SB-0384, As Passed Senate, June 8, 2011

SUBSTITUTE FOR

SENATE BILL NO. 384

(As amended June 8, 2011)

<<A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 16104, 17048, 17049, 17050, 17076, 17078, 17548,

17549, 17745, 17757, 18048, 18049, and 20201 (MCL 333.16104, 333.17048,

333.17049, 333.17050, 333.17076, 333.17078, 333.17548, 333.17549,

333.17745, 333.17757, 333.18048, 333.18049, and 333.20201), section 16104 as amended by 1993 PA 80, section 17048 as amended by 2010 PA 124, sections 17049 and 17549 as amended by 2004 PA 512, section 17050 as amended by 1990 PA 247, sections 17076 and 17548 as amended by 1996 PA 355, section 17078 as amended and sections 18048 and 18049 as added by 2006 PA 161, section 17745 as amended by 2006 PA 672, section 17757 as amended by 1986 PA 304, and section 20201 as amended by 2006 PA 38.>>

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

<<Sec. 16104. (1) "DEA registration number" means the number

associated with a certificate of registration issued to a

practitioner to prescribe, dispense, or administer controlled

substances by the United States department of justice drug

enforcement administration.

(2)(1) "Delegation" means an authorization granted by a licensee

to a licensed or unlicensed individual to perform selected acts, tasks,

or functions that fall within the scope of practice of the delegator and

that are not within the scope of practice of the delegatee and that, in

the absence of the authorization, would constitute illegal practice of a

licensed profession.

(3)(2) "Department" means the department of commerce licensing and

regulatory affairs.

(4)(3) "Director" means the director of commerce the department or

the director's designee.

(5)(4) "Disciplinary subcommittee" means a disciplinary

subcommittee appointed under section 16216.

(6)(5) "Good moral character" means good moral character as defined and determined under Act No. 381 of the Public Acts of 1974, as amended, being sections 1974 PA 381, MCL 338.41 to 338.47. of the Michigan Compiled Laws.>>

     Sec. 17048. (1) Except as otherwise provided in this section

and section 17049(5), a physician who is a sole practitioner or who

practices in a group of physicians and treats patients on an

outpatient basis shall not supervise more than 4 physician's

assistants. If a physician described in this subsection supervises

physician's assistants at more than 1 practice site, the physician

shall not supervise more than 2 physician's assistants by a method

other than the physician's actual physical presence at the practice

site.

     (2) A physician who is employed by, under contract or

subcontract to, or has privileges at a health facility or agency

licensed under article 17 or a state correctional facility may

supervise more than 4 physician's assistants at the health facility

or agency or state correctional facility.

     (3) To the extent that a particular selected medical care

service requires extensive medical training, education, or ability

or poses serious risks to the health and safety of patients, the

board may prohibit or otherwise restrict the delegation of that

medical care service or may require higher levels of supervision.

     (4) A physician shall not delegate ultimate responsibility for

the quality of medical care services, even if the medical care

services are provided by a physician's assistant.

     (5) The board may promulgate rules for the delegation by a

supervising physician to a physician's assistant of the function of

prescription of drugs. The rules may define the drugs or classes of

drugs the prescription of which shall not be delegated and other

procedures and protocols necessary to promote consistency with

Senate Bill No. 384 as amended June 8, 2011

federal and state drug control and enforcement laws. Until the

rules are promulgated, a supervising physician may delegate the

prescription of drugs other than controlled substances as defined

by article 7 or federal law. When delegated prescription occurs,

both the physician's assistant's name and the supervising

physician's name shall be used, recorded, or otherwise indicated in

connection with each individual prescription.

     (6) A supervising physician may delegate in writing to a

physician's assistant the ordering, receipt, and dispensing of

complimentary starter dose drugs other than including controlled

substances as defined by article 7 or federal law that are included

in schedules 2 to 5 of part 72. When the delegated ordering,

receipt, or dispensing of complimentary starter dose drugs occurs,

both the physician's assistant's name and the supervising

physician's name shall be used, recorded, or otherwise indicated in

connection with each order, receipt, or dispensing. <<When the

delegated ordering, receipt, or dispensing of complimentary starter

dose drugs that are included in schedules 2 to 5 occurs, both the

physician's assistant's and the supervising physician's DEA registration

numbers shall be used, recorded, or otherwise indicated in connection

with each order, receipt, or dispensing.>> As used in this

subsection, "complimentary starter dose" means that term as defined

in section 17745. It is the intent of the legislature in enacting

this subsection to allow a pharmaceutical manufacturer or wholesale

distributor, as those terms are defined in part 177, to distribute

complimentary starter dose drugs to a physician's assistant, as

described in this subsection, in compliance with section 503(d) of

the federal food, drug, and cosmetic act, 21 USC 353.

