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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 3965 By: McEntire and Echols of the
House
and
Stanley of the Senate
COMMITTEE SUBSTITUTE
An Act relating to physician assistants ; amending 59
O.S. 2021, Section 353.1a, which relates to the
Oklahoma Pharmacy Act; clarifying which prescriptions
for controlled dangerous substances pharmacists may
dispense; amending 59 O.S. 2021, Sections 519.2,
519.3, 519.6, 519.11, as amended by Section 1,
Chapter 164, O.S.L. 2022 , and 521.2 (59 O.S. Supp.
2023, Section 519.11) , which relate to the Physician
Assistant Act; modifying definitions; increasing the
number of Physician Assistant Committee members;
clarifying certain requirements for the chair;
increasing member requirements for a quorum; adding
provisions regarding postgraduate clinical practice ;
clarifying filing requirements for practice
agreements; clarifying language regarding practicing
medicine, prescribing drugs, and using medical
supplies under a practice agreement ; modifying
billing and payment authority; amending 63 O.S. 2021,
Section 1-317, as amended by Section 1, Chapter 184,
O.S.L. 2022 (63 O.S. Supp. 2023, Section 1 -317),
which relates to the Oklahoma Public Health Code ;
clarifying the authority of physician assistant s to
carry out certain functions; amending 63 O.S. 2021,
Sections 2-101, as last amended by Section 1, Chapter
375, O.S.L. 2023, and 2-312, as amended by S ection 2,
Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2023,
Sections 2-101 and 2-312), which relate to the
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Uniform Controlled Dangerous Substances Act ;
modifying definitions related to physician
assistants; clarifying which physician assistants may
prescribe and administer certain controlled
substances; repealing 59 O.S. 2021, Section 521. 4,
which relates to physician supervision and practice
agreements; and declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 59 O.S. 2021, Section 353.1a, is
amended to read as follows:
Section 353.1a A. Prescribing authority shall be allowed,
under the medical direction of a supervising physician, for an
advanced practice nurse recognized by t he Oklahoma Board of Nursing
in one of the following categories: advanced registered nurse
practitioners, clinical nurse specialists, or certified nurse -
midwives. The advanced practice nurse may write or sign, or
transmit by word of mouth, telephone or o ther means of communication
an order for drugs or medical supplies that is intended to be
filled, compounded, or dispensed by a pharmacist. The supervising
physician and the advanced practice nurse shall be identified at the
time of origination of the pre scription and the name of the advanced
practice nurse shall be printed on the prescription label.
B. Pharmacists may dispense prescriptions for non -controlled
prescription drugs authorized by an advanced practice nurse or
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physician assistant, not located in Oklahoma, provided that they are
licensed in the state in which they are actively prescr ibing.
C. Pharmacists may only dispense prescriptions for controlled
dangerous substances prescribed by an:
1. An advanced practice nurse or physician assistant licensed
in the State of Oklahoma and supervi sed by an Oklahoma-licensed
practitioner; or
2. Physician assistant licensed in the State of Oklahoma and
supervised by an Oklahoma-licensed practitioner .
SECTION 2. AMENDATORY 59 O.S. 2 021, Section 519.2, is
amended to read as follows:
Section 519.2 As used in the Physicia n Assistant Act:
1. "Board" means the State Board of Medical Li censure and
Supervision;
2. "Committee" means the Physician Assistant Committee;
3. "Practice of medicine" means services which require train ing
in the diagnosis, treatment and prevention of disease, including the
use and administration of drugs, and whi ch are performed by
physician assistants so long as such services are within the
physician assistants ' skill,. For a physician assistant required to
practice under supervision of a delegating physician, services form
a component of the physician's scope of practice, and are provided
with physician supervision, including authenticating by signature
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any form that may be authenticated by the delegating physician 's
signature with prior delegation by the physic ian;
4. "Patient care setting" means and includes, but is not
limited to, a physic ian's office, clinic, hospital, nursing home,
extended care facility, p atient's home, ambulatory surgical center,
hospice facility or any other setting authorized by the del egating
physician;
5. "Physician assistant" means a health care professional,
qualified by academic and clinical education and licensed by the
State Board of Medical Licensure and Supervision, to practice
medicine with physician supervision as a physician assistant;
6. 5. "Delegating physician" means an individual holding a
license in good standing as a physician from the State Board of
Medical Licensure and Supervision or the State Board of Osteopathic
Examiners, who supervises one or more physician assistants and
delegates decision making pursuant to the practice agreement;
7. 6. "Supervision" means overseeing or delegating the
activities of the medical services rendered by a physician assistant
through a practice agreement between a medical doctor or osteopathic
delegating physician performing procedures or directly or indirectly
involved with the treatment of a patient , and the physician
assistant working jointly toward a common goal of providing
services. Delegation shall be defined by the pra ctice agreement.
The physical presence of the delegating physician is not required as
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long as the delegating physician and physician assistant are or can
be easily in contact with each other by telecommunication. At all
times a physician assistant required to practice under supervision
shall be considered an agent of the delegating phys ician;
8. 7. "Telecommunication" means the use of electroni c
technologies to transmit words, sounds or images for interpersonal
communication, clinical care (telemedicine) and review of electronic
health records; and
9. 8. "Practice agreement" means a written agreement between a
physician assistant and the a delegating physician concerning the
scope of practice of the physician assistant to only be determined
by the delegating physician and the physician assistant based on the
education, training, skills and experience of the physician
assistant. The agreement shall i nvolve the joint formulation,
discussion and agreement on the methods of supervision and
collaboration for diagnosis, consultation and treatment of medical
conditions and shall include the scope of and any limitations on
prescribing. A practice agreement is require d for a physician
assistant described in subsection C of Section 4 of this act.
