As Introduced
136th General Assembly
Regular Session H. B. No. 52
2025-2026
Representative Deeter
Cosponsors: Representatives Baker, Thomas, D., Lorenz, Mathews, T., Fischer,
Gross, Williams, McClain, Manning, Robb Blasdel, Pizzulli, Holmes, Hiner, Hoops,
Peterson, Jones, Mathews, A., Santucci, Klopfenstein, Mullins, Barhorst
A B I L L
To amend sections 4723.01, 4723.43, 4723.432,
4729.01, 4731.27, 4731.35, and 4761.17; to enact
new section 4723.433 and section 4731.513; and
to repeal sections 4723.433, 4723.434, and
4723.435 of the Revised Code to revise the law
governing the practice of certified registered
nurse anesthetists.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4723.01, 4723.43, 4723.432,
4729.01, 4731.27, 4731.35, and 4761.17 be amended and new
section 4723.433 and section 4731.513 of the Revised Code be
enacted to read as follows:
Sec. 4723.01. As used in this chapter:
(A) "Registered nurse" means an individual who holds a
current, valid license issued under this chapter that authorizes
the practice of nursing as a registered nurse.
(B) "Practice of nursing as a registered nurse" means
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providing to individuals and groups nursing care requiring
specialized knowledge, judgment, and skill derived from the
principles of biological, physical, behavioral, social, and
nursing sciences. Such nursing care includes:
(1) Identifying patterns of human responses to actual or
potential health problems amenable to a nursing regimen;
(2) Executing a nursing regimen through the selection,
performance, management, and evaluation of nursing actions;
(3) Assessing health status for the purpose of providing
nursing care;
(4) Providing health counseling and health teaching;
(5) Administering medications, treatments, and executing
regimens authorized by an individual who is authorized to
practice in this state and is acting within the course of the
individual's professional practice;
(6) Teaching, administering, supervising, delegating, and
evaluating nursing practice.
(C) "Nursing regimen" may include preventative,
restorative, and health-promotion activities.
(D) "Assessing health status" means the collection of data
through nursing assessment techniques, which may include
interviews, observation, and physical evaluations for the
purpose of providing nursing care.
(E) "Licensed practical nurse" means an individual who
holds a current, valid license issued under this chapter that
authorizes the practice of nursing as a licensed practical
nurse.
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(F) "The practice of nursing as a licensed practical
nurse" means providing to individuals and groups nursing care
requiring the application of basic knowledge of the biological,
physical, behavioral, social, and nursing sciences at the
direction of a registered nurse or any of the following who is
authorized to practice in this state: a physician, physician
assistant, dentist, podiatrist, optometrist, or chiropractor.
Such nursing care includes:
(1) Observation, patient teaching, and care in a diversity
of health care settings;
(2) Contributions to the planning, implementation, and
evaluation of nursing;
(3) Administration of medications and treatments
authorized by an individual who is authorized to practice in
this state and is acting within the course of the individual's
professional practice;
(4) Administration to an adult of intravenous therapy
authorized by an individual who is authorized to practice in
this state and is acting within the course of the individual's
professional practice, on the condition that the licensed
practical nurse is authorized under section 4723.18 or 4723.181
of the Revised Code to perform intravenous therapy and performs
intravenous therapy only in accordance with those sections;
(5) Delegation of nursing tasks as directed by a
registered nurse;
(6) Teaching nursing tasks to licensed practical nurses
and individuals to whom the licensed practical nurse is
authorized to delegate nursing tasks as directed by a registered
nurse.
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(G) "Certified registered nurse anesthetist" means an
advanced practice registered nurse who holds a current, valid
license issued under this chapter and is designated as a
certified registered nurse anesthetist in accordance with
section 4723.42 of the Revised Code and rules adopted by the
board of nursing.
(H) "Clinical nurse specialist" means an advanced practice
registered nurse who holds a current, valid license issued under
this chapter and is designated as a clinical nurse specialist in
accordance with section 4723.42 of the Revised Code and rules
adopted by the board of nursing.
(I) "Certified nurse-midwife" means an advanced practice
registered nurse who holds a current, valid license issued under
this chapter and is designated as a certified nurse-midwife in
accordance with section 4723.42 of the Revised Code and rules
adopted by the board of nursing.
