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A bill to be entitled 1
An act relating to physician assistant and advanced 2
practice registered nurse services; amending s. 3
382.008, F.S.; revising who may file a certificate of 4
death or fetal death; revising the definition of 5
"primary or attending practitioner"; revising who may 6
note corrected information on a permanent certificate 7
of death or fetal death; amending s. 400.601, F.S.; 8
providing and revising definitions; amending s. 9
400.6095, F.S.; revising the roles and 10
responsibilities of the plan of care team; amending s. 11
401.45, F.S.; revising who is required to sign a 12
patient's order not to resuscitate; providing an 13
effective date. 14
15
Be It Enacted by the Legislature of the State of Florida: 16
17
Section 1. Paragraph (a) of subsection (2) and subsections 18
(3) and (5) of section 382.008, Florida Statutes, are amended to 19
read: 20
382.008 Death, fetal death, and nonviable birth 21
registration.— 22
(2)(a) The funeral director who first assume s custody of a 23
dead body or fetus shall electronically file the certificate of 24
death or fetal death. In the absence of the funeral director, 25
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the physician, physician assistant, advanced practice registered 26
nurse registered under s. 464.0123, advanced practice registered 27
nurse providing hospice care pursuant to a written protocol with 28
a licensed physician, or other person in attendance at or after 29
the death or the district medical examiner of the county in 30
which the death occurred or the body was found shall 31
electronically file the certificate of death or fetal death. The 32
person who files the certificate shall obtain personal data from 33
a legally authorized person as described in s. 497.005 or the 34
best qualified person or source available. The medical 35
certification of cause of death must be furnished to the funeral 36
director, either in person or via certified mail or electronic 37
transfer, by the physician, physician assistant, advanced 38
practice registered nurse registered under s. 464.0123, advanced 39
practice registered nurse providing hospice care pursuant to a 40
written protocol with a licensed physician, or medical examiner 41
responsible for furnishing such information. For fetal deaths, 42
the physician, physician assistant, advanced practice registered 43
nurse registered under s. 464.0123, advanced practice registered 44
nurse providing hospice care pursuant to a written protocol with 45
a licensed physician, midwife, or hospital administrator shall 46
provide any medical or health information to the funeral 47
director within 72 h ours after expulsion or extraction. 48
(3) Within 72 hours after receipt of a death or fetal 49
death certificate from the funeral director, the medical 50
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certification of cause of death shall be completed and made 51
available to the funeral director by the decede nt's primary or 52
attending practitioner or, if s. 382.011 applies, the district 53
medical examiner of the county in which the death occurred or 54
the body was found. The primary or attending practitioner or the 55
medical examiner shall certify over his or her sig nature the 56
cause of death to the best of his or her knowledge and belief. 57
As used in this section, the term "primary or attending 58
practitioner" means a physician, physician assistant, or 59
advanced practice registered nurse registered under s. 464.0123 , 60
or an advanced practice registered nurse providing hospice care 61
pursuant to a written protocol with a licensed physician, who 62
treated the decedent through examination, medical advice, or 63
medication during the 12 months preceding the date of death. 64
(a) The department may grant the funeral director an 65
extension of time upon a good and sufficient showing of any of 66
the following conditions: 67
1. An autopsy is pending. 68
2. Toxicology, laboratory, or other diagnostic reports 69
have not been completed. 70
3. The identity of the decedent is unknown and further 71
investigation or identification is required. 72
(b) If the decedent's primary or attending practitioner or 73
the district medical examiner of the county in which the death 74
occurred or the body was found indicates tha t he or she will 75
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sign and complete the medical certification of cause of death 76
but will not be available until after the 5 -day registration 77
deadline, the local registrar may grant an extension of 5 days. 78
If a further extension is required, the funeral dire ctor must 79
provide written justification to the registrar. 80
(5) A permanent certificate of death or fetal death, 81
containing the cause of death and any other information that was 82
previously unavailable, shall be registered as a replacement for 83
the temporary certificate. The permanent certificate may also 84
include corrected information if the items being corrected are 85
noted on the back of the certificate and dated and signed by the 86
funeral director, physician, physician assistant, advanced 87
practice registered nurse registered under s. 464.0123 , an 88
advanced practice registered nurse providing hospice care 89
pursuant to a written protocol with a licensed physician , or 90
district medical examiner of the county in which the death 91
occurred or the body was found, as appr opriate. 92
Section 2. Subsection (10) of section 400.601, Florida 93
