N.Y. Comp. Codes R. & Regs. Tit. 8 § 64.7 - [Effective 7/10/2025] Provision of certain medical services pursuant to non-patient specific orders and protocols
(a)
Immunizations.
(1) As used in this
subdivision:
(i)
Immunizing
agents means vaccines and immunoglobulin drugs approved by the federal
Food and Drug Administration to provide immunity against diseases caused by the
infectious agents described in clauses (a) through
(e) of this subparagraph.
(a) In the case of adults, vaccines against
the following infectious diseases: Hepatitis A, Hepatitis B, Influenza,
Pneumococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, Polio,
Pertussis, Human Papilloma Virus, Meningococcus, Respiratory Syncytial Virus,
and Herpes Zoster;
(b) In the case
of infants and children under the age of 18, vaccines against the following
infectious diseases: Diphtheria, Tetanus, Pertussis, Measles, Mumps, Rubella,
Varicella, Haemophilus Influenzae Type b (Hib), Polio, Hepatitis B, Hepatitis
A, Influenza, Meningococcus, Pneumococcus, Rotavirus, Respiratory Syncytial
Virus, and Human Papilloma Virus;
(c) immunizing agents against an infectious
disease that causes an epidemic or a community wide outbreak, provided that
such immunizing agents are administered as part of a public health program
established by the Commissioner of the Department of Health, a County
Commissioner of Health, or a County Public Health Director to immunize persons
against the infectious disease during the epidemic or community outbreak of the
infectious disease;
(d) additional
immunizing agents approved by resolution of the Board of Regents upon
recommendation by the commissioner that such additional immunization agents are
safe and effective immunization agents for registered professional nurses to
administer to patients, pursuant to a non-patient specific order and protocol
as prescribed in this section, after consideration of the recommendations of
State and/or nationwide authorities that evaluate the effectiveness and safety
of immunization agents, including but not limited to the Centers for Disease
Control and Prevention of the U.S. Department of Health and Human Services.
Such additional immunization agents, which are not specifically enumerated in
this subparagraph, may be removed by resolution of the Board of Regents, upon
recommendation of the commissioner that such immunization agents are not safe
and effective immunization agents for registered professional nurses to
administer to patients, pursuant to a non-patient specific order and protocol
as prescribed in this section, after consideration of the recommendations of
State and/or nationwide authorities that evaluate the effectiveness and safety
of immunization agents, including but not limited to the Centers for Disease
Control and Prevention of the U.S. Department of Health and Human Services;
and
(e) vaccines that are fully
approved or authorized for emergency use by the federal Food and Drug
Administration to provide immunity against COVID-19 and administered in
accordance with applicable federal Food and Drug Administration requirements
and recommendations.
(ii)
Entity means a State or local government, partnership,
corporation or other legal entity that is authorized by the Public Health Law,
Education Law or other State statute to provide professional nursing
services.
(2) A
registered professional nurse may administer immunizing agent(s) pursuant to a
written non-patient specific order and protocol prescribed or ordered by a
licensed physician or a certified nurse practitioner, provided that the
requirements of this subdivision are met.
(i)
The registered professional nurse shall be certified in cardio-pulmonary
resuscitation or basic life support by the American Red Cross, the American
Heart Association or an equivalent organization acceptable to the department
which has an established record of providing programs of cardio-pulmonary
resuscitation training.
(ii) The
registered professional nurse shall ensure that anaphylactic agents, syringes
and needles are available at the location where the immunizing agents are being
administered.
(3) Order
and protocol.
(i) The non-patient specific
order shall include, at a minimum, the following:
(a) the name, license number and signature of
the licensed physician or certified nurse practitioner who orders or prescribes
the non-patient specific order and protocol;
(b) the name of the specific immunizing
agent(s) to be administered;
(c) a
protocol for administering the ordered immunizing agent(s) or a specific
reference to a separate written protocol for administering the ordered
immunizing agent(s), which shall meet the requirements of subparagraph (ii) of
this paragraph;
(d) the period of
time that the order is effective, including the beginning and ending
dates;
(e) a description of the
group(s) of persons to be immunized, including the age range of such
persons;
(f) the name and license
number of the registered professional nurse(s) authorized to execute the
non-patient specific order and protocol to administer the immunizing agent(s);
or the name of the entity that employs or contracts with registered
professional nurses to execute the non-patient specific order and protocol,
provided that the registered professional nurse(s) execute the non-patient
specific order and protocol only in the course of such employment or pursuant
to such contract and provided further that the entity is legally authorized to
employ or contract with registered professional nurses to provide nursing
services.