(J) "Certified nurse practitioner" means an advanced
practice registered nurse who holds a current, valid license
issued under this chapter and is designated as a certified nurse
practitioner in accordance with section 4723.42 of the Revised
Code and rules adopted by the board of nursing.
(K) "Physician" means an individual authorized under
Chapter 4731. of the Revised Code to practice medicine and
surgery or osteopathic medicine and surgery.
(L) "Collaboration" or "collaborating" means the
following:
(1) In the case of a clinical nurse specialist or a
certified nurse practitioner, that one or more podiatrists
acting within the scope of practice of podiatry in accordance
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with section 4731.51 of the Revised Code and with whom the nurse
has entered into a standard care arrangement or one or more
physicians with whom the nurse has entered into a standard care
arrangement are continuously available to communicate with the
clinical nurse specialist or certified nurse practitioner either
in person or by electronic communication;
(2) In the case of a certified nurse-midwife, that one or
more physicians with whom the certified nurse-midwife has
entered into a standard care arrangement are continuously
available to communicate with the certified nurse-midwife either
in person or by electronic communication.
(M) "Supervision," "Consultation" or "consulting," as it
pertains to a certified registered nurse anesthetist, means that
the certified registered nurse anesthetist is under the
direction of a podiatrist acting within the podiatrist's scope
of practice in accordance with section 4731.51 of the Revised
Code, a dentist acting within the dentist's scope of practice in
accordance with Chapter 4715. of the Revised Code, or a
physician, and, when administering anesthesia, the certified
registered nurse anesthetist is in the immediate presence of the
podiatrist,a dentist who holds a conscious sedation or general
anesthesia permit as described in section 4715.03 of the Revised
Code, or physician, or podiatrist, in accordance with policies
established by the setting where the nurse and dentist,
physician, or podiatrist practice, has requested, either
verbally or in writing, the nurse to perform for a patient any
of the nursing care activities authorized by division (D) of
section 4723.43 of the Revised Code .
(N) "Standard care arrangement" means a written, formal
guide for planning and evaluating a patient's health care that
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is developed by one or more collaborating physicians or
podiatrists and a clinical nurse specialist, certified nurse-
midwife, or certified nurse practitioner and meets the
requirements of section 4723.431 of the Revised Code.
(O) "Advanced practice registered nurse" means an
individual who holds a current, valid license issued under this
chapter that authorizes the practice of nursing as an advanced
practice registered nurse and is designated as any of the
following:
(1) A certified registered nurse anesthetist;
(2) A clinical nurse specialist;
(3) A certified nurse-midwife;
(4) A certified nurse practitioner.
(P) "Practice of nursing as an advanced practice
registered nurse" means providing to individuals and groups
nursing care that requires knowledge and skill obtained from
advanced formal education, training, and clinical experience.
Such nursing care includes the care described in section 4723.43
of the Revised Code.
(Q) "Dialysis care" means the care and procedures that a
dialysis technician or dialysis technician intern is authorized
to provide and perform, as specified in section 4723.72 of the
Revised Code.
(R) "Dialysis technician" means an individual who holds a
current, valid certificate to practice as a dialysis technician
issued under section 4723.75 of the Revised Code.
(S) "Dialysis technician intern" means an individual who
has not passed the dialysis technician certification examination
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required by section 4723.751 of the Revised Code, but who has
successfully completed a dialysis training program approved by
the board of nursing under section 4723.74 of the Revised Code
within the previous eighteen months.
(T) "Certified community health worker" means an
individual who holds a current, valid certificate as a community
health worker issued under section 4723.85 of the Revised Code.
(U) "Medication aide" means an individual who holds a
current, valid certificate issued under this chapter that
authorizes the individual to administer medication in accordance
with section 4723.67 of the Revised Code ;.
(V) "Nursing specialty" means a specialty in practice as a
certified registered nurse anesthetist, clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner.
(W) "Physician assistant" means an individual who is
licensed to practice as a physician assistant under Chapter
4730. of the Revised Code.
(X) "Podiatrist" means an individual authorized under
Chapter 4731. of the Revised Code to practice podiatric medicine
and surgery.
