OK
Oklahoma Senate Bill SB458

Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB458 Compare Versions

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3-
4-
5-An Act
6-ENROLLED SENATE
7-BILL NO. 458 By: Stanley, Green, Hamilton,
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28+ENGROSSED HOUSE AMENDME NT
29+ TO
30+ENGROSSED SENATE BILL NO . 458 By: Stanley, Green, Hamilton,
831 Young, Murdock, Coleman,
9-Rogers, Daniels, Paxton, Dahm ,
10-Woods, Pederson, Burns, Prieto,
11-and Bergstrom of the Senate
32+Rogers, Daniels, Paxton,
33+and Dahm of the Senate
1234
1335 and
1436
15- McEntire, Wallace, Townley,
16-Pfeiffer, Lowe (Dick), Archer,
17-Bennett, Moore, Fetgatter,
18-McDugle, McBride, Kerbs, Grego,
19-Cantrell, Nichols, Echols,
20-Talley, Strom, and Stark of the
21-House
22-
23-
24-
25-An Act relating to the practice of nursing; providing
26-for independent prescriptive authority of Advanced
27-Practice Registered Nurses who meet certain
37+ McEntire of the House
38+
39+
40+
41+[ nursing - prescriptive authority – application -
42+supervision - controlled dangerous substances -
43+supervision requirement – codification - effective
44+date ]
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48+
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50+AUTHOR: Remove Representative Stark as House coauthor.
51+Add as House Coauthors: Wallace, Townley, Pfeiffer, Lowe
52+(Dick), Archer, Bennett, Moore, Fetga tter, McDugle,
53+McBride, Kerbs, Grego, Cantrell, Nichols, Echols, Talley,
54+and Strom
55+
56+AUTHOR: Add the following Senate coauthors: Woods, Pederson, and
57+Burns
58+
59+
60+AMENDMENT NO. 1. Strike the stricken title, enacting clause, and
61+entire bill and insert:
62+
63+
64+"An Act relating to the practice of nursing ;
65+providing for independent prescriptive authority of
66+Advanced Practice Registered Nurses who meet certain
2867 requirements; providing certain construction; stating
2968 application criteria; specifying duration of
3069 authority; authorizing supervision by Advanced
3170 Practice Registered Nurse with independent
3271 prescriptive authority who meets certain
3372 requirements; authorizing Oklahoma Board of Nursing
3473 to prescribe additional qualifications; providing for
3574 application approval, denial, reapplication, fees,
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36101 and independent prescriptive authority revocation;
37102 amending 59 O.S. 2021, Section 353.1, as amended by
38103 Section 6, Chapter 288, O.S.L. 2022 (59 O .S. Supp.
39104 2023, Section 353.1), which relates to definitions
40105 used in the Oklahoma Pharmacy Act; modifying and
41106 adding definitions; amending 59 O.S. 2021, Section
42107 353.1a, which relates to prescriptive authority of
43108 Advanced Practice Registered Nurses; modifyi ng
44109 prescriptive authority of ce rtain Advanced Practice
45110 Registered Nurses; amending 59 O.S. 2021, Section
46111 567.3a, which relates to definitions us ed in the
47112 Oklahoma Nursing Practice Act; modifying and adding
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49-ENR. S. B. NO. 458 Page 2
50113 definitions; amending 59 O.S. 2021, Section 567.4a,
51114 which relates to prescriptive authority; specifying
52115 authority of the Board to grant prescriptive
53116 authority; directing the Board to promulgate certain
54117 rules; modifying references; conforming language;
55118 clarifying certain educational requirement; amending
56119 59 O.S. 2021, Section 567.5a, which relates to
57120 Advanced Practice Registered Nurse license; providing
58121 for independent prescriptive authority by
59122 endorsement; amending 63 O.S. 2021, Section 2-312, as
60123 amended by Section 2, Chapter 184, O.S.L. 2022 (63
61124 O.S. Supp. 2023, Section 2-312), which relates to
62125 controlled dangerous substances; conforming language
63126 relating to supervision r equirement; updating
64127 statutory language; updating statutory references;
65128 providing for codification; and declaring an
66129 emergency.
67130
68131
69132
70-SUBJECT: Practice of nursing
133+
71134
72135 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
73-
74136 SECTION 1. NEW LAW A new section of law to be codified
75137 in the Oklahoma Statutes as Sect ion 567.4c of Title 59, unless there
76138 is created a duplication in numbering, reads as follows:
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78139 A. 1. An Advanced Practice Registered Nurse recognized by the
79140 Oklahoma Board of Nursing as a Certified Nurse Practitioner ,
80141 Clinical Nurse Specialist , or Certified Nurse-Midwife who has
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81168 completed a minimum of six thousand two hundred forty (6,240) hours
82169 of practice with prescriptive authority supervised by a physician or
83170 completed an accredited residency program may apply to the Oklahoma
84171 Board of Nursing for authority to prescribe and order independent of
85172 supervision. This paragraph shall not be construed to exclude
86173 practice hours with supervised prescriptive authority obtained prior
87174 to the effective date of this act from being counted toward the
88175 hours required in this paragraph.
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92176 2. The application for independent prescriptive authority shall
93177 include proof that the Certified Nurse Practitioner, Clinical Nurse
94178 Specialist, or Certified Nurse-Midwife:
95-
96179 a. holds a valid, current license in the appropriate
97180 Advanced Practice Registered Nurse role issued by the
98181 Board and is in good standing with the Board, and
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100182 b. has completed a minimum of six thousand two hundred
101183 forty (6,240) hours of practice with prescriptive
102184 authority supervised by a physicia n or completed an
103185 accredited residency pro gram.
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105186 3. Independent prescriptive authority granted under this
106187 subsection shall be valid until the expiration of the current
107188 license to practice and may be renewed upon application to the Board
108189 at the same time and for the same period as the renewal of the
109190 license to practice.
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111217 B. The Board shall review any application submitted under this
112218 section and shall approve or deny the application, stating the
113219 reason or reasons for denial, if denied. If denied, the applicant
114220 may reapply using the process prescribe d by subsection A of this
115221 section.
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117222 C. The Board may suspend or revoke independent prescriptive
118223 authority granted under this section for good cause at any time.
119-
120224 D. The Board may establish a fee for the review of initial and
121225 renewal applications under the provisions of this section.
122-
123226 SECTION 2. NEW LAW A new section of law to be c odified
124227 in the Oklahoma Statutes as Section 567.5b of Title 59, unless there
125228 is created a duplication in numbering, reads as follows:
126-
127229 A. The Oklahoma Board of Nursing, the State Board of Medical
128230 Licensure and Supervision, and the State Board of Osteopathic
129231 Examiners shall collaborate to promulgate a uniform set of rules:
130-
131232 1. Governing supervision requirements of an Advanced Practice
132233 Registered Nurse who has n ot obtained independent prescriptive
133234 authority under Section 1 of this act; and
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137235 2. That impose a reaso nable limit on the monetary amount that a
138236 supervising physician may charge an Advanced Practice Registered
139237 Nurse for supervision. Nothing in this paragr aph shall be construed
140238 to require a supervising physician to charge a fee for supervision.
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142239 B. The Oklahoma Board of Nursing, the State Board of Medical
143240 Licensure and Supervision, and the State Board of Osteopathic
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144267 Examiners may collaborate to promulgate a uniform set of rules
145268 imposing a reasonable limit on the number of Advanced Practice
146269 Registered Nurses that a physician may supervise; provided, however,
147270 such rules shall allow a physician to seek a waiver to exceed this
148271 limit for such purposes as may be d etermined by the Boards in the
149272 uniform set of rules.
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151273 C. The State Board of Medical Licensure and Super vision and the
152274 State Board of Osteopathic Examiners s hall make available, and keep
153275 updated, in a conspicuous location on the Inter net website of each
154276 Board a list of physicians who are available to supervise Advanced
155277 Practice Registered Nurses. The Boards shall develop procedures
156278 necessary for the implement ation of this section.
157-
158279 SECTION 3. NEW LAW A new secti on of law to be codifie d
159280 in the Oklahoma Statutes as Section 355.5 of Title 59, unless there
160281 is created a duplication in numbe ring, reads as follows:
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162282 A. A licensed practitioner, or the employer of the licensed
163283 practitioner on his or her behalf, shall carr y malpractice insurance
164284 or demonstrate proof of financial responsibility in a minimum amount
165285 of One Million Dollars ($1,000,00 0.00) per occurrence and Three
166286 Million Dollars ($3,00 0,000.00) in the aggregate per year.
167-
168287 B. A licensed practitioner who is emplo yed by or under contract
169288 with a federal agency that carries malpractice insurance in any
170289 amount on behalf of the licensed prac titioner shall be deemed in
171290 compliance with subsectio n A of this section when practicing under
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172317 such federal employment or contract . However, to the extent the
173318 licensed practitioner practices outside of such federal employment
174319 or contract, the licensed pra ctitioner, or the employer of the
175320 licensed practitioner, shall comply with subsection A of this
176321 section.
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179-ENR. S. B. NO. 458 Page 5
180322 SECTION 4. AMENDATORY 59 O.S. 2021, Section 353.1, as
181323 amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 202 3,
182324 Section 353.1), is amended to read as follows:
183-
184-Section 353.1. For the purposes of the Oklahoma Pharmacy Act:
185-
325+Section 353.1 For the purposes of the Oklahoma Pharmacy Act:
186326 1. "Accredited program" means those seminars, classes,
187327 meetings, work projects, and other educational courses approved by
188328 the Board State Board of Pharmacy for purposes of continuing
189329 professional education;
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191330 2. "Act" means the Oklahoma Pharmacy Act;
192-
193331 3. "Administer" means the direct application of a drug, whether
194332 by injection, inhalation, ingestion or any other means, to the body
195333 of a patient;
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197334 4. "Assistant pharmacist" means any person presently licen sed
198335 as an assistant pharmacist in the State of Oklahom a this state by
199336 the Board pursuant to Section 353.10 of this title and for the
200337 purposes of the Oklahoma Pharmacy Act shal l be considered the same
201338 as a pharmacist, except where otherwise specified;
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203339 5. "Board" or "State Board" means the State Board of Pharmacy;
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204365
205366 6. "Certify" or "certification of a prescription" means the
206367 review of a filled prescription by a licensed pharmac ist or a
207368 licensed practitioner with dispensing authority to confirm that the
208369 medication, labeling, and packaging of the filled prescription are
209370 is accurate and meet all requirements prescribed by state and
210371 federal law. For the purposes of this paragraph, "licensed
211372 practitioner" shall not include optometrists with dispensing
212373 authority;
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214374 7. "Chemical" means any medicinal substance, whether simple or
215375 compound or obtained through the process of the science and art of
216376 chemistry, whether of organic or inorganic ori gin;
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218377 8. "Compounding" means the combining, admixing, mixing,
219378 diluting, pooling, reconstituting or otherwise altering of a drug or
220379 bulk drug substance to create a drug. Compounding includes the
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223380 preparation of drugs or devices in anticipation of prescript ion drug
224381 orders based on routine, regularly observed prescribing patterns;
225-
226382 9. "Continuing professional education" means professional,
227383 pharmaceutical education in the general areas of the socioeconomic
228384 and legal aspects of health care; the properties and actions of
229385 drugs and dosage forms; and the etiology, characteristics and
230386 therapeutics of the diseased state;
231-
232387 10. "Dangerous drug", "legend drug", "prescription drug" or "Rx
233388 Only" means a drug:
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235389 a. for human use subject to 21 U.S.C. 353(b)(1), or
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236415
237416 b. is labeled "Prescription Only", or labeled with the
238417 following statement: "Caution: Federal law restricts
239418 this drug except for to use by or on the order of a
240419 licensed veterinarian.";
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242420 11. "Director" means the Executive Director of the State Board
243421 of Pharmacy unless context clearly indicates otherwise;
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245422 12. "Dispense" or "dispensing" means the interpretation,
246423 evaluation, and implementation of a prescription d rug order
247424 including the preparation and delivery of a drug or device to a
248425 patient or a patient's agent in a suitable container appropria tely
249426 labeled for subsequent administration to, or use by, a patient.
250427 Dispense includes sell, distribute, leave with, gi ve away, dispose
251428 of, deliver or supply;
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253429 13. "Dispenser" means a retail pharmacy, hospital pharmacy, a
254430 group of chain pharmacies under c ommon ownership and control that do
255431 not act as a wholesale distributor, or any other person authorized
256432 by law to dispense or administer prescription drugs, and the
257433 affiliated warehouses or distributions of such entities under common
258434 ownership and control t hat do not act as a wholesale distributor.
259435 For the purposes of this paragraph, "dispenser" dispenser does not
260436 mean a person who dispenses only products to be used in animals in
261437 accordance with 21 U.S.C. 360b(a)(5);
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263438 14. "Distribute" or "distribution" means the sale, purchase,
264439 trade, delivery, handling, storage, or receipt of a product, and
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267466 does not include the d ispensing of a product pursuant to a
268467 prescription executed in accordance with 21 U.S.C. 353(b)(1) or the
269468 dispensing of a product approved under 21 U.S.C. 360b(b); provided,
270469 taking actual physical possession of a product or title shall not be
271470 required;
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273471 15. "Doctor of Pharmacy" means a person licensed by the Board
274472 to engage in the practice of pharmacy. The terms "pharmacist",
275473 "D.Ph.", and "Doctor of Pharmacy" shall be interchangeable and shall
276474 have the same meaning wherever they appear in the Oklahoma Statu tes
277475 and the rules promulgated by the Board;
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279476 16. "Drug outlet" means all manufacturers, repackagers,
280477 outsourcing facilities, wholesale distributors, third-party
281478 logistics providers, pharmacies, and all other facilities which are
282479 engaged in dispensing, deli very, distribution or storage of
283480 dangerous drugs;
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285481 17. "Drugs" means all medicinal substances and preparations
286482 recognized by the United States Pharmacopoeia Pharmacopeia and
287483 National Formulary, or any revision thereof, and all substances and
288484 preparations intended for external and/or internal use in the cure,
289485 diagnosis, mitigation, treatment or preventi on of disease in humans
290486 or animals and all substances and preparations, other than food,
291487 intended to affect the structure or any function of the body of a
292488 human or animals;
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294515 18. "Drug sample" means a unit of a prescription drug packaged
295516 under the authority and responsibility of the manufacturer that is
296517 not intended to be sold and is intended to promote the sale of the
297518 drug;
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299519 19. "Durable medical equipment" has the same meaning as
300520 provided by Section 2 of this act Section 375.2 of this title;
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302521 20. "Filled prescription" means a packaged prescription
303522 medication to which a label has been affixed which contain s such
304523 information as is required by the Oklahoma Pharmacy Act;
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306524 21. "Hospital" means any institution licensed as a hospital by
307525 this state for the care and treatment of patients, or a pharmacy
308526 operated by the Oklahoma Department of Veterans Affairs;
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312527 22. "Licensed practitioner" means:
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314528 a. an allopathic physician,
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316529 b. an osteopathic physician,
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318530 c. a podiatric physician,
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320531 d. a dentist,
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322532 e. a veterinarian or,
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324533 f. an optometrist, or
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326534 g. a Certified Nurse Practitioner, Clinical Nurse
327535 Specialist, or Certified Nurse -Midwife who has
328536 obtained independent prescriptive authority under
329537 Section 1 of this act,
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331564 licensed to practice and authorized to prescribe dangerous drugs
332565 within the scope of practice of such p ractitioner;
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334566 23. "Manufacturer" or "virtual manufacturer" means with respect
335567 to a product:
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337568 a. a person that holds an application approved under 21
338569 U.S.C. 355 or a license issued under 42 U.S.C. 262 for
339570 such product, or if such product is not the subject of
340571 an approved application or license, the person who
341572 manufactured the product,
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343573 b. a co-licensed partner of the person described in
344574 subparagraph a of this paragraph that obtains the
345575 product directly from a person described in this
346576 subparagraph or subparagraph a of this paragraph,
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348577 c. an affiliate of a person described in subpara graph a
349578 or b of this paragraph who receives the product
350579 directly from a person described in this subparagraph
351580 or in subparagraph a or b of this paragraph, or
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355581 d. a person who contracts with another to manufacture a
356582 product;
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358583 24. "Manufacturing" means the production, preparation,
359584 propagation, compounding, conversion or processing of a device or a
360585 drug, either directly or indirectly by extraction from substances of
361586 natural origin or independently by means of chemical or biological
362587 synthesis and includes any packaging or repackaging of the
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363614 substances or labeling or relabeling of its container, and the
364615 promotion and marketing of such drugs or devices. The term
365616 "manufacturing" manufacturing also includes the preparation and
366617 promotion of commercially available products from bulk compounds for
367618 resale by licensed pharmacies, licensed practitioners or other
368619 persons;
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370620 25. "Medical gas" means those gases including those in liquid
371621 state upon which the manufacturer or distributor has placed one of
372622 several cautions, such as "Rx Only", in compliance with federal law;
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374623 26. "Medical gas order" means an order for medical gas issued
375624 by a licensed prescriber;
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377625 27. "Medical gas distributor" means a person licensed to
378626 distribute, transfer, wholesale, deliver or sell medical gases on
379627 drug orders to suppliers or other entities licensed to use,
380628 administer or distribute medical gas and may also include a patient
381629 or ultimate user;
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383630 28. "Medical gas supplier" means a person who di spenses medical
384631 gases on drug orders only to a patient or ultimate user;
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386632 29. "Medicine" means any drug or combination of drugs which has
387633 the property of curing, preventing, treating, diagnosing or
388634 mitigating diseases, or which is used for that purpose;
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390635 30. "Nonprescription drugs" means medicines or drugs which are
391636 sold without a prescription and which are prepackaged for use by the
392637 consumer and labeled in accordance with the requirements of the
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393664 statutes and regulations of this state and the federal gov ernment.