(ii) The
written protocol, incorporated into the order prescribed in subparagraph (i) of
this paragraph, shall, at a minimum, require the registered professional
nurse(s) to ensure that:
(a) each potential
recipient is assessed, pursuant to criteria in the protocol, for conditions
that would qualify or preclude him or her from receiving the ordered immunizing
agent(s);
(b) the potential
recipient, or when the potential recipient lacks capacity to consent, a person
authorized pursuant to law to consent to health care for the potential
recipient, receives federally required vaccine information, such as vaccine
information statements, if applicable, and instructions on addressing adverse
reactions to the vaccine;
(c)
informed consent for administering the ordered immunizing agent(s) has been
obtained, pursuant to the criteria in the protocol, from the recipient, or when
the recipient lacks capacity to consent, a person authorized pursuant to law to
consent to health care for the recipient;
(d) the administration of the ordered
immunizing agent(s) is documented, including the recipient's name, date of
administration, address of administration, administering nurse, immunization
agent(s), manufacturer(s), lot number(s), in accordance with criteria in the
protocol and that documentation relating to the immunizing agent(s) is
maintained in accordance with section
29.2(a)(3) of this
Title;
(e) the recipient, or when
the recipient lacks capacity to consent, a person authorized pursuant to law to
consent to health care for the recipient, receives a certificate of
immunization with the recipient's name, date of administration, address of
administration, administering nurse, immunization agent(s), manufacturer(s),
and lot number(s). With the consent of the recipient or a person authorized to
consent for the recipient, the registered professional nurse shall communicate
this information to the recipient's primary health care provider;
(f) adverse outcomes resulting from the
administered immunizing agent(s) shall be reported to the United States
Department of Health and Human Services, as may be required by Federal Law;
and
(g) immunizing agents
administered to recipients are reported to the Department of Health or the New
York City Department of Health and Mental Hygiene, as may be required by
law.
(b) Anaphylaxis treatment agents.
(1) Pursuant to section
6909
(5) the Education Law, a registered
professional nurse shall be authorized to administer anaphylaxis treatment
agents, including but not limited to epinephrine, for the emergency treatment
of anaphylaxis, pursuant to a non-patient specific order and protocol
prescribed and ordered by a licensed physician or a certified nurse
practitioner, provided the order and protocol meets the requirements of
paragraph (2) this subdivision.
(2)
Order and protocol.
(i) The registered
professional nurse shall either maintain or ensure the maintenance of a copy of
the non-patient specific order and protocol prescribed by a licensed physician
or a certified nurse practitioner which authorizes a registered professional
nurse to administer anaphylaxis treatment agents, including but not limited to
epinephrine, for the emergency treatment of anaphylaxis, in accordance with the
requirements of paragraph (1) of this subdivision. The order prescribed in
subparagraph (ii) of this paragraph shall incorporate a protocol that meets the
requirements of subparagraph (iii) of this paragraph. Such order and protocol
shall be considered a record of the patient who receives the anaphylaxis
treatment agent and maintained as a record for the period of time prescribed in
section 29.2(a)(3) of this
Title.
(ii) The order shall
authorize one or more named registered professional nurses, or registered
professional nurses who are not individually named but are identified as
employed or under contract with an entity that is legally authorized to employ
or contract with registered professional nurses to provide nursing services, to
administer specified anaphylaxis treatment agents for a prescribed period of
time. In instances in which the registered professional nurses are not
individually named in the order, but are identified as employed or under
contract with an entity that is legally authorized to employ or contract with
registered professional nurses to provide nursing services, such registered
professional nurses shall not be authorized by such order to administer
anaphylaxis treatment agents outside of such employment or contract. The order
shall contain but shall not be limited to the following information:
(a) the specific anaphylaxis treatment agents
that the registered professional nurse(s) is permitted to administer;
(b) the period of time that the order is
effective, including the beginning and end date;
(c) the name and license number of the
registered professional nurse(s) authorized to administer the anaphylaxis
treatment agent(s) pursuant to the order; or the name of the entity that is
legally authorized to employ or contract with registered professional nurses to
provide nursing services with whom registered professional nurses who are not
individually named are employed or under contract to administer the prescribed
anaphylaxis treatment agent(s) pursuant to the order;
(d) in instances in which the registered
professional nurses are not individually named in the order, but are identified
as employed or under contract with an entity that is legally authorized to
employ or contract with registered professional nurses to provide nursing
services, the order shall contain a statement limiting the registered
professional nurses to administering anaphylaxis treatment agents only in the
course of such employment or pursuant to such contract; and
(e) the name, license number, and signature
of the licensed physician or certified nurse practitioner who has issued the
order.