(Y) "Dentist" means an individual who is licensed to
practice dentistry under Chapter 4715. of the Revised Code.
Sec. 4723.43. A certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner, clinical nurse specialist, or certified
registered nurse anesthetist may provide to individuals and
groups nursing care that requires knowledge and skill obtained
from advanced formal education and clinical experience. In this
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capacity as an advanced practice registered nurse, a certified
nurse-midwife is subject to division (A) of this section, a
certified registered nurse anesthetist is subject to division
(B) of this section, a certified nurse practitioner is subject
to division (C) (B) of this section, and a clinical nurse
specialist is subject to division (D) (C) of this section, and a
certified registered nurse anesthetist is subject to division
(D) of this section and section 4723.433 of the Revised Code .
(A) A nurse authorized to practice as a certified nurse-
midwife, in collaboration with one or more physicians, may
provide the management of preventive services and those primary
care services necessary to provide health care to women
antepartally, intrapartally, postpartally, and gynecologically,
consistent with the nurse's education and certification, and in
accordance with rules adopted by the board of nursing.
No certified nurse-midwife may perform version, deliver
breech or face presentation, use forceps, do any obstetric
operation, or treat any other abnormal condition, except in
emergencies. Division (A) of this section does not prohibit a
certified nurse-midwife from performing episiotomies or normal
vaginal deliveries, or repairing vaginal tears. A certified
nurse-midwife may, in collaboration with one or more physicians,
prescribe drugs and therapeutic devices in accordance with
section 4723.481 of the Revised Code.
(B) A nurse authorized to practice as a certified
registered nurse anesthetist, consistent with the nurse's
education and certification and in accordance with rules adopted
by the board, may do the following:
(1) With supervision and in the immediate presence of a
physician, podiatrist, or dentist, administer anesthesia and
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perform anesthesia induction, maintenance, and emergence;
(2) With supervision, obtain informed consent for
anesthesia care and perform preanesthetic preparation and
evaluation, postanesthetic preparation and evaluation,
postanesthesia care, and, subject to section 4723.433 of the
Revised Code, clinical support functions;
(3) With supervision and in accordance with section
4723.434 of the Revised Code, engage in the activities described
in division (A) of that section.
The physician, podiatrist, or dentist supervising a
certified registered nurse anesthetist must be actively engaged
in practice in this state. When a certified registered nurse
anesthetist is supervised by a podiatrist, the nurse's scope of
practice is limited to the anesthesia procedures that the
podiatrist has the authority under section 4731.51 of the
Revised Code to perform. A certified registered nurse
anesthetist may not administer general anesthesia under the
supervision of a podiatrist in a podiatrist's office. When a
certified registered nurse anesthetist is supervised by a
dentist, the nurse's scope of practice is limited to the
anesthesia procedures that the dentist has the authority under
Chapter 4715. of the Revised Code to perform.
(C) A nurse authorized to practice as a certified nurse
practitioner, in collaboration with one or more physicians or
podiatrists, may provide preventive and primary care services,
provide services for acute illnesses, and evaluate and promote
patient wellness within the nurse's nursing specialty,
consistent with the nurse's education and certification, and in
accordance with rules adopted by the board. A certified nurse
practitioner may, in collaboration with one or more physicians
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or podiatrists, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.
When a certified nurse practitioner is collaborating with
a podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
(D) (C) A nurse authorized to practice as a clinical nurse
specialist, in collaboration with one or more physicians or
podiatrists, may provide and manage the care of individuals and
groups with complex health problems and provide health care
services that promote, improve, and manage health care within
the nurse's nursing specialty, consistent with the nurse's
education and in accordance with rules adopted by the board. A
clinical nurse specialist may, in collaboration with one or more
physicians or podiatrists, prescribe drugs and therapeutic
devices in accordance with section 4723.481 of the Revised Code.