394665 Such items shall also include medical and dental supplies and
395666 bottled or nonbulk chemicals which are sold or offered for sale to
396667 the general public if such articles or preparations meet the
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399668 requirements of the Federal Food, Drug, and Cosmetic Act, 21
400669 U.S.C.A., Section 321 et seq.;
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402670 31. "Outsourcing facility" including "virtual outsourcing
403671 facility" means a facility at one geographic location or address
404672 that:
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406673 a. is engaged in the compounding of sterile drugs,
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408674 b. has elected to register as an outsourcing facility,
409675 and
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411676 c. complies with all requirements of 21 U.S.C. 353b;
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413677 32. "Package" means the smallest individual saleable unit of
414678 product for distribution by a manufacturer or repackager that is
415679 intended by the manufacturer for ultimate s ale to the dispenser of
416680 such product. For the purposes of this paragraph, "individual
417681 saleable unit" means the smallest container of a product introduced
418682 into commerce by the manufacturer or repackager that is intended by
419683 the manufacturer or repackager fo r individual sale to a dispenser;
420-
421684 33. "Person" means an individual, partnership, limited
422685 liability company, corporation or association, unless the context
423686 otherwise requires;
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425713 34. "Pharmacist-in-charge" or "PIC" means the pharmacist
426714 licensed in this state responsible for the management control of a
427715 pharmacy and all other aspects of the practice of pharmacy in a
428716 licensed pharmacy as defined by Section 353.18 of this title;
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430717 35. "Pharmacy" means a place regularly licensed by the State
431718 Board of Pharmacy in which prescriptions, dru gs, medicines,
432719 chemicals and poisons are compounded or dispensed or such place
433720 where pharmacists practice the profession of pharmacy, or a pharmacy
434721 operated by the Oklahoma Department of Veterans Affairs;
435-
436722 36. "Pharmacy technician", "technician", "Rx tech", or "tech"
437723 means a person issued a Technician permit by the State Board of
438724 Pharmacy to assist the pharmacist and perform nonjudgmental,
439725 technical, manipulative, non-discretionary functions in the
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442726 prescription department under the immediate and direct supe rvision
443727 of a pharmacist;
444-
445728 37. "Poison" means any substance which when introduced into the
446729 body, either directly or by absorption, produces violent, morbid or
447730 fatal changes, or which destroys living tissue with which such
448731 substance comes into contact;
449-
450732 38. "Practice of pharmacy" means:
451-
452733 a. the interpretation and evaluation of prescription
453734 orders,
454-
455735 b. the compounding, dispensing, administering and
456736 labeling of drugs and devices, except labeling by a
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457763 manufacturer, repackager or distributor of
458764 nonprescription drug s and commercially packaged legend
459765 drugs and devices,
460-
461766 c. the participation in drug selection and drug
462767 utilization reviews,
463-
464768 d. the proper and safe storage of drugs and devices and
465769 the maintenance of proper records thereof,
466-
467770 e. the responsibility for advising by counseling and
468771 providing information, where professionally necessary
469772 or where regulated, of therapeutic values, content,
470773 hazards and use of drugs and devices,
471-
472774 f. the offering or performing of those ac ts, services,
473775 operations or transactions necessary i n the conduct,
474776 operation, management and c ontrol of a pharmacy, or
475-
476777 g. the provision of those acts or services that are
477778 necessary to provide pharmaceutical care;
478-
479779 39. "Preparation" means an article which may or may not contain
480780 sterile products compounded in a licensed pharmacy pursuant to the
481781 order of a licensed prescriber;
482-
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485782 40. "Prescriber" means a person licensed in this state who is
486783 authorized to prescribe dangerous drugs within the scope of practice
487784 of the person's profession;
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489811 41. "Prescription" means and includes any order for drug or
490812 medical supplies written or signed, or transmitted by word of mouth,
491813 telephone or other means of communication:
492-
493814 a. by a licensed prescriber,
494-
495815 b. under the supervision of an Oklahoma licensed
496816 practitioner, an Oklahoma licensed advanced practice
497817 registered nurse or an Oklahoma licensed by a
498818 physician assistant pursuant to a practice agreement ,
499819 or
500-
501820 c. (1) under the supervision of a supervising physician,
502821 by a Certified Nurse Practitioner, Clinical Nurse
503822 Specialist, or Certified Nurse-Midwife licensed
504823 in this state who has not obtained independent
505824 prescriptive authority under Section 1 of this
506825 act, or
507-
508826 (2) by a Certified Nurse Practitioner, Clinical Nurse
509827 Specialist, or Certified Nurse-Midwife licensed
510828 in this state who has obtained independent
511829 prescriptive authority under Section 1 of this
512830 act, or
513-
514831 d. by an Oklahoma licensed wholesaler or di stributor as
515832 authorized in Section 353.29.1 of this title;
516-
517833 42. "Product" means a prescription drug in a finished dosage
518834 form for administration to a patient without substantial further
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519861 manufacturing, such as capsules, tablets, and lyophilized products
520862 before reconstitution. "Product" does not include blood components
521863 intended for transfusion, radioactive drugs or biologics and medical
522864 gas;
523-
524865 43. "Repackager", including "virtual repackager", means a
525866 person who owns or operates an establishment that repac ks and
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528867 relabels a product or package for further sale or distribution
529868 without further transaction;
530-
531869 44. "Sterile drug" means a drug that is intended for parenteral
532870 administration, an ophthalmic or oral inhalation drug in aqueous
533871 format, or a drug that is required to be sterile under state and
534872 federal law;
535-
536873 45. "Supervising physician" means an individual holding a
537874 current license to practice as a physician from the State Board of
538875 Medical Licensure and Supervision, pursuant to the provisions of the
539876 Oklahoma Allopathic Medical and Surgical Licensure and Supervision
540877 Act, or the State Board of Osteopathic Examiners, pursuant to the
541878 provisions of the Oklahoma Osteopathic Medicine Act, who supervises
542879 an advanced practice registered nurse a Certified Nurse
543880 Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
544881 as defined in Section 567.3a of this title who has not obtained
545882 independent prescriptive authority under Section 1 of this act,
546-
547883 and who is not in training as an intern, resident, or fellow . To be
548884 eligible to supervise an advanced practice registered nurse, such
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549911 The supervising physician shall remain in compliance with the rules
550912 promulgated by the State Board of Medical Licensure and Supervision
551913 or the State Board of Osteopathic Examiners;
552-
553914 46. "Supportive personnel" means technicians and auxiliary
554915 supportive persons who are regularly paid employees of a pharmacy
555916 who work and perform tasks in the pharmacy as authorized by Section
556917 353.18A of this title;
557-
558918 47. "Third-party logistics provider" including "virtual third-
559919 party logistics provider" means an entity that provides or
560920 coordinates warehousing, or other logistics services of a product in
561921 interstate commerce on behalf of a manufacturer, wholesale
562922 distributor, or dispenser of a produc t but does not take ownership
563923 of the product, nor have responsibility to direct the sale or
564924 disposition of the product. For the purposes of this paragraph,
565925 "third-party logistics provider" does not include shippers and the
566926 United States Postal Service;
567-
568927 48. "Wholesale distributor" including "virtual wholesale
569928 distributor" means a person other than a manufacturer, a
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572929 manufacturer's co-licensed partner, a third-party logistics
573930 provider, or repackager engaged in wholesale distribution as defined
574931 by 21 U.S.C. 353(e)(4) as amended by the Drug Supply Chain Security
575932 Act;
576-
577933 49. "County jail" means a facility operated by a county for the
578934 physical detention and correction of persons charged with, or
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579961 convicted of, criminal o ffenses or ordinance violations or persons
580962 found guilty of civil or criminal contempt;
581-
582963 50. "State correctional facility" means a facility or
583964 institution that houses a prisoner population under the jurisdiction
584965 of the Department of Corrections;
585-
586966 51. "Unit dose package" means a package that contains a single
587967 dose drug with the name, strength, control number, and expiration
588968 date of that drug on the label; and
589-
590969 52. "Unit of issue package" means a package that provides
591970 multiple doses of the same drug, but each drug is individually
592971 separated and includes the name, lot number, and expiration date.
593-
594972 SECTION 5. AMENDATORY 59 O.S. 2021, Section 353.1a, is
595973 amended to read as follows:
596-
597-Section 353.1a. A. Prescribing 1. Prescriptive authority
598-shall be allowed, under the medical direction of a supervising
599-physician, for an advanced practice nurse a licensed Advanced
600-Practice Registered Nurse recognized by the Oklahoma Board of
601-Nursing in one of the following categories: advanced registered
602-nurse practitioners, clinical nurse specialists, or certified nurse -
974+Section 353.1a A. Prescribing 1. Prescriptive authority shall
975+be allowed, under the medical direction of a supervising physician,
976+for an advanced practice nurse a licensed Advanced Practice
977+Registered Nurse recognized by the Oklahom a Board of Nursing in one
978+of the following categories: advanced registered nurse
979+practitioners, clinical nurse specialists, or certified nurse-
603980 midwives as a Certified Nurse Practitioner, Clinical Nurse
604981 Specialist, or Certified Nurse-Midwife who has not obtained
605982 independent prescriptive authority under Section 1 of this act.
606-
607983 2. Prescriptive authority shall be allowed, independent of the
608984 medical direction of a supervising physician, for a licensed
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6091011 Advanced Practice Registered Nurse recognized by the Oklahoma Board
6101012 of Nursing as a Certified Nurse Practitioner, Clinical Nurse
6111013 Specialist, or Certified Nurse-Midwife who has obtained independent
6121014 prescriptive authority under Section 1 of this act.
613-
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6161015 B. The advanced practice nurse Advanced Practice Registered
6171016 Nurse may write or sign, or transmit by word of mouth, telephone or
6181017 other means of communication an order for drugs or medical supplies
6191018 that is intended to be filled, compounded, or dispensed by a
6201019 pharmacist. The supervising physician, if applicable, and the
6211020 advanced practice nurse prescribing Advanced Practice Registered
6221021 Nurse shall be identified at the time of origination of the
6231022 prescription and the name of the advanced practice nurse prescribing
6241023 Advanced Practice Registered Nurse shall be printed on the
6251024 prescription label.
626-
6271025 B. C. Pharmacists may dispense prescriptions for non-controlled
6281026 prescription drugs authorized by an advanced practice nurse Advanced
6291027 Practice Registered Nurse or physician assistant, not located in
6301028 Oklahoma this state, provided that they are licensed in the state in
6311029 which they are actively prescribing.
632-
6331030 C. D. 1. Pharmacists may only dispense prescriptions for
6341031 controlled dangerous substances prescribed by an advanced practice
6351032 nurse or physician assistant Advanced Practice Registered Nurse
6361033 licensed in the State of Oklahoma and supervised by an Oklahoma-
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6371060 licensed practitioner this state who meets the criteria in paragraph
6381061 1 or 2 of subsection A of this section.
639-
6401062 2. Pharmacists may only dispense prescriptions for controlled
6411063 dangerous substances prescribed by a physician assistant licensed in
6421064 this state pursuant to a practice agreeme nt.
