| 15 | | - | Section 1. Section 19a-490m of the general statutes is repealed and the |
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| 16 | | - | following is substituted in lieu thereof (Effective from passage): |
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| 17 | | - | (a) Each hospital and outpatient surgical facility shall develop |
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| 18 | | - | protocols for accurate identification procedures that shall be used by |
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| 19 | | - | such hospital or outpatient surgical facility prior to surgery. Such |
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| 20 | | - | protocols shall include, but need not be limited to, (1) procedures to be |
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| 21 | | - | followed to identify the (A) patient, (B) surgical procedure to be |
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| 22 | | - | performed, and (C) body part on which the surgical procedure is to be |
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| 23 | | - | performed, and (2) alternative identification procedures in urgent or |
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| 24 | | - | emergency circumstances or where the patient is nonspeaking, |
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| 25 | | - | comatose or incompetent or is a child. After January 1, 2006, no hospital |
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| 26 | | - | or outpatient surgical facility may anesthetize a patient or perform |
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| 27 | | - | surgery unless the protocols have been followed. Each hospital and |
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| 28 | | - | outpatient surgical facility shall make a copy of the protocols available |
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| 29 | | - | to the Commissioner of Public Health upon request. |
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| 30 | | - | (b) Not later than October 1, 2006, the Department of Public Health Substitute House Bill No. 5278 |
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| 18 | + | Section 1. (NEW) (Effective July 1, 2022) (a) As used in this section: 1 |
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| 19 | + | (1) "Health care provider" means a physician licensed pursuant to 2 |
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| 20 | + | chapter 370 of the general statutes, a student in a medical school 3 |
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| 21 | + | participating in a course of instruction, a person participating in a 4 |
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| 22 | + | residency program or clinical training program, a physician assistant 5 |
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| 23 | + | licensed pursuant to chapter 370 of the general statutes or an advanced 6 |
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| 24 | + | practice registered nurse licensed pursuant to chapter 378 of the general 7 |
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| 25 | + | statutes; 8 |
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| 26 | + | (2) "Intimate examination" means an inpatient or outpatient pelvic, 9 |
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| 27 | + | prostate or rectal examination; and 10 |
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| 28 | + | (3) "Legal representative" means a court-appointed fiduciary, 11 |
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| 29 | + | including a guardian or conservator, or a person with power of attorney 12 |
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| 30 | + | authorized to act on a patient's behalf or, if the patient is a minor, the 13 |
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| 31 | + | patient's parent or guardian. 14 |
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| 32 | + | (b) A health care provider may perform an intimate examination on 15 |
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| 33 | + | a patient who is (1) under deep sedation or anesthesia, or (2) 16 |
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| 34 | + | unconscious only when (A) the patient or the legal representative of the 17 Substitute Bill No. 5278 |
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| 34 | | - | shall report, in accordance with section 11-4a, to the joint standing |
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| 35 | | - | committee of the General Assembly having cognizance of matters |
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| 36 | | - | relating to public health describing the protocols developed pursuant to |
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| 37 | | - | subsection (a) of this section. |
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| 38 | | - | (c) Not later than January 1, 2023, each hospital and outpatient |
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| 39 | | - | surgical facility shall develop and implement procedures for securing |
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| 40 | | - | on a written or electronic form a patient's express written consent to an |
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| 41 | | - | intimate examination. A health care provider at each hospital and |
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| 42 | | - | outpatient surgical facility shall obtain such consent in advance of |
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| 43 | | - | performing an intimate examination on a patient who will be under |
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| 44 | | - | deep sedation or general anesthesia, or is rendered unconscious, unless |
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| 45 | | - | the intimate examination is within the scope of a planned procedure, |
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| 46 | | - | diagnostic examination or surgical procedure for which the patient has |
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| 47 | | - | provided general consent. If a student in a medical school participating |
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| 48 | | - | in a course of instruction or person participating in a residency program |
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| 49 | | - | or clinical training program performs an intimate examination on a |
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| 50 | | - | patient exclusively for training purposes, and not (1) as part of the |