SECTION 3. AMENDATORY 59 O.S. 2021, Section 519.3, is
amended to read as follows:
Section 519.3 A. There is hereby created the Physician
Assistant Committee, which shall be composed of seven (7) nine (9)
members. Three Five members of the Commi ttee shall be physician
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assistants appointed by the State Board of Medical Licensure and
Supervision from a list of qualified individuals submitted by the
Oklahoma Academy of Physician Assistants. One member shall be a
physician appointed by the Board fro m its membership. One member
shall be a physician appointed by the Board from a list of qualified
individuals submitted by the Oklahoma State Medical Associatio n and
who is not a member of the Board. One member shall be a physician
appointed by the State Board of Osteopathic Examiners from its
membership. One member shall be a physician appointed by the State
Board of Osteopathic Examiners from a list of qualif ied individuals
submitted by the Oklahoma Osteopathic Association and who is not a
member of said board.
B. The term of office for each member of the Committee shall be
five (5) years.
C. The Committee shall meet at least quarterly. At the initial
meeting of each calendar year, the Committee members shall elect a
chair from the physician assist ant members. The chair or his or her
designee shall represent the Committee at all meeting s of the Board.
Four Five members shall constitute a quorum for the pur pose of
conducting official business of the Committee.
D. The State Board of Medical Licensu re and Supervision is
hereby granted the power and authority to promulgate rules, which
are in accordance with the provisions of Section 519.1 et seq. of
this title, governing the requirements for licensure as a physician
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assistant, as well as to establish standards for training, approve
institutions for training, and regulate the standards of practi ce of
a physician assistant after licensure, including the power of
revocation of a license.
E. The State Board of Medical Licensure and Supervision is
hereby granted the power and authority to investigate all
complaints, hold hearings, subpoena witnesses and initiate
prosecution concerning violations of Section 519.1 et seq. of this
title. When such complaints involve physicians licensed by the
State Board of Osteopathic Examiners, the State Board of Osteopathic
Examiners shall be officially notified of such complaints.
F. 1. The Committee shall advise the Board on al l matters
pertaining to the practice of physician assistants.
2. The Committee shall review and make recommendations to the
Board on all applications for licensure as a physician assistant and
all applications to practice which shall be approved by the Bo ard.
When considering applicants for licensure, to establish standards of
training or approve institutions for training, the Committee shall
include the Director, or designee, of all Physi cian Assistant
educational programs conducted by institutions of hi gher education
in the state as members.
3. The Committee shall assist and advise the Board i n all
hearings involving physician assistants who are deemed to be in
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violation of Section 519.1 et seq. of this title or the rules of the
Board.
SECTION 4. AMENDATORY 59 O.S. 2021, Section 519.6, is
amended to read as follows:
Section 519.6 A. No health care services may be performed by a
physician assistant unless a current license is on file with and
approved by the State Board of Medical Licensure and Supervision.
B. A physician assistant with six thousand two hundred forty
(6,240) or more hours of postgraduate clinical practice experience
who has reported those hours to the Board shall not be requi red to
practice under the supervision of a delegating physician.
1. A physician assistant may report the completion of
postgraduate clinical practice experience to the Board at any time
after completion of at least six thousand two hundred forty (6,240)
such hours.
2. Hours earned prior to the enactment of this subsection shall
be counted towards the six thousand two hundred forty (6,240) hours.
3. The Board shall maintain, make available, and keep updated,
on the Internet website of the Board , a list of physician assistants
who have reported completion of six thousand two hundre d forty
(6,240) or more postgraduate clinical pract ice experience hours.
4. The Board shall, within ninety (90) days of enactment,
prescribe a form for reporting post graduate clinical practice
experience by a physician assistant. The Board shall make available
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and keep updated on the Internet website of the Board the prescribed
form. This reporting form may be filed electronically. The Board
shall not charge a fee for reporting hours or filing of the
prescribed form.
5. Nothing in this subsection shall prohibit a physician
assistant from maintaining a practice agreement; however, such an
agreement is not required for a physician assistant w ith the
reported six thousand two hundred forty (6,240) hours of
postgraduate clinical practice experience. Provided any practice
agreements are subject to the req uirements of paragraphs 1, 2, 3,
and 4 of subsection C of this section.
6. Nothing in this subsection shall restrict the ability of the
Board to require supervision as a part of disciplinary action
against the license of a physician assistant .
C. A physician assistant with less than six thousand two
hundred forty (6,240) hours of postgraduate clinical practice
experience or who has completed six thousand two hundred forty
(6,240) hours but has not reported those hours t o the Board shall
practice under the supervision of a delegating physician with the
following requirements:
1. All practice agreements and any amendments shall be filed
with the State Board of Medical Licensure and Supervision within ten
(10) business days of being executed. Practice agre ements may be
filed electronically. The State Board of Medical Licensure and
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Supervision shall not charge a fee for filing practice agreements or
amendments of practice agreements.;
B. 2. A physician assistant may have p ractice agreements with
multiple allopathic or osteopathic physicians. Each physician shall
be in good standing with the State Board of Medical Licensure and
Supervision or the State Boar d of Osteopathic Examiners.;
C. 3. The delegating physician need not be physically present
nor be specifically consulted before each delegated patient care
service is performed by a physician assistant, so long as the
delegating physician and physician assi stant are or can be easily in
contact with one another by means of t elecommunication. In all
patient care settings, the The delegating physician shall provide
appropriate methods of participating in health care services
provided by the physician assistant including:
a. being responsible for the formulation or approval of
all orders and protocols, whethe r standing orders,
direct orders or any other orders or protocols, which
direct the delivery of health care services provided
by a physician assistant, and periodically reviewing
such orders and protocols,
b. regularly reviewing the health care services pr ovided
by the physician assistant and any problems or
complications encountered,
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c. being available physically or through telemedicine or
direct telecommunications for consultation, assistance
with medical emergencies or pat ient referral,
d. reviewing a sample of outpatient medical records.
