24 LC 55 0307S
The Senate Committee on Regulated Industries and Utilities offered 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 revise regulations concerning advanced practice registered nurses and3
physician assistants; to authorize advanced practice registered nurses and physician assistants4
to sign death certificates; to revise provisions relating to the number of advanced practice5
registered nurses and physician assistants that a physician can authorize and supervise at any6
one time; to provide for related matters; to provide for effective dates; to repeal conflicting7
laws; and for other purposes.8
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
PART I10
SECTION 1-1.11
Code Section 31-10-15 of the Official Code of Georgia Annotated, relating to death12
certificates, filing, medical certification, forwarding death certificate to decedent's county of13
residence, and purging voter registration list, is amended by revising subsections (c) and (e)14
as follows:15
- 1 - 24 LC 55 0307S
"(c)(1) The medical certification as to the cause and circumstances of death shall be16
completed, signed, and returned to the funeral director or person acting as such within 7217
hours after death by the physician, or advanced practice registered nurse acting pursuant18
to the authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant19
acting pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in20
charge of the patient's care for the illness or condition which resulted in death, except21
when inquiry is required by Article 2 of Chapter 16 of Title 45, the 'Georgia Death22
Investigation Act.' In the absence of said physician, advanced practice registered nurse,23
or licensed physician assistant or with that physician's approval, the certificate may be24
completed and signed by an associate physician, the chief medical officer of the25
institution in which death occurred, or the physician who performed an autopsy upon the26
decedent, provided that such individual has access to the medical history of the case,27
views the deceased at or after death, and death is due to natural causes. If, 30 days after28
a death, the physician, or advanced practice registered nurse acting pursuant to the29
authority of Code Sections 43-34-23 and 43-34-25 or licensed physician assistant acting30
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, who is in charge of31
the patient's care for the illness or condition which resulted in death has failed to32
complete, sign, and return the medical certification as to the cause and circumstances of33
death to the funeral director or person acting as such, the funeral director or person acting34
as such shall be authorized to report such physician, advanced practice registered nurse,35
or licensed physician assistant to their respective licensing boards for disciplinary action36
to the Georgia Composite Medical Board for discipline pursuant to Code37
Section 43-34-8.38
(2) In any area in this state which is in a state of emergency as declared by the Governor39
due to an influenza pandemic, in addition to any other person authorized by law to40
complete and sign a death certificate, any registered professional nurse employed by a41
long-term care facility, advanced practice nurse, physician assistant, registered nurse42
- 2 - 24 LC 55 0307S
employed by a home health agency, or nursing supervisor employed by a hospital shall43
be authorized to complete and sign the death certificate, provided that such person has44
access to the medical history of the case, such person views the deceased at or after death,45
the death is due to natural causes, and an inquiry is not required under Article 2 of46
Chapter 16 of Title 45, the 'Georgia Death Investigation Act.' In such a state of47
emergency, the death certificate shall be filed by the funeral director in accordance with48
subsection (b) of this Code section; or, if the certificate is not completed and signed by49
an appropriate physician, advanced practice registered nurse acting pursuant to the50
authority of Code Sections 43-34-23 and 43-34-25, licensed physician assistant acting51
pursuant to the authority of Code Sections 43-34-23 and 43-34-103, or coroner, the public52
health director of preparedness shall cause the death certificate to be completed, signed,53
and filed by some other authorized person within ten days after death.54
(3) An authorized individual completing and signing a death certificate in good faith and55
in accordance with this subsection shall be immune from civil liability for any acts or56
omissions relating to the medical certification, absent wanton misconduct or intentional57
wrongdoing. This immunity is in addition to any other legal immunity from liability to58
which such individuals may be entitled."59
"(e) If the cause of death cannot be determined within 48 hours after death, the medical60
certification shall be completed as provided by regulation. The attending physician,61
advanced practice registered nurse acting pursuant to the authority of Code62
Sections 43-34-23 and 43-34-25, licensed physician assistant acting pursuant to the63
authority of Code Sections 43-34-23 and 43-34-103, or coroner shall give the funeral64
director or person acting as such notice of the reason for the delay, and final disposition of65
the body shall not be made until authorized by the attending physician, coroner, or medical66
examiner."67
- 3 - 24 LC 55 0307S
SECTION 1-2.68
Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,69
physician assistants, and others, is amended by revising subparagraph (b)(1)(B) of Code70
Section 43-34-23, relating to delegation of authority to nurse or physician assistant, as71
follows:72
"(B) A physician may delegate to those health care healthcare professionals identified73
in subparagraph (A) of this paragraph:74
(i) The authority to order controlled substances selected from a formulary of such75
drugs established by the board and the authority to order dangerous drugs, medical76
treatments, and diagnostic studies;77
(ii) The authority to request, receive, and sign for professional samples and to78
distribute professional samples to patients. The office or facility at which the health79
care healthcare professional identified in subparagraph (A) of this paragraph is80
working shall maintain a general list of the professional samples approved by the81