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| 51 | | - | patient's clinical care, or (2) when such student or person is part of the |
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| 52 | | - | patient's clinical care team, the hospital or outpatient surgical facility |
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| 53 | | - | shall obtain a separate written consent from the patient detailing such |
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| 54 | | - | student's or person's involvement in the intimate examination. Express |
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| 55 | | - | written patient consent shall not be required under this subsection for |
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| 56 | | - | intimate examinations performed in an emergency or urgent care |
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| 57 | | - | situation for diagnostic or treatment purposes. Each hospital and |
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| 58 | | - | outpatient surgical facility shall make a copy of the procedures and |
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| 59 | | - | consent forms developed under this subsection available to the |
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| 60 | | - | Commissioner of Public Health upon request. As used in this |
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| 61 | | - | subsection, (A) "health care provider" means a physician licensed |
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| 62 | | - | pursuant to chapter 370, a student in a medical school participating in a |
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| 63 | | - | course of instruction, a person participating in a residency program or |
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| 64 | | - | clinical training program, a physician assistant licensed pursuant to |
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| 65 | | - | chapter 370 or an advanced practice registered nurse licensed pursuant Substitute House Bill No. 5278 |
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| 37 | + | LCO {\\PRDFS1\HCOUSERS\BARRYJN\WS\2022HB-05278- |
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| 38 | + | R01-HB.docx } |
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| 39 | + | 2 of 3 |
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| 67 | | - | Public Act No. 22-33 3 of 9 |
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| 41 | + | patient provided written informed consent to the intimate examination, 18 |
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| 42 | + | (B) the performance of an intimate examination is within the scope of 19 |
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| 43 | + | the surgical procedure or diagnostic examination to be performed on 20 |
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| 44 | + | the patient, or (C) in the case of an unconscious patient, the intimate 21 |
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| 45 | + | examination is required for diagnostic purposes. 22 |
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| 46 | + | (c) To obtain informed consent to perform an intimate examination 23 |
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| 47 | + | from a patient or the legal representative of a patient pursuant to 24 |
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| 48 | + | subparagraph (A) of subdivision (2) of subsection (b) of this section, the 25 |
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| 49 | + | health care provider shall comply with the following requirements: 26 |
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| 50 | + | (1) Provide the patient or the patient's legal representative with a 27 |
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| 51 | + | written or electronic informed consent form that (A) may be included as 28 |
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| 52 | + | a distinct or separate section of a general informed consent form, (B) 29 |
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| 53 | + | contains the following heading at the top of the form in at least eighteen 30 |
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| 54 | + | point, boldface type: "CONSENT FOR EXAMINATION OF PELVIC, 31 |
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| 55 | + | PROSTATE OR RECTAL REGION", (C) specifies the nature and 32 |
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| 56 | + | purpose of the intimate examination, (D) informs the patient or the 33 |
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| 57 | + | patient's legal representative that a medical student or resident may be 34 |
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| 58 | + | present if the patient or the patient's legal representative authorizes the 35 |
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| 59 | + | student or resident to perform the intimate examination or to observe or 36 |
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| 60 | + | otherwise be present at the intimate examination for training purposes, 37 |
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| 61 | + | either in person or through electronic means, (E) allows the patient or 38 |
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| 62 | + | the patient's legal representative the opportunity to consent to or refuse 39 |
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| 63 | + | to consent to the intimate examination, and (F) allows a patient or a 40 |
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| 64 | + | patient's legal representative that consents to an intimate examination 41 |
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| 65 | + | under subparagraph (E) of this subdivision the opportunity to authorize 42 |
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| 66 | + | or refuse to authorize a medical student or resident to perform the 43 |
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| 67 | + | intimate examination or observe or otherwise be present at the intimate 44 |
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| 68 | + | examination for training purposes, either in person or through 45 |
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| 69 | + | electronic means; 46 |
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| 70 | + | (2) Obtain the signature of the patient or the patient's legal 47 |
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| 71 | + | representative on the informed consent form provided under 48 |