(iii) The
protocol, incorporated into the order prescribed in subparagraph (ii) of this
paragraph, shall require the registered professional nurse to meet the
following requirements:
(a) Each registered
professional nurse shall ensure that a record of all persons to whom they have
administered an anaphylaxis treatment agent, including but not limited to: the
recipient's name, date, address of administration, administering nurse,
anaphylaxis treatment agent, manufacturer, and lot number, is recorded and
maintained in accordance with section
29.2(a)(3) of this
Title.
(b) The registered
professional nurse shall contact the local emergency medical services system
following the administration of the anaphylaxis treatment agent, or shall
ensure that equivalent follow-up care is provided through other
arrangements.
(c) The registered
professional nurse shall report to the local emergency medical system or other
provider of equivalent follow-up care information concerning the administration
of the anaphylaxis treatment agent, including but not limited to: when it was
administered, the dosage, strength, and route of administration. The registered
professional nurse shall also report such information to the patient's primary
care provider if one exists, unless the patient is unable to communicate the
identity of his or her primary care
provider.
(c) Tuberculosis tests.
(1) As used in this subdivision,
tuberculosis tests means one or more laboratory or point of
care tests approved by the Federal Food and Drug Administration to detect or
screen for tuberculosis infections, including, but not limited to, tuberculin
skin tests (purified protein derivative [PPD] tests).
(2) A registered professional nurse may
administer tuberculosis tests pursuant to a written non-patient specific order
and protocol prescribed or ordered by a licensed physician or a certified nurse
practitioner, provided that the requirements of this subdivision are
met.
(3) Order and protocol.
(i) The non-patient specific order shall
include, at a minimum, the following:
(a) the
name, license number and signature of the licensed physician or certified nurse
practitioner who orders or prescribes the non-patient specific order and
protocol;
(b) the name of the
specific tuberculosis tests to be administered;
(c) a protocol for administering the ordered
tuberculosis tests or a specific reference to a separate written protocol for
administering the ordered tuberculosis tests, which shall meet the requirements
of subparagraph (ii) of this paragraph;
(d) the period of time that the order is
effective, including the beginning and ending dates;
(e) a description of the group(s) of persons
to be treated; and
(f) the name and
license number of the registered professional nurse(s) authorized to execute
the non-patient specific order and protocol to administer the tuberculosis
tests; or the name of the entity that employs or contracts with registered
professional nurses to execute the non-patient specific order and protocol,
provided that the registered professional nurse(s) execute the non-patient
specific order and protocol only in the course of such employment or pursuant
to such contract and provided further that the entity that is legally
authorized to employ or contract with registered professional to provide
nursing services.
(ii)
The written protocol, incorporated into the order prescribed in subparagraph
(i) of this paragraph, shall, at a minimum, require the registered professional
nurse(s) to ensure that:
(a) each potential
recipient is assessed, pursuant to criteria in the protocol, for conditions
that would qualify or preclude him or her from receiving the ordered
tuberculosis tests;
(b) informed
consent for administering the ordered tuberculosis tests or disclosing the
tuberculosis tests results to a third party (if applicable) has been obtained
pursuant to the criteria in the protocol from the recipient, or when the
recipient lacks capacity to consent, a person authorized pursuant to law to
consent to health care for the recipient;
(c) any tuberculosis test results are
disclosed and any recommendations for follow up care are made in accordance
with the criteria in the protocol; and
(d) the administration of the ordered
tuberculosis tests and the test results are documented in the recipient's
medical record in accordance with the criteria in the protocol and that
documentation relating to tuberculosis testing is maintained in accordance with
section 29.2(a)(3) of this
Title;
(e) additional requirements
for tuberculin skin tests. If the non-patient specific order authorizes a
tuberculin skin tests, the written protocol shall, in addition to the
foregoing:
(1) require the registered
professional nurse to have emergency anaphylaxis treatment agents available at
the tuberculin skin testing site, except in an emergency determined by the
Commissioner of Health, New York City Commissioner of the Department of Health
and Mental Hygiene, a county commissioner of health, or a county public health
director;
(2) require that, prior
to administering the tuberculin skin tests, the potential test recipient or a
person authorized pursuant to law to consent to health care for the recipient
receives written information regarding the potential side effects and/or
adverse reactions to the tuberculin skin tests and the appropriate course of
action in the event of an adverse reaction to the test;
(3) require that, prior to administering the
tuberculin skin tests, the potential test recipient or his or her authorized
representative is informed of the need for a test evaluation within 48 to 72
hours after the test is administered;
(4) require that the test recipient or
recipient's authorized representative receives a signed certificate of
tuberculin skin testing, which shall include the results with the recipient's
name, date of tests, address where the tests was administered, administering
nurse, manufacturer and lot numbers for the tuberculin solution administered,
as well as any recommendations for future tests; and
(5) require that the name of the manufacturer
and lot number of the tuberculin solution that was administered to the
recipient are documented in his or her medical record, along with the date that
the tuberculin skin tests was administered and the date that the test results
were evaluated.