643-
6441065 SECTION 6. AMENDATORY 59 O.S. 2021, Section 567.3a, is
6451066 amended to read as follows:
646-
647-Section 567.3a. As used in the Oklahoma Nursing Practice Act:
648-
1067+Section 567.3a As used in the Oklahoma Nursing Practice Act:
6491068 1. "Board" means the Oklahoma Board of Nursing;
650-
6511069 2. "The practice of nursing" means the performance of services
6521070 provided for purposes of nursing diagnosis and treatment of human
6531071 responses to actual or potential health problems consistent with
6541072 educational preparation. Knowledge and skill are the basis for
6551073 assessment, analysis, planning, intervention, and evaluation used in
6561074 the promotion and mainten ance of health and nursing management of
6571075 illness, injury, infirmity, restoration or optimal function, or
658-
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6601076 death with dignity. Practice is based on understanding the human
6611077 condition across the human lifespan and understanding the
6621078 relationship of the individ ual within the environment. This
6631079 practice includes execution of the medical regime including the
6641080 administration of medications and treatments prescribed by any
6651081 person authorized by state law to so prescribe;
666-
6671082 3. "Registered nursing" means the practice of the full scope of
6681083 nursing which includes, but is not limited to:
6691084
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6701110 a. assessing the health status of individuals, families
6711111 and groups,
672-
6731112 b. analyzing assessment data to determine nursing care
6741113 needs,
675-
6761114 c. establishing goals to meet identified health care
6771115 needs,
678-
6791116 d. planning a strategy of care,
680-
6811117 e. establishing priorities of nursing intervention to
6821118 implement the strategy of care,
683-
6841119 f. implementing the strategy of care,
685-
6861120 g. delegating such tasks as may safely be performed by
6871121 others, consistent with educational preparatio n and
6881122 that do not conflict with the provisions of the
6891123 Oklahoma Nursing Practice Act,
690-
6911124 h. providing safe and effective nursing care rendered
6921125 directly or indirectly,
693-
6941126 i. evaluating responses to interventions,
695-
6961127 j. teaching the principles and practice of nursing,
697-
6981128 k. managing and supervising the practice of nursing,
699-
7001129 l. collaborating with other health professionals in the
7011130 management of health care,
702-
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704-
7051131 m. performing additional nursing functions in accordance
7061132 with knowledge and skills acquired beyond basic
7071133 nursing preparation, and
7081134
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7091160 n. delegating those nursing tasks as defined in the rules
7101161 of the Board that may be performed by an advanced
7111162 unlicensed assistive person;
712-
7131163 4. "Licensed practical nursing" means the practice of nursing
7141164 under the supervision or direction of a regis tered nurse, licensed
7151165 physician or dentist. This directed scope of nursing practice
7161166 includes, but is not limited to:
717-
7181167 a. contributing to the assessment of the health status of
7191168 individuals and groups,
720-
7211169 b. participating in the development and modification of
7221170 the plan of care,
723-
7241171 c. implementing the appropriate aspects of the plan of
7251172 care,
726-
7271173 d. delegating such tasks as may safely be performed by
7281174 others, consistent with educational preparation and
7291175 that do not conflict with the Oklahoma Nursing
7301176 Practice Act,
731-
7321177 e. providing safe and effective nursing care rendered
7331178 directly or indirectly,
734-
7351179 f. participating in the evaluation of responses to
7361180 interventions,
737-
7381181 g. teaching basic nursing skills and related principles,
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7401208 h. performing additional nursing procedures in accordance
7411209 with knowledge and skills acquired through education
7421210 beyond nursing preparation, and
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7461211 i. delegating those nursing tasks as defined in the rules
7471212 of the Board that may be performed by an advanced
7481213 unlicensed assistive person;
749-
7501214 5. "Advanced Practice Registered Nurse " means a licensed
7511215 Registered Nurse:
752-
7531216 a. who has completed an advanced practice registered
7541217 nursing education program in preparation for one of
7551218 four recognized advanced practice registered nurse
7561219 Advanced Practice Registered Nurse roles,
757-
7581220 b. who has passed a national certification examination
7591221 recognized by the Board that measures the advanced
7601222 practice registered nurse Advanced Practice Registered
7611223 Nurse role and specialty competencies and who
7621224 maintains recertification in the role and specialty
7631225 through a national certification program,
764-
7651226 c. who has acquired advanced clinical knowledge and
7661227 skills in preparation for providing both direct and
7671228 indirect care to patients; however, the defining
7681229 factor for all Advanced Practice Registered Nurses is
7691230 that a significant compone nt of the education and
7701231 practice focuses on direct care of individuals,
7711232
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7721258 d. whose practice builds on the competencies of
7731259 Registered Nurses by demonstrating a greater depth and
7741260 breadth of knowledge, a greater synthesis of data, and
7751261 increased complexity of sk ills and interventions, and
776-
7771262 e. who has obtained a license as an Advanced Practice
7781263 Registered Nurse in one of the following roles:
7791264 Certified Registered Nurse Anesthetist, Certified
7801265 Nurse-Midwife, Clinical Nurse Specialist, or Certified
7811266 Nurse Practitioner.
782-
7831267 Only those persons who hold a license to practice advanced
7841268 practice registered nursing in this state shall have the right to
7851269 use the title "Advanced Practice Registered Nurse" and to use the
7861270 abbreviation "APRN". Only those persons who have obtained a lice nse
7871271 in the following disciplines shall have the right to fulfill the
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7901272 roles and use the applicable titles: Certified Registered Nurse
7911273 Anesthetist and the abbreviation "CRNA", Certified Nurse-Midwife and
7921274 the abbreviation "CNM", Clinical Nurse Specialist and the
7931275 abbreviation "CNS", and Certified Nurse Practitioner and the
7941276 abbreviation "CNP".
795-
7961277 It shall be unlawful for any person to assume the role or use
7971278 the title Advanced Practice Registered Nurse or use the abbreviation
7981279 "APRN" or use the respective specialty role titles and abbreviations
7991280 or to use any other titles or abbreviations that would reasonably
8001281 lead a person to believe the user is an Advanced Practice Registered
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8011308 Nurse, unless permitted by the Oklahoma Nursing Practice Act. Any
8021309 individual doing so shal l be guilty of a misdemeanor, which shall be
8031310 punishable, upon conviction, by imprisonment in the county jail for
8041311 not more than one (1) year or by a fine of not less than One Hundred
8051312 Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or
8061313 by both such imprisonment and fine for each offense;
807-
8081314 6. "Certified Nurse Practitioner" is means an Advanced Practice
8091315 Registered Nurse who performs in an expanded role in the delivery of
8101316 health care:
811-
8121317 a. consistent with advanced educational preparation as a
8131318 Certified Nurse Practitioner in an area of specialty,
814-
8151319 b. functions within the Certified Nurse Practitioner
8161320 scope of practice for the selected area of
8171321 specialization, and
818-
8191322 c. is in accord with the standards for Certified Nurse
8201323 Practitioners as identified by the certifying body and
8211324 approved by the Board.
822-
8231325 A Certified Nurse Practitioner shall be eligible, in accordance
8241326 with the scope of practice of the Certified Nurse Practitioner, to
8251327 obtain recognition as authorized by the Board to prescribe, as
8261328 defined by the rules promulgated by the Board pursuant to this
8271329 section and subject to the medical direction of a supervising
8281330 physician Section 567.4a of this title and Section 1 of this act.
8291331 This authorization shall not include dispensing drugs, but shall not
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8301358 preclude, subject to federal regulations, the receipt of, the
8311359 signing for, or the dispensing of professional samples to patients.
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834-
8351360 The Certified Nurse Practitioner accepts responsibility,
8361361 accountability, and obligation to practice in accordance with usual
8371362 and customary advanced practice registered nursing standards and
8381363 functions as defined by the scope of practice/role definition
8391364 statements for the Certified Nurse Practitioner;
840-
8411365 7. a. "Clinical Nurse Specialist" is means an Advanced
8421366 Practice Registered Nurse who holds:
843-
8441367 (1) a master's degree or higher in nursing with
8451368 clinical specialization preparation to function
8461369 in an expanded role,
847-
8481370 (2) specialty certification from a national
8491371 certifying organization recognized by the Board,
850-
8511372 (3) an Advanced Practice Registered Nurse licen se
8521373 from the Board, and
853-
8541374 (4) any nurse holding a specialty certification as a
8551375 Clinical Nurse Specialist valid on January 1,
8561376 1994, granted by a national certifying
8571377 organization recognized by the Board, shall be
8581378 deemed to be a Clinical Nurse Specialist under
8591379 the provisions of the Oklahoma Nursing Practice
8601380 Act.
8611381
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8621407 b. In the expanded role, the Clinical Nurse Specialist
8631408 performs at an advanced practice level which shall
8641409 include, but not be limited to:
865-
8661410 (1) practicing as an expert clinician in the
8671411 provision of direct n ursing care to a selected
8681412 population of patients or clients in any setting,
8691413 including private practice,
870-
8711414 (2) managing the care of patients or clients with
8721415 complex nursing problems,
873-
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8761416 (3) enhancing patient or client care by integrating
8771417 the competencies of clin ical practice, education,
8781418 consultation, and research, and
879-
8801419 (4) referring patients or clients to other services.
881-
8821420 c. A Clinical Nurse Specialist in accordance with the
8831421 scope of practice of such Clinical Nurse Specialist
8841422 shall be eligible to obtain recognition as authorized
8851423 by the Board to prescribe, as defined by the rules
8861424 promulgated by the Board pursuant to this section, and
8871425 subject to the medical direction of a supervising
8881426 physician Section 567.4a of this title and Section 1
8891427 of this act. This authorization shall not include
8901428 dispensing drugs, but shall not preclude, subject to
8911429 federal regulations, the receipt of, the signing for,
8921430 or the dispensing of professional samples to patients.
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8941457 d. The Clinical Nurse Specialist accepts responsibility,
8951458 accountability, and obligation to practice in
8961459 accordance with usual and customary advanced practice
8971460 nursing standards and functions as defined by the
8981461 scope of practice/role definition statements for the
8991462 Clinical Nurse Specialist;
900-
9011463 8. "Nurse-Midwife" is "Certified Nurse-Midwife" means a nurse
9021464 who has received an Advanced Practice Registered Nurse license from
9031465 the Oklahoma Board of Nursing who possesses evidence of
9041466 certification according to the requirements of the American College
9051467 of Nurse-Midwives.
906-
9071468 A Certified Nurse-Midwife in accordance with the scope of
9081469 practice of such Certified Nurse-Midwife shall be eligible to obtain
9091470 recognition as authorized by the Board to prescribe, as defined by
9101471 the rules promulgated by the Board pursuant to this section and
9111472 subject to the medical direction of a supervising physician Section
9121473 567.4a of this title and Section 1 of this act. This authorization
9131474 shall not include the dispensing of drugs, but shall not preclude,
9141475 subject to federal regulations, the receipt of, the sig ning for, or
9151476 the dispensing of professional samples to patients.
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9191477 The Certified Nurse-Midwife accepts responsibility,
9201478 accountability, and obligation to practice in accordance with usual
9211479 and customary advanced practice registered nursing standards and
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9221506 functions as defined by the scope of practice/role definition
9231507 statements for the Certified Nurse-Midwife;
924-
9251508 9. "Nurse-midwifery practice" means providing management of
9261509 care of normal newborns and women, antepartally, intrapartally,
9271510 postpartally and gynecologicall y, occurring within a health care
9281511 system which provides for medical consultation, medical management
9291512 or referral, and is in accord with the standards for nurse-midwifery
9301513 practice as defined by the American College of Nurse-Midwives;
931-
9321514 10. a. "Certified Registered Nurse Anestheti st" is an
9331515 Advanced Practice Registered Nurse who:
934-
9351516 (1) is certified by the National Board of
9361517 Certification and Recertification for Nurse
9371518 Anesthetists as a Certified Registered Nurse
9381519 Anesthetist within one (1) year following
9391520 completion of an approved certified registered
9401521 nurse anesthetist Certified Registered Nurse
9411522 Anesthetist education program, and continues to
9421523 maintain such recertification by the National
9431524 Board of Certification and Recertification for
9441525 Nurse Anesthetists, and
945-
9461526 (2) administers anesthesia in co llaboration with a
9471527 medical doctor, an osteopathic physician, a
9481528 podiatric physician or a dentist licensed in this
9491529 state and under conditions in which timely onsite
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9501556 consultation by such doctor, osteopath, podiatric
9511557 physician or dentist i s available.
952-
9531558 b. A Certified Registered Nurse Anesthetist, in
9541559 collaboration with a medical doctor, osteopathic
9551560 physician, podiatric physician or dentist licensed in
9561561 this state, and under conditions in which timely, on-
9571562 site consultation by such medical docto r, osteopathic
9581563 physician, podiatric physician or dentist is
9591564 available, shall be authorized, pursuant to rules
9601565 adopted by the Oklahoma Board of Nursing, to order,
961-
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9631566 select, obtain and administer legend drugs, Schedules
9641567 II through V controlled substances, devices, and
9651568 medical gases only when engaged in the preanesthetic
9661569 preparation and evaluation; anesthesia induction,
9671570 maintenance and emergence; and postanesthesia care. A
9681571 Certified Registered Nurse Anesthetist may order,
9691572 select, obtain and administer drugs only during the
9701573 perioperative or periobstetrical period.
971-
9721574 c. A Certified Registered Nurse Anesthetist who applies
9731575 for authorization to order, select, obtain and
9741576 administer drugs shall:
975-
9761577 (1) be currently recognized as a Certified Registered
9771578 Nurse Anesthetist in this state,
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9781604
9791605 (2) provide evidence of completion, within the two-
9801606 year period immediately preceding the date of
9811607 application, of a minimum of fifteen (15) units
9821608 of continuing education in advanced pharmacology
9831609 related to the administration of anesthesia as
9841610 recognized by the Nation al Board of Certification
9851611 and Recertification for Nurse Anesthetists, and
986-
9871612 (3) complete and submit a notarized application, on a
9881613 form prescribed by the Board, accompanied by the
9891614 application fee established pursuant to this
9901615 section.
991-
9921616 d. The authority to order , select, obtain and administer
9931617 drugs shall be terminated if a Certified Registered
9941618 Nurse Anesthetist has:
995-
9961619 (1) ordered, selected, obtained or administered drugs
9971620 outside of the Certified Registered Nurse
9981621 Anesthetist scope of practice or ordered,
9991622 selected, obtained or administered drugs for
10001623 other than therapeutic purposes, or
1001-
10021624 (2) violated any provision of state laws or rules or
10031625 federal laws or regulations pertaining to the
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10061626 practice of nursing or the authority to order,
10071627 select, obtain and administer drugs.
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10081653
10091654 e. The Oklahoma Board of Nursing shall notify the State
10101655 Board of Pharmacy after termination of or a change in
10111656 the authority to order, select, obtain and administer
10121657 drugs for a Certified Registered Nurse Anesthetist.
1013-
10141658 f. The Board shall provide by rule for biennial
10151659 application renewal and reauthorization of authority
10161660 to order, select, obtain and administer drugs for
10171661 Certified Registered Nurse Anesthetists. At the time
10181662 of application renewal, a Certified Registered Nurse
10191663 Anesthetist shall submit documentation of a min imum of
10201664 eight (8) units of continuing education, completed
10211665 during the previous two (2) years, in advanced
10221666 pharmacology relating to the administration of
10231667 anesthesia, as recognized by the Council on
10241668 Recertification of Nurse Anesthetists or the Council
10251669 on Certification of Nurse Anesthetists National Board
10261670 of Certification and Recertification for Nurse
10271671 Anesthetists.
1028-
10291672 g. This paragraph shall not prohibit the administration
10301673 of local or topical anesthetics as now permitted by
10311674 law. Provided further , nothing in this paragraph
10321675 shall limit the authority of the Board of Dentistry to
10331676 establish the qualifications for dentists who direct
10341677 the administration of anesthesia.
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10351703
10361704 h. As used in this parag raph, "collaboration" means an
10371705 agreement between a medical doc tor, osteopathic
10381706 physician, podiatric physician or dentist performing
10391707 the procedure or directly involved with the procedure
10401708 and the Certified Registered Nurse Anesthetist working
10411709 jointly toward a common goal providing services for
10421710 the same patient. This c ollaboration involves the
10431711 joint formulation, discussion and agreement of the
10441712 anesthesia plan by both parties, and the collaborating
10451713 medical doctor, osteopathic physician, podiatric
10461714 physician or dentist performing the procedure or
10471715 directly involved with the procedure and that
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10501716 collaborating physician shall remain available for
10511717 timely onsite consultation during the delivery of
10521718 anesthesia for diagnosis, consultation, and treatment
10531719 of medical conditions;
1054-
10551720 11. "Supervising physician" means an individual holding a
10561721 current license to practice as a physician from the State Board of
10571722 Medical Licensure and Supervision or the State Board of Osteopathic
10581723 Examiners, who supervises a Certified Nurse Practitioner , a Clinical
10591724 Nurse Specialist, or a Certified Nurse-Midwife who has not obtained
10601725 independent prescriptive authority under Section 1 of this act, and
10611726 who is not in training as an intern, resident, or fellow. To be
10621727 eligible to supervise such Advanced Practice Regi stered Nurse, such
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10631754 The supervising physician shall remain in compliance with the rules
10641755 promulgated by the State Board of Medical Licensure and Supervision
10651756 or the State Board of Osteopathic Examiners;
1066-
10671757 12. "Supervision of an Advanced Practice Registered Nurse with
10681758 prescriptive authority" means overseeing and accepting
10691759 responsibility for the ordering and transmission by a Certified
10701760 Nurse Practitioner, a Clinical Nurse Specialist, or a Certified
10711761 Nurse-Midwife who has not obtained independent prescriptive
10721762 authority under Section 1 of this act of written, telephonic,
10731763 electronic or oral prescriptions for drugs and other medical
10741764 supplies, subject to a defined formulary; and
1075-
10761765 13. "Advanced Unlicensed Assistant" means any person who has
10771766 successfully completed a certified training program approved by the
10781767 Board that trains the Advanced Unlicensed Assistant to perform
10791768 specified technical skills identified by the Board in acute care
10801769 settings under the direction and supervision of the Registered Nurse
10811770 or Licensed Practical Nurse.