When a clinical nurse specialist is collaborating with a
podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
(D) A nurse authorized to practice as a certified
registered nurse anesthetist, in consultation with a physician,
podiatrist, or dentist actively engaged in practice in this
state, may perform for a patient any of the following nursing
care activities, consistent with the nurse's education and
certification, and in accordance with rules adopted by the board
and policies established by the setting where the nurse and
consulting physician, podiatrist, or dentist practice:
(1) Obtaining informed consent for anesthesia care and
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performing preanesthetic preparation and evaluation;
(2) Administering anesthesia, by performing anesthesia
induction, maintenance, and emergence;
(3) Performing epidural or spinal anesthetic procedures;
(4) Performing postanesthetic preparation and evaluation
and providing postanesthesia care;
(5) Performing clinical support functions;
(6) As necessary for patient management and care,
selecting, ordering, and administering treatments, drugs, and
intravenous fluids for conditions related to either the
administration of anesthesia or the performance of clinical
support functions;
(7) Performing and documenting evaluations and
assessments, which may include ordering and evaluating one or
more diagnostic tests for conditions related to the
administration of anesthesia or the performance of clinical
support functions;
(8) Directing a registered nurse, licensed practical
nurse, or respiratory therapist to do the following, but only if
the nurse or therapist is authorized by law to do so:
(a) Provide supportive care, with such care to include
monitoring vital signs, conducting electrocardiograms, and
administering intravenous fluids;
(b) Administer treatments, drugs, and intravenous fluids
for conditions related to either the administration of
anesthesia or the performance of clinical support functions.
When a certified registered nurse anesthetist consults
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with a dentist, the nurse's scope of practice is limited to the
anesthesia procedures that the dentist has the authority to
perform under the dentist's conscious sedation or general
anesthesia permit issued under Chapter 4715. of the Revised
Code.
Division (D) of this section does not authorize a
certified registered nurse anesthetist to prescribe a drug for
use outside of the setting where the nurse practices.
Sec. 4723.432. (A) An advanced practice registered nurse
who is designated as a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner shall cooperate
with the state medical board in any investigation the board
conducts with respect to a physician or podiatrist who
collaborates with the nurse. The nurse shall cooperate with the
board in any investigation the board conducts with respect to
the unauthorized practice of medicine by the nurse.
(B) An advanced practice registered nurse who is
designated as a certified registered nurse anesthetist shall
cooperate with the board of nursing, state medical board, or
state dental board in any investigation either board conducts
conducted by such board with respect to a consulting physician,
podiatrist, or dentist who permits requests that the nurse to
practice with the supervision of that physician, podiatrist, or
dentistperform nursing care activities as described in division
(D) of section 4723.43 of the Revised Code . The
The nurse also shall cooperate with either the state
medical board or state dental board in any investigation it
conducts with respect to the unauthorized practice of medicine
or dentistry by the nurse.
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Sec. 4723.433. (A) A certified registered nurse
anesthetist shall not engage in one or more of the nursing care
activities described in division (D) of section 4723.43 of the
Revised Code if either of the following determines that it is
not in the patient's best interest for the nurse to perform such
an activity or activities:
(1) The nurse's consulting physician, podiatrist, or
dentist;
(2) The setting where the nurse and physician, podiatrist,
or dentist practice.
If a consulting physician, podiatrist, or dentist or
setting makes such a determination, the patient's medical or
electronic health record shall indicate that the nurse is
prohibited from performing the activity or activities.
(B) If a certified registered nurse anesthetist performs
one or more of the activities described in division (D) of
section 4723.43 of the Revised Code, the nurse shall so indicate
in the patient's medical or electronic health record.
(C) This section does not prohibit a certified registered
nurse anesthetist from implementing a verbal order issued by a
consulting physician, podiatrist, or dentist.
Sec. 4729.01. As used in this chapter:
(A) "Pharmacy," except when used in a context that refers
to the practice of pharmacy, means any area, room, rooms, place
of business, department, or portion of any of the foregoing
where the practice of pharmacy is conducted.