(d) Human Immunodeficiency Virus (HIV) tests.
(1) As used in this subdivision,
human immunodeficiency virus (HIV) test means HIV-related test
as defined in section
63.1 of this Title.
(2) Pursuant to section 6909(5) of the
Education Law, a registered professional nurse shall be authorized to execute
an order to administer HIV tests, pursuant to a non-patient specific order and
protocol prescribed and ordered by a licensed physician or a certified nurse
practitioner, provided the order and protocol meet the requirements of
paragraph (3) of this subdivision. The following provisions apply to the
administration of an HIV test pursuant to a non-patient specific standing order
when such test is administered by a registered professional nurse.
(3) Order and protocol.
(i) The registered professional nurse shall
either maintain or ensure the maintenance of a copy of the non-patient specific
order and protocol prescribed by a licensed physician or a certified nurse
practitioner, which authorizes a registered professional nurse to execute the
order to administer an HIV test, in accordance with the requirements of
paragraph (2) of this subdivision. The order prescribed in subparagraph (ii) of
this paragraph shall incorporate a protocol that meets the requirements of
subparagraph (iii) of this paragraph. Such order and protocol shall be
considered a record of the patient who has received an HIV test and be
maintained as a record for the period of time prescribed in section
29.2(a)(3) of this
Title.
(ii) The order shall
authorize one or more named registered professional nurses, or registered
professional nurses who are not individually named but are identified as
employed or under contract with an entity that is legally authorized to employ
or contract with registered professional nurses to provide nursing services, to
execute the order to administer HIV tests for a prescribed period of time. In
instances in which the registered professional nurses are not individually
named in the order, but are identified as employed or under contract with an
entity that is legally authorized to employ or contract with registered
professional nurses to provide nursing services, such registered professional
nurses shall not be authorized by such order to execute the order to administer
HIV tests outside of such employment or contract. The order shall contain but
shall not be limited to the following information:
(a) identification of the HIV test;
(b) the period of time that the order is
effective, including the beginning and ending dates;
(c) the name and license number of the
registered professional nurse(s) authorized to execute the order to administer
the HIV test; or the name of the entity that is legally authorized to employ or
contract with registered professional nurses to provide nursing services with
whom registered professional nurses who are not individually named are employed
or under contract to execute the order to administer the HIV test;
(d) in instances in which registered
professional nurses are not individually named in the order, but are identified
as employed or under contract with an entity that is legally authorized to
employ or contract with registered professional nurses to provide nursing
services, the order shall contain a statement limiting registered professional
nurses to execute the order to administer HIV tests only in the course of such
employment or pursuant to such contract; and
(e) the name, license number, and signature
of the licensed physician or certified nurse practitioner that has issued the
order.
(iii) The
protocol, incorporated into the order prescribed in subparagraph (ii) of this
paragraph, shall require the registered professional nurse to meet the
following requirements:
(a) the registered
professional nurse shall ensure that each potential recipient is assessed for
conditions that would preclude HIV testing and ensure that each recipient's
record of the HIV test with manufacturer and lot number or a potential
recipient's refusal to be tested is documented in accordance with section
29.2(a)(3) of this
Title;
(b) the registered
professional nurse shall execute the order to administer an HIV test in
accordance with applicable State laws and regulations, including but not
limited to, article 27-F of the Public Health Law and 10 NYCRR Part
63;
(c) the registered professional
nurse shall certify that he/she obtained the written, informed consent of the
recipient, or when the recipient lacks capacity to consent, a person authorized
pursuant to law to consent to health care for such individual, prior to
ordering the performance of the HIV test. Informed consent shall include
pre-test counseling to the recipient, or if the recipient lacks capacity to
consent, a person authorized pursuant to law to consent to health care for such
individual. The written informed consent and the pre-test counseling shall be
obtained and conducted in accordance with article 27-F of the Public Health Law
and 10 NYCRR Part 63;
(d) a
physician or nurse practitioner who issues a non-patient specific order for HIV
testing shall retain responsibility for communication of a confirmatory,
positive HIV test result to the recipient, or when the recipient lacks capacity
to consent, a person authorized pursuant to law to consent to health care for
such individual. A registered professional nurse is not authorized to deliver a
final confirmatory HIV positive test result through a non-patient specific
order. A registered professional nurse may only deliver a confirmatory,
positive HIV test result through a patient specific order as directed by the
treating physician or nurse practitioner;
(e) the registered professional nurse shall,
upon request, ensure that the recipient, or when the recipient lacks capacity
to consent, a person authorized pursuant to law to consent to health care for
such individual, is provided with a signed certificate of HIV testing and
results, with the recipient's name, date of the test, address where the test
was administered, the name of the administering nurse, manufacturer and product
lot number;
(f) with the consent of
the recipient or when the recipient lacks capacity to consent, a person
authorized pursuant to law to consent to health care for such individual, and
with an appropriate authorization for the release of confidential HIV
information, the registered professional nurse shall ensure that this
information is communicated to the recipient's primary health care provider if
one exists in accordance with the requirements of article 27-F of the Public
Health Law and 10 NYCRR Part 63; and
(g) each registered professional nurse shall
ensure that a record of all persons so tested including the recipient's name,
date of the test, address where the test was administered, administering nurse,
test results, manufacturer, lot numbers and such other information as may be
necessary pursuant to the protocol is recorded and maintained in accordance
with section
29.2(a)(3) of this
Title and article 27-F of the Public Health Law and 10 NYCRR Part
63.