delegating physician for request, receipt, and distribution by the health care healthcare82
professional identified in subparagraph (A) of this paragraph as well as a complete list83
of the specific number and dosage of each professional sample and medication84
voucher received. Professional samples that are distributed by a health care85
healthcare professional identified in subparagraph (A) of this paragraph shall be so86
noted in the patient's medical record. In addition to the requirements of this Code87
section, all professional samples shall be maintained as required by applicable state88
and federal laws and regulations; and89
(iii) The authority to sign, certify, and endorse all documents relating to health care90
healthcare provided to a patient within his or her scope of authorized practice,91
including, but not limited to, documents relating to physical examination forms of all92
state agencies and verification and evaluation forms of the Department of Human93
Services, the State Board of Education, local boards of education, the Department of94
- 4 - 24 LC 55 0307S
Community Health, and the Department of Corrections; provided, however, that a95
health care healthcare professional identified in subparagraph (A) of this paragraph96
shall not have the authority to sign death certificates or assign a percentage of a97
disability rating.98
Healthcare professionals identified in subparagraph (A) of this paragraph must99
complete biennial continuing education regarding the recognition and documentation100
of the causes of death and appropriate execution of death certificates, as approved by101
the board."102
SECTION 1-3.103
Said chapter is further amended by revising subsections (b) and (e.1) of Code104
Section 43-34-25, relating to delegation of certain medical acts to advanced practice105
registered nurse, construction and limitations of such delegation, definitions, conditions of106
nurse protocol, and issuance of prescription drug orders, as follows:107
"(b) In addition to and without limiting the authority granted pursuant to Code108
Section 43-34-23, a physician may delegate to an advanced practice registered nurse in109
accordance with a nurse protocol agreement the authority to order drugs, medical devices,110
medical treatments, diagnostic studies, or radiographic imaging tests or to sign death111
certificates. A selection box shall be added to death certificates to be checked off by112
nonphysicians completing the form."113
"(e.1) Except for death certificates and assigning a percentage of a disability rating, an114
advanced practice registered nurse may be delegated the authority to sign, certify, and115
endorse all documents relating to health care healthcare provided to a patient within his or116
her scope of authorized practice, including, but not limited to, documents relating to117
physical examination forms of all state agencies and verification and evaluation forms of118
the Department of Human Services, the State Board of Education, local boards of119
education, the Department of Community Health, and the Department of Corrections."120
- 5 - 24 LC 55 0307S
SECTION 1-4.121
Said chapter is further amended by revising subsections (j) and (l) of Code122
Section 43-34-103, relating to application for licensure as a physician assistant, authorized123
delegated authority, and prohibited acts, as follows:124
"(j) A physician assistant shall be allowed to make a pronouncement of death pursuant to125
authority delegated by the supervising physician of the physician assistant and to certify126
such pronouncement in the same manner as a physician, including by signing death127
certificates. A selection box shall be added to death certificates to be checked off by128
nonphysicians completing the form."129
"(l) Except for death certificates and assigning a percentage of a disability rating, a130
physician assistant may be delegated the authority to sign, certify, and endorse all131
documents relating to health care provided to a patient within his or her scope of authorized132
practice, including, but not limited to, documents relating to physical examination forms133
of all state agencies and verification and evaluation forms of the Department of Human134
Services, the State Board of Education, local boards of education, the Department of135
Community Health, and the Department of Corrections."136
PART II137
SECTION 2-1.138
Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,139
acupuncture, physician assistants, and others, is amended in Code Section 43-34-25, relating140
to delegation of certain medical acts to advanced practice registered nurse, construction and141
limitations of such delegation, definitions, conditions of nurse protocol, and issuance of142
prescription drug orders, by revising subsections (g), (g.1), and (g.2) as follows:143
"(g) Except as otherwise provided in subsection (g.1) or (g.2) of this Code section, a144
delegating physician may not enter into a nurse protocol agreement pursuant to this Code145
- 6 - 24 LC 55 0307S
section or enter into a job description with a physician assistant pursuant to Code146
Section 43-34-103 with more than four the combined equivalent of eight advanced practice147
registered nurses or physician assistants at any one time, except this limitation shall not148
apply to an advanced practice registered nurse who is practicing:149
(1) In a hospital licensed under Title 31;150
(2) In any college or university as defined in Code Section 20-8-1;151
(3) In the Department of Public Health;152
(4) In any county board of health;153
(4.1) In any community service board;154
(5) In any free health clinic;155
(6) In a birthing center;156
(7) In any entity:157
(A) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal158
Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or159
indigent Medicaid and medicare Medicare patients; or160
(B) Which has been established under the authority of or is receiving funds pursuant161
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act;162
(8) In any local board of education which has a school nurse program;163
(9) In a health maintenance organization that has an exclusive contract with a medical164
group practice and arranges for the provision of substantially all physician services to165
enrollees in health benefits of the health maintenance organization; or166
(10) In any emergency medical services system operated by, or on behalf of, any county,167