Statutes, is renumbered as subsection (11), subsection (4) is 94
amended, and a new subsection (10) is added to that section, to 95
read: 96
400.601 Definitions. —As used in this part, the term: 97
(4) "Hospice care team" means an interdisciplinary team of 98
qualified professionals and volunteers who, in consultation with 99
the patient, the patient's family, and the patient's primary or 100
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attending practitioner physician, collectively assess, 101
coordinate, and provide the appropriate palliative and 102
supportive care to hospice patients and their families. 103
(10) "Primary or attending practitioner" means a physician 104
licensed under chapter 458 or 459, a physician assistant 105
licensed under s. 458.347 or s. 459.022 , or an advanced practice 106
registered nurse registered under s. 464.0123 under a written 107
protocol with a supervising physician. 108
Section 3. Subsections (7), (8), and (9) of section 109
400.6095, Florida Statutes, are renumbered as subsections (8), 110
(9), and (10), respectively, subsections (2), (5), (6), and 111
present subsection (8) of that section are amended, and a new 112
subsection (7) is added to that section, to read: 113
400.6095 Patient admission; assessment; plan of care; 114
discharge; death.— 115
(2) Admission to a hospice program shall be made upon a 116
diagnosis and prognosis of terminal illness by the patient's 117
primary or attending practitioner a physician licensed pursuant 118
to chapter 458 or chapter 459 and shall be dependent on the 119
expressed request and informed c onsent of the patient. 120
(5) Each hospice, in collaboration with the patient and 121
the patient's primary or attending practitioner physician, shall 122
prepare and maintain a plan of care for each patient, and the 123
care provided to a patient must be in accordance with the plan 124
of care. The plan of care shall be made a part of the patient's 125
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medical record and shall include, at a minimum: 126
(a) Identification of the primary caregiver, or an 127
alternative plan of care in the absence of a primary caregiver, 128
to ensure that the patient's needs will be met. 129
(b) The patient's diagnosis, prognosis, and preferences 130
for care. 131
(c) Assessment of patient and family needs, identification 132
of the services required to meet those needs, and plans for 133
providing those services throug h the hospice care team, 134
volunteers, contractual providers, and community resources. 135
(d) Plans for instructing the patient and family in 136
patient care. 137
(e) Identification of the nurse designated to coordinate 138
the overall plan of care for each patient an d family. 139
(f) A description of how needed care and services will be 140
provided in the event of an emergency. 141
(6) The hospice shall provide an ongoing assessment of the 142
patient and family needs, update the plan of care to meet 143
changing needs, coordinate t he care provided with the patient's 144
primary or attending practitioner physician, and document the 145
services provided. 146
(7) The care a patient receives while he or she is 147
enrolled in hospice or receiving palliative care may be managed 148
by a primary or attend ing practitioner. Management of the care 149
includes, but is not limited to, admission, transfer, and 150
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discharge from hospice enrollment or a hospice inpatient 151
facility. 152
(9)(8) The hospice care team may withhold or withdraw 153
cardiopulmonary resuscitation if p resented with an order not to 154
resuscitate executed pursuant to s. 401.45. The agency shall 155
adopt rules providing for the implementation of such orders. 156
Hospice staff shall not be subject to criminal prosecution or 157
civil liability, nor be considered to have engaged in negligent 158
or unprofessional conduct, for withholding or withdrawing 159
cardiopulmonary resuscitation pursuant to such an order and 160
applicable rules. The absence of an order to resuscitate 161
executed pursuant to s. 401.45 does not preclude a practitioner 162
physician from withholding or withdrawing cardiopulmonary 163
resuscitation as otherwise permitted by law. 164
Section 4. Paragraph (a) of subsection (3) of section 165
401.45, Florida Statutes, is amended to read: 166
401.45 Denial of emergency treatment; civi l liability.— 167
(3)(a) Resuscitation may be withheld or withdrawn from a 168
patient by an emergency medical technician or paramedic if 169
evidence of an order not to resuscitate by the patient's 170
physician or physician assistant is presented to the emergency 171
medical technician or paramedic. An order not to resuscitate, to 172
be valid, must be on the form adopted by rule of the department. 173
The form must be signed by the patient's physician , or physician 174
assistant, or advanced practice registered nurse providing 175
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hospice care pursuant to a written protocol with a licensed 176
physician, and by the patient or, if the patient is 177
incapacitated, the patient's health care surrogate or proxy as 178
provided in chapter 765, court -appointed guardian as provided in 179
chapter 744, or attorn ey in fact under a durable power of 180
attorney as provided in chapter 709. The court -appointed 181
guardian or attorney in fact must have been delegated authority 182
to make health care decisions on behalf of the patient. 183
Section 5. This act shall take effect July 1, 2025. 184