     (7) Beginning on the effective date of the amendatory act that

added this subsection July 19, 2010, if 1 or more individuals

licensed under part 170 to engage in the practice of medicine,

licensed under part 175 to engage in the practice of osteopathic

medicine and surgery, or licensed under part 180 to engage in the

practice of podiatric medicine and surgery, and 1 or more

physician's assistants organize a professional service corporation

pursuant to section 4 of the professional service corporation act,

1962 PA 192, MCL 450.224, or a professional limited liability

company pursuant to section 904 of the Michigan limited liability

company act, 1993 PA 23, MCL 450.4904, the individuals who are the

supervising physicians of the physician's assistants shall be

shareholders in the same professional service corporation or

members in the same professional limited liability company as the

physician's assistants and shall meet all of the applicable

requirements of part 170, 175, or 180. If 1 or more physician's

assistants organized a professional service corporation pursuant to

section 4 of the professional service corporation act, 1962 PA 192,

MCL 450.224, or a professional limited liability company pursuant

to section 904 of the Michigan limited liability company act, 1993

PA 23, MCL 450.4904, before the effective date of the amendatory

act that added this subsection July 19, 2010 that has only

physician's assistants as shareholders or members, the individuals

who are the supervising physicians of the physician's assistants

shall meet all of the applicable requirements of part 170, 175, or

180.

     (8) In addition to the requirements of section 17068 and

beginning on the effective date of the amendatory act that added

this subsection July 19, 2010, the department shall include on the

form used for renewal of licensure a space for a physician's

assistant to disclose whether he or she is a shareholder in a

professional service corporation pursuant to section 4 of the

professional service corporation act, 1962 PA 192, MCL 450.224, or

a member in a professional limited liability company pursuant to

section 904 of the Michigan limited liability company act, 1993 PA

23, MCL 450.4904, which corporation or company was organized before

the effective date of the amendatory act that added this subsection

July 19, 2010. A physician's assistant who is a shareholder in a

professional service corporation or a member in a professional

limited liability company described in this subsection shall

disclose all of the following in the form used for renewal of

licensure provided by the department:

     (a) Whether any individuals licensed under part 170 to engage

in the practice of medicine, licensed under part 175 to engage in

the practice of osteopathic medicine and surgery, or licensed under

part 180 to engage in the practice of podiatric medicine and

surgery are shareholders in the professional service corporation or

members in the professional limited liability company.

     (b) The name and license number of the individual licensed

under part 170 to engage in the practice of medicine, licensed

under part 175 to engage in the practice of osteopathic medicine

and surgery, or licensed under part 180 to engage in the practice

of podiatric medicine and surgery who supervises the physician's

assistant.

     (c) Whether the individual licensed under part 170 to engage

in the practice of medicine, licensed under part 175 to engage in

the practice of osteopathic medicine and surgery, or licensed under

part 180 to engage in the practice of podiatric medicine and

surgery disclosed in subdivision (b) is a shareholder in the same

professional service corporation or member in a professional

limited liability company as the physician's assistant.

     Sec. 17049. (1) In addition to the other requirements of this

section and subject to subsection (5), a physician who supervises a

physician's assistant is responsible for all of the following:

     (a) Verification of the physician's assistant's credentials.

     (b) Evaluation of the physician's assistant's performance.

     (c) Monitoring the physician's assistant's practice and

provision of medical care services.

     (2) Subject to section 16215 or 17048, as applicable, a

physician who supervises a physician's assistant may delegate to

the physician's assistant the performance of medical care services

for a patient who is under the case management responsibility of

the physician, if the delegation is consistent with the physician's

assistant's training.

     (3) A physician who supervises a physician's assistant is

responsible for the clinical supervision of each physician's

assistant to whom the physician delegates the performance of

medical care service under subsection (2).