(B) "Practice of pharmacy" means providing pharmacist care
requiring specialized knowledge, judgment, and skill derived
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from the principles of biological, chemical, behavioral, social,
pharmaceutical, and clinical sciences. As used in this division,
"pharmacist care" includes the following:
(1) Interpreting prescriptions;
(2) Dispensing drugs and drug therapy related devices;
(3) Compounding drugs;
(4) Counseling individuals with regard to their drug
therapy, recommending drug therapy related devices, and
assisting in the selection of drugs and appliances for treatment
of common diseases and injuries and providing instruction in the
proper use of the drugs and appliances;
(5) Performing drug regimen reviews with individuals by
discussing all of the drugs that the individual is taking and
explaining the interactions of the drugs;
(6) Performing drug utilization reviews with licensed
health professionals authorized to prescribe drugs when the
pharmacist determines that an individual with a prescription has
a drug regimen that warrants additional discussion with the
prescriber;
(7) Advising an individual and the health care
professionals treating an individual with regard to the
individual's drug therapy;
(8) Acting pursuant to a consult agreement, if an
agreement has been established;
(9) Engaging in the administration of immunizations to the
extent authorized by section 4729.41 of the Revised Code;
(10) Engaging in the administration of drugs to the extent
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authorized by section 4729.45 of the Revised Code.
(C) "Compounding" means the preparation, mixing,
assembling, packaging, and labeling of one or more drugs in any
of the following circumstances:
(1) Pursuant to a prescription issued by a licensed health
professional authorized to prescribe drugs;
(2) Pursuant to the modification of a prescription made in
accordance with a consult agreement;
(3) As an incident to research, teaching activities, or
chemical analysis;
(4) In anticipation of orders for drugs pursuant to
prescriptions, based on routine, regularly observed dispensing
patterns;
(5) Pursuant to a request made by a licensed health
professional authorized to prescribe drugs for a drug that is to
be used by the professional for the purpose of direct
administration to patients in the course of the professional's
practice, if all of the following apply:
(a) At the time the request is made, the drug is not
commercially available regardless of the reason that the drug is
not available, including the absence of a manufacturer for the
drug or the lack of a readily available supply of the drug from
a manufacturer.
(b) A limited quantity of the drug is compounded and
provided to the professional.
(c) The drug is compounded and provided to the
professional as an occasional exception to the normal practice
of dispensing drugs pursuant to patient-specific prescriptions.
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(D) "Consult agreement" means an agreement that has been
entered into under section 4729.39 of the Revised Code.
(E) "Drug" means:
(1) Any article recognized in the United States
pharmacopoeia and national formulary, or any supplement to them,
intended for use in the diagnosis, cure, mitigation, treatment,
or prevention of disease in humans or animals;
(2) Any other article intended for use in the diagnosis,
cure, mitigation, treatment, or prevention of disease in humans
or animals;
(3) Any article, other than food, intended to affect the
structure or any function of the body of humans or animals;
(4) Any article intended for use as a component of any
article specified in division (E)(1), (2), or (3) of this
section; but does not include devices or their components,
parts, or accessories.
"Drug" does not include "hemp" or a "hemp product" as
those terms are defined in section 928.01 of the Revised Code.
(F) "Dangerous drug" means any of the following:
(1) Any drug to which either of the following applies:
(a) Under the "Federal Food, Drug, and Cosmetic Act," 52
Stat. 1040 (1938), 21 U.S.C.A. 301, as amended, the drug is
required to bear a label containing the legend "Caution: Federal
law prohibits dispensing without prescription" or "Caution:
Federal law restricts this drug to use by or on the order of a
licensed veterinarian" or any similar restrictive statement, or
the drug may be dispensed only upon a prescription;
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(b) Under Chapter 3715. or 3719. of the Revised Code, the
drug may be dispensed only upon a prescription.
(2) Any drug that contains a schedule V controlled
substance and that is exempt from Chapter 3719. of the Revised
Code or to which that chapter does not apply;
(3) Any drug intended for administration by injection into
the human body other than through a natural orifice of the human
body;
(4) Any drug that is a biological product, as defined in
section 3715.01 of the Revised Code.
(G) "Federal drug abuse control laws" has the same meaning
as in section 3719.01 of the Revised Code.