1082-
10831771 SECTION 7. AMENDATORY 59 O.S. 2021, Section 567.4a, is
10841772 amended to read as follows:
1085-
1086-Section 567.4a. The Oklahoma Board of Nursing may grant
1773+Section 567.4a The Oklahoma Board of Nursing may grant
10871774 prescriptive authority through the Advanced Practice Registered
10881775 Nurse license to Certified Nurse Practitioners, Clinical Nurse
10891776 Specialists, and Certified Nurse-Midwives who meet the requirements
10901777 for prescriptive authority identified by law and in the Board's
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10911804 rules. The rules regarding prescriptive authority recognition
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1093-ENR. S. B. NO. 458 Page 26
10941805 promulgated by the Oklahoma Board of Nursing pursuant to paragraphs
10951806 6 through 9, 11 and 12 of this section, Section 567.3a of this
10961807 title, and Section 1 of this act shall:
1097-
10981808 1. Define the procedure for documenting supervision by a
10991809 supervising physician licensed in Oklahoma to practice by the State
11001810 Board of Medical Licensure and Supervision or the State Board of
11011811 Osteopathic Examiners as defined in Section 567.3a of this title of
11021812 a Certified Nurse Practitioner, Clinical Nurse Specialist, or
11031813 Certified Nurse-Midwife who has not obtained independent
11041814 prescriptive authority under Section 1 of this act. Such procedure
11051815 shall include a written statement that defines appropriate referral,
11061816 consultation, and collaboration between the Advanced Practice
11071817 Registered Nurse, recogni zed to prescribe as defined in paragraphs 6
11081818 through 9, 11 and 12 of Section 567.3a of this title, and the
11091819 supervising physician. The written statement shall include a method
11101820 of assuring availability of the supervising physician through direct
11111821 contact, telecommunications or other appropriate electronic means
11121822 for consultation, assistance with medical emergencies, or patient
11131823 referral. The written statement shall be part of the initial
11141824 application and the renewal application submitted to the Board for
11151825 recognition for prescriptive authority for the Advanced Practice
11161826 Registered Nurse. Changes to the written statement shall be filed
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11171853 with the Board within thirty (30) days of the change and shall be
11181854 effective on filing;
1119-
11201855 2. Define the procedure for documenting independent
11211856 prescriptive authority for Certified Nurse Practitioners, Clinical
11221857 Nurse Specialists, and Certified Nurse-Midwives who have obtained
11231858 independent prescriptive authori ty under Section 1 of this act;
1124-
11251859 3. Define minimal requirements for initial application for
11261860 prescriptive authority which shall include, but not be limited to,
11271861 evidence of completion of a minimum of forty-five (45) contact hours
11281862 or three (3) academic credit hours of education in
11291863 pharmacotherapeutics, clinical application, and use of
11301864 pharmacological agents in the prevention of illness, and in the
11311865 restoration and maintenance of health in a program beyond basic
11321866 registered nurse preparation, approved by the Board. Such contact
11331867 hours or academic credits shall be obtained within a time period of
11341868 three (3) years immediately preceding the date of application for
11351869 prescriptive authority ;
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1137-ENR. S. B. NO. 458 Page 27
1138-
11391870 3. 4. Define minimal requirements for application for renewal
11401871 of prescriptive authority which shall include, but not be limited
11411872 to, documentation of a minimum of:
1142-
11431873 a. fifteen (15) contact hours or one (1) academic credit
11441874 hour of education in pharmacother apeutics, clinical
11451875 application, and use of pharmacological agents in the
11461876 prevention of illness, and in the restoration and
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11471903 maintenance of health in a program beyond basic
11481904 registered nurse preparation, and
1149-
11501905 b. two (2) hours of education in pain management or two
11511906 (2) hours of education in opioid use or addiction,
11521907 unless the Advanced Practice Registered Nurse has
11531908 demonstrated to the satisfaction of the Board that the
11541909 Advanced Practice Registered Nurse does not currently
11551910 hold a valid federal Drug Enforcement Adm inistration
11561911 registration number,
1157-
11581912 approved by the Board, within the two-year period immediately
11591913 preceding the effective date of application for renewal of
11601914 prescriptive authority;
1161-
11621915 4. 5. Require that beginning July 1, 2002, an Advanced Practice
11631916 Registered Nurse shall demonstrate demonstrates successful
11641917 completion of a master's degree or higher in a clinical nurse
11651918 specialty one of the following Advanced Practice Registered Nurse
11661919 roles:
1167-
11681920 a. Certified Nurse Practitioner,
1169-
11701921 b. Clinical Nurse Specialist, or
1171-
11721922 c. Certified Nurse-Midwife,
1173-
11741923 in order to be eligible for initial application for prescriptive
11751924 authority under the provisions of the Oklahoma Nursing Practice Act;
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11761950
11771951 5. 6. Define the method for communicating authority to
11781952 prescribe or termination of same, and the formulary to the State
11791953 Board of Pharmacy, all pharmacies, and all registered pharmacists ;
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11831954 6. 7. Define terminology used in such rules;
1184-
11851955 7. 8. Define the parameters for the prescribing practices of
11861956 the Advanced Practice Re gistered Nurse;
1187-
11881957 8. 9. Define the methods for termination of prescriptive
11891958 authority for the Advanced Practice Registered N urse; and
1959+9. 10. a. Establish a Formulary Advisory Council that shall
1960+develop and submit to the Board recommendations for an
1961+exclusionary formulary that shall list drugs or
1962+categories of drugs that shall not be prescribed by an
1963+Advanced Practice Registere d Nurse recognized to
1964+prescribe by the Oklahoma Board of Nursing. The
1965+Formulary Advisory Council shall also develop and
1966+submit to the Board recommendations for practice-
1967+specific prescriptive standards for each category of
1968+Advanced Practice Registered Nurs e recognized to
1969+prescribe by the Oklahoma Board of Nursing pursuant to
1970+the provisions of the Oklahoma Nursing Practice Act.
1971+The Board shall either accept or reject the
1972+recommendations made by the Council. No amendments to
1973+the recommended exclusionary for mulary may be made by
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2000+the Board without the approval of the Formulary
2001+Advisory Council.
2002+b. The Formulary Advisory Council shall be compos ed of
2003+twelve (12) members as follo ws:
2004+(1) four members, to include a pediatrician, an
2005+obstetrician-gynecological physic ian, a general
2006+internist, and a family practice physician;
2007+provided, that three of such members shall be
2008+appointed by the Oklahoma State M edical
2009+Association, and one shall be appointed by the
2010+Oklahoma Osteopathic Association,
2011+(2) four members who are regis tered pharmacists,
2012+appointed by the Oklahoma Pharmaceutical
2013+Association, and
2014+(3) four members, one of whom shall be a Certified
2015+Nurse Practitioner, one of whom shall be a
2016+Clinical Nurse Specialist, one of whom shall be a
2017+Certified Nurse-Midwife, and one of whom shall be
2018+a current member of the Oklahoma Board of
2019+Nursing, all of whom shall be appointed by the
2020+Oklahoma Board of Nursing.
2021+c. All professional members of the Formul ary Advisory
2022+Council shall be in active clinical practice, at least
2023+fifty percent (50%) of the time, within their defined
2024+
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2050+area of specialty. The members of the Formulary
2051+Advisory Council shall serve at the pleasure of the
2052+appointing authority for a term o f three (3) years.
2053+The terms of the members shall be staggered. Members
2054+of the Council may serve beyond the expiration of
2055+their term of office until a successor is appointed by
2056+the original appointing authority. A vacan cy on the
2057+Council shall be filled for the balance of the
2058+unexpired term by the original appointing authority.
2059+d. Members of the Council shall elect a chair and a vice-
2060+chair vice chair from among the membership of the
2061+Council. For the transaction of business, at leas t
2062+seven members, with a minimum of two members present
2063+from each of the identified categories of physicians,
2064+pharmacists and advanced practice registered nurses
2065+Advanced Practice Registered Nurses, shall constitute
2066+a quorum. The Council shall recommend an d the Board
2067+shall approve and implement an initial exclusionary
2068+formulary on or before January 1, 1997. The Council
2069+and the Board shall annually review the approved
2070+exclusionary formulary and shall make any necessary
2071+revisions utilizing the same procedure s used to
2072+develop the initial exclusionary formulary.
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2099+SECTION 8. AMENDATORY 59 O.S. 2021, Section 567.5a, is
2100+amended to read as follows:
2101+Section 567.5a A. All applicants for a license to practice as
2102+an Advanced Practice Registered Nurse shall be subject to Section
2103+567.8 of this title.
2104+B. An applicant for an initial license to practice as an
2105+Advanced Practice Registered Nurse shall:
2106+1. Submit a completed written application and appropriate fees
2107+as established by the Oklahoma Board of Nursing;
2108+2. Submit a criminal history records check that complies with
2109+Section 567.18 of this title;
2110+3. Hold a current Registered Nurse license in this state;
2111+4. Have completed an advanced practice registered nursing
2112+education program in one of the four advanced practice registered
2113+nurse Advanced Practice Registered Nurse roles and a specialty area
2114+recognized by the Board. Effective January 1, 2016, the applicant
2115+shall have completed an accredited graduate level advanced practice
2116+registered nursing education program in at least one of the
2117+following population foci: family/individual across the lifespan,
2118+adult-gerontology, neonatal, pediatrics, women's health/gender-
2119+related, or psychiatric/mental health;
2120+5. Be currently certified in an advanced practice specialty
2121+certification consistent with educational preparation and by a
2122+national certifying body recognized by the Board; and
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2149+6. Provide any and all other evidence as required by the Board
2150+in its rules.
2151+C. The Board may issue a license by endorsement to an Advanced
2152+Practice Registered Nurse licensed under the laws of another state
2153+if the applicant meets the qualifications for licensure in this
2154+state. An applicant by endorsement shall:
2155+1. Submit a completed written application and appr opriate fees
2156+as established by the B oard;
2157+2. Hold a current Registered Nurse license in this state;
2158+3. Hold recognition as an Advanced Practice Registered Nurse in
2159+a state or territory;
2160+4. Have completed an advanced practice registered nursing
2161+education program in one of the four roles an d a specialty area
2162+recognized by the Board. Effective January 1, 2016, the applicant
2163+shall have completed an accredited graduate level advanced practice
2164+registered nursing education program in at least one of the
2165+following population foci: family/individ ual across the lifespan,
2166+adult-gerontology, neonatal, pediatrics, women's health/gender-
2167+related, or psychiatric/mental health;
2168+5. Be currently certified in an advanced practice specialty
2169+certification consistent with ed ucational preparation and by a
2170+national certifying body recognized by the Board;
2171+6. Meet continued competency requirements as set forth in Board
2172+rules; and
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2199+7. Provide any and all other evidence as required by the Board
2200+in its rules.
2201+D. The Board may iss ue prescriptive authority recognitio n by
2202+endorsement to an Advanced Practice Registered Nurse licensed as an
2203+APRN-CNP, APRN-CNS, or APRN-CNM under the laws of another state if
2204+the applicant meets the requirements set forth in this section. An
2205+applicant for prescriptive authority recognition by endorsement
2206+shall:
2207+1. Submit a completed written application and appropriate fees
2208+as established by the Board;
2209+2. Hold current Registered Nurse and Advanced Practice
2210+Registered Nurse licenses (APRN-CNP, APRN-CNS, or APRN-CNM) in the
2211+state;
2212+3. Hold current licensure or recognition as an Advanced
2213+Practice Registered Nurse in the same role and specialty with
2214+prescribing privileges in another state or territory;
2215+4. Submit documentation verifying successful completion of a
2216+graduate level advanced practic e registered nursing education
2217+program that included an academic course in pharmacotherapeutic
2218+management, and didactic and clinical preparation for prescribing
2219+incorporated throughout the program;
2220+5. Submit a written statement from an Oklahoma licensed
2221+physician supervising prescriptive authority as required by the
2222+Board in its rules, or submit documentation that the applicant meets
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2249+the requirements for independent prescriptive authority under
2250+Section 1 of this act;
2251+6. Meet continued competency requirements as set forth in Board
2252+rules; and
2253+7. Provide any and all other evidence as required by the Board
2254+in its rules.
2255+E. An Advanced Practice Registered Nurse license issued under
2256+this section shall be renewed concurrently with the regis tered nurse
2257+license, provided that qualifying criteria continue to be met.
2258+F. The Board may reinstate a license as set forth in Boa rd
2259+rules.
2260+SECTION 9. AMENDATORY 63 O.S. 2021, Section 2-312, as
2261+amended by Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2023,
2262+Section 2-312), is amended to read as follows:
2263+Section 2-312. A. A physician, podiatrist, optometrist or a
2264+dentist who has complied with the registration requirements of the
2265+Uniform Controlled Dangerous Substances Act, in good faith and in
2266+the course of such person's professional practice only, may
2267+prescribe and administer controlled dangerous substances, or may
2268+cause the same to be administered by medical or paramedical
2269+personnel acting under the direction and supervision of the
2270+physician, podiatrist, optometrist or dentist, and only may dispense
2271+controlled dangerous substances pursuant to the provisions of
2272+Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes.
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2299+B. A veterinarian who has complied with the registration
2300+requirements of the Uniform Controlled Dangerous Substances Act, in
2301+good faith and in the course of the professional practice of the
2302+veterinarian only, and not for use by a human being, may prescribe,
2303+administer, and dispense controlled dangerous substances and may
2304+cause them to be administered by an assistant or orderly under the
2305+direction and supervision of the veterinarian.
2306+C. 1. An advanced practice nurse Advanced Practice Registered
2307+Nurse who is recognized to prescribe by the Oklahoma Board of
2308+Nursing as an advanced registered nurse practitioner, clinical nurse
2309+specialist or certified nurse-midwife, a Certified Nurse
2310+Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
2311+but who has not obtained independent prescriptive authority under
2312+Section 1 of this act and therefore is subject to medical direction
2313+by a supervising physician, pursuant to Section 567.3a of Title 59
2314+of the Oklahoma Statutes, and who has complied with the registration
2315+requirements of the Uniform Controlled Dange rous Substances Act, in
2316+good faith and in the course of professional practice only, may
2317+prescribe and administer Schedule III, IV and V controlled dangerous
2318+substances.
2319+2. An Advanced Practice Registered Nurse who is recognized to
2320+prescribe by the Okla homa Board of Nursing as a Certified Nurse
2321+Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
2322+who has obtained independent prescriptive authority under Section 1
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2349+of this act, and who has complied with the registration requirements
2350+of the Uniform Controlled Dangerous Substances Act, in good faith
2351+and in the course of professional practice only, may prescribe and
2352+administer Schedule III, IV, and V controlled dangerous substances.
2353+D. An advanced practice nurse Advanced Practice Registered
2354+Nurse who is recognized to order, select, obtain and administer
2355+drugs by the Oklahoma Board of Nursing as a certified registered
2356+nurse anesthetist Certified Registered Nurse Anesthetist pursuant to
2357+Section 353.1b of Title 59 of the Oklahoma Statutes and who has
2358+complied with the registration requirements of the Uniform
2359+Controlled Dangerous Substances Act, in good faith and in the course
2360+of such practitioner's professional practice only, may order,
2361+select, obtain and administer Schedules II through V controlled
2362+dangerous substances in a preanesthetic preparation or evaluation;
2363+anesthesia induction, maintenance or emergence; or postanesthesia
2364+care setting only. A certified registered nurse anestheti st
2365+Certified Registered Nurse Anesthetist may order, select, obtain and
2366+administer such drugs only during the perioperative or
2367+periobstetrical period.
