24 LC 33 9690S
The House Committee on Health offers the following substitute to HB 1046:
A BILL TO BE ENTITLED
AN ACT
To amend Code Section 31-10-15 and Chapter 34 of Title 43 of the Official Code of Georgia1
Annotated, relating to death certificates and physicians, physician assistants, and others,2
respectively, so as to authorize advanced practice registered nurses and physician assistants3
to sign death certificates; to provide for related matters; to repeal conflicting laws; and for4
other purposes.5
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:6
SECTION 1.7
Code Section 31-10-15 of the Official Code of Georgia Annotated, relating to death8
certificates, filing, medical certification, forwarding death certificate to decedent's county of9
residence, and purging voter registration list, is amended by revising subsections (c) and (e)10
as follows:11
"(c)(1) The medical certification as to the cause and circumstances of death shall be12
completed, signed, and returned to the funeral director or person acting as such within 7213
hours after death by the physician, or advanced practice registered nurse acting pursuant14
to the authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant15
acting pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in16
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charge of the patient's care for the illness or condition which resulted in death, except17
when inquiry is required by Article 2 of Chapter 16 of Title 45, the 'Georgia Death18
Investigation Act.' In the absence of said physician, advanced practice registered nurse,19
or licensed physician assistant or with that physician's approval, the certificate may be20
completed and signed by an associate physician, the chief medical officer of the21
institution in which death occurred, or the physician who performed an autopsy upon the22
decedent, provided that such individual has access to the medical history of the case,23
views the deceased at or after death, and death is due to natural causes. If, 30 days after24
a death, the physician, or advanced practice registered nurse acting pursuant to the25
authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant acting26
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in charge of27
the patient's care for the illness or condition which resulted in death has failed to28
complete, sign, and return the medical certification as to the cause and circumstances of29
death to the funeral director or person acting as such, the funeral director or person acting30
as such shall be authorized to report such physician, advanced practice registered nurse,31
or licensed physician assistant to their respective licensing boards for disciplinary action32
to the Georgia Composite Medical Board for discipline pursuant to Code Section33
43-34-8.34
(2) In any area in this state which is in a state of emergency as declared by the Governor35
due to an influenza pandemic, in addition to any other person authorized by law to36
complete and sign a death certificate, any registered professional nurse employed by a37
long-term care facility, advanced practice nurse, physician assistant, registered nurse38
employed by a home health agency, or nursing supervisor employed by a hospital shall39
be authorized to complete and sign the death certificate, provided that such person has40
access to the medical history of the case, such person views the deceased at or after death,41
the death is due to natural causes, and an inquiry is not required under Article 2 of42
Chapter 16 of Title 45, the 'Georgia Death Investigation Act.' In such a state of43
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emergency, the death certificate shall be filed by the funeral director in accordance with44
subsection (b) of this Code section; or, if the certificate is not completed and signed by45
an appropriate physician, advanced practice registered nurse acting pursuant to the46
authority of Code Sections 43-34-23 and 43-34-25, licensed physician assistant acting47
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, or coroner, the public48
health director of preparedness shall cause the death certificate to be completed, signed,49
and filed by some other authorized person within ten days after death."50
"(e) If the cause of death cannot be determined within 48 hours after death, the medical51
certification shall be completed as provided by regulation. The attending physician,52
advanced practice registered nurse acting pursuant to the authority of Code Sections53
43-34-23 and 43-34-25, licensed physician assistant acting pursuant to the authority of54
Code Sections 43-34-23 and 43-34-103, or coroner shall give the funeral director or person55
acting as such notice of the reason for the delay, and final disposition of the body shall not56
be made until authorized by the attending physician, coroner, or medical examiner."57
SECTION 2.58
Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,59
physician assistants, and others, is amended by revising subparagraph (b)(1)(B) of Code60
Section 43-34-23, relating to delegation of authority to nurse or physician assistant, as61
follows:62
"(B) A physician may delegate to those health care healthcare professionals identified63
in subparagraph (A) of this paragraph:64
(i) The authority to order controlled substances selected from a formulary of such65
drugs established by the board and the authority to order dangerous drugs, medical66
treatments, and diagnostic studies;67
(ii) The authority to request, receive, and sign for professional samples and to68
distribute professional samples to patients. The office or facility at which the health69
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care healthcare professional identified in subparagraph (A) of this paragraph is70
working shall maintain a general list of the professional samples approved by the71
delegating physician for request, receipt, and distribution by the health care healthcare72
professional identified in subparagraph (A) of this paragraph as well as a complete list73