(H) "Prescription" means all of the following:
(1) A written, electronic, or oral order for drugs or
combinations or mixtures of drugs to be used by a particular
individual or for treating a particular animal, issued by a
licensed health professional authorized to prescribe drugs;
(2) For purposes of sections 4723.4810, 4729.282,
4730.432, and 4731.93 of the Revised Code, a written,
electronic, or oral order for a drug to treat chlamydia,
gonorrhea, or trichomoniasis issued to and in the name of a
patient who is not the intended user of the drug but is the
sexual partner of the intended user;
(3) For purposes of sections 3313.7110, 3313.7111,
3314.143, 3326.28, 3328.29, 4723.483, 4729.88, 4730.433,
4731.96, and 5101.76 of the Revised Code, a written, electronic,
or oral order for an epinephrine autoinjector issued to and in
the name of a school, school district, or camp;
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(4) For purposes of Chapter 3728. and sections 4723.483,
4729.88, 4730.433, and 4731.96 of the Revised Code, a written,
electronic, or oral order for an epinephrine autoinjector issued
to and in the name of a qualified entity, as defined in section
3728.01 of the Revised Code;
(5) For purposes of sections 3313.7115, 3313.7116,
3314.147, 3326.60, 3328.38, 4723.4811, 4730.437, 4731.92, and
5101.78 of the Revised Code, a written, electronic, or oral
order for injectable or nasally administered glucagon in the
name of a school, school district, or camp.
(I) "Licensed health professional authorized to prescribe
drugs" or "prescriber" means an individual who is authorized by
law to prescribe drugs or dangerous drugs or drug therapy
related devices in the course of the individual's professional
practice, including only the following:
(1) A dentist licensed under Chapter 4715. of the Revised
Code;
(2) A clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner who holds a current, valid
license issued under Chapter 4723. of the Revised Code to
practice nursing as an advanced practice registered nurse;
(3) A certified registered nurse anesthetist who holds a
current, valid license issued under Chapter 4723. of the Revised
Code to practice nursing as an advanced practice registered
nurse, but only to the extent of the nurse's authority under
sections section 4723.43 and 4723.434 of the Revised Code;
(4) An optometrist licensed under Chapter 4725. of the
Revised Code to practice optometry;
(5) A physician authorized under Chapter 4731. of the
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Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery;
(6) A physician assistant who holds a license to practice
as a physician assistant issued under Chapter 4730. of the
Revised Code, holds a valid prescriber number issued by the
state medical board, and has been granted physician-delegated
prescriptive authority;
(7) A veterinarian licensed under Chapter 4741. of the
Revised Code;
(8) A certified mental health assistant licensed under
Chapter 4772. of the Revised Code who has been granted
physician-delegated prescriptive authority by the physician
supervising the certified mental health assistant.
(J) "Sale" or "sell" includes any transaction made by any
person, whether as principal proprietor, agent, or employee, to
do or offer to do any of the following: deliver, distribute,
broker, exchange, gift or otherwise give away, or transfer,
whether the transfer is by passage of title, physical movement,
or both.
(K) "Wholesale sale" and "sale at wholesale" mean any sale
in which the purpose of the purchaser is to resell the article
purchased or received by the purchaser.
(L) "Retail sale" and "sale at retail" mean any sale other
than a wholesale sale or sale at wholesale.
(M) "Retail seller" means any person that sells any
dangerous drug to consumers without assuming control over and
responsibility for its administration. Mere advice or
instructions regarding administration do not constitute control
or establish responsibility.
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(N) "Price information" means the price charged for a
prescription for a particular drug product and, in an easily
understandable manner, all of the following:
(1) The proprietary name of the drug product;
(2) The established (generic) name of the drug product;
(3) The strength of the drug product if the product
contains a single active ingredient or if the drug product
contains more than one active ingredient and a relevant strength
can be associated with the product without indicating each
active ingredient. The established name and quantity of each
active ingredient are required if such a relevant strength
cannot be so associated with a drug product containing more than
one ingredient.
(4) The dosage form;
(5) The price charged for a specific quantity of the drug
product. The stated price shall include all charges to the
consumer, including, but not limited to, the cost of the drug
product, professional fees, handling fees, if any, and a
statement identifying professional services routinely furnished
by the pharmacy. Any mailing fees and delivery fees may be
stated separately without repetition. The information shall not
be false or misleading.
(O) "Wholesale distributor of dangerous drugs" or
"wholesale distributor" means a person engaged in the sale of
dangerous drugs at wholesale and includes any agent or employee
of such a person authorized by the person to engage in the sale
of dangerous drugs at wholesale.
(P) "Manufacturer of dangerous drugs" or "manufacturer"
means a person, other than a pharmacist or prescriber, who
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manufactures dangerous drugs and who is engaged in the sale of
those dangerous drugs.