2368+E. A physician assistant who is recognized to prescribe by the
2369+State Board of Medical Licensure and Supe rvision under the medical
2370+direction of a supervising physician, pursuant to Section 519.6 of
2371+Title 59 of the Oklahoma Statutes, and who has complied with the
2372+registration requirements of the Uniform Controlled Dangerous
2373+
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2399+Substances Act, in good faith and in the course of professional
2400+practice only, may prescribe and administe r Schedule II through V
2401+controlled dangerous substances.
2402+SECTION 10. It being immediately necessary for the preservation
2403+of the public peace, health or safety, an emergency is hereby
2404+declared to exist, by reason whereof this act shall take effect and
2405+be in full force from and after its passage and approval."
2406+Passed the House of Representatives the 13th day of February,
2407+2024.
2408+
2409+
2410+
2411+
2412+
2413+Presiding Officer of the House of
2414+ Representatives
2415+
2416+
2417+Passed the Senate the ____ day of __________, 2024.
2418+
2419+
2420+
2421+
2422+
2423+Presiding Officer of the Senate
2424+
2425+
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2451+ENGROSSED SENATE
2452+BILL NO. 458 By: Stanley, Green, Hamilton,
2453+Young, Murdock, Coleman,
2454+Rogers, Daniels, Paxton,
2455+and Dahm of the Senate
2456+
2457+ and
2458+
2459+ McEntire of the House
2460+
2461+
2462+
2463+[ nursing - prescriptive authority – application -
2464+supervision - controlled dangerous substances -
2465+supervision requirement – codification - effective
2466+date ]
2467+
2468+
2469+
2470+
2471+BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
2472+SECTION 11. NEW LAW A new section of law to be codified
2473+in the Oklahoma Statutes as Sect ion 567.4c of Title 59, unless there
2474+is created a duplication in numbering, reads as follows:
2475+A. 1. An Advanced Practice Registered Nurse recognized by the
2476+Oklahoma Board of Nursing as a Certified Nurse Practitioner,
2477+Clinical Nurse Specialist , or Certified Nurse-Midwife who has
2478+completed a minimum of six thousand two hundred forty (6,240) hours
2479+of practice with prescriptive authority supervised by a physician or
2480+a supervising Advanced Practice Registered Nurse may apply to the
2481+Oklahoma Board of Nursing for authority to prescribe and order
2482+independent of supervision. This paragraph shall not be construed
2483+to exclude practice hours with supervised prescriptive authority
2484+
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2510+obtained prior to the eff ective date of this act from being counted
2511+toward the two-thousand-hour requirement of this paragraph.
2512+2. The application for independent prescriptive authority shall
2513+include proof that the Certified Nurse Practitioner , Clinical Nurse
2514+Specialist, or Certified Nurse -Midwife:
2515+a. holds a valid, current license in the appropriate
2516+Advanced Practice Registered Nurse role issued by the
2517+Board and is in good standing with the Board, and
2518+b. has completed a minimum of two thousand (2,000) hours
2519+of practice with prescriptive authority supervised by
2520+a physician or supervising Advanced Practice
2521+Registered Nurse.
2522+3. Independent prescriptive authority granted under this
2523+subsection shall be valid until the expiration of the cu rrent
2524+license to practice and may be r enewed upon application to the Board
2525+at the same time and for the same period as the renewal of the
2526+license to practice.
2527+B. 1. A Certified Nurse Practitioner, Clinical Nurse
2528+Specialist, or Certified Nurse-Midwife who has obtained independent
2529+prescriptive authority under subsection A of this section and who
2530+has completed a minimum of eight thousand (8,000) hours of practice
2531+with independent prescriptive authority may serve as a supervising
2532+Advanced Practice Registered Nurse.
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2559+2. Notwithstanding paragraph 1 of this subsection , an Advanced
2560+Practice Registered Nurse who has been licensed and in practice for
2561+a minimum of five (5) years as of the effective date of this act
2562+without a lapse of work , upon obtainment of independent prescri ptive
2563+authority under subsection A of this sec tion, may serve as a
2564+supervising Advanced Practice Registered Nurse.
2565+3. The Board may at its discretion prescribe by rule additional
2566+qualifications for supervising Advanced Practice Registered Nurses
2567+including, but not limited to, qualifications pertaining to the
2568+Advanced Practice Registered Nurse role or specialty.
2569+C. The Board shall review any application submitted under this
2570+section and shall approve or deny the application, stating the
2571+reason or reasons for denial, if denied. If denied, the applicant
2572+may reapply using the process prescribed b y subsection A of this
2573+section.
2574+D. The Board may suspend or revoke independent prescriptive
2575+authority granted under this section for good cause at any time.
2576+E. The Board may establish a fee for the review of initial and
2577+renewal applications under the pro visions of this section.
2578+SECTION 12. NEW LAW A new section of law to be codified
2579+in the Oklahoma Statutes as Section 355.5 of Title 59, unless there
2580+is created a duplication in numbering, re ads as follows:
2581+A. A licensed practitioner, or the em ployer of the licensed
2582+practitioner on his or her behalf, shall carry malpra ctice insurance
2583+
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2609+or demonstrate proof of financial responsibility in a minimum amount
2610+of One Million Dollars ($1,000,000.00) pe r occurrence and Three
2611+Million Dollars ($3,000,000.00) in the aggregate per year.
2612+B. A licensed practitioner who is employed by o r under contract
2613+with a federal agency that carries malpractice insurance in any
2614+amount on behalf of the licensed practitioner shall be deemed in
2615+compliance with subsection A of th is section when practicing under
2616+such federal employment or contract. Howev er, to the extent the
2617+licensed practitioner practices outside of such federal employment
2618+or contract, the licensed practitione r, or the employer of the
2619+licensed practitioner, shall comply with subsection A of this
2620+section.
2621+SECTION 13. AMENDATORY 59 O.S. 2021, Section 353.1, as
2622+amended by Section 6, Chap ter 288, O.S.L. 2022 (59 O.S. Supp. 2022,
2623+Section 353.1), is amended to r ead as follows:
2624+Section 353.1. For the purposes of the Oklahoma Pharmacy Act:
2625+1. “Accredited program” means those seminars, classes,
2626+meetings, work projects, and other educational courses approved by
2627+the Board State Board of Pharmacy for purposes of continuing
2628+professional education;
2629+2. “Act” means the Oklahoma Pharmacy Act;
2630+3. “Administer” means the direct applicati on of a drug, whether
2631+by injection, inhalation, ingestion or any other means, to the body
2632+of a patient;
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2659+4. “Assistant pharmacist” means any person presently licen sed
2660+as an assistant pharmacist in the State of Oklahom a this state by
2661+the Board pursuant to S ection 353.10 of this title and for the
2662+purposes of the Oklahoma Pharmacy Act shal l be considered the same
2663+as a pharmacist, except where otherwise specified;
2664+5. “Board” or “State Board” means the State Board of Pharmacy;
2665+6. “Certify” or “certification of a prescription” means the
2666+review of a filled prescription by a licensed pharmac ist or a
2667+licensed practitioner with dispensing authority to confirm that the
2668+medication, labeling and packaging of the filled prescription are
2669+accurate and meet all requirement s prescribed by state and feder al
2670+law. For the purposes of this paragraph, “licensed practitioner”
2671+shall not include optometrists with dispensing authority;
2672+7. “Chemical” means any medicinal substance, whether simple or
2673+compound or obtained through the p rocess of the science and art o f
2674+chemistry, whether of organic or inorganic ori gin;
2675+8. “Compounding” means the combining, admixing, mixing,
2676+diluting, pooling, reconstitutin g or otherwise altering of a drug or
2677+bulk drug substance to create a drug. Compounding includes the
2678+preparation of drugs or devices in anticipation of prescript ion drug
2679+orders based on routine, regularly observed prescribing patterns;
2680+9. “Continuing professional education” means professional,
2681+pharmaceutical education in the general are as of the socioeconomic
2682+and legal aspects of health care; the properties and actions of
2683+
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2709+drugs and dosage forms; and the etiology, characteristics and
2710+therapeutics of the dis eased state;
2711+10. “Dangerous drug”, “legend drug”, “prescription drug” or “Rx
2712+Only” means a drug:
2713+a. for human use subject to 21 U.S.C. 353(b)(1), or
2714+b. is labeled “Prescription Only”, or labeled with the
2715+following statement: “Caution: Federal law restricts
2716+this drug except for to use by or on the order of a
2717+licensed veterinarian.”;
2718+11. “Director” means the Executive Director of the State Board
2719+of Pharmacy unless context clearly indicates otherwise;
2720+12. “Dispense” or “dispensing” means the interpretation,
2721+evaluation, and implementation of a prescription d rug order
2722+including the preparati on and delivery of a drug or de vice to a
2723+patient or a patient’s agent in a suitable container appropria tely
2724+labeled for subsequent administration to, or use by, a patient .
2725+Dispense includes sell, distribute, leave with, gi ve away, dispose
2726+of, deliver or supply;
2727+13. “Dispenser” means a retail pharmacy, hospital pharmacy, a
2728+group of chain pharmacies under c ommon ownership and control that do
2729+not act as a wholesale distribu tor, or any other person authorized
2730+by law to dispense or administer prescription drug s, and the
2731+affiliated warehouse s or distributions of such entities under common
2732+ownership and control t hat do not act as a wholesale distributor.
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2759+For the purposes of this paragraph, “dispenser” dispenser does not
2760+mean a person who dispenses only products to be used in animals in
2761+accordance with 21 U.S.C. 360b(a)(5);
2762+14. “Distribute” or “distribution” means the sale, purchase,
2763+trade, delivery, handling, storage, or receipt of a product, and
2764+does not include the d ispensing of a product pursuant to a
2765+prescription executed in accordance with 21 U.S. C. 353(b)(1) or the
2766+dispensing of a product approved under 21 U.S.C. 360 b(b); provided,
2767+taking actual physical possession of a product or title shall not be
2768+required;
2769+15. “Doctor of Pharmacy” means a person licensed by the Board
2770+to engage in the practice of pharmacy. The terms “pharmacist”,
2771+“D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and shall
2772+have the same meaning wherever they appear in the Oklahoma Statu tes
2773+and the rules promulgated by the Board;
2774+16. “Drug outlet” means all manufacturer s, repackagers,
2775+outsourcing facilities, wholesale distributors, third-party
2776+logistics providers, pharmacies, and all other facilities which are
2777+engaged in dispensing, deli very, distribution or storage of
2778+dangerous drugs;
2779+17. “Drugs” means all medicinal su bstances and preparations
2780+recognized by the United States Pharmacopoeia Pharmacopeia and
2781+National Formulary, or any revision thereof, and all substances and
2782+preparations intended for external and/or internal us e in the cure,
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2809+diagnosis, mitigation, treatment or preventi on of disease in humans
2810+or animals and all substances and preparations, other than food,
2811+intended to affect the structure or any function of the body of a
2812+human or animals;
2813+18. “Drug sample” means a unit of a prescription dr ug packaged
2814+under the authority and responsibility of the manufacturer that is
2815+not intended to be sold and is intended to promote the sale of the
2816+drug;
2817+19. “Durable medical equipment” has the same meaning as
2818+provided by Section 2 of this act Section 375.2 of this title ;
2819+20. “Filled prescription” means a packaged prescription
2820+medication to which a label has been affixed which contain s such
2821+information as is required by the Oklahoma Pharmacy Act;
2822+21. “Hospital” means any institution licensed as a hospital by
2823+this state for the care a nd treatment of patients, or a pharmacy
2824+operated by the Oklahoma Department of Veterans Affairs;
2825+22. “Licensed practitioner” means:
2826+a. an allopathic physician,
2827+b. an osteopathic physician,
2828+c. a podiatric physician,
2829+d. a dentist,
2830+e. a veterinarian or,
2831+f. an optometrist, or
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2858+g. a Certified Nurse Practitioner, Clinical Nurse
2859+Specialist, or Certified Nurse -Midwife who has
2860+obtained independent prescriptive authority under
2861+Section 1 of this act,
2862+licensed to practice and authorized to prescribe dangerous drugs
2863+within the scope of practice of such p ractitioner;
2864+23. “Manufacturer” or “virtual manufacturer” means with respect
2865+to a product:
2866+a. a person that holds an application approved under 21
2867+U.S.C. 355 or a license issued under 42 U.S.C. 262 for
2868+such product, or if such product is not the subject of
2869+an approved application or license, the person who
2870+manufactured the pro duct,
2871+b. a co-licensed partner of the person described in
2872+subparagraph a of this paragraph that obtains the
2873+product directly from a person described in this
2874+subparagraph or subparagraph a of this paragraph,
2875+c. an affiliate of a person described in subpara graph a
2876+or b of this paragraph who receives the product
2877+directly from a person described in this s ubparagraph
2878+or in subparagraph a or b of this paragraph, or
2879+d. a person who contracts with another to manufacture a
2880+product;
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2906+
2907+24. “Manufacturing” means the production, preparation,
2908+propagation, compounding, conversion or processing of a device or a
2909+drug, either directly or indirectly by extraction from substances of
2910+natural origin or independently by means of chemic al or biological
2911+synthesis and includes any packaging or repackaging of the
2912+substances or labeling or relabeling of its container, and the
2913+promotion and marketing of such drug s or devices. The term
2914+“manufacturing” manufacturing also includes the preparation and
2915+promotion of commercially available products from bulk compounds for
2916+resale by licensed pharmacies, licensed practitioners or other
2917+persons;
2918+25. “Medical gas” means those gases including those in liquid
2919+state upon which the manufacturer or distributor has placed one of
2920+several cautions, such as “Rx Only”, in compliance with federal law;
2921+26. “Medical gas order” means an order for medical g as issued
2922+by a licensed prescriber;
2923+27. “Medical gas distributor” means a person licensed to
2924+distribute, transfer, wholesale, deliver or se ll medical gases on
2925+drug orders to suppliers or other entities licensed to use,
2926+administer or distribute medical gas and may also include a patient
2927+or ultimate user;
2928+28. “Medical gas supplier” means a person who di spenses medical
2929+gases on drug orders only to a patient or ultimate user;
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2955+
2956+29. “Medicine” means any drug or combination of drugs which has
2957+the property of curing, preventing, treating, diagnosing or
2958+mitigating diseases, or which is used for that purpose;
2959+30. “Nonprescription drugs” means medicines or drugs which are
2960+sold without a prescription and which are prepackaged for use by the
2961+consumer and labeled in ac cordance with the requirements of the
2962+statutes and regulations of this state and the federal gov ernment.