of the specific number and dosage of each professional sample and medication74
voucher received. Professional samples that are distributed by a health care75
healthcare professional identified in subparagraph (A) of this paragraph shall be so76
noted in the patient's medical record. In addition to the requirements of this Code77
section, all professional samples shall be maintained as required by applicable state78
and federal laws and regulations; and79
(iii) The authority to sign, certify, and endorse all documents relating to health care80
healthcare provided to a patient within his or her scope of authorized practice,81
including, but not limited to, documents relating to physical examination forms of all82
state agencies and verification and evaluation forms of the Department of Human83
Services, the State Board of Education, local boards of education, the Department of84
Community Health, and the Department of Corrections; provided, however, that a85
health care healthcare professional identified in subparagraph (A) of this paragraph86
shall not have the authority to sign death certificates or assign a percentage of a87
disability rating.88
Healthcare professionals identified in subparagraph (A) of this paragraph must89
complete biennial continuing education regarding the recognition and documentation90
of the causes of death and appropriate execution of death certificates, as approved by91
the board."92
SECTION 3.93
Said chapter is further amended by revising subsections (b), (e.1), and (m) of Code Section94
43-34-25, relating to delegation of certain medical acts to advanced practice registered nurse,95
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construction and limitations of such delegation, definitions, conditions of nurse protocol, and96
issuance of prescription drug orders, as follows:97
"(b) In addition to and without limiting the authority granted pursuant to Code Section98
43-34-23, a physician may delegate to an advanced practice registered nurse in accordance99
with a nurse protocol agreement the authority to order drugs, medical devices, medical100
treatments, diagnostic studies, or radiographic imaging tests or to sign death certificates. 101
A selection box shall be added to death certificates to be checked off by nonphysicians102
completing the form."103
"(e.1) Except for death certificates and assigning a percentage of a disability rating, an104
advanced practice registered nurse may be delegated the authority to sign, certify, and105
endorse all documents relating to health care healthcare provided to a patient within his or106
her scope of authorized practice, including, but not limited to, documents relating to107
physical examination forms of all state agencies and verification and evaluation forms of108
the Department of Human Services, the State Board of Education, local boards of109
education, the Department of Community Health, and the Department of Corrections."110
"(m)(1) The board shall have the authority to promulgate rules and regulations governing111
a delegating physician in order to carry out the intents and purposes of this Code section.112
(2)(A) Further, the board shall be authorized to:113
(1)(i) Require that a nurse protocol agreement shall be filed by the delegating114
physician with the board within a reasonable time from the date of execution;115
(2)(ii) Determine, after review of a filed nurse protocol agreement, if such nurse116
protocol agreement fails to meet accepted standards of medical practice as established117
by the board; and118
(3)(iii) Require the delegating physician to amend any such noncompliant nurse119
protocol agreement in order to meet such accepted standards.120
(B) If a medical practice has an existing authorized nurse protocol agreement and an121
alternate delegating physician or a change in the delegating physician within the same122
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or similar specialty, such new nurse protocol agreement for the new alternate delegating123
physician or a change in the delegating physician, upon submission, shall be124
automatically deemed authorized by the board.125
(C) If a delegating physician submits a nurse protocol agreement for a new advanced126
practice registered nurse and such nurse protocol agreement has substantially the same127
terms and provisions as a nurse protocol agreement previously submitted by such128
delegating physician for another advanced practice registered nurse and authorized by129
the board, the nurse protocol agreement for the new advanced practice registered nurse,130
upon submission, shall be automatically deemed authorized by the board."131
SECTION 4.132
Said chapter is further amended by revising subsections (j) and (l) of Code Section133
43-34-103, relating to application for licensure as a physician assistant, authorized delegated134
authority, and prohibited acts, as follows:135
"(j) A physician assistant shall be allowed to make a pronouncement of death pursuant to136
authority delegated by the supervising physician of the physician assistant and to certify137
such pronouncement in the same manner as a physician, including by signing death138
certificates. A selection box shall be added to death certificates to be checked off by139
nonphysicians completing the form."140
"(l) Except for death certificates and assigning a percentage of a disability rating, a141
physician assistant may be delegated the authority to sign, certify, and endorse all142
documents relating to health care provided to a patient within his or her scope of authorized143
practice, including, but not limited to, documents relating to physical examination forms144
of all state agencies and verification and evaluation forms of the Department of Human145
Services, the State Board of Education, local boards of education, the Department of146
Community Health, and the Department of Corrections."147
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SECTION 5.148
All laws and parts of laws in conflict with this Act are repealed.149
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