(e) Opioid related overdose treatment.
(1) As used in this subdivision, opioid
related overdose treatment shall include the administration of naloxone or
another drug approved by the Federal Food and Drug Administration to treat
opioid related overdose.
(2) A
registered professional nurse may administer opioid related overdose treatment
for the urgent or emergency treatment of opioid related overdose or suspected
opioid related overdose pursuant to a written non-patient specific order and
protocol prescribed or ordered by a licensed physician or a certified nurse
practitioner, provided that the requirements of this subdivision are
met.
(3) Order and protocol.
(i) The non-patient specific order shall
include, at a minimum, the following:
(a) the
name, license number and signature of the licensed physician or certified nurse
practitioner who orders or prescribes the non-patient specific order and
protocol;
(b) the name, dose and
route of administration of the drug to be administered to treat opioid related
overdose;
(c) a protocol for
administering the ordered opioid related overdose treatment or a specific
reference to a separate written protocol for administering the ordered opioid
related overdose treatment, which shall meet the requirements of subparagraph
(ii) of this paragraph;
(d) the
period of time that the order is effective, including the beginning and ending
dates;
(e) a description of the
group(s) of persons to be treated; and
(f) the name and license number of the
registered professional nurse(s) authorized to execute the non-patient specific
order and protocol to administer the opioid related overdose treatment; or the
name of the entity that employs or contracts with registered professional
nurses to execute the non-patient specific order and protocol, provided that
the registered professional nurses execute the non-patient specific order and
protocol only in the course of such employment or pursuant to such contract and
provided further that the entity is legally authorized to employ or contract
with registered professional nurses to provide nursing
services.
(ii) The
written protocol, incorporated into the order prescribed in subparagraph (i) of
this paragraph, shall, at a minimum, include instructions for administering the
opioid related overdose treatment and require the registered professional nurse
to ensure that:
(a) each potential recipient
is assessed, pursuant to criteria in the protocol, for conditions that would
qualify or preclude him or her from receiving the ordered opioid related
overdose treatment;
(b) consent to
administer treatment is obtained, pursuant to criteria in the protocol, if the
potential recipient is capable of providing it;
(c) the opioid related overdose treatment is
documented, pursuant to criteria in the protocol, and includes the name and
dose of drug administered, the date, time and location of the treatment, the
recipient's name and the administering registered professional nurse's name and
this medical documentation relating to opioid related overdose treatment is
maintained in accordance with paragraph 29.2(a)(3) of this Title; and
(d) when opioid related overdose treatment is
administered outside of a general hospital, the recipient of the treatment is
transferred to a hospital for follow-up care to the extent possible along with
documentation describing the opioid related overdose treatment that was
administered, in accordance with criteria in the
protocol.
(f) Hepatitis C tests.
(1) As used in this subdivision,
hepatitis C tests mean one or more laboratory or point of care
tests approved by the Federal Food and Drug Administration to detect the
presence of antibodies or antigens to hepatitis C or the hepatitis C
virus.
(2) A registered
professional nurse may administer hepatitis C tests pursuant to a written
non-patient specific order and protocol prescribed or ordered by a licensed
physician or a certified nurse practitioner, provided that the requirements of
this subdivision are met.
(3) Order
and protocol.
(i) The non-patient specific
order shall include, at a minimum, the following:
(a) the name, license number and signature of
the licensed physician or certified nurse practitioner who orders or prescribes
the non-patient specific order and protocol;
(b) the name of the specific hepatitis C
tests to be administered;
(c) a
protocol for administering the ordered hepatitis C tests or a specific
reference to a separate written protocol for administering the ordered
hepatitis C tests, which shall meet the requirements of subparagraph (ii) of
this paragraph;
(d) the period of
time that the order is effective, including the beginning and ending
dates;
(e) a description of the
group(s) of persons to be tested; and
(f) the name and license number of the
registered professional nurse(s) authorized to execute the non-patient specific
order and protocol to administer the hepatitis C tests; or the name of the
entity that employs or contracts with registered professional nurses to execute
the non-patient specific order and protocol, provided that the registered
professional nurses execute the non-patient specific order and protocol only in
the course of such employment or pursuant to such contract and provided further
that the entity is legally authorized to employ or contract with registered
professional nurses to provide nursing services.
