatrist retains the authority to restrict certain drugs within these approved categories.

C. The physician assistant, pursuant to § 54.1-2952.1 of the Code of Virginia, shall only dispense manufacturer's professional samples or administer controlled substances in good faith for medical or therapeutic purposes within the course of his professional practice.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 6.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 17, Issue 21, eff. August 1, 2001; Volume 35, Issue 23, eff. August 22, 2019; Volume 37, Issue 13, eff. March 16, 2021.

18VAC85-50-150. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 6.2, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 17, Issue 21, eff. August 1, 2001; repealed, Virginia Register Volume 29, Issue 20, eff. July 3, 2013.

18VAC85-50-160. Disclosure.

A. Each prescription for a Schedule II through V drug shall bear the name of the patient care team physician or podiatrist and of the physician assistant.

B. The physician assistant shall disclose to the patient that he is a licensed physician assistant, and also the name, address and telephone number of the patient care team physician or podiatrist. Such disclosure shall either be included on the prescription or be given in writing to the patient.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 6.3, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 32, Issue 7, eff. January 15, 2016; Volume 37, Issue 13, eff. March 16, 2021.

18VAC85-50-170. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 7.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 14, Issue 21, eff. August 5, 1998; Volume 16, Issue 13, eff. April 12, 2000; repealed, Virginia Register Volume 18, Issue 21, eff. July 31, 2002.

Part VI
Standards of Professional Conduct

18VAC85-50-175. 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.

18VAC85-50-176. 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.

18VAC85-50-177. 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 properly manage patient records and shall maintain timely, accurate, legible and complete records.

C. Practitioners shall provide patient records to another practitioner or to the patient or his personal representative in a timely manner and in accordance with provisions of § 32.1-127.1:03 of the Code of Virginia.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005.

18VAC85-50-178. Practitioner-patient communication.

A. 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 treatments or plans 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.

B. 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 and shall refer to or consult with other health care professionals if so indicated.

C. 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.

1. 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.

2. 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.

3. 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.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 1, eff. October 19, 2005.

18VAC85-50-179. Practitioner responsibility.

A. A practitioner shall not:

1. Perform procedures or techniques that are outside the scope of his practice or for which he is not trained and individually competent;

2. 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;

3. Engage in an egregious pattern of disruptive behavior or 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

4. 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 in subdivision A 3 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.

18VAC85-50-180. 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 Virginia Register Volume 22, Issue 1, eff. October 19, 2005.

18VAC85-50-181. 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; and

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 patient care team physician, a physician assistant 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 Virginia Register Volume 22, Issue 1, eff. October 19, 2005; amended, Virginia Register Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021.

18VAC85-50-182. Anabolic steroids.

A physician assistant shall not 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 Virginia Register Volume 22, Issue 1, eff. October 19, 2005.

18VAC85-50-183. 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 supervisor and a 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 Virginia Register Volume 22, Issue 1, eff. October 19, 2005.

18VAC85-50-184. 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 22, Issue 1, eff. October 19, 2005.

18VAC85-50-191. Practice and supervision of laser hair removal.

A. A physician assistant, as authorized pursuant to § 54.1-2952 of the Code of Virginia, 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. Physician assistants 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 physician assistant who delegates the practice of laser hair removal and provides supervision for such practice shall ensure the supervised person has completed the training required in subsection A of this section.

D. A physician assistant 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 physician assistant shall ensure that persons the physician assistant supervises also receive ongoing training to maintain competency.

E. A physician assistant may delegate laser hair removal to a properly trained person under the physician assistant's direction and supervision. Direction and supervision shall mean that the physician assistant is readily available at the time laser hair removal is being performed. The supervising physician assistant 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.

FORMS (18VAC85-50).

Application for a License to Practice as a Physician Assistant, by endorsement or examination, online form available at: https://www.license.dhp.virginia.gov/apply/

Instructions for Completing an Application to Practice as a Physician Assistant in Virginia (rev. 11/2017)

Form B, Employment History (rev. 7/2017)

Form B, Supplemental Form (rev. 9/2018)

ARRT Fluoroscopy Examination Application for a Physician Assistant (rev. 2/2014)

Physician Assistant Authorization to Use Fluoroscopy (rev. 1/2014)

Practice Agreement as a Physician Assistant (PA) (rev. 10/2019)

Application for Registration for Volunteer Practice (rev. 8/2015)

Sponsor Certification for Volunteer Registration (rev. 3/2018)

Application for Restricted Volunteer License (rev. 8/2015)

Forms (18VAC85-50-9999)

Fluoroscopy Educational Framework for the Physician Assistant, December 2009, American Academy of Physician Assistants, 950 North Washington Street, Alexandria, VA 22314 and the American Society of Radiologic Technologists, 15000 Central Avenue, SE, Albuquerque, NM 87123

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.