Such reviews shall take place at a site agreed upon
between the delegating physician and physician
assistant in the pra ctice agreement which may also
occur using electronic or virtual con ferencing, and
e. that it remains clear that the physician assistant is
an agent of the delegating physician; but, in no event
shall the delegating physician be an employee of the
physician assistant.;
D. 4. In patients with newly diagnosed complex illnesses , the
physician assistant shal l contact the delegating physician within
forty-eight (48) hours of the physician assistant's initial
examination or treatment and schedule the patient for ap propriate
evaluation by the delegating physician as directed by the physician.
The delegating physician shall determine which conditions qualify as
complex illnesses based on the clinical setting and the skill and
experience of the physician assistant .
E. 1. D. A physician assistant under the direction of a
delegating physician not practicing under a practice agreement may
prescribe written and oral prescriptions and orders. The p hysician
assistant not practicing under a practice agreement may prescribe
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medical supplies, services, and drugs, including controlled
medications in Schedules II III through V pursuant to Section 2-312
of Title 63 of the Oklahoma Statutes, and medical supplies and
services as delegated by the delegat ing physician and as approved by
the State Board of Medical Licensure and Supervision after
consultation with the Sta te Board of Pharmacy on the Physician
Assistant Drug Formulary . Physician assistants not practicing under
a practice agreement may not dispense drugs, but may request,
receive, and sign for professional samples and may distribute
professional samples to patients .
2. A physician assistant may write an order for a Schedule II
drug for immediate or ongo ing administration on site. Prescriptions
and orders for Schedule II drugs written by a physician assistant
must be included on a written protocol determined by the delegating
physician and approved by the medical staff committee of the
facility or by direct verbal order of the delegating physician .
Physician assistants may not dispense drugs, but may request,
receive, and sign for professi onal samples and may distribute
professional samples to patients.
F. E. A physician assistant may perform health care s ervices in
patient care settings as authorized by the delega ting physician
practicing under a practice agreement m ay prescribe written and oral
prescriptions and orders. The physician assistant practicing under
a practice agreement may prescribe medical supplies, services, and
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drugs, including controlled medications in Schedule s II through V
pursuant to Section 2-312 of Title 63 of the Oklahoma Statutes,
written and oral prescriptions and orders only as delegated by the
delegating physician and prescriptions and orders for Schedule II
drugs written by such physician assistant sh all be included on a
written protocol det ermined by the delegating physician. Physician
assistants practicing under a practice agreement may not dispense
drugs, but may request, receive, and sign for professional samples
and may distribute professional sa mples to patients. Provided that
a physician assistant practicing under a practice agree ment may not
prescribe any controlled medications in a Schedule that the
delegating physician is not registered to prescribe .
G. F. Each physician assistant licensed under the Physician
Assistant Act shall keep his or her lice nse available for inspection
at the primary place of business and shall, when enga ged in
professional activitie s, identify himself or herself as a physician
assistant.
H. G. A physician assistant shall be bound by the provisions
contained in Sections 725.1 through 725.5 of Title 59 of the
Oklahoma Statutes this title.
SECTION 5. AMENDATORY 59 O.S. 2 021, Section 519.11, as
amended by Section 1, Chapter 164, O.S.L. 2022 (59 O.S. Supp. 2023,
Section 519.11), is amended to read as follows:
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Section 519.11 A. Nothing in the Physician Assistant Act shall
be construed to prevent or restrict the practice, services or
activities of any person s of other licensed professions or personnel
supervised by licensed professions in th is state from perform ing
work incidental to the practi ce of their profession or occupation,
if that person does not represent himself or herself as a physician
assistant.
B. Nothing stated in the Physician Assistant Act shall prevent
any hospital from requiring the physician assistant o r the
delegating physician to meet and maintain certain staff appointment
and credentialing qualificatio ns for the privilege of practicing as,
or utilizing, a physician assistant in the hospital.
C. Nothing in the Physician Assistant Act shall be construe d to
permit a physician assistant to practice medicine or prescribe drugs
and medical supplies in this s tate except when suc h actions are
performed under the supervision and at the direction of a physician
or physicians approved by the State Board of Medic al Licensure and
Supervision.
D. Nothing herein shall be construed to require licensure under
the Physician Assistant Act o f a physician assistant student
enrolled in a physician assistant educational program accredited by
the Accreditation Review Commiss ion on Education for t he Physician
Assistant.
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E. D. Notwithstanding any other provision of law, no one who is
not a physician licensed to practice medicine in this state may
perform acts restricted to such physicians pursuant to the
provisions of Section 1-731 of Title 63 of t he Oklahoma Statutes.
This paragraph is inseverable.
F. E. Nothing in the Physic ian Assistant Act sh all limit the
activities of a physician assistant in the performance of their
duties if the physician assistant is employed by or under contract
with the United States Department of Veterans Affairs or if the
physician assistant is employed by, under contract with, or
commissioned by one of the uniformed services; provided, the
physician assistant must be currently licensed in this state or any
other state or currently credentialed as a physician assistant by
the United States Department of Veterans Affairs or the applicable
uniformed service. Any physician assistant who is employed by or
under contract with the United States Department of Veterans Affairs
or is employed by, under contract with, or commissioned by one of
the uniformed services and practices outside of such employment,
contract, or commission shall be subject to the Physician Assistant
Act while practicing outside of such employment, contract, or
commission. As used in this subsection, "uniformed services" shall
have the same meaning as prov ided by Title 10 of the U.S . Code.
SECTION 6. AMENDATORY 59 O.S. 2021, Section 521.2, is
amended to read as follows:
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Section 521.2 A. Payment for services within the physician
assistant's scope of practice by a health insurance plan shall be
made when ordered or performed by the ph ysician assistant, if the
same service would have been covered if orde red or performed by a
physician. An in-network A physician assistant shall be authorized
to bill for and receive direct payment for the medically necessary
services the physician assist ant delivers.