(ii) The written protocol, incorporated into
the order prescribed in subparagraph (i) of this paragraph, shall, at a
minimum, require the registered professional nurse(s) to ensure that:
(a) each potential recipient is assessed,
pursuant to criteria in the protocol, for conditions that would qualify or
preclude him or her from receiving the ordered hepatitis C tests;
(b) informed consent for administering the
ordered hepatitis C tests or disclosing the hepatitis C test results to a third
party (if applicable) has been obtained pursuant to the criteria in the
protocol from the recipient, or when the recipient lacks capacity to consent, a
person authorized pursuant to law to consent to health care for the
recipient;
(c) confirmatory,
positive hepatitis C test results are not disclosed to the test recipient or
the recipient's authorized representative by the registered professional nurse
without a patient specific order from a licensed physician, licensed physician
assistant or certified nurse practitioner; and
(d) the administration of the ordered
hepatitis C test(s) is documented in the recipient's medical record in
accordance with criteria in the protocol and that documentation relating to the
hepatitis C testing is maintained in accordance with section
29.2(a)(3) of this
Title.
(g) Screening for syphilis, gonorrhea and/or
chlamydia infections.
(1) As used in this
subdivision, screening means an assessment of an individual to
ascertain his or her risk of having a syphilis, gonorrhea and/or chlamydia
infection and may include the administration of one or more laboratory or point
of care tests approved by the Federal Food and Drug Administration to detect or
screen for syphilis, gonorrhea and/or chlamydia infections.
(2) A registered professional nurse may
screen persons at increased risk for syphilis, gonorrhea and/or chlamydia
pursuant to a written non-patient specific order and protocol prescribed or
ordered by a licensed physician or a certified nurse practitioner, provided
that the requirements of this subdivision are met.
(3) Order and protocol.
(i) The non-patient specific order shall
include, at a minimum, the following:
(a) the
name, license number and signature of the licensed physician or certified nurse
practitioner who orders or prescribes the non-patient specific order and
protocol;
(b) the name of the
specific laboratory or point of care test(s) or assessment procedures to be
administered;
(c) a protocol for
administering the ordered screening for syphilis, gonorrhea and/or chlamydia
infections or a specific reference to a separate written protocol for
administering the ordered screening for syphilis, gonorrhea and/or chlamydia,
which shall meet the requirements of subparagraph (ii) of this
paragraph;
(d) the period of time
that the order is effective, including the beginning and ending
dates;
(e) a description of the
group(s) of persons to be screened; and
(f) the name and license number of the
registered professional nurse(s) authorized to execute the non-patient specific
order and protocol to screen for syphilis, gonorrhea and/or chlamydia
infections; or the name of the entity that employs or contracts with registered
professional nurses to execute the non-patient specific order and protocol,
provided that the registered professional nurses execute the non-patient
specific order and protocol only in the course of such employment or pursuant
to such contract and provided further that the entity is legally authorized to
employ or contract with registered professional nurses to provide nursing
services.
(ii) The
written protocol, incorporated into the order prescribed in subparagraph (i) of
this paragraph, shall, at a minimum, include instructions for screening for
syphilis, gonorrhea and/or chlamydia infections and require the registered
professional nurse(s) to ensure that:
(a)
each potential recipient is assessed, pursuant to criteria in the protocol, for
conditions that would qualify or preclude him or her from receiving the ordered
screening tests for syphilis, gonorrhea and/or chlamydia infections;
(b) informed consent for administering the
ordered screening for syphilis, gonorrhea and/or chlamydia has been obtained
from the recipient pursuant to the criteria in the protocol, or when the
recipient lacks capacity to consent, from a person authorized pursuant to law
to consent to health care for the recipient;
(c) positive test results for syphilis,
gonorrhea and/or chlamydia infections are not disclosed to the test recipient
or the recipient's authorized representative by the registered professional
nurse without a patient specific order from a licensed physician, licensed
physician assistant or certified nurse practitioner; and
(d) the administration of the ordered
screening for syphilis, gonorrhea and/or chlamydia is documented in the
recipient's medical record in accordance with criteria in the protocol and that
documentation relating to the screening for syphilis, gonorrhea and/or
chlamydia is maintained in accordance with section
29.2(a)(3) of this
Title.
(h) COVID-19 tests and influenza tests.