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| 72 | + | subdivision (1) of this subsection; and 49 Substitute Bill No. 5278 |
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| 69 | | - | to chapter 378, and (B) "intimate examination" means a pelvic, prostate |
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| 70 | | - | or rectal examination. |
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| 71 | | - | Sec. 2. Subsection (b) of section 20-10b of the general statutes is |
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| 72 | | - | repealed and the following is substituted in lieu thereof (Effective October |
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| 73 | | - | 1, 2022): |
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| 74 | | - | (b) Except as otherwise provided in subsections (d), (e) and (f) of this |
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| 75 | | - | section, a licensee applying for license renewal shall earn a minimum of |
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| 76 | | - | fifty contact hours of continuing medical education within the |
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| 77 | | - | preceding twenty-four-month period. Such continuing medical |
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| 78 | | - | education shall (1) be in an area of the physician's practice; (2) reflect the |
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| 79 | | - | professional needs of the licensee in order to meet the health care needs |
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| 80 | | - | of the public; and (3) during the first renewal period in which continuing |
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| 81 | | - | medical education is required and not less than once every six years |
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| 82 | | - | thereafter, include at least one contact hour of training or education in |
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| 83 | | - | each of the following topics: (A) Infectious diseases, including, but not |
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| 84 | | - | limited to, acquired immune deficiency syndrome and human |
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| 85 | | - | immunodeficiency virus, (B) risk management, including, but not |
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| 86 | | - | limited to, prescribing controlled substances and pain management, and |
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| 87 | | - | [, for registration periods beginning on or after October 1, 2019, such risk |
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| 88 | | - | management continuing medical education may also include] screening |
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| 89 | | - | for inflammatory breast cancer and gastrointestinal cancers, including |
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| 90 | | - | colon, gastric, pancreatic and neuroendocrine cancers and other rare |
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| 91 | | - | gastrointestinal tumors, and, for registration periods beginning on or |
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| 92 | | - | after October 1, 2022, such risk management continuing medical |
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| 93 | | - | education may also include screening for endometriosis, (C) sexual |
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| 94 | | - | assault, (D) domestic violence, (E) cultural competency, including, but |
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| 95 | | - | not limited to, the effects of systemic racism, explicit and implicit bias, |
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| 96 | | - | racial disparities, and the experiences of transgender and gender diverse |
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| 97 | | - | persons on patient diagnosis, care and treatment, and (F) behavioral |
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| 98 | | - | health, provided further that [on and after January 1, 2016,] such |
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| 99 | | - | behavioral health continuing medical education may include, but not be Substitute House Bill No. 5278 |
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| 103 | | - | limited to, at least two contact hours of training or education during the |
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| 104 | | - | first renewal period in which continuing education is required and not |
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| 105 | | - | less than once every six years thereafter, on diagnosing and treating (i) |
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| 106 | | - | cognitive conditions, including, but not limited to, Alzheimer's disease, |
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| 107 | | - | dementia, delirium, related cognitive impairments and geriatric |
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| 108 | | - | depression, or (ii) mental health conditions, including, but not limited |
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| 109 | | - | to, mental health conditions common to veterans and family members |
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| 110 | | - | of veterans. Training for mental health conditions common to veterans |
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| 111 | | - | and family members of veterans shall include best practices for (I) |
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| 112 | | - | determining whether a patient is a veteran or family member of a |
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| 113 | | - | veteran, (II) screening for conditions such as post-traumatic stress |
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| 114 | | - | disorder, risk of suicide, depression and grief, and (III) suicide |
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| 115 | | - | prevention training. For purposes of this section, qualifying continuing |
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| 116 | | - | medical education activities include, but are not limited to, courses |
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| 117 | | - | offered or approved by the American Medical Association, American |
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| 118 | | - | Osteopathic Association, Connecticut Hospital Association, |
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| 119 | | - | Connecticut State Medical Society, Connecticut Osteopathic Medical |