B. To ensure accountability and transparency for patients ,
payers and the health care system, an in-network a physician
assistant shall be identified a s the rendering professional in the
billing and claims process when the physician assistan t delivers
medical or surgical services to patients.
C. No insurance comp any or third-party payer shall impose a
practice, education, or collaboration requirement th at is
inconsistent with or more rest rictive than existing phys ician
assistant state laws o r regulations.
SECTION 7. AMENDATORY 63 O.S. 2021, Section 1 -317, as
amended by Section 1, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2023,
Section 1-317), is amended to read as follows:
Section 1-317. A. A death certificate for each death which
occurs in this state sha ll be filed with the State Department of
Health, within three (3) days after such death.
B. The funeral director shall personally si gn the death
certificate and shall be responsible for filing the death
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certificate. If the funeral director is not availab le, the person
acting as such who first assumes custody of a dead body in
accordance with Section 1158 of Title 21 of the Oklahoma St atutes
shall personally sign a nd file the death certificate. The personal
data shall be obtained from the next of kin or t he best qualified
person or source available. The certificat e shall be completed as
to personal data and delivered to the attending physician or the
medical examiner responsible for completing the medical
certification portion of the certificate of death within twenty-four
(24) hours after the death. No later than July 1, 2012, the
personal data, and no later than July 1, 2017, the me dical
certificate portion, sha ll be entered into the prescribed electronic
system provided by the State Registrar of Vital Statistics and the
information submitted to the State Registr ar of Vital Statistics.
The resultant certificate produced by the elect ronic system shall be
provided to the physician or medical examiner for medical
certification within twenty-four (24) hours after the death.
C. The medical certification shall be comp leted and signed
within forty-eight (48) hours after death by the physic ian,
physician assistant, or advanced practice registered nurse in charge
of the patient's care for the illness or condition which resulted in
death, except when inquiry as to the ca use of death is required by
Section 938 of this title. No later than July 1, 2017, the medical
certification portion of certificate data shall be entered into the
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prescribed electronic system prov ided by the State Reg istrar of
Vital Statistics and the infor mation submitted to the State
Registrar of Vital Statistics.
D. In the event that the physician, physician assistant, or
advanced practice registered nurse in charge of the patient's care
for the illness or conditio n which resulted in death is not in
attendance at the time of death, the medical certification shall be
completed and signed within forty-eight (48) hours after death by
the physician, physician assistant, or advanced practice register ed
nurse in attendance at the time of death, except:
1. When the patient is under hospice care at the time of death,
the medical certification may be signed by the hospice's medical
director; and
2. When inquiry as to the cause of death is required by Se ction
938 of this title.
Provided, that such certification, i f signed by other than the
attending physician, physician assistant, or advanced practice
registered nurse, shall note on the face the name of the attending
physician, physician assistant, or advanced practice registered
nurse and that the information show n is only as reported.
E. A certifier completing cause of death on a ce rtificate of
death who knows that a lethal drug, overdose or other means of
assisting suicide within the meaning of Section s 3141.2 through
3141.4 of this title caused or contributed t o the death shall list
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that means among the chain of events under cause of death or list it
in the box that describes how the injury occurred. If such means is
in the chain of events under cause of death or in the b ox that
describes how the injury occurre d, the certifier shall indicate
"suicide" as the manner of death.
F. The authority of a physician assistant subject to subsection
C of Section 4 of this act to carry out the functions described in
this section shall be governed by the practice agreement as provided
by Section 519.6 of Title 59 of the Oklahoma Statutes.
SECTION 8. AMENDATORY 63 O.S. 2021, Sect ion 2-101, as
last amended by Section 1, Chapter 375, O.S.L. 2023 (63 O.S. Supp.
2023, Section 2-101), is amended to read as follows:
Section 2-101. As used in the Uniform Controlled Dangerous
Substances Act:
1. "Administer" means the direct application of a controlled
dangerous substance, whether by injection, inhalation, ingestion or
any other means, to the body of a patient, animal or research
subject by:
a. a practitioner (or, in the presence of the
practitioner, by the authorized agent of the
practitioner), or
b. the patient or research subject at the direction and
in the presence of the practitioner;
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2. "Agent" means a peace officer appointed by and who acts on
behalf of the Director of the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control or an authorized person who acts on behalf
of or at the direction of a person who manufactures, distributes,
dispenses, prescribes, administers or uses for scientific purposes
controlled dangerous substances but does not include a common or
contract carrier, public warehouser or employee thereof, or a person
required to register under the Uniform Controlled Dangerous
Substances Act;
3. "Board" means the Advisory Board to the Director of the
Oklahoma State Bureau of Narcotics and Dangerous Drugs Control;
4. "Bureau" means the Oklahoma State Bureau of Narcotics and
Dangerous Drugs Control;
5. "Coca leaves" includes cocaine and any compound,
manufacture, salt, derivative, mixture or preparation of coca
leaves, except derivatives of coca leaves which do not contain
cocaine or ecgonine;
6. "Commissioner" or "Director" means the Director of the
Oklahoma State Bureau of Narcotics and Dangerous Drugs Control;
7. "Control" means to add, remove or change the placement of a
drug, substance or immediate precursor under the Uniform Controlled
Dangerous Substances Act;
8. "Controlled dangerous substance" means a drug, substance or
immediate precursor in Schedules I through V of the Uniform
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Controlled Dangerous Substances Act or any drug, substance or
immediate precursor listed either temporarily or permanently as a
federally controlled substance. Any conflict between state and
federal law with regard to the particular schedule in which a
substance is listed shall be resolved in favor of state law;
9. "Counterfeit substance" means a controlled substance which,
or the container or labeling of which without authorization, bears
the trademark, trade name or other identifying marks, imprint,
number or device or any likeness thereof of a manufacturer,
distributor or dispenser other than the person who in fact
manufactured, distributed or dispensed the substance;
10. "Deliver" or "delivery" means the actual, constructive or
attempted transfer from one person to another of a controlled
dangerous substance or drug paraphernalia, whether or not there is
an agency relationship;
11. "Dispense" means to deliver a controlled dangerous
substance to an ultimate user or human research subject by or
pursuant to the lawful order of a practitioner, including the
prescribing, administering, packaging, labeling or compounding
necessary to prepare the substance for such distribution.