(1) As used in this subdivision:
(i) COVID-19 test means one or more
laboratory or point of care tests that have been fully approved or have
received emergency use authorization by the Federal Food and Drug
Administration to detect COVID-19 or its antibodies or to detect COVID-19 and
influenza virus; and
(ii) influenza
test means one or more laboratory or point of care tests approved by the
Federal Food and Drug Administration to detect influenza virus.
(2) A registered professional
nurse may administer a COVID-19 test or an influenza test pursuant to a written
non-patient specific order and protocol prescribed or ordered by a licensed
physician or a certified nurse practitioner, provided that the requirements of
this subdivision are met.
(3) Order
and protocol.
(i) The non-patient specific
order shall include, at a minimum, the following:
(a) the name, license number and signature of
the licensed physician or certified nurse practitioner who orders or prescribes
the nonpatient specific order and protocol;
(b) the name of the specific COVID-19 or
influenza test to be administered;
(c) a protocol for administering the ordered
COVID-19 or influenza test or a specific reference to a separate written
protocol for administering the ordered test, which shall meet the requirements
of subparagraph (ii) of this paragraph;
(d) the period of time that the order is
effective, including the beginning and ending dates;
(e) a description of the group(s) of persons
to be tested; and
(f) the name and
license number of the registered professional nurse(s) authorized to execute
the non-patient specific order and protocol to administer the ordered COVID-19
or influenza test, or the name of the entity that employs or contracts with
registered professional nurse(s) to execute the non-patient specific order and
protocol, provided that the registered professional nurse(s) execute the
non-patient specific order and protocol only in the course of such employment
or pursuant to such contract and the entity is legally authorized to employ or
contract with registered professional nurses to provide nursing
services.
(ii) The
written protocol, incorporated into the order prescribed in subparagraph (i) of
this paragraph, shall, at a minimum, require the registered professional
nurse(s) to ensure that:
(a) each potential
recipient is assessed, pursuant to criteria in the protocol, for conditions
that would qualify or preclude him or her from receiving the ordered
test;
(b) informed consent for
administering the ordered test or disclosing the test results to a third party
(if applicable) has been obtained pursuant to the criteria in the protocol from
the recipient, or when the recipient lacks capacity to consent, a person
authorized pursuant to law to consent to health care for the
recipient;
(c) positive diagnostic
test results shall be disclosed to the test recipient, or the recipient's
authorized representative, by the registered professional nurse as specifically
authorized by the protocol or pursuant to a patient specific order from a
licensed physician, licensed physician assistant, or certified nurse
practitioner; and
(d) the
administration of the ordered test(s) is documented in the recipient's medical
record in accordance with criteria in the protocol. Such documentation shall be
maintained in accordance with section
29.2(a)(3) of this
Title.
(i) Emergency medical care.
(1) As used in this subdivision:
(i) Hospital means a general hospital as
defined in subdivision 10 of section
2801 of the
public health law.
(ii) Standing
order means a written non-patient specific order and protocol prescribed or
ordered by a licensed physician or certified nurse practitioner for providing
emergency medical care to patients.
(iii) Patient means a person receiving
medical care in a hospital or from another health care provider.
(v) Emergency medical care means medical care
that is ordered or prescribed to expedite the detection of signs and symptoms
of certain emergency medical conditions in patients or expedite medical
intervention for emergency medical conditions or suspected emergency medical
conditions. Such emergency medical care includes:
(a) administering an electrocardiogram to
detect electrocardiographic changes and/or arrythmias associated with acute
coronary syndrome, as set forth in a standing order;
(b) administering point-of-care tests that
are approved by the United States Food and Drug Administration to determine
blood glucose levels in patients with suspected hypoglycemia for the purpose of
evaluating acute mental status changes, as set forth in a standing
order;
(c) administering tests,
which may include laboratory or point-of-care tests that are approved by the
United States Food and Drug Administration or the department of health, to
patients who meet criteria for severe sepsis and septic shock as set forth in a
standing order; and
(d)
establishing peripheral venous access on patients who meet severe sepsis and
septic shock criteria as set forth in a standing order.
(2) A registered professional
nurse may provide emergency medical care pursuant to a standing order, provided
that the requirements of this subdivision are met. The registered professional
nurse shall:
(i) be certified in
cardio-pulmonary resuscitation, basic life support or more advanced life
support by the American Red Cross, the American Heart Association, or an
equivalent organization, acceptable to the department, which provides
cardio-pulmonary resuscitation or life support training programs; or
(ii) be trained in or credentialed in basic
or more advanced life support in a hospital if the registered professional
nurse works in the hospital.
(3) Standing order.