2963+Such items shall also include medi cal and dental supplies and
2964+bottled or nonbulk chemicals which are sold or offered for sale to
2965+the general public if such articles or preparations meet the
2966+requirements of the Federal Food, Drug, and Cosmetic Act, 21
2967+U.S.C.A., Section 321 et seq.;
2968+31. “Outsourcing facility” including “virtual outsourcing
2969+facility” means a facility at one geographic location or address
2970+that:
2971+a. is engaged in the compounding of steril e drugs,
2972+b. has elected to register as an outsourcing facility,
2973+and
2974+c. complies with all requ irements of 21 U.S.C. 353b;
2975+32. “Package” means the smallest individual saleable unit of
2976+product for distribution by a manufacturer or repackager that is
2977+intended by the manufacturer for ultimate s ale to the dispenser of
2978+such product. For the purposes of this paragraph, “individual
2979+saleable unit” means the smallest container of a product introduced
2980+
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3006+into commerce by the manufacturer or repackager that is intended by
3007+the manufacturer or repackager fo r individual sale to a dispenser;
3008+33. “Person” means an individual, partnership, limited
3009+liability company, corporation or association, unless the context
3010+otherwise requires;
3011+34. “Pharmacist-in-charge” or “PIC” means the pharmacist
3012+licensed in this state responsible for the management control of a
3013+pharmacy and all other aspects of the practice of pharmacy in a
3014+licensed pharmacy as defined by Section 353.18 of this title;
3015+35. “Pharmacy” means a place regularly licensed by the State
3016+Board of Pharmacy in which prescriptions, drug s, medicines,
3017+chemicals and poisons are compounded or dispensed or such place
3018+where pharmacists practice the profession of pharmacy, or a pharmacy
3019+operated by the Oklahoma Department of Veterans Affairs;
3020+36. “Pharmacy technician”, “technician”, “Rx tech”, or “tech”
3021+means a person issued a Technician permit by the State Board of
3022+Pharmacy to assist the pharmacist and perform nonjudgmental,
3023+technical, manipulative, non-discretionary functions in the
3024+prescription department under the immediate and direct super vision
3025+of a pharmacist;
3026+37. “Poison” means any substance which when introduced into the
3027+body, either directly or by absorption, produces violent, morbid or
3028+fatal changes, or which destroys living tissue with which such
3029+substance comes into contact;
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3031+ENGR. S. B. NO. 458 Page 13 1
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3055+
3056+38. “Practice of pharmacy” means:
3057+a. the interpretation and evaluation of prescription
3058+orders,
3059+b. the compounding, dispensing, administering and
3060+labeling of drugs and devices, except labeling by a
3061+manufacturer, repackager or distributor of
3062+nonprescription drugs and commercially packaged legend
3063+drugs and devices,
3064+c. the participation in drug selection and drug
3065+utilization reviews,
3066+d. the proper and safe storage of drugs and devices and
3067+the maintenance of proper records thereof,
3068+e. the responsibility for advising by counseling and
3069+providing information, where professionally necessary
3070+or where regulated, of therapeutic values, content,
3071+hazards and use of drugs and devices,
3072+f. the offering or performing of those ac ts, services,
3073+operations or transactions necessary in the conduct,
3074+operation, management and c ontrol of a pharmacy, or
3075+g. the provision of those acts or services that are
3076+necessary to provide pharmaceutical care;
3077+39. “Preparation” means an article which may or may not contain
3078+sterile products compounded in a licensed pharmacy pursuant to the
3079+order of a licensed prescriber;
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3081+ENGR. S. B. NO. 458 Page 14 1
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3105+
3106+40. “Prescriber” means a person licensed in this state who is
3107+authorized to prescribe dangerous drugs withi n the scope of practice
3108+of the person’s profession;
3109+41. “Prescription” means and includes any order for drug or
3110+medical supplies written or signed, or transmitted by word of mouth,
3111+telephone or other means of communication:
3112+a. by a licensed prescriber,
3113+b. under the supervision of an Oklahoma licensed
3114+practitioner, an Oklahoma licensed advanced practice
3115+registered nurse or an Oklahoma licensed a supervising
3116+physician, by a physician assistant licensed in this
3117+state, or
3118+c. (1) under the supervision of a supervising physician
3119+or supervising Advanced Practice Registered
3120+Nurse, by a Certified Nurse Practitioner,
3121+Clinical Nurse Specialist, or Certified Nurse-
3122+Midwife licensed in this state who has not
3123+obtained independent prescriptive authority under
3124+Section 1 of this act, or
3125+(2) by a Certified Nurse Practitioner, Clinical Nurs e
3126+Specialist, or Certified Nurse-Midwife licensed
3127+in this state who has obtained independent
3128+prescriptive authority under Section 1 of this
3129+act, or
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3156+d. by an Oklahoma licensed wholesaler or di stributor as
3157+authorized in Section 353.29.1 of this title;
3158+42. “Product” means a prescription drug in a finished dosage
3159+form for administration to a patient without substantial further
3160+manufacturing, such as capsules, tablets, and lyophilized products
3161+before reconstitution. “Product” does not include blo od components
3162+intended for transfusion, radioactive drugs or biologics and medical
3163+gas;
3164+43. “Repackager”, including “virtual repackager”, means a
3165+person who owns or operates an establishment that repac ks and
3166+relabels a product or package for further sale or distribution
3167+without further transaction;
3168+44. “Sterile drug” means a drug that is intended for parenteral
3169+administration, an ophthalmic or oral inhalation drug in aqueous
3170+format, or a drug that is required to be sterile under sta te and
3171+federal law;
3172+45. “Supervising Advanced Practice Registered Nurse” has the
3173+same meaning as provided by Section 567.3a of this title;
3174+46. “Supervising physician” means an individual holding a
3175+current license to practice as a physician from the State Board of
3176+Medical Licensure and Supervision, pursuant to the provisions of the
3177+Oklahoma Allopathic Medical and Surgical Licensure and Supervision
3178+Act, or the State Board of Osteopathic Examiners, pursuant to the
3179+provisions of the Oklahoma Osteopathic Medicine Act, who supervises
3180+
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3205+
3206+an advanced practice registered nurse a Certified Nurse
3207+Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
3208+as defined in Section 567.3a of this title who has not obtained
3209+independent prescriptive authority under Section 1 of this act,
3210+and who is not in trai ning as an intern, resident, or fellow. To be
3211+eligible to supervise an advanced practice registered nurse, such
3212+The supervising physician shall remain in compliance with the rules
3213+promulgated by the State Board of Medical Licensure and Supervision
3214+or the State Board of Osteopathic Examiners;
3215+46. 47. “Supportive personnel” means technicians and auxiliary
3216+supportive persons who are regularly paid employees of a pharmacy
3217+who work and perform tasks in the pharmacy as authorized by Section
3218+353.18A of this title;
3219+47. 48. “Third-party logistics provider” including “virtual
3220+third-party logistics provider” means an entity that provides or
3221+coordinates warehousing, or other logistics services of a product in
3222+interstate commerce on behalf of a manufacturer, wholesale
3223+distributor, or dispenser of a product but does not take ownership
3224+of the product, nor have responsibility to direct the sale or
3225+disposition of the product. For the purposes of this paragraph,
3226+“third-party logistics provider” does not include shippers and the
3227+United States Postal Service;
3228+48. 49. “Wholesale distributor” including “virtual wholesale
3229+distributor” means a person other than a manufacturer, a
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3256+manufacturer’s co-licensed partner, a third-party logistics
3257+provider, or repackager engaged in wholesale distribution as defined
3258+by 21 U.S.C. 353(e)(4) as amended by the Drug Supply Chain Security
3259+Act;
3260+49. 50. “County jail” means a facility operated by a county for
3261+the physical detention and correction of persons charged with, or
3262+convicted of, criminal o ffenses or ordinance violations or persons
3263+found guilty of civil or criminal contempt;
3264+50. 51. “State correctional facility” means a facility or
3265+institution that houses a prisoner population under the jurisdiction
3266+of the Department of Corrections;
3267+51. 52. “Unit dose package” means a package that contains a
3268+single dose drug with the name, strength, control number, and
3269+expiration date of that drug on the label; and
3270+52. 53. “Unit of issue package” means a package that provides
3271+multiple doses of the same drug, but each drug is individually
3272+separated and includes the name, lot number, and expiration date.
3273+SECTION 14. AMENDATORY 59 O.S. 2021, Section 353.1a, is
3274+amended to read as follows:
3275+Section 353.1a. A. Prescribing 1. Prescriptive authority
3276+shall be allowed, under the medical direction of a supervising
3277+physician or supervising Advanced Practice Registered Nurse, for an
3278+advanced practice nurse a licensed Advanced Practice Registered
3279+Nurse recognized by the Oklahom a Board of Nursing in one of the
3280+
3281+ENGR. S. B. NO. 458 Page 18 1
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3306+following categories: advanced registered nurse practitioners,
3307+clinical nurse specialists, or certified nurse-midwives as a
3308+Certified Nurse Practitioner, Clinical Nurse Specialist, or
3309+Certified Nurse-Midwife who has not obtained independent
3310+prescriptive authority under Section 1 of this act.
3311+2. Prescriptive authority shall be allowed, independent of the
3312+medical direction of a supervising physician or supervising Advanced
3313+Practice Registered Nurse, for a licensed Advanced Practice
3314+Registered Nurse recognized by the Oklahoma Board of Nursing as a
3315+Certified Nurse Practitioner, Clinical Nurse Specialist, or
3316+Certified Nurse-Midwife who has obtained independent prescriptive
3317+authority under Section 1 of this act.
3318+B. The advanced practice nurse Advanced Practice Registered
3319+Nurse may write or sign, or transmit by word of mouth, telephone or
3320+other means of communication an order for drugs or medical supplies
3321+that is intended to be filled, compounded, or dis pensed by a
3322+pharmacist. The supervising physician or supervising Advanced
3323+Practice Registered Nurse, if applicable, and the advanced practice
3324+nurse prescribing Advanced Practice Registered Nurse shall be
3325+identified at the time of origination of the prescription and the
3326+name of the advanced practice nurse prescribing Advanced Practice
3327+Registered Nurse shall be printed on the prescription label.
3328+B. C. Pharmacists may dispense prescriptions for non-controlled
3329+prescription drugs authorized by an advanced practice nurse Advanced
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3356+Practice Registered Nurse or physician assistant, not located in
3357+Oklahoma this state, provided that they are licensed in the state in
3358+which they are actively prescribing.
3359+C. D. 1. Pharmacists may only dispense prescriptions for
3360+controlled dangerous substances prescribed by an advanced practice
3361+nurse or physician assistant Advanced Practice Registered Nurse
3362+licensed in the State of Oklahoma and supervised by an Oklahoma-
3363+licensed practitioner this state who meets the criteria in paragraph
3364+1 or 2 of subsection A of this section.
3365+2. Pharmacists may only dispense prescriptions for co ntrolled
3366+dangerous substances prescribed by a physician assistant licensed in
3367+this state and supervised by a supervising physician licensed in
3368+this state.
3369+SECTION 15. AMENDATORY 59 O.S. 2021, Section 567.3a, is
3370+amended to read as f ollows:
3371+Section 567.3a. As used in the Oklahoma Nursing Practice Act:
3372+1. “Board” means the Oklahoma Board of Nursing;
3373+2. “The practice of nursing” means the performance of services
3374+provided for purposes of nursing diagnosis and treatment of human
3375+responses to actual or potential health problems consistent with
3376+educational preparation. Knowledge and skill are the basis for
3377+assessment, analysis, planning, interven tion, and evaluation used in
3378+the promotion and mainten ance of health and nursing management of
3379+illness, injury, infirmity, restoration or optimal function, or
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3406+death with dignity. Practice is based on understanding the human
3407+condition across the human life span and understanding the
3408+relationship of the individ ual within the environment. This
3409+practice includes execution of the medical regime including the
3410+administration of medications and treatments prescribed by any
3411+person authorized by state law to so pres cribe;
3412+3. “Registered nursing” means the practice of the full scope of
3413+nursing which includes, but is not limited to:
3414+a. assessing the health status of individuals, families
3415+and groups,
3416+b. analyzing assessment data to determine nursing care
3417+needs,
3418+c. establishing goals to meet identified health care
3419+needs,
3420+d. planning a strategy of care,
3421+e. establishing priorities of nursing intervention to
3422+implement the strategy of care,
3423+f. implementing the strategy of care,
3424+g. delegating such tasks as may safely be perfo rmed by
3425+others, consistent with educational preparatio n and
3426+that do not conflict with the p rovisions of the
3427+Oklahoma Nursing Practice Act,
3428+h. providing safe and effective nursing care rendered
3429+directly or indirectly,
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3456+i. evaluating responses to intervention s,
3457+j. teaching the principles and practice of nursing,
3458+k. managing and supervising the prac tice of nursing,
3459+l. collaborating with other health professionals in the
3460+management of health care,
3461+m. performing additional nursing functions in accordance
3462+with knowledge and skills acquired beyond basic
3463+nursing preparation, and
3464+n. delegating those nursin g tasks as defined in the rules
3465+of the Board that may be performed by an advanced
3466+unlicensed assistive person;
3467+4. “Licensed practical nursing” means the practice of nursing
3468+under the supervision or direction of a regis tered nurse, licensed
3469+physician or dentist. This directed scope of nursing practice
3470+includes, but is not limited to:
3471+a. contributing to the assessment of the health status of
3472+individuals and groups,
3473+b. participating in the development and modification of
3474+the plan of care,
3475+c. implementing the appropriate aspects of the plan of
3476+care,
3477+d. delegating such tasks as may safely be performed by
3478+others, consistent with educational preparation and
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3505+that do not conflict with the Oklahoma Nursing
3506+Practice Act,
3507+e. providing safe and effective nursing care r endered
3508+directly or indirectly,
3509+f. participating in the evaluation of responses to
3510+interventions,
3511+g. teaching basic nursing skills and related principles,
3512+h. performing additional nursing procedures in accordance
3513+with knowledge and skills acquired through education
3514+beyond nursing preparation, and
3515+i. delegating those nursing tasks as defined in the rules
3516+of the Board that may be performed by an advanced
3517+unlicensed assistive person;
3518+5. “Advanced Practice Registered Nurse ” means a licensed
3519+Registered Nurse:
3520+a. who has completed an advanced practice registered
3521+nursing education program in preparation for one of
3522+four recognized advanced practice registered nurse
3523+Advanced Practice Registered Nurse roles,
3524+b. who has passed a national certification examination
3525+recognized by the Board that measures the advanced
3526+practice registered nurse Advanced Practice Registered
3527+Nurse role and specialty competencies and who
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3554+maintains recertification in the role and specialty
3555+through a national certification program,
3556+c. who has acquired advanced clinical knowledge and
3557+skills in preparation for providing both direct and
3558+indirect care to patients; however, the defining
3559+factor for all Advanced Pr actice Registered Nurses is
3560+that a significant compone nt of the education and
3561+practice focuses on direct care of individuals,
3562+d. whose practice builds on the competencies of
3563+Registered Nurses by demonstrating a greater depth and
3564+breadth of knowledge, a gre ater synthesis of data, and
3565+increased complexity of sk ills and interventions, and
3566+e. who has obtained a license as an Advanced Practice
3567+Registered Nurse in one of the following roles:
3568+Certified Registered Nurse Anesthetist, Certified
3569+Nurse-Midwife, Clinical Nurse Specialist, or Certified
3570+Nurse Practitioner.
3571+Only those persons who hold a license t o practice advanced
3572+practice registered nursing in this state shall have the right to
3573+use the title “Advanced Practice Registered Nurse” and to use the
3574+abbreviation “APRN”. Only those persons who have obtained a lice nse
3575+in the following disciplines shall have the right to fulfill the
3576+roles and use the applicable titles: Certified Registered Nurse
3577+Anesthetist and the abbreviation “CRNA”, Certified Nurse-Midwife and
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3579+ENGR. S. B. NO. 458 Page 24 1
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3604+the abbreviation “CNM”, Clinical Nurse Specialist and the
3605+abbreviation “CNS”, and Certified Nurse Practitioner and the
3606+abbreviation “CNP”.
3607+It shall be unlawful for any person to assume the role or use
3608+the title Advanced Practice Registered Nurse or use th e abbreviation
3609+“APRN” or use the respective specialty role titles and abbreviations
3610+or to use any other titles or abbreviations that would reasonably
3611+lead a person to believe the user is an Advanced Practice Registered
3612+Nurse, unless permitted by the Oklaho ma Nursing Practice Act. Any
3613+individual doing so shal l be guilty of a misdemeanor, which sha ll be
3614+punishable, upon conviction, by imprisonment in the county jail for
3615+not more than one (1) year or by a fine of not less than One Hundred
3616+Dollars ($100.00) no r more than One Thousand Dollars ($1,000.00), or
3617+by both such imprisonment and fine for each offense;
3618+6. “Certified Nurse Practitioner” is means an Advanced Practice
3619+Registered Nurse who performs in an expanded role in the delivery of
3620+health care:
3621+a. consistent with advanced educational preparation as a
3622+Certified Nurse Practitioner in an area of specialty,
3623+b. functions within the Certified Nurse Practitioner
3624+scope of practice for the selected area of
3625+specialization, and
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3652+c. is in accord with the standards f or Certified Nurse
3653+Practitioners as identified by the certifying body and
3654+approved by the Board.