     (4) Subject to subsection (5), a physician who supervises a

physician's assistant shall keep on file in the physician's office

or in the health facility or agency or correctional facility in

which the physician supervises the physician's assistant a

permanent, written record that includes the physician's name and

license number and the name and license number of each physician's

assistant supervised by the physician.

     (5) A group of physicians practicing other than as sole

practitioners may designate 1 or more physicians in the group to

fulfill the requirements of subsections (1) and (4).

     (6) Notwithstanding any law or rule to the contrary, a

physician is not required to countersign orders written in a

patient's clinical record by a physician's assistant to whom the

physician has delegated the performance of medical care services

for a patient. Notwithstanding any law or rule to the contrary, a

physician is not required to sign an official form that lists the

physician's signature as the required signatory if that official

form is signed by a physician's assistant to whom the physician has

delegated the performance of medical care services.

     Sec. 17050. In addition to its other powers and duties under

this article, the board may prohibit a physician from supervising 1

or more physician's assistants for any of the grounds set forth in

section 16221 or for failure to supervise a physician's assistant

in accordance with this part and rules promulgated under this part.

     Sec. 17076. (1) Except in an emergency situation, a

physician's assistant shall provide medical care services only

under the supervision of a physician or properly designated

alternative physician, and only if those medical care services are

within the scope of practice of the supervising physician and are

delegated by the supervising physician.

     (2) A physician's assistant shall provide medical care

services only in a medical care setting where the supervising

physician regularly sees patients. However, a A physician's

assistant may make calls or go on rounds under the supervision of a

Senate Bill No. 384 as amended June 8, 2011

physician in private homes, public institutions, emergency

vehicles, ambulatory care clinics, hospitals, intermediate or

extended care facilities, health maintenance organizations, nursing

homes, or other health care facilities. to the extent permitted by

the bylaws, rules, or regulations of the governing facility or

organization, if any. Notwithstanding any law or rule to the

contrary, a physician's assistant may make calls or go on rounds as

provided in this subsection without restrictions on the time or

frequency of visits by the physician or the physician's assistant.

     (3) A physician's assistant may prescribe drugs as a delegated

act of a supervising physician , but shall do so only in accordance

with procedures and protocol for the prescription established by

rule of the appropriate board. Until the rules are promulgated, a A

physician's assistant may prescribe a drug, other than including a

controlled substance as defined by article 7 or federal law that is

included in schedules 2 to 5 of part 72, as a delegated act of the

supervising physician. When delegated prescription occurs, both the

physician's assistant's name and the supervising physician's name

shall be used, recorded, or otherwise indicated in connection with

each individual prescription so that the individual who dispenses

or administers the prescription knows under whose delegated

authority the physician's assistant is prescribing. <<When delegated

prescription of drugs that are included in schedules 2 to 5 occurs,

both the physician's assistant's and the supervising physician's DEA registration numbers shall be used, recorded, or otherwise indicated

in connection with each individual prescription.>>

     (4) A physician's assistant may order, receive, and dispense

complimentary starter dose drugs, other than including controlled

substances as defined by article 7 or federal law that are included

in schedules 2 to 5 of part 72, as a delegated act of a supervising

physician. When the delegated ordering, receipt, or dispensing of

Senate Bill No. 384 as amended June 8, 2011

complimentary starter dose drugs occurs, both the physician's

assistant's name and the supervising physician's name shall be

used, recorded, or otherwise indicated in connection with each

order, receipt, or dispensing so that the individual who processes

the order or delivers the complimentary starter dose drugs or to

whom the complimentary starter dose drugs are dispensed knows under

whose delegated authority the physician's assistant is ordering,

receiving, or dispensing. <<When the delegated ordering, receipt,

or dispensing of complimentary starter dose drugs that are included

in schedules 2 to 5 occurs, both the physician's assistant's and the supervising physician's DEA registration numbers shall be used,

recorded, or otherwise indicated in connection with each order,

receipt, or dispensing.>> As used in this subsection,

"complimentary starter dose" means that term as defined in section

17745. It is the intent of the legislature in enacting this

subsection to allow a pharmaceutical manufacturer or wholesale

distributor, as those terms are defined in part 177, to distribute

complimentary starter dose drugs to a physician's assistant, as

described in this subsection, in compliance with section 503(d) of

the federal food, drug, and cosmetic act, chapter 675, 52 Stat.