"Dispenser" is a practitioner who delivers a controlled dangerous
substance to an ultimate user or human research subject;
12. "Distribute" means to deliver other than by administering
or dispensing a controlled dangerous substance;
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13. "Distributor" means a commercial entity engaged in the
distribution or reverse distribution of narcotics and dangerous
drugs and who complies with all regulations promulgated by the
federal Drug Enforcement Administration and the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control;
14. "Drug" means articles:
a. recognized in the official United States Pharmacopeia,
official Homeopathic Pharmacopoeia of the United
States, or official National Formulary, or any
supplement to any of them,
b. intended for use in the diagnosis, cure, mitigation,
treatment or prevention of disease in man or other
animals,
c. other than food, intended to affect the structure or
any function of the body of man or other animals, and
d. intended for use as a component of any article
specified in this paragraph;
provided, however, the term drug does not include devices or their
components, parts or accessories;
15. "Drug-dependent person" means a person who is using a
controlled dangerous substance and who is in a state of psychic or
physical dependence, or both, arising from administration of that
controlled dangerous substance on a continuous basis. Drug
dependence is characterized by behavioral and other responses which
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include a strong compulsion to take the substance on a continuous
basis in order to experience its psychic effects, or to avoid the
discomfort of its absence;
16. "Home care agency" means any sole proprietorship,
partnership, association, corporation, or other organization which
administers, offers, or provides home care services, for a fee or
pursuant to a contract for such services, to clients in their place
of residence;
17. "Home care services" means skilled or personal care
services provided to clients in their place of residence for a fee;
18. "Hospice" means a centrally administered, nonprofit or for-
profit, medically directed, nurse-coordinated program which provides
a continuum of home and inpatient care for the terminally ill
patient and the patient's family. Such term shall also include a
centrally administered, nonprofit or for-profit, medically directed,
nurse-coordinated program if such program is licensed pursuant to
the provisions of the Uniform Controlled Dangerous Substances Act.
A hospice program offers palliative and supportive care to meet the
special needs arising out of the physical, emotional and spiritual
stresses which are experienced during the final stages of illness
and during dying and bereavement. This care is available twenty-
four (24) hours a day, seven (7) days a week, and is provided on the
basis of need, regardless of ability to pay. "Class A" Hospice
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refers to Medicare-certified hospices. "Class B" refers to all
other providers of hospice services;
19. "Imitation controlled substance" means a substance that is
not a controlled dangerous substance, which by dosage unit
appearance, color, shape, size, markings or by representations made,
would lead a reasonable person to believe that the substance is a
controlled dangerous substance. In the event the appearance of the
dosage unit is not reasonably sufficient to establish that the
substance is an imitation controlled substance, the court or
authority concerned should consider, in addition to all other
factors, the following factors as related to "representations made"
in determining whether the substance is an imitation controlled
substance:
a. statements made by an owner or by any other person in
control of the substance concerning the nature of the
substance, or its use or effect,
b. statements made to the recipient that the substance
may be resold for inordinate profit,
c. whether the substance is packaged in a manner normally
used for illicit controlled substances,
d. evasive tactics or actions utilized by the owner or
person in control of the substance to avoid detection
by law enforcement authorities,
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e. prior convictions, if any, of an owner, or any other
person in control of the object, under state or
federal law related to controlled substances or fraud,
and
f. the proximity of the substances to controlled
dangerous substances;
20. "Immediate precursor" means a substance which the Director
has found to be and by regulation designates as being the principal
compound commonly used or produced primarily for use, and which is
an immediate chemical intermediary used, or likely to be used, in
the manufacture of a controlled dangerous substance, the control of
which is necessary to prevent, curtail or limit such manufacture;
21. "Laboratory" means a laboratory approved by the Director as
proper to be entrusted with the custody of controlled dangerous
substances and the use of controlled dangerous substances for
scientific and medical purposes and for purposes of instruction;
22. "Manufacture" means the production, preparation,
propagation, compounding or processing of a controlled dangerous
substance, either directly or indirectly by extraction from
substances of natural or synthetic origin, or independently by means
of chemical synthesis or by a combination of extraction and chemical
synthesis. "Manufacturer" includes any person who packages,
repackages or labels any container of any controlled dangerous
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substance, except practitioners who dispense or compound
prescription orders for delivery to the ultimate consumer;
23. "Marijuana" means all parts of the plant Cannabis sativa
L., whether growing or not; the seeds thereof; the resin extracted
from any part of such plant; and every compound, manufacture, salt,
derivative, mixture or preparation of such plant, its seeds or
resin, but shall not include:
a. the mature stalks of such plant or fiber produced from
such stalks,
b. oil or cake made from the seeds of such plant,
including cannabidiol derived from the seeds of the
marijuana plant,
c. any other compound, manufacture, salt, derivative,
mixture or preparation of such mature stalks (except
the resin extracted therefrom), including cannabidiol
derived from mature stalks, fiber, oil or cake,
d. the sterilized seed of such plant which is incapable
of germination,
e. for any person participating in a clinical trial to
administer cannabidiol for the treatment of severe
forms of epilepsy pursuant to Section 2-802 of this
title, a drug or substance approved by the federal
Food and Drug Administration for use by those
participants,