(i) The standing order shall include, at a
minimum:
(a) the name, license number and
signature of the licensed physician or certified nurse practitioner who orders
or prescribes the standing order;
(b) the name of the medical condition(s) for
which the emergency medical care is ordered or prescribed to screen
for;
(c) the name of the specific
laboratory or point of care test(s), other medical test(s), or medical
procedure(s) to be performed;
(d) a
protocol for providing the ordered emergency medical care or a specific
reference to a separate written protocol for providing the ordered emergency
medical care, which shall meet the requirements of subparagraph (ii) of this
paragraph;
(e) the period of time
that the order is effective, including the beginning and ending
dates;
(f) a description of the
group(s) of patients or persons who may receive the ordered emergency medical
care; and
(g) the name and license
number of the registered professional nurse(s) authorized to execute the
standing order or the name of the entity that employs or contracts with
registered professional nurses to execute the standing order, provided that the
registered professional nurses execute the standing order only in the course of
such employment or pursuant to such contract and provided further that the
entity is legally authorized to employ or contract with registered professional
nurses to provide nursing services.
(ii) The written protocol, incorporated into
the standing order prescribed in subparagraph (i) of this paragraph, shall, at
a minimum, ensure that:
(a) each potential
recipient of ordered emergency medical care is assessed, pursuant to measurable
criteria in the protocol, for conditions that would qualify or preclude them
from receiving the ordered emergency medical care;
(b) consent to provide the ordered emergency
medical care pursuant to criteria in the protocol if the potential recipient is
capable of providing it or from a person authorized by law to consent to health
care on behalf of the potential recipient, if immediately available;
(c) instructions necessary for providing the
ordered emergency medical care;
(d)
any follow up actions to be undertaken by the registered professional nurse are
described, including, but not limited to, disclosing test results to a third
party or the recipient of the ordered test;
(e) when ordered emergency medical care is
provided outside of a hospital, the recipient of the medical care is
transferred to a general hospital for follow-up care in accordance with
criteria in the protocol; and
(f)
the provision of the ordered emergency medical care is documented in the
patient's medical record and the documentation relating to the ordered
emergency medical care is maintained in accordance with section
29.2(a)(3) of this
Title.
(iii) Nothing in
this subdivision shall construed to authorize a registered professional nurse
to determine or rule out any medical diagnosis or determine any medical
treatment to be provided.
(iv)
Nothing in this subdivision shall be construed to delay access to medical
services to be provided by a licensed physician, or emergency transportation to
a hospital.
(j)
Pregnancy tests.
(1) As used in this
subdivision, pregnancy test means a laboratory or point-of-care test that is
approved by the United States Food and Drug Administration to determine
pregnancy.
(2) A registered
professional nurse may administer a pregnancy test pursuant to a non-patient
specific order and protocol prescribed or ordered by a licensed physician or a
certified nurse practitioner, provided that the requirements of this
subdivision are met.
(3) Order and
protocol.
(i) The order shall include, at a
minimum:
(a) the name, license number and
signature of the licensed physician or certified nurse practitioner who orders
or prescribes the nonpatient specific order and protocol;
(b) the name of the specific pregnancy test
to be administered;
(c) a protocol
for administering the ordered pregnancy test or a specific reference to a
separate written protocol administering the ordered pregnancy test, which shall
meet the requirements of subparagraph (ii) of this paragraph;
(d) the period of time that the order is
effective, including the beginning and ending dates;
(e) a description of the group(s) of persons
to be tested; and
(f) the name and
license number of the registered professional nurse(s) authorized to execute
the non-patient specific order and protocol to administer the pregnancy test,
or the name of the entity that employs or contracts with registered
professional nurses to execute the non-patient specific order and protocol only
in the course of such employment or pursuant to such contract and provided
further that the entity is legally authorized to employ or contract with
registered professional nurses to provide nursing services.
(ii) The written protocol,
incorporated into the order prescribed in subparagraph (i) of this paragraph,
shall, at a minimum, ensure that:
(a) each
potential recipient is screened, pursuant to criteria in the protocol, for
conditions that would qualify or preclude them from receiving the ordered
pregnancy test;
(b) informed
consent for administering the ordered pregnancy test or disclosing the test
results to a third party (if applicable) has been obtained pursuant to criteria
in the protocol from the recipient or when the recipient lacks capacity to
consent, a person authorized by law to consent to health care for the
recipient;
(c) any follow up
actions to be undertaken by the registered professional nurse are described,
including, but not limited to, disclosing test results to a third party or the
recipient of the ordered test; and
(d) the administration of the ordered
pregnancy tests is documented in the recipient's medical record in accordance
with criteria in the protocol, and that documentation relating to the pregnancy
test is maintained in accordance with section
29.2(a)(3) of this
Title.
Notes
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No prior version found.