1051, 21 U.S.C. 21 USC 353.

     Sec. 17078. (1) A physician's assistant is the agent of the

his or her supervising physician under this part or part 175 or

supervising podiatrist under part 180. A communication made to a

physician's assistant that would be a privileged communication if

made to the supervising physician under this part or part 175 or

supervising podiatrist under part 180 is a privileged communication

to the physician's assistant and the supervising physician or

supervising podiatrist to the same extent as if the communication

were made to the supervising physician or supervising podiatrist.

     (2) A physician's assistant shall conform to minimal standards

of acceptable and prevailing practice for the supervising physician

under this part or part 175 or supervising podiatrist under part

180.

     Sec. 17548. (1) Except as otherwise provided in this

subsection and section 17549(5), a physician who is a sole

practitioner or who practices in a group of physicians and treats

patients on an outpatient basis shall not supervise more than 4

physician's assistants. If a physician described in this subsection

supervises physician's assistants at more than 1 practice site, the

physician shall not supervise more than 2 physician's assistants by

a method other than the physician's actual physical presence at the

practice site.

     (2) A physician who is employed by or under contract or

subcontract to or has privileges at a health facility licensed

under article 17 or a state correctional facility may supervise

more than 4 physician's assistants at the health facility or agency

or state correctional facility.

     (3) To the extent that a particular selected medical care

service requires extensive medical training, education, or ability

or pose serious risks to the health and safety of patients, the

board may prohibit or otherwise restrict the delegation of that

medical care service or may require higher levels of supervision.

     (4) A physician shall not delegate ultimate responsibility for

the quality of medical care services, even if the medical care

services are provided by a physician's assistant.

     (5) The board may promulgate rules for the delegation by a

supervising physician to a physician's assistant of the function of

prescription of drugs. The rules may define the drugs or classes of

Senate Bill No. 384 as amended June 8, 2011

drugs the prescription of which shall not be delegated and other

procedures and protocols necessary to promote consistency with

federal and state drug control and enforcement laws. Until the

rules are promulgated, a supervising physician may delegate the

prescription of drugs other than controlled substances as defined

by article 7 or federal law. When delegated prescription occurs,

both the physician's assistant's name and the supervising

physician's name shall be used, recorded, or otherwise indicated in

connection with each individual prescription.

     (6) A supervising physician may delegate in writing to a

physician's assistant the ordering, receipt, and dispensing of

complimentary starter dose drugs other than including controlled

substances as defined by article 7 or federal law that are included

in schedules 2 to 5 of part 72. When the delegated ordering,

receipt, or dispensing of complimentary starter dose drugs occurs,

both the physician's assistant's name and the supervising

physician's name shall be used, recorded, or otherwise indicated in

connection with each order, receipt, or dispensing. <<When the

delegated ordering, receipt, or dispensing of complimentary starter

dose drugs that are included in schedules 2 to 5 occurs, both the physician's assistant's and the supervising physician's DEA

registration numbers shall be used, recorded, or otherwise indicated

in connection with each order, receipt, or dispensing.>> As used in this

subsection, "complimentary starter dose" means that term as defined

in section 17745. It is the intent of the legislature in enacting

this subsection to allow a pharmaceutical manufacturer or wholesale

distributor, as those terms are defined in part 177, to distribute

complimentary starter dose drugs to a physician's assistant, as

described in this subsection, in compliance with section 503(d) of

the federal food, drug, and cosmetic act, chapter 675, 52 Stat.

1051, 21 U.S.C. 21 USC 353.

     Sec. 17549. (1) In addition to the other requirements of this

section and subject to subsection (5), a physician who supervises a

physician's assistant is responsible for all of the following:

     (a) Verification of the physician's assistant's credentials.

     (b) Evaluation of the physician's assistant's performance.

     (c) Monitoring the physician's assistant's practice and

provision of medical care services.

     (2) Subject to section 16215 or 17548, as applicable, a

physician who supervises a physician's assistant may delegate to

the physician's assistant the performance of medical care services

for a patient who is under the case management responsibility of

the physician, if the delegation is consistent with the physician's

assistant's training.