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f. for any person or the parents, legal guardians or
caretakers of the person who have received a written
certification from a physician licensed in this state
that the person has been diagnosed by a physician as
having Lennox-Gastaut syndrome, Dravet syndrome, also
known as severe myoclonic epilepsy of infancy, or any
other severe form of epilepsy that is not adequately
treated by traditional medical therapies, spasticity
due to multiple sclerosis or due to paraplegia,
intractable nausea and vomiting, appetite stimulation
with chronic wasting diseases, the substance
cannabidiol, a nonpsychoactive cannabinoid, found in
the plant Cannabis sativa L. or any other preparation
thereof, that has a tetrahydrocannabinol concentration
not more than three-tenths of one percent (0.3%) and
that is delivered to the patient in the form of a
liquid,
g. any federal Food-and-Drug-Administration-approved drug
or substance, or
h. industrial hemp, from the plant Cannabis sativa L. and
any part of such plant, whether growing or not, with a
delta-9 tetrahydrocannabinol concentration not more
than three-tenths of one percent (0.3%) on a dry-
weight basis which shall only be grown pursuant to the
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Oklahoma Industrial Hemp Program and may be shipped
intrastate and interstate;
24. "Medical purpose" means an intention to utilize a
controlled dangerous substance for physical or mental treatment, for
diagnosis, or for the prevention of a disease condition not in
violation of any state or federal law and not for the purpose of
satisfying physiological or psychological dependence or other abuse;
25. "Mid-level practitioner" means an Advanced Practice
Registered Nurse as defined and within parameters specified in
Section 567.3a of Title 59 of the Oklahoma Statutes, or a certified
animal euthanasia technician as defined in Section 698.2 of Title 59
of the Oklahoma Statutes, or an animal control officer registered by
the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control
under subsection B of Section 2-301 of this title within the
parameters of such officer's duties under Sections 501 through 508
of Title 4 of the Oklahoma Statutes;
26. "Narcotic drug" means any of the following, whether
produced directly or indirectly by extraction from substances of
vegetable origin, or independently by means of chemical synthesis,
or by a combination of extraction and chemical synthesis:
a. opium, coca leaves and opiates,
b. a compound, manufacture, salt, derivative or
preparation of opium, coca leaves or opiates,
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c. cocaine, its salts, optical and geometric isomers, and
salts of isomers,
d. ecgonine, its derivatives, their salts, isomers and
salts of isomers, and
e. a substance, and any compound, manufacture, salt,
derivative or preparation thereof, which is chemically
identical with any of the substances referred to in
subparagraphs a through d of this paragraph, except
that the words narcotic drug as used in Section 2-101
et seq. of this title shall not include decocainized
coca leaves or extracts of coca leaves, which extracts
do not contain cocaine or ecgonine;
27. "Opiate" or "opioid" means any Schedule II, III, IV or V
substance having an addiction-forming or addiction-sustaining
liability similar to morphine or being capable of conversion into a
drug having such addiction-forming or addiction-sustaining
liability. The terms do not include, unless specifically designated
as controlled under the Uniform Controlled Dangerous Substances Act,
the dextrorotatory isomer of 3-methoxy-n-methyl-morphinan and its
salts (dextromethorphan). The terms do include the racemic and
levorotatory forms;
28. "Opium poppy" means the plant of the species Papaver
somniferum L., except the seeds thereof;
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29. "Peace officer" means a police officer, sheriff, deputy
sheriff, district attorney's investigator, investigator from the
Office of the Attorney General, or any other person elected or
appointed by law to enforce any of the criminal laws of this state
or of the United States;
30. "Person" means an individual, corporation, government or
governmental subdivision or agency, business trust, estate, trust,
partnership or association, or any other legal entity;
31. "Poppy straw" means all parts, except the seeds, of the
opium poppy, after mowing;
32. "Practitioner" means:
a. (1) a medical doctor or osteopathic physician,
(2) a dentist,
(3) a podiatrist,
(4) an optometrist,
(5) a veterinarian,
(6) a physician assistant or an Advanced Practice
Registered Nurse under the supervision of a
licensed medical doctor or osteopathic physician;
or a physician assistant,
(7) a scientific investigator, or
(8) any other person,
licensed, registered or otherwise permitted to
prescribe, distribute, dispense, conduct research with
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respect to, use for scientific purposes or administer
a controlled dangerous substance in the course of
professional practice or research in this state, or
b. a pharmacy, hospital, laboratory or other institution
licensed, registered or otherwise permitted to
distribute, dispense, conduct research with respect
to, use for scientific purposes or administer a
controlled dangerous substance in the course of
professional practice or research in this state;
33. "Production" includes the manufacture, planting,
cultivation, growing or harvesting of a controlled dangerous
substance;
34. "State" means the State of Oklahoma or any other state of
the United States;
35. "Ultimate user" means a person who lawfully possesses a
controlled dangerous substance for the person's own use or for the
use of a member of the person's household or for administration to
an animal owned by the person or by a member of the person's
household;
36. "Drug paraphernalia" means all equipment, products and
materials of any kind which are used, intended for use, or fashioned
specifically for use in planting, propagating, cultivating, growing,
harvesting, manufacturing, comp ounding, converting, producing,
processing, preparing, testing, analyzing, packaging, repackaging,
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storing, containing, concealing, injecting, ingesting, inhaling or
otherwise introducing into the human body, a controlled dangerous
substance in violation o f the Uniform Controlled Dangerous
Substances Act including, but not limited to:
a. kits used, intended for use, or fashioned specifically
for use in planting, propagating, cultivating, growing
or harvesting of any species of plant which is a
controlled dangerous substance or from which a
controlled dangerous substance can be derived,