municipality, or hospital authority with a full-time physician medical director and who168
does not order drugs, except that he or she may order up to a 14 day supply of drugs as169
necessary in an emergency situation, excluding Schedule II controlled substances and170
benzodiazepines; provided, however, that an advanced practice registered nurse shall not171
order radiographic imaging, diagnostic studies, or medical devices pursuant to this172
- 7 - 24 LC 55 0307S
paragraph; and provided, further, that a patient shall be referred to a physician, a dentist,173
or a federally qualified health center.174
(g.1) A delegating physician may not enter into a nurse protocol agreement pursuant to this175
Code section or enter into a job description with a physician assistant pursuant to Code176
Section 43-34-103 with more than the combined equivalent of eight advanced practice177
registered nurses or physician assistants at any one time, may not supervise more than four178
the combined equivalent of eight advanced practice registered nurses or physician179
assistants at any one time pursuant to nurse protocol agreements or job descriptions, and180
shall not be required to conduct any meetings, observations, or review of medical records181
except as otherwise provided in this subsection, if the advanced practice registered nurses182
practice at a location that:183
(1) Maintains evidence based clinical practice guidelines;184
(2) Is accredited by an accrediting body, approved by the board, such as the Joint185
Commission or a nationally recognized accrediting organization with comparable186
standards;187
(3) Requires the delegating physician to document and maintain a record of review of188
at least 10 percent of the advanced practice registered nurses' medical records to monitor189
quality of care being provided to patients, which may be conducted electronically or on190
site;191
(4) Requires the delegating physician and advanced practice registered nurse to192
participate in and maintain documentation of quarterly clinical collaboration meetings,193
either by telephone, in person, or on site, for purposes of monitoring care being provided194
to patients; and195
(5) Requires the delegating physician's name, contact information, and record of the visit196
to be provided to the patient's primary care provider of choice with the patient's consent197
within 24 hours of the visit.198
- 8 - 24 LC 55 0307S
(g.2) A delegating physician may not enter into a nurse protocol agreement pursuant to this199
Code section or enter into a job description with a physician assistant pursuant to Code200
Section 43-34-103 with more than the combined equivalent of eight advanced practice201
registered nurses or physician assistants at any one time or supervise more than four the202
combined equivalent of eight advanced practice registered nurses or physician assistants203
at any one time in any emergency medical services system operated by, or on behalf of, any204
county, municipality, or hospital authority with a full-time medical director."205
SECTION 2-2.206
Said chapter is further amended in Code Section 43-34-103, relating to application for207
licensure as a physician assistant, authorized delegated authority, and prohibited acts, by208
revising subsection (b) as follows:209
"(b)(1) No primary supervising physician shall enter into a job description with a210
physician assistant pursuant to this Code section or a nurse protocol agreement with an211
advanced practice registered nurse pursuant to Code Section 43-34-25 with more than the212
combined equivalent of eight physician assistants or advanced practice registered nurses213
or supervise more than four the combined equivalent of eight physician assistants or214
advanced practice registered nurses at a time except as provided in paragraph (3) or (4)215
of this subsection.216
(2) A primary supervising physician shall designate in writing to the board such other217
physicians who may serve as an alternate supervising physician for each physician218
assistant with which such primary supervising physician has entered into a job219
description. The board shall have authority to approve or deny such designations in220
whole or in part; provided, however, that a physician may be listed as an alternate221
supervising physician for any number of physician assistants so long as he or she only222
supervises as many physician assistants at any one time as allowed by paragraphs (1)223
and (3) of this subsection.224
- 9 - 24 LC 55 0307S
(3) No primary supervising physician shall have more than eight physician assistants225
who have completed a board approved anesthesiologist assistant program licensed to him226
or her at a time or supervise more than four physician assistants who have completed a227
board approved anesthesiologist assistant program at any one time.228
(4) Except for physician assistants who have completed a board approved229
anesthesiologist assistant program, the limitation in paragraph (1) of this subsection shall230
not apply to a physician assistant who is practicing:231
(A) In a hospital licensed under Title 31;232
(B) In any college or university as defined in Code Section 20-8-1;233
(C) In the Department of Public Health;234
(D) In any county board of health;235
(E) In any community service board;236
(F) In any free health clinic;237
(G) In a birthing center;238
(H) In any entity:239
(i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal240
Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or241
indigent Medicaid and Medicare patients; or242
(ii) Which has been established under the authority of or is receiving funds pursuant243
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act; or244
(I) In a health maintenance organization that has an exclusive contract with a medical245
group practice and arranges for the provision of substantially all physician services to246
enrollees in health benefits of the health maintenance organization."247
- 10 - 24 LC 55 0307S
PART III248
SECTION 3-1.249
(a) Except as provided in subsection (b) of this section, this Act shall become effective on250
the first day of the month following the month in which it is approved by the Governor or251
becomes law without such approval.252
(b) Part I of this Act shall become effective on July 1, 2024.253
SECTION 3-2.254
All laws and parts of laws in conflict with this Act are repealed.255
- 11 -