(Q) "Terminal distributor of dangerous drugs" or "terminal
distributor" means a person who is engaged in the sale of
dangerous drugs at retail, or any person, other than a
manufacturer, repackager, outsourcing facility, third-party
logistics provider, wholesale distributor, or pharmacist, who
has possession, custody, or control of dangerous drugs for any
purpose other than for that person's own use and consumption.
"Terminal distributor" includes pharmacies, hospitals, nursing
homes, and laboratories and all other persons who procure
dangerous drugs for sale or other distribution by or under the
supervision of a pharmacist, licensed health professional
authorized to prescribe drugs, or other person authorized by the
state board of pharmacy.
(R) "Promote to the public" means disseminating a
representation to the public in any manner or by any means,
other than by labeling, for the purpose of inducing, or that is
likely to induce, directly or indirectly, the purchase of a
dangerous drug at retail.
(S) "Person" includes any individual, partnership,
association, limited liability company, or corporation, the
state, any political subdivision of the state, and any district,
department, or agency of the state or its political
subdivisions.
(T)(1) "Animal shelter" means a facility operated by a
humane society or any society organized under Chapter 1717. of
the Revised Code or a dog pound operated pursuant to Chapter
955. of the Revised Code.
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(2) "County dog warden" means a dog warden or deputy dog
warden appointed or employed under section 955.12 of the Revised
Code.
(U) "Food" has the same meaning as in section 3715.01 of
the Revised Code.
(V) "Pain management clinic" has the same meaning as in
section 4731.054 of the Revised Code.
(W) "Investigational drug or product" means a drug or
product that has successfully completed phase one of the United
States food and drug administration clinical trials and remains
under clinical trial, but has not been approved for general use
by the United States food and drug administration.
"Investigational drug or product" does not include controlled
substances in schedule I, as defined in section 3719.01 of the
Revised Code.
(X) "Product," when used in reference to an
investigational drug or product, means a biological product,
other than a drug, that is made from a natural human, animal, or
microorganism source and is intended to treat a disease or
medical condition.
(Y) "Third-party logistics provider" means a person that
provides or coordinates warehousing or other logistics services
pertaining to dangerous drugs including distribution, on behalf
of a manufacturer, wholesale distributor, or terminal
distributor of dangerous drugs, but does not take ownership of
the drugs or have responsibility to direct the sale or
disposition of the drugs.
(Z) "Repackager of dangerous drugs" or "repackager" means
a person that repacks and relabels dangerous drugs for sale or
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distribution.
(AA) "Outsourcing facility" means a facility that is
engaged in the compounding and sale of sterile drugs and is
registered as an outsourcing facility with the United States
food and drug administration.
(BB) "Laboratory" means a laboratory licensed under this
chapter as a terminal distributor of dangerous drugs and
entrusted to have custody of any of the following drugs and to
use the drugs for scientific and clinical purposes and for
purposes of instruction: dangerous drugs that are not controlled
substances, as defined in section 3719.01 of the Revised Code;
dangerous drugs that are controlled substances, as defined in
that section; and controlled substances in schedule I, as
defined in that section.
(CC) "Overdose reversal drug" means both of the following:
(1) Naloxone;
(2) Any other drug that the state board of pharmacy,
through rules adopted in accordance with Chapter 119. of the
Revised Code, designates as a drug that is approved by the
federal food and drug administration for the reversal of a known
or suspected opioid-related overdose.
Sec. 4731.27. (A) As used in this section,
"collaboration," "consultation," "physician," and "standard care
arrangement," and "supervision" have the same meanings as in
section 4723.01 of the Revised Code.
(B) A physician or podiatrist shall enter into a standard
care arrangement with each clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner with whom the
physician or podiatrist is in collaboration.
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The collaborating physician or podiatrist shall fulfill
the responsibilities of collaboration, as specified in the
arrangement and in accordance with division (A) of section
4723.431 of the Revised Code. A copy of the standard care
arrangement shall be retained on file by the nurse's employer.
Prior approval of the standard care arrangement by the state
medical board is not required, but the board may periodically
review it.