b. kits used, intended for use, or fashioned specifically
for use in manufacturing, compounding, converting,
producing, processing or preparing controlled
dangerous substances ,
c. isomerization devices used, intended for use, or
fashioned specifically for use in increasing the
potency of any species of plant which is a controlled
dangerous substance,
d. testing equipment used, intended for use, or fashioned
specifically for use in identifying, or in analyzing
the strength, effectiveness or purity of controlled
dangerous substances,
e. scales and balances used, intended for use, or
fashioned specifically for use in weighing or
measuring controlled dangerous substances,
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f. diluents and adulterants, such as quinine
hydrochloride, mannitol, mannite, dextrose and
lactose, used, intended for use, or fashioned
specifically for use in cutting controlled dangerous
substances,
g. separation gins and sifters used, intended for use, or
fashioned specifically for use in removing twigs and
seeds from, or in otherwise cleaning or refining,
marijuana,
h. blenders, bowls, containers, spoons and mixing devices
used, intended for use, or fashioned specifically for
use in compounding controlled dange rous substances,
i. capsules, balloons, envelopes and other containers
used, intended for use, or fashioned specifically for
use in packaging small quantities of controlled
dangerous substances,
j. containers and other objects used, intended for use,
or fashioned specifically for use in parenterally
injecting controlled dangerous substances into the
human body,
k. hypodermic syringes, needles and other objects used,
intended for use, or fashioned specifically for use in
parenterally injecting controlled dan gerous substances
into the human body,
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l. objects used, intended for use, or fashioned
specifically for use in ingesting, inhaling or
otherwise introducing marijuana, cocaine, hashish or
hashish oil into the human body, such as:
(1) metal, wooden, acrylic, glass, stone, plastic or
ceramic pipes with or without screens, permanent
screens, hashish heads or punctured metal bowls,
(2) water pipes,
(3) carburetion tubes and devices,
(4) smoking and carburetion masks,
(5) roach clips, meaning objects used to hold burning
material, such as a marijuana cigarette, that has
become too small or too short to be held in the
hand,
(6) miniature cocaine spoons and cocaine vials,
(7) chamber pipes,
(8) carburetor pipes,
(9) electric pipes,
(10) air-driven pipes,
(11) chillums,
(12) bongs, or
(13) ice pipes or chillers,
m. all hidden or novelty pipes, and
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n. any pipe that has a tobacco bowl or chamber of less
than one-half (1/2) inch in diameter in which there is
any detectable residue of any controlled dangerous
substance as defined in this section or any other
substances not legal for possession or use;
provided, however, the term drug paraphernalia shall not include
separation gins intended for use in preparing tea or spice, clamps
used for constructing electrical equipment, water pipes designed for
ornamentation in which no detectable amount of an illegal substance
is found or pipes designed and used solely for smoking tobacco,
traditional pipes of an American Indian tribal religious ceremony,
antique pipes that are thirty (30) years of age or older, or drug
testing strips possessed by a person for purposes of determining the
presence of fentanyl or a fentanyl-related compound;
37. a. "Synthetic controlled substance" means a substance:
(1) the chemical structure of which is substantially
similar to the chemical structure of a controlled
dangerous substance in Schedule I or II,
(2) which has a stimulant, depressant, or
hallucinogenic effect on the central nervous
system that is substantially similar to or
greater than the stimulant, depressant or
hallucinogenic effect on the central nervous
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system of a controlled dangerous substance in
Schedule I or II, or
(3) with respect to a particular person, which such
person represents or intends to have a stimulant,
depressant, or hallucinogenic effect on the
central nervous system that is substantially
similar to or greater than the stimulant,
depressant, or hallucinogenic effect on the
central nervous system of a controlled dangerous
substance in Schedule I or II.
b. The designation of gamma butyrolactone or any other
chemical as a precursor, pursuant to Section 2-322 of
this title, does not preclude a finding pursuant to
subparagraph a of this paragraph that the chemical is
a synthetic controlled substance.
c. "Synthetic controlled substance" does not include:
(1) a controlled dangerous substance,
(2) any substance for which there is an approved new
drug application,
(3) with respect to a particular person any
substance, if an exemption is in effect for
investigational use, for that person under the
provisions of Section 505 of the Federal Food,
Drug and Cosmetic Act, Title 21 of the United
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States Code, Section 355, to the extent conduct
with respect to such substance is pursuant to
such exemption, or
(4) any substance to the extent not intended for
human consumption before such an exemption takes
effect with respect to that substance.
d. Prima facie evidence that a substance containing
salvia divinorum has been enhanced, concentrated or
chemically or physically altered shall give rise to a
rebuttable presumption that the substance is a
synthetic controlled substance;
38. "Tetrahydrocannabinols" means all substances that have been
chemically synthesized to emulate the tetrahydrocannabinols of
marijuana, specifically including any tetrahydrocannabinols derived
from industrial hemp;
39. "Isomer" means the optical isomer, except as used in
subsections C and F of Section 2-204 of this title and paragraph 4
of subsection A of Section 2-206 of this title. As used in
subsections C and F of Section 2-204 of this title, isomer means the
optical, positional or geometric isomer. As used in paragraph 4 of
subsection A of Section 2-206 of this title, the term isomer means
the optical or geometric isomer;
40. "Hazardous materials" means materials, whether solid,
liquid or gas, which are toxic to human, animal, aquatic or plant
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life, and the disposal of which materials is controlled by state or
federal guidelines;
41. "Anhydrous ammonia" means any substance that exhibits
cryogenic evaporative behavior and tests positive for ammonia;
42. "Acute pain" means pain, whether resulting from disease,
accidental or intentional trauma or other cause, that the
practitioner reasonably expects to last only a short period of time.