3655+A Certified Nurse Practitioner shall be eligible, in accordance
3656+with the scope of practice of the Certified Nurse Practitioner, to
3657+obtain recognition as author ized by the Board to prescribe, as
3658+defined by the rules promulgated by the Board pursuant to this
3659+section and subject to the medical direction of a supervising
3660+physician Section 567.4a of this title and Section 1 of this act.
3661+This authorization shall not include dispensing drugs, but shall not
3662+preclude, subject to federal regulations, the receipt of, the
3663+signing for, or the dispensing of professional samples to patients.
3664+The Certified Nurse Practitioner accepts responsibility,
3665+accountability, and obligatio n to practice in accordance with usual
3666+and customary advanced practice registered nursing sta ndards and
3667+functions as defined by the scope of practice/role definition
3668+statements for the Certified Nurse Practitioner;
3669+7. a. “Clinical Nurse Specialist ” is means an Advanced
3670+Practice Registered Nurse who holds:
3671+(1) a master’s degree or higher in nursi ng with
3672+clinical specialization preparation to function
3673+in an expanded role,
3674+(2) specialty certification from a national
3675+certifying organization recognized by the Board,
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3702+(3) an Advanced Practice Registered Nurse licen se
3703+from the Board, and
3704+(4) any nurse holding a specialty certification as a
3705+Clinical Nurse Specialist valid on January 1,
3706+1994, granted by a national certifying
3707+organization recognized by the Board, sha ll be
3708+deemed to be a Clinical Nurse Specialist under
3709+the provisions of the Oklahoma Nursing P ractice
3710+Act.
3711+b. In the expanded role, the Clinical Nurse Specialist
3712+performs at an advanced practice level which shall
3713+include, but not be limited to:
3714+(1) practicing as an expert clinician in the
3715+provision of direct n ursing care to a selected
3716+population of patients or clients in any setting,
3717+including private practice,
3718+(2) managing the care of patients or clients with
3719+complex nursing problems,
3720+(3) enhancing patient or client care by integrating
3721+the competencies of clin ical practice, education,
3722+consultation, and research, and
3723+(4) referring patients or clients to other services.
3724+c. A Clinical Nurse Specialist in accordance with the
3725+scope of practice of such Clinical Nu rse Specialist
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3752+shall be eligible to obtain recognition as authorized
3753+by the Board to prescrib e, as defined by the rules
3754+promulgated by the Board pursuant to this section, and
3755+subject to the medical direction of a supervising
3756+physician Section 567.4a of thi s title and Section 1
3757+of this act. This authorization shall not include
3758+dispensing drugs, bu t shall not preclude, subject to
3759+federal regulations, the receipt of, the signing for,
3760+or the dispensing of professional samples to pat ients.
3761+d. The Clinical Nurse Specialist accepts responsibility,
3762+accountability, and obligation to practice in
3763+accordance with usual and customary advanced practice
3764+nursing standards and functions as defined by the
3765+scope of practice/role definition statemen ts for the
3766+Clinical Nurse Specialist;
3767+8. “Nurse-Midwife” is “Certified Nurse-Midwife” means a nurse
3768+who has received an Advanced Practice Registered Nurse license from
3769+the Oklahoma Board of Nursing who possesses evidence of
3770+certification according to the requirements of the American College
3771+of Nurse-Midwives.
3772+A Certified Nurse-Midwife in accordance with the scope of
3773+practice of such Certified Nurse-Midwife shall be eligible to obtain
3774+recognition as authorized by the Board to prescribe, as defined by
3775+the rules promulgated by the Board pursuant to this section and
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3802+subject to the medical direction of a supervising physician Section
3803+567.4a of this title and Section 1 of this act. This authorization
3804+shall not include the dispensing of drugs, but shall not precl ude,
3805+subject to federal regu lations, the receipt of, the sig ning for, or
3806+the dispensing of professional samples to patien ts.
3807+The Certified Nurse-Midwife accepts responsibility,
3808+accountability, and obligation to practice in accordance with usual
3809+and customary advanced practice registe red nursing standards and
3810+functions as defined by the scope of practice/role definition
3811+statements for the Certified Nurse-Midwife;
3812+9. “Nurse-midwifery practice” means providing management of
3813+care of normal newborns and women, antepartally, intrapartally,
3814+postpartally and gynecologicall y, occurring within a health care
3815+system which provides for m edical consultation, medical management
3816+or referral, and is in accord with the standards for nurse-midwifery
3817+practice as defined by the American College of Nurse -Midwives;
3818+10. a. “Certified Registered Nurse Anestheti st” is an
3819+Advanced Practice Registered Nurse who:
3820+(1) is certified by the National Board of
3821+Certification and Recertification for Nurse
3822+Anesthetists as a Certified Registered Nurse
3823+Anesthetist within on e (1) year following
3824+completion of an approved certified registered
3825+nurse anesthetist Certified Registered Nurse
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3852+Anesthetist education program, and continues to
3853+maintain such recertification by the National
3854+Board of Certificatio n and Recertification for
3855+Nurse Anesthetists, and
3856+(2) administers anesthesia in co llaboration with a
3857+medical doctor, an o steopathic physician, a
3858+podiatric physician or a dentist licensed in this
3859+state and under conditions in which timely onsite
3860+consultation by such doctor, osteopath, podiatric
3861+physician or dentist i s available.
3862+b. A Certified Registered Nurse Anesthetist, in
3863+collaboration with a medical doctor, osteopathic
3864+physician, podiatric physician or dentist licensed in
3865+this state, and under condition s in which timely, on-
3866+site consultation by such medical docto r, osteopathic
3867+physician, podiatric physician or dentist is
3868+available, shall be authorized, pursuant to rules
3869+adopted by the Oklahoma Board of Nursing, to order,
3870+select, obtain and administer leg end drugs, Schedules
3871+II through V controlled substances, devices, and
3872+medical gases only when engaged in the pr eanesthetic
3873+preparation and evaluation; anesthesia induction,
3874+maintenance and emergence; and postanesthesia care. A
3875+Certified Registered Nurse Anesthetist may order,
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3902+select, obtain and adminis ter drugs only during the
3903+perioperative or periobstetrical peri od.
3904+c. A Certified Registered Nurse Anesthetist who applies
3905+for authorization to order, select, obtain and
3906+administer drugs shall:
3907+(1) be currently recognized as a Certified Registered
3908+Nurse Anesthetist in this state,
3909+(2) provide evidence of completion, wi thin the two-
3910+year period immediately preceding the date of
3911+application, of a minimum of fifteen (15) units
3912+of continuing education in advanced pharmacology
3913+related to the administration of anes thesia as
3914+recognized by the Nation al Board of Certification
3915+and Recertification for Nurse Anesthetists, and
3916+(3) complete and submit a notarized application, on a
3917+form prescribed by the Board, accompanied by the
3918+application fee establish ed pursuant to this
3919+section.
3920+d. The authority to order , select, obtain and administ er
3921+drugs shall be terminated if a Certified Registered
3922+Nurse Anesthetist has:
3923+(1) ordered, selected, obtained or administered drugs
3924+outside of the Certified Registered Nurse
3925+Anesthetist scope of practice or ordered,
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3952+selected, obtained or administered drugs for
3953+other than therapeutic purposes, or
3954+(2) violated any provision of state laws or rules or
3955+federal laws or regulations pertaining to the
3956+practice of nursing or the author ity to order,
3957+select, obtain and administer drugs.
3958+e. The Oklahoma Board of Nursing shall notify the State
3959+Board of Pharmacy after termination of or a change in
3960+the authority to order, select, obtain and administer
3961+drugs for a Certified Registered Nurse Anesthet ist.
3962+f. The Board shall provide by rule for biennial
3963+application renewal and reauth orization of authority
3964+to order, select, obtain and administer drugs for
3965+Certified Registered Nurse Anesthetists. At the time
3966+of application renewal, a Certified Registered Nurse
3967+Anesthetist shall submit documentation of a min imum of
3968+eight (8) units of co ntinuing education, completed
3969+during the previous two (2) years, in advanced
3970+pharmacology relating to the administration of
3971+anesthesia, as recognized by the Council on
3972+Recertification of Nurse Anesthetists or the Council
3973+on Certification of Nurse Anestheti sts National Board
3974+of Certification and Recertification for Nurse
3975+Anesthetists.
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4002+g. This paragraph shall not prohibit the administration
4003+of local or topical anesthetics as now permitted by
4004+law. Provided further , nothing in this paragraph
4005+shall limit the authority of t he Board of Dentistry to
4006+establish the qualifications for dentists who direct
4007+the administration of anesthesia.
4008+h. As used in this parag raph, “collaboration” means an
4009+agreement between a medical doc tor, osteopathic
4010+physician, podiatric physician or dentist performing
4011+the procedure or directly involved with the procedure
4012+and the Certified Registered Nurse Anesthetist working
4013+jointly toward a common goal providing services for
4014+the same patient. This c ollaboration involves the
4015+joint formulation, discussion an d agreement of the
4016+anesthesia plan by both parties, and the collaborating
4017+medical doctor, osteopathic physician, podiatric
4018+physician or dentist performing the procedure or
4019+directly involved with the procedure and that
4020+collaborating physician shall re main available for
4021+timely onsite consultation during the delivery of
4022+anesthesia for diagnosis, consultation, and treatment
4023+of medical conditions;
4024+11. “Supervising Advanced Practice Registered Nurse” means an
4025+Advanced Practice Registered Nurse holding a current license to
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4052+practice who has obtained independent prescriptive authority under
4053+Section 1 of this act and who otherwise meets the qualification s of
4054+a supervising Advanced Practice Registered Nur se under Section 1 of
4055+this act who supervises a Certified Nurse Practitioner, a Clinical
4056+Nurse Specialist, or a Certified Nurse-Midwife who has not obtained
4057+independent prescriptive authority under Section 1 of this act ;
4058+12. “Supervising physician” means an individual holding a
4059+current license to practice as a physi cian from the State Board of
4060+Medical Licensure and Supervision or the State Board of Osteopathic
4061+Examiners, who supervises a Certified Nurse Practitioner , a Clinical
4062+Nurse Specialist, or a Certified Nurse-Midwife who has not obtained
4063+independent prescriptive authority under Section 1 of this act, and
4064+who is not in training as an intern, resident, or fellow. To be
4065+eligible to supervise such Advanced Practice Regi stered Nurse, such
4066+The supervising physician shall remain in compliance with the rules
4067+promulgated by the State Board of Medical Licensure and Supervision
4068+or the State Board of Osteopathic Examiners;
4069+12. 13. “Supervision of an Advanced Practice Registered Nurse
4070+with prescriptive authority” means overseeing and accepting
4071+responsibility for the ordering and transmission by a Certified
4072+Nurse Practitioner, a Clinical Nurse Specialist, or a Certified
4073+Nurse-Midwife who has not obtained independent prescriptive
4074+authority under Section 1 of this act of written, telephonic,
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4101+electronic or oral prescriptions for drugs and oth er medical
4102+supplies, subject to a defined formulary; and
4103+13. 14. “Advanced Unlicensed Assistant” means any person who
4104+has successfully completed a certified training program approved by
4105+the Board that trains the Advanced Unlicensed Assistant to perform
4106+specified technical skills identified by the Board in acute care
4107+settings under the direction and supervision of the Registered Nurse
4108+or Licensed Practical Nurse.
4109+SECTION 16. AMENDATORY 59 O.S. 2021, Section 567.4a, is
4110+amended to read as follows:
4111+Section 567.4a. The Oklahoma Board of Nursing may grant
4112+prescriptive authority through the Advanc ed Practice Registered
4113+Nurse license to Certified Nurse Practitioners, Clinical Nurse
4114+Specialists, and Certified Nurse-Midwives who meet the requirements
4115+for prescriptive authority identified by law and in the Board’s
4116+rules. The rules regarding prescriptiv e authority recognition
4117+promulgated by the Oklahoma Board of Nursing pursuant to paragraphs
4118+6 through 9, 11 and 12 of this section, Section 567.3a of this
4119+title, and Section 1 of this act shall:
4120+1. Define the procedure for documenting supervision by a
4121+supervising physician licensed in Oklahoma to practice by the State
4122+Board of Medical Licensure and Supervision or the State Board of
4123+Osteopathic Examiners as defined in Section 567.3a of this title or
4124+by a supervising Advanced Practice Registered Nurse as defined in
4125+
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4151+Section 567.3a of this t itle of a Certified Nurse Practitioner,
4152+Clinical Nurse Specialist, or Certified Nurse-Midwife who has not
4153+obtained independent prescriptive authority under Section 1 of this
4154+act. Such procedure shall include a written statement th at defines
4155+appropriate referral, consultation, and collaboration between the
4156+Advanced Practice Registered Nurse, recogni zed to prescribe as
4157+defined in paragraphs 6 through 9, 11 and 12 of Section 567.3a of
4158+this title, and the supervising physician or supervising Advanced
4159+Practice Registered Nurse. The written statement shall include a
4160+method of assuring availability of the supervising physician or
4161+supervising Advanced Practice Registered Nurse through direct
4162+contact, telecommunications or other appropriate electronic means
4163+for consultation, assistance with medical emergencies, or patient
4164+referral. The written statement shall be part of the initial
4165+application and the renewal application submitted to the Board for
4166+recognition for prescriptive authority for the Advanced Practice
4167+Registered Nurse. Changes to the written statement shall be filed
4168+with the Board within thirty (30) day s of the change and shall be
4169+effective on filing;
4170+2. Define the procedure for documenting independent
4171+prescriptive authority for Certified Nurse Practitioners, Clinical
4172+Nurse Specialists, and Certified Nurse-Midwives who have obtained
4173+independent prescriptive authori ty under Section 1 of this act;
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4200+3. Define minimal requirements for initial application for
4201+prescriptive authority which shall in clude, but not be limited to,
4202+evidence of completion of a minimum of forty-five (45) contact hours
4203+or three (3) academic credit hours of education in
4204+pharmacotherapeutics, clinical application, and use of
4205+pharmacological agents in the prevention of illness , and in the
4206+restoration and maintenance of health in a program beyond basic
4207+registered nurse preparation, approved by the Board. Such contact
4208+hours or academic credits shall be obtained within a time period of
4209+three (3) years immediately preceding the da te of application for
4210+prescriptive authority ;
4211+3. 4. Define minimal requirements for application for renewal
4212+of prescriptive authority which shall include, but not be limited
4213+to, documentation of a minimum of:
4214+a. fifteen (15) contact hours or one (1) acade mic credit
4215+hour of education in pharmacother apeutics, clinical
4216+application, and use of pharmacological agents in the
4217+prevention of illness, and in the restoration and
4218+maintenance of health in a program beyond basic
4219+registered nurse preparation, and
4220+b. two (2) hours of education in pain management or two
4221+(2) hours of education in opioid use or addiction,
4222+unless the Advanced Practice Registered Nurse has
4223+demonstrated to the satisfaction of the Board that the
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4250+Advanced Practice Registered Nurse does not current ly
4251+hold a valid federal Drug Enforcement Adm inistration
4252+registration number,
4253+approved by the Board, within the two-year period immediately
4254+preceding the effective date of application for renewal of
4255+prescriptive authority;
4256+4. 5. Require that beginning July 1, 2002, an Advanced Practice
4257+Registered Nurse shall demonstrate demonstrates successful
4258+completion of a master’s degree or higher in a clinical nurse
4259+specialty one of the following Advanced Practice Registered Nurse
4260+roles:
4261+a. Certified Nurse Pract itioner,
4262+b. Clinical Nurse Specialist, or
4263+c. Certified Nurse-Midwife,
4264+in order to be eligible for initial application fo r prescriptive
4265+authority under the provisions of the Oklahoma Nursing Practice Act;
4266+5. 6. Define the method for communicating authority to
4267+prescribe or termination of same, and the formulary to the State
4268+Board of Pharmacy, all pharmacies, and all registered pharmacists ;
4269+6. 7. Define terminology used in such rules;
4270+7. 8. Define the parameters for the prescribing practices of
4271+the Advanced Practice Re gistered Nurse;
4272+8. 9. Define the methods for termination of prescriptive
4273+authority for the Advanced Practice Registered N urse; and
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11904299
11914300 9. 10. a. Establish a Formulary Advisory Council that shall
11924301 develop and submit to the Board recommendations for an
11934302 exclusionary formulary that shall list drugs or
11944303 categories of drugs that shall not be prescribed by an
11954304 Advanced Practice Registere d Nurse recognized to
11964305 prescribe by the Oklahoma Board of Nursing. The
11974306 Formulary Advisory Council shall also develop and
11984307 submit to the Board recommendations for practice-
11994308 specific prescriptive standards for each category of
12004309 Advanced Practice Registered Nurs e recognized to
12014310 prescribe by the Oklahoma Board of Nursing pursuant to
12024311 the provisions of the Oklahoma Nursing Practice Act.