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| 120 | | - | Society, county medical societies or equivalent organizations in another |
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| 121 | | - | jurisdiction, educational offerings sponsored by a hospital or other |
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| 122 | | - | health care institution or courses offered by a regionally accredited |
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| 123 | | - | academic institution or a state or local health department. The |
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| 124 | | - | commissioner, or the commissioner's designee, may grant a waiver for |
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| 125 | | - | not more than ten contact hours of continuing medical education for a |
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| 126 | | - | physician who: (I) Engages in activities related to the physician's service |
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| 127 | | - | as a member of the Connecticut Medical Examining Board, established |
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| 128 | | - | pursuant to section 20-8a; (II) engages in activities related to the |
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| 129 | | - | physician's service as a member of a medical hearing panel, pursuant to |
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| 130 | | - | section 20-8a; or (III) assists the department with its duties to boards and |
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| 131 | | - | commissions as described in section 19a-14. |
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| 132 | | - | Sec. 3. (Effective July 1, 2022) (a) As used in this section: |
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| 133 | | - | (1) "Biorepository" means a facility that collects, catalogs and stores Substitute House Bill No. 5278 |
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| 79 | + | (3) Sign the informed consent form provided under subdivision (1) of 50 |
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| 80 | + | this subsection. 51 |
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| 81 | + | (d) The Department of Public Health (1) shall investigate any alleged 52 |
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| 82 | + | violation of subsection (b) or (c) of this section pursuant to subdivision 53 |
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| 83 | + | (11) of subsection (a) of section 19a-14 of the general statutes, and (2) if 54 |
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| 84 | + | the department determines a violation was committed, may take 55 |
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| 85 | + | disciplinary action under section 19a-17 of the general statutes. 56 |
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| 86 | + | This act shall take effect as follows and shall amend the following |
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| 87 | + | sections: |
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| 137 | | - | samples of biological material, including, but not limited to, urine, |
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| 138 | | - | blood, tissue, cells, DNA, RNA and protein, from humans for laboratory |
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| 139 | | - | research; and |
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| 140 | | - | (2) "Phenotypic data" means clinical information regarding a person's |
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| 141 | | - | disease symptoms and relevant demographic data regarding the |
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| 142 | | - | person, including, but not limited to, the person's age, sex, race and |
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| 143 | | - | ethnicity. |
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| 144 | | - | (b) The University of Connecticut Health Center, in consultation with |
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| 145 | | - | a research laboratory, shall develop a plan to establish an endometriosis |
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| 146 | | - | data and biorepository program in the state to promote (1) early |
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| 147 | | - | detection of endometriosis in adolescents and adults, (2) new |
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| 148 | | - | therapeutic strategies for treatment and better overall management of |
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| 149 | | - | endometriosis, and (3) early access to the latest therapeutic options for |
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| 150 | | - | persons diagnosed with endometriosis. |
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| 151 | | - | (c) In developing the plan pursuant to subsection (b) of this section, |
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| 152 | | - | The University of Connecticut Health Center shall require the |
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| 153 | | - | endometriosis data and biorepository program to have the following |
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| 154 | | - | functions: |
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| 155 | | - | (1) Collecting standardized phenotypic data along with the collection |
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| 156 | | - | of biological samples of a person's endometriosis and control samples to |
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| 157 | | - | improve the characterization of endometriosis and of the person with |
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| 158 | | - | endometriosis; |
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| 159 | | - | (2) Developing standard operating procedures for retention and |
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| 160 | | - | storage of biological samples of endometriosis and control samples, |
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| 161 | | - | including, but not limited to, collection, transportation, processing and |
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| 162 | | - | long-term storage of such samples; |
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| 163 | | - | (3) Curating biological samples of endometriosis from a diverse |
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| 164 | | - | cross-section of communities to ensure representation of all groups |