Acute pain does not include chronic pain, pain being treated as part
of cancer care, hospice or other end-of-life care, or pain being
treated as part of palliative care;
43. "Chronic pain" means pain that persists beyond the usual
course of an acute disease or healing of an injury. Chronic pain
may or may not be associated with an acute or chronic pathologic
process that causes continuous or intermittent pain over months or
years;
44. "Initial prescription" means a prescription issued to a
patient who:
a. has never previously been issued a prescription for
the drug or its pharmaceutical equivalent in the past
year, or
b. requires a prescription for the drug or its
pharmaceutical equivalent due to a surgical procedure
or new acute event and has previously had a
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prescription for the drug or its pharmaceutical
equivalent within the past year.
When determining whether a patient was previously issued a
prescription for a drug or its pharmaceutical equivalent, the
practitioner shall consult with the patient and review the medical
record and prescription monitoring information of the patient;
45. "Patient-provider agreement" means a written contract or
agreement that is executed between a practitioner and a patient,
prior to the commencement of treatment for chronic pain using an
opioid drug as a means to:
a. explain the possible risk of development of physical
or psychological dependence in the patient and prevent
the possible development of addiction,
b. document the understanding of both the practitioner
and the patient regarding the patient-provider
agreement of the patient,
c. establish the rights of the patient in association
with treatment and the obligations of the patient in
relation to the responsible use, discontinuation of
use, and storage of opioid drugs, including any
restrictions on the refill of prescriptions or the
acceptance of opioid prescriptions from practitioners,
d. identify the specific medications and other modes of
treatment, including physical therapy or exercise,
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relaxation or psychological counseling, that are
included as a part of the patient-provider agreement,
e. specify the measures the practitioner may employ to
monitor the compliance of the patient including, but
not limited to, random specimen screens and pill
counts, and
f. delineate the process for terminating the agreement,
including the consequences if the practitioner has
reason to believe that the patient is not complying
with the terms of the agreement. Compliance with the
"consent items" shall constitute a valid, informed
consent for opioid therapy. The practitioner shall be
held harmless from civil litigation for failure to
treat pain if the event occurs because of nonadherence
by the patient with any of the provisions of the
patient-provider agreement;
46. "Serious illness" means a medical illness or physical
injury or condition that substantially affects quality of life for
more than a short period of time. Serious illness includes, but is
not limited to, Alzheimer's disease or related dementias, lung
disease, cancer, heart failure, renal failure, liver failure or
chronic, unremitting or intractable pain such as neuropathic pain;
and
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47. "Surgical procedure" means a procedure that is performed
for the purpose of structurally altering the human body by incision
or destruction of tissues as part of the practice of medicine. This
term includes the diagnostic or therapeutic treatment of conditions
or disease processes by use of instruments such as lasers,
ultrasound, ionizing, radiation, scalpels, probes or needles that
cause localized alteration or transportation of live human tissue by
cutting, burning, vaporizing, freezing, suturing, probing or
manipulating by closed reduction for major dislocations or
fractures, or otherwise altering by any mechanical, thermal, light-
based, electromagnetic or chemical means.
SECTION 9. AMENDATORY 63 O.S. 2021, Section 2-312, as
amended by Section 2, Chapter 184, O.S.L. 2022 (63 O. S. Supp. 2023,
Section 2-312), is amended to read as follows:
Section 2-312. A. A physician, podiatrist, optometrist or a
dentist who has complied with the registration req uirements of the
Uniform Controlled Dangerous Substances Act, in good faith and in
the course of such person's professional practice only, may
prescribe and administer controlled dangerous substances, or may
cause the same to be administered by medical or paramedical
personnel acting under the direction and supervision of the
physician, podiatrist, optometrist or dentist, and only may dispense
controlled dangerous substances pursuant to the provisions of
Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes.
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B. A veterinarian who has complied with the registration
requirements of the Uniform Controlled Dangerous Substances Act, in
good faith and in the course of the professional practice of the
veterinarian only, and not for use by a human being, ma y prescribe,
administer, and dispense controlled dangerous substances and m ay
cause them to be administered by an assistant or orderly under the
direction and supervision of the veterinarian.
C. An advanced practice nurse who is recognized to prescribe by
the Oklahoma Board of Nursing as an advanced registered nurse
practitioner, clinical nurse specialist or certified nurse-midwife,
who is subject to medical direction by a supervising physician,
pursuant to Section 567.3a of Title 59 of the Oklahoma Statut es, and
who has complied with the registration requirements of the Uniform
Controlled Dangerous Substances Act, in good faith and in the course
of professional practice only, may prescribe and administer Schedule
III, IV and V controlled dangerous substanc es.
D. An advanced practice nurse who is recognized to order,
select, obtain and administer drugs by the Oklahoma Board of Nursing
as a certified registered nurse anesthetist pursuant to Section
353.1b of Title 59 of the Oklahoma Statutes and who has comp lied
with the registration requirements of the Uniform Controlled
Dangerous Substances Act, in good faith and in the course of such
practitioner's professional practice only, may order, select, obtain
and administer Schedules II through V controlled danger ous
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substances in a preanesthetic preparation or evaluation; anesthesia
induction, maintenance or emergence; or postanesthesia care setting
only. A certified registered nurse anesthetist may order, select,
obtain and administer such drugs only during the perioperative or
periobstetrical period.
E. A physician assistant who is r ecognized to prescribe by the
State Board of Medical Licensure and Supervision under the medical
direction of a supervising physician, pursuant to Section 519.6 of
Title 59 of the Oklahoma Statutes, and who has complied with the
registration requirements o f the Uniform Controlled Da ngerous
Substances Act, in good faith and in the course of professional
practice only, may prescribe and administer Schedule II through V
controlled dangerous substances subject to the restrictions in
Section 519.6 of Title 59 of the Oklahoma Statu tes.
SECTION 10. REPEALER 59 O.S. 2021, Section 521.4, is
hereby repealed.
SECTION 11. It being immediately necessary for t he preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
COMMITTEE REPORT BY: COMMITTEE ON RULES, dated 02/28/2024 - DO PASS,
As Amended and Coauthored.