12034312 The Board shall either accept or reject the
12044313 recommendations made by the Council. No amendments to
12054314 the recommended exclusionary for mulary may be made by
12064315 the Board without the approval of the Formulary
12074316 Advisory Council.
1208-
12094317 b. The Formulary Advisory Council shall be compos ed of
12104318 twelve (12) members as follo ws:
1211-
12124319 (1) four members, to include a pediatrician, an
12134320 obstetrician-gynecological physic ian, a general
12144321 internist, and a family practice physician;
12154322 provided, that three of such members shall be
12164323 appointed by the Oklahoma State M edical
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12174350 Association, and one shall be appointed by the
12184351 Oklahoma Osteopathic Association,
1219-
12204352 (2) four members who are regis tered pharmacists,
12214353 appointed by the Oklahoma Pharmaceutical
12224354 Association, and
1223-
1224-
1225-ENR. S. B. NO. 458 Page 29
12264355 (3) four members, one of whom shall be a Certified
12274356 Nurse Practitioner, one of whom shall be a
12284357 Clinical Nurse Specialist, one of whom shall be a
12294358 Certified Nurse-Midwife, and one of whom shall be
12304359 a current member of the Oklahoma Board of
12314360 Nursing, all of whom shall be appointed by the
12324361 Oklahoma Board of Nursing.
1233-
12344362 c. All professional members of the Formul ary Advisory
12354363 Council shall be in active clinical practice, at least
12364364 fifty percent (50%) of the time, within their defined
12374365 area of specialty. The members of the Formulary
12384366 Advisory Council shall serve at the pleasure of the
12394367 appointing authority for a term o f three (3) years.
12404368 The terms of the members shall be staggered. Members
12414369 of the Council may serve beyond the expiration of
12424370 their term of office until a successor is appointed by
12434371 the original appointing authority. A vacan cy on the
12444372 Council shall be filled for the balance of the
12454373 unexpired term by the original appointing authority.
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12464399
12474400 d. Members of the Council shall elect a chair and a vice-
12484401 chair vice chair from among the membership of the
12494402 Council. For the transaction of business, at leas t
12504403 seven members, with a minimum of two members present
12514404 from each of the identified categories of physicians,
12524405 pharmacists and advanced practice registered nurses
12534406 Advanced Practice Registered Nurses, shall constitute
12544407 a quorum. The Council shall recommend an d the Board
12554408 shall approve and impl ement an initial exclusionary
12564409 formulary on or before January 1, 1997. The Council
12574410 and the Board shall annually review the approved
12584411 exclusionary formulary and shall make any necessary
12594412 revisions utilizing the same procedure s used to
12604413 develop the initial excl usionary formulary.
1261-
1262-SECTION 8. AMENDATORY 59 O.S. 2021, Section 567.5a, is
4414+SECTION 17. AMENDATORY 59 O.S. 2021, Section 567.5a, is
12634415 amended to read as follows:
1264-
12654416 Section 567.5a. A. All applicants for a license to practice a s
12664417 an Advanced Practice Registered Nurse shall be subject to Section
12674418 567.8 of this title.
1268-
1269-ENR. S. B. NO. 458 Page 30
1270-
12714419 B. An applicant for an initial license to practice as an
12724420 Advanced Practice Registered Nurse shall:
1273-
12744421 1. Submit a completed written application and appropriate fees
12754422 as established by the Oklahoma Board of Nursing;
12764423
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12774449 2. Submit a criminal history records check that complies with
12784450 Section 567.18 of this title;
1279-
12804451 3. Hold a current Registered Nurse license in this state;
1281-
12824452 4. Have completed an advanced practice registered nursing
12834453 education program in one of the four advanced practice regi stered
12844454 nurse Advanced Practice Registered Nurse roles and a specialty area
12854455 recognized by the Board. Effective January 1, 2016, the applicant
12864456 shall have completed an accredited graduate level advanced practice
12874457 registered nursing education program in at lea st one of the
12884458 following population foci: family/individual across the lifespan,
1289-adult-gerontology, neonatal, pediatrics, women 's health/gender-
4459+adult-gerontology, neonatal, pediatrics, women’s health/gender-
12904460 related, or psychiatric/mental health;
1291-
12924461 5. Be currently certified in an advanced practice specialty
12934462 certification consistent with educational preparation and by a
12944463 national certifying body recognized by the Board; and
1295-
12964464 6. Provide any and all other evidence as required by the Board
12974465 in its rules.
1298-
12994466 C. The Board may issue a license by endorsement to an Advanced
13004467 Practice Registered Nurse licensed under the laws of another state
13014468 if the applicant meets the qualifications for licensure in this
13024469 state. An applicant by endorsement shall:
1303-
13044470 1. Submit a completed written application and appr opriate fees
13054471 as established by the Board ;
1306-
13074472 2. Hold a current Registered Nurse license in this state;
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13094499 3. Hold recognition as an Advanced Practice Registered Nurse in
13104500 a state or territory;
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1313-ENR. S. B. NO. 458 Page 31
13144501 4. Have completed an advanced practice registered nursing
13154502 education program in one of the four roles and a specialty area
13164503 recognized by the Board. Effective January 1, 2016, the applicant
13174504 shall have completed an accredited graduate level advanced practice
13184505 registered nursing education program in at least one of the
13194506 following population foci: family/individual across the lifespan,
1320-adult-gerontology, neonatal, pediatrics, women 's health/gender-
4507+adult-gerontology, neonatal, pediatrics, women’s health/gender-
13214508 related, or psychiatric/mental health;
1322-
13234509 5. Be currently certified in an advanced practice specialty
13244510 certification consistent with ed ucational preparation and by a
13254511 national certifying body recognized by the Board;
1326-
13274512 6. Meet continued competency requirements as set forth in Board
13284513 rules; and
1329-
13304514 7. Provide any and all other evidence as required by the Board
13314515 in its rules.
1332-
13334516 D. The Board may iss ue prescriptive authority recognition by
13344517 endorsement to an Advanced Practice Registered Nurse licensed as an
13354518 APRN-CNP, APRN-CNS, or APRN-CNM under the laws of another state if
13364519 the applicant meets the requirements set forth in this section. An
13374520 applicant for prescriptive authority recognition by endorsement
13384521 shall:
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13404548 1. Submit a completed written application and appropriate fees
13414549 as established by the Board;
1342-
13434550 2. Hold current Registered Nurse and Advanced Practice
13444551 Registered Nurse licenses (APRN-CNP, APRN-CNS, or APRN-CNM) in the
13454552 state;
1346-
13474553 3. Hold current licensure or recognition as an Advanced
13484554 Practice Registered Nurse in the same role and specialty with
13494555 prescribing privileges in another state or territory;
1350-
13514556 4. Submit documentation verifying successful completion of a
13524557 graduate level advanced practice re gistered nursing education
13534558 program that included an academic course in pharmacotherapeutic
13544559 management, and didactic and clinical preparation for prescribing
13554560 incorporated throughout the program;
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1357-ENR. S. B. NO. 458 Page 32
1358-
13594561 5. Submit a written statement from an Oklahoma licensed
1360-physician supervising prescriptive authority as required by the
1361-Board in its rules, or submit documentation that the applicant meets
1362-the requirements for independent prescriptive authority under
1363-Section 1 of this act ;
1364-
4562+physician or supervising Advanced Practice Registered Nurse
4563+supervising prescriptive authority as required by the Board in its
4564+rules, or submit documentation that the applicant meets the
4565+requirements for independ ent prescriptive authority under Section 1
4566+of this act;
13654567 6. Meet continued competency requirements as set forth in Board
13664568 rules; and
1367-
13684569 7. Provide any and all other evidence as required by the Board
13694570 in its rules.
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13704596
13714597 E. An Advanced Practice Registered Nurse license issued under
13724598 this section shall be renewed concurrently with the reg istered nurse
13734599 license, provided that qualifying criteria continue to be met.
1374-
13754600 F. The Board may reinstate a license as set forth in Boa rd
13764601 rules.
1377-
1378-SECTION 9. AMENDATORY 63 O.S. 2021, Section 2 -312, as
1379-amended by Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 202 3,
4602+SECTION 18. AMENDATORY 63 O.S. 2021, Section 2-312, as
4603+amended by Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2022,
13804604 Section 2-312), is amended to read as follows:
1381-
13824605 Section 2-312. A. A physician, podiatrist, optometrist or a
13834606 dentist who has complied with the registration requirements of the
13844607 Uniform Controlled Dange rous Substances Act, in good faith and in
1385-the course of such person 's professional practice only, may
4608+the course of such person’s professional practice only, may
13864609 prescribe and administer controlled dangerous substances, or may
13874610 cause the same to be administered by medical or paramedical
13884611 personnel acting under the di rection and supervision of the
13894612 physician, podiatrist, optometrist or dentist, and only may dispense
13904613 controlled dangerous substances pursuant to the provisions of
13914614 Sections 355.1 and 355.2 of Title 59 of the Oklahoma Statutes.
1392-
13934615 B. A veterinarian who has comp lied with the registration
13944616 requirements of the Uniform Controlled Dangerous Substances Act, in
13954617 good faith and in the course of the professional practice of the
13964618 veterinarian only, and not for use by a human being, may prescribe,
13974619 administer, and dispense con trolled dangerous substances and may
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13984646 cause them to be administered by an assistant or orderly under the
13994647 direction and supervision of the veterinarian.
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1401-ENR. S. B. NO. 458 Page 33
1402-
14034648 C. 1. An advanced practice nurse Advanced Practice Registered
14044649 Nurse who is recognized to prescribe by t he Oklahoma Board of
14054650 Nursing as an advanced registered nurse practitioner, clinical nurse
14064651 specialist or certified nurse-midwife, a Certified Nurse
14074652 Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
14084653 but who has not obtained independent prescriptive authority u nder
14094654 Section 1 of this act and therefore is subject to medical direction
1410-by a supervising physician, pursuant to Section 567.3a of Title 59
1411-of the Oklahoma Statutes, and who has complied with the registration
4655+by a supervising physician, or supervising Advanced Prac tice
4656+Registered Nurse pursuant to Section 567.3a of Title 59 of the
4657+Oklahoma Statutes, and who has complied with the registration
14124658 requirements of the U niform Controlled Dange rous Substances Act, in
14134659 good faith and in the course of professional practice only, may
14144660 prescribe and administer Schedule III, IV and V controlled dangerous
14154661 substances.
1416-
14174662 2. An Advanced Practice Registered Nurs e who is recognized to
14184663 prescribe by the Okla homa Board of Nursing as a Certified Nurse
14194664 Practitioner, Clinical Nurse Specialist, or Certified Nurse-Midwife
14204665 who has obtained independent prescriptive authority under Section 1
14214666 of this act, and who has complied with the registration requirements
14224667 of the Uniform Controlled Dangerous Substances Act, in good faith
14234668 and in the course of professional practice only, may prescribe and
14244669 administer Schedule III, IV, and V controlled dangerous substances.
14254670
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14264696 D. An advanced practice nurse Advanced Practice Registered
14274697 Nurse who is recognized to order, select, obtain and administer
14284698 drugs by the Oklahoma Board of Nursing as a certified registered
14294699 nurse anesthetist Certified Registered Nurse Anesthetist pursuant to
14304700 Section 353.1b of Title 59 of the Oklahoma Statutes and who has
14314701 complied with the registration requirements of the Uniform
14324702 Controlled Dangerous Substances Act, in good faith and in the course
1433-of such practitioner 's professional practice only, may order,
4703+of such practitioner’s professional practice only, may order,
14344704 select, obtain and administer Schedules II through V controlled
14354705 dangerous substances in a preanesthetic preparation or evaluation;
14364706 anesthesia induction, maintenance or emergence; or postanesthesia
14374707 care setting only. A certified registered nurse anestheti st
14384708 Certified Registered Nurse Anesthetist may order, select, obtain and
14394709 administer such drugs only during the perioperative or
14404710 periobstetrical period.
1441-
14424711 E. A physician assistant who is recognized to prescribe by the
14434712 State Board of Medical Licensure and Supe rvision under the medical
1444-
1445-ENR. S. B. NO. 458 Page 34
14464713 direction of a supervising physician, pursuant to Section 519.6 of
14474714 Title 59 of the Oklahoma Statutes, and who has complied w ith the
14484715 registration requirements of the Uniform Controlled Dangerous
14494716 Substances Act, in good faith and in the course of professional
14504717 practice only, may prescribe and administe r Schedule II through V
14514718 controlled dangerous substances.
1452-
1453-SECTION 10. It being immediately necessary for the preservation
1454-of the public peace, health or safety, an emergency is hereby
1455-declared to exist, by reason whereof this act shall take effect and
1456-be in full force from and after its passage and approval.
1457-
1458-
1459-ENR. S. B. NO. 458 Page 35
1460-Passed the Senate the 19th day of March, 2024.
4719+SECTION 19. This act shall become effective November 1, 2023.
4720+
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4746+Passed the Senate the 6th day of March, 2023.
14614747
14624748
14634749
14644750 Presiding Officer of the Senate
14654751
14664752
1467-Passed the House of Representatives the 13th day of February,
1468-2024.
4753+Passed the House of Representatives the ____ day of __________,
4754+2023.
14694755
14704756
14714757
14724758 Presiding Officer of the House
14734759 of Representatives
14744760
1475-OFFICE OF THE GOVERNOR
1476-Received by the Office of the Governor this _______ _____________
1477-day of _________________ __, 20_______, at _______ o'clock _______ M.
1478-By: _________________________________
1479-Approved by the Governor of the State of Oklahoma this _______ __
1480-day of _________________ __, 20_______, at _______ o'clock _______ M.
1481-
1482- _________________________________
1483- Governor of the State of Oklahoma
1484-
1485-
1486-OFFICE OF THE SECRETARY OF STATE
1487-Received by the Office of the Secretary of State this _______ ___
1488-day of _________________ _, 20 _______, at _______ o'clock _______ M.
1489-By: _________________________________
4761+