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| 165 | | - | affected by endometriosis, including, but not limited to, black persons, Substitute House Bill No. 5278 |
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| 91 | + | Statement of Legislative Commissioners: |
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| 92 | + | In Section 1(a)(1), "licensed pursuant to chapter 370 of the general |
|---|
| 93 | + | statutes" was inserted after "assistant" and "licensed pursuant to chapter |
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| 94 | + | 378 of the general statutes" was inserted after "nurse" for clarity and |
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| 95 | + | consistency. |
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| 167 | | - | Public Act No. 22-33 6 of 9 |
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| 168 | | - | |
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| 169 | | - | Latino persons, other persons of color, transgender and gender diverse |
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| 170 | | - | persons and persons with disabilities; |
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| 171 | | - | (4) Researching the pathogenesis, pathophysiology, progression and |
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| 172 | | - | prognosis of endometriosis and the development of noninvasive |
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| 173 | | - | diagnostic biomarkers, novel targeted therapeutics, curative therapies |
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| 174 | | - | and preventive interventions with regard to endometriosis, including |
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| 175 | | - | medical and surgical interventions; |
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| 176 | | - | (5) Serving as a centralized resource for endometriosis information; |
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| 177 | | - | (6) Facilitating collaboration among researchers and health care |
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| 178 | | - | professionals, educators and students regarding best practices for the |
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| 179 | | - | diagnosis, care and treatment of endometriosis; and |
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| 180 | | - | (7) Researching the impact of endometriosis on residents of the state, |
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| 181 | | - | including, but not limited to, its impact on health and comorbidity, |
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| 182 | | - | health care costs and overall quality of life. |
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| 183 | | - | (d) Not later than January 1, 2023, the chairman of the board of |
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| 184 | | - | directors of The University of Connecticut Health Center shall report, in |
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| 185 | | - | accordance with the provisions of section 11-4a of the general statutes, |
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| 186 | | - | regarding the plan developed pursuant to subsections (b) and (c) of this |
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| 187 | | - | section and the anticipated timeline for establishing the endometriosis |
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| 188 | | - | data and biorepository program to the joint standing committee of the |
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| 189 | | - | General Assembly having cognizance of matters relating to public |
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| 190 | | - | health. |
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| 191 | | - | Sec. 4. Section 19a-266 of the general statutes is repealed and the |
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| 192 | | - | following is substituted in lieu thereof (Effective October 1, 2022): |
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| 193 | | - | (a) For purposes of this section: |
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| 194 | | - | (1) "Breast cancer screening and referral services" means necessary |
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| 195 | | - | breast cancer screening services and referral services for a procedure Substitute House Bill No. 5278 |
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| 196 | | - | |
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| 197 | | - | Public Act No. 22-33 7 of 9 |
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| 198 | | - | |
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| 199 | | - | intended to treat cancer of the human breast, including, but not limited |
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| 200 | | - | to, surgery, radiation therapy, chemotherapy, hormonal therapy and |
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| 201 | | - | related medical follow-up services. |
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| 202 | | - | (2) "Cervical cancer screening and referral services" means necessary |
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| 203 | | - | cervical cancer screening services and referral services for a procedure |
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| 204 | | - | intended to treat cancer of the human cervix, including, but not limited |
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| 205 | | - | to, surgery, radiation therapy, cryotherapy, electrocoagulation and |
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| 206 | | - | related medical follow-up services. |
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| 207 | | - | (3) "Tomosynthesis" means a digital x-ray mammogram that creates |
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| 208 | | - | two-dimensional and three-dimensional images of the breasts. |
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| 209 | | - | [(3)] (4) "Unserved or underserved populations" means women who |
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| 210 | | - | are: (A) At or below two hundred fifty per cent of the federal poverty |
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| 211 | | - | level for individuals; (B) without health insurance that covers breast |
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| 212 | | - | cancer screening mammography or cervical cancer screening services; |
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| 213 | | - | and (C) twenty-one to sixty-four years of age. |