A physician or podiatrist who terminates collaboration
with a certified nurse-midwife, certified nurse practitioner, or
clinical nurse specialist before their standard care arrangement
expires shall give the nurse the written or electronic notice of
termination required by division (D)(1) of section 4723.431 of
the Revised Code.
Nothing in this division prohibits a hospital from hiring
a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner as an employee and negotiating
standard care arrangements on behalf of the employee as
necessary to meet the requirements of this section. A standard
care arrangement between the hospital's employee and the
employee's collaborating physician is subject to approval by the
medical staff and governing body of the hospital prior to
implementation of the arrangement at the hospital.
(C) A physician or podiatrist shall cooperate with the
board of nursing in any investigation the board conducts with
respect to a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner who collaborates with the
physician or podiatrist or with respect to a certified
registered nurse anesthetist who practices in consultation with
the supervision of the physician or podiatrist.
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Sec. 4731.35. (A) This chapter does not apply to or
prohibit in any way the administration of anesthesia by a
certified registered nurse anesthetist under the direction of
and in the immediate presence of an individual authorized by
this chapter to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery an
individual from practicing as a certified registered nurse
anesthetist in accordance with Chapter 4723. of the Revised
Code.
(B) This chapter does not prohibit an individual from
practicing as an anesthesiologist assistant in accordance with
Chapter 4760. of the Revised Code.
Sec. 4731.513. In administering and enforcing sections
4731.51 to 4731.61 of the Revised Code and in adopting rules
under section 4731.05 of the Revised Code, the state medical
board shall not prohibit a podiatrist who practices in a setting
other than as described in section 4731.51 of the Revised Code
from consulting with a certified registered nurse anesthetist.
For purposes of this section, "certified registered nurse
anesthetist" and "consulting" have the same meanings as in
section 4723.01 of the Revised Code.
Sec. 4761.17. All of the following apply to the practice
of respiratory care by a person who holds a license or limited
permit issued under this chapter:
(A) The person shall practice only pursuant to a
prescription or other order for respiratory care issued by any
of the following:
(1) A physician;
(2) A clinical nurse specialist, certified nurse-midwife,
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As Introduced
or certified nurse practitioner who holds a current, valid
license issued under Chapter 4723. of the Revised Code to
practice nursing as an advanced practice registered nurse and
has entered into a standard care arrangement with a physician;
(3) A certified registered nurse anesthetist who holds a
current, valid license issued under Chapter 4723. of the Revised
Code to practice nursing as an advanced practice registered
nurse and acts in compliance with sections section 4723.43,
4723.433, and 4723.434 of the Revised Code;
(4) A physician assistant who holds a valid prescriber
number issued by the state medical board, has been granted
physician-delegated prescriptive authority, and has entered into
a supervision agreement that allows the physician assistant to
prescribe or order respiratory care services.
(B) The person shall practice only under the supervision
of any of the following:
(1) A physician;
(2) A certified nurse practitioner, certified nurse-
midwife, or clinical nurse specialist;
(3) A physician assistant who is authorized to prescribe
or order respiratory care services as provided in division (A)
(4) of this section.
(C)(1) When practicing under the prescription or order of
a certified nurse practitioner, certified nurse midwife, or
clinical nurse specialist or under the supervision of such a
nurse, the person's administration of medication that requires a
prescription is limited to the drugs that the nurse is
authorized to prescribe pursuant to section 4723.481 of the
Revised Code.
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733 H. B. No. 52 Page 27
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(2) When practicing under the order of a certified
registered nurse anesthetist, the person's administration of
medication is limited to the drugs that the nurse is authorized
to order or direct the person to administer, as provided in
sections section 4723.43, 4723.433, and 4723.434 of the Revised
Code.
(3) When practicing under the prescription or order of a
physician assistant or under the supervision of a physician
assistant, the person's administration of medication that
requires a prescription is limited to the drugs that the
physician assistant is authorized to prescribe pursuant to the
physician assistant's physician-delegated prescriptive
authority.
Section 2. That existing sections 4723.01, 4723.43,
4723.432, 4729.01, 4731.27, 4731.35, and 4761.17 of the Revised
Code are hereby repealed.
Section 3. That sections 4723.433, 4723.434, and 4723.435
of the Revised Code are hereby repealed.
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