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| 214 | | - | (b) There is established, within existing appropriations, a breast and |
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| 215 | | - | cervical cancer early detection and treatment referral program, within |
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| 216 | | - | the Department of Public Health, to (1) promote screening, detection |
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| 217 | | - | and treatment of breast cancer and cervical cancer among unserved or |
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| 218 | | - | underserved populations, while giving priority consideration to women |
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| 219 | | - | in minority communities who exhibit higher rates of breast cancer and |
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| 220 | | - | cervical cancer than the general population, (2) educate the public |
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| 221 | | - | regarding breast cancer and cervical cancer and the benefits of early |
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| 222 | | - | detection, and (3) provide counseling and referral services for treatment. |
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| 223 | | - | (c) The program shall include, but not be limited to: |
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| 224 | | - | (1) Establishment of a public education and outreach initiative to |
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| 225 | | - | publicize breast cancer and cervical cancer early detection services and |
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| 226 | | - | the extent of coverage for such services by health insurance; the benefits |
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| 227 | | - | of early detection of breast cancer and the recommended frequency of Substitute House Bill No. 5278 |
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| 228 | | - | |
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| 229 | | - | Public Act No. 22-33 8 of 9 |
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| 230 | | - | |
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| 231 | | - | screening services, including clinical breast examinations and |
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| 232 | | - | mammography, which shall include, where possible, tomosynthesis; |
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| 233 | | - | and the medical assistance program and other public and private |
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| 234 | | - | programs and the benefits of early detection of cervical cancer and the |
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| 235 | | - | recommended frequency of pap tests and tests for human |
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| 236 | | - | papillomavirus; |
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| 237 | | - | (2) Development of professional education programs, including the |
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| 238 | | - | benefits of early detection of breast cancer and the recommended |
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| 239 | | - | frequency of mammography and the benefits of early detection of |
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| 240 | | - | cervical cancer and the recommended frequency of pap tests and tests |
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| 241 | | - | for human papillomavirus; |
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| 242 | | - | (3) Establishment of a system to track and follow up on all women |
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| 243 | | - | screened for breast cancer and cervical cancer in the program. The |
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| 244 | | - | system shall include, but not be limited to, follow-up of abnormal |
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| 245 | | - | screening tests and referral to treatment when needed and tracking |
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| 246 | | - | women to be screened at recommended screening intervals; |
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| 247 | | - | (4) Assurance that all participating providers of breast cancer and |
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| 248 | | - | cervical cancer screening are in compliance with national and state |
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| 249 | | - | quality assurance legislative mandates. |
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| 250 | | - | (d) The Department of Public Health shall provide unserved or |
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| 251 | | - | underserved populations, while giving priority consideration to women |
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| 252 | | - | in minority communities who exhibit higher rates of breast cancer and |
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| 253 | | - | cervical cancer than the general population, within existing |
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| 254 | | - | appropriations and through contracts with health care providers: (1) (A) |
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| 255 | | - | Clinical breast examinations, (B) screening mammograms, [and] which |
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| 256 | | - | shall include, where possible, tomosynthesis, (C) pap tests, and (D) tests |
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| 257 | | - | for human papillomavirus, as recommended in the most current breast |
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| 258 | | - | and cervical cancer screening guidelines established by the United |
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| 259 | | - | States Preventive Services Task Force, for the woman's age and medical |
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| 260 | | - | history; and (2) a pap test every six months for women who have tested Substitute House Bill No. 5278 |
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| 261 | | - | |
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| 262 | | - | Public Act No. 22-33 9 of 9 |
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| 263 | | - | |
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| 264 | | - | HIV positive. |
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| 97 | + | PH Joint Favorable Subst. -LCO |
|---|