     (3) A physician who supervises a physician's assistant is

responsible for the clinical supervision of each physician's

assistant to whom the physician delegates the performance of

medical care service under subsection (2).

     (4) Subject to subsection (5), a physician who supervises a

physician's assistant shall keep on file in the physician's office

or in the health facility or agency or state correctional facility

in which the physician supervises the physician's assistant a

permanent, written record that includes the physician's name and

license number and the name and license number of each physician's

assistant supervised by the physician.

     (5) A group of physicians practicing other than as sole

practitioners may designate 1 or more physicians in the group to

fulfill the requirements of subsections (1) and (4).

     (6) Notwithstanding any law or rule to the contrary, a

physician is not required to countersign orders written in a

patient's clinical record by a physician's assistant to whom the

physician has delegated the performance of medical care services

for a patient. Notwithstanding any law or rule to the contrary, a

physician is not required to sign an official form that lists the

physician's signature as the required signatory if that official

form is signed by a physician's assistant to whom the physician has

delegated the performance of medical care services.

     Sec. 17745. (1) Except as otherwise provided in this

subsection, a prescriber who wishes to dispense prescription drugs

shall obtain from the board a drug control license for each

location in which the storage and dispensing of prescription drugs

occur. A drug control license is not necessary if the dispensing

occurs in the emergency department, emergency room, or trauma

center of a hospital licensed under article 17 or if the dispensing

involves only the issuance of complimentary starter dose drugs.

     (2) A dispensing prescriber shall dispense prescription drugs

only to his or her own patients.

     (3) A dispensing prescriber shall include in a patient's chart

or clinical record a complete record, including prescription drug

names, dosages, and quantities, of all prescription drugs dispensed

directly by the dispensing prescriber or indirectly under his or

her delegatory authority. If prescription drugs are dispensed under

the prescriber's delegatory authority, the delegatee who dispenses

the prescription drugs shall initial the patient's chart, clinical

record, or log of prescription drugs dispensed. In a patient's

chart or clinical record, a dispensing prescriber shall distinguish

Senate Bill No. 384 as amended June 8, 2011

between prescription drugs dispensed to the patient and

prescription drugs prescribed for the patient. A dispensing

prescriber shall retain information required under this subsection

for not less than 5 years after the information is entered in the

patient's chart or clinical record.

     (4) A dispensing prescriber shall store prescription drugs

under conditions that will maintain their stability, integrity, and

effectiveness and will assure that the prescription drugs are free

of contamination, deterioration, and adulteration.

     (5) A dispensing prescriber shall store prescription drugs in

a substantially constructed, securely lockable cabinet. Access to

the cabinet shall be limited to individuals authorized to dispense

prescription drugs in compliance with this part and article 7.

     (6) Unless otherwise requested by a patient, a dispensing

prescriber shall dispense a prescription drug in a safety closure

container that complies with the poison prevention packaging act of

1970, Public Law 91-601, 84 Stat. 1670 15 USC 1471 to 1477.

     (7) A dispensing prescriber shall dispense a drug in a

container that bears a label containing all of the following

information:

     (a) The name and address of the location from which the

prescription drug is dispensed.

     (b) The patient's name and record number.

     (c) The date the prescription drug was dispensed.

     (d) The prescriber's name <<or>>, if dispensed under the

prescriber's delegatory authority, <<shall list>> the name of

the delegatee.

     (e) The directions for use.

     (f) The name and strength of the prescription drug.

     (g) The quantity dispensed.

     (h) The expiration date of the prescription drug or the

statement required under section 17756.

     (8) A dispensing prescriber who dispenses a complimentary

starter dose drug to a patient shall give the patient at least all

of the following information, either by dispensing the

complimentary starter dose drug to the patient in a container that

bears a label containing the information or by giving the patient a

written document which may include, but is not limited to, a

preprinted insert that comes with the complimentary starter dose

drug, that contains the information:

     (a) The name and strength of the complimentary starter dose

drug.

     (b) Directions for the patient's use of the complimentary

starter dose drug.

     (c) The expiration date of the complimentary starter dose drug

or the statement required under section 17756.

     (9) The information required under subsection (8) is in

addition to, and does not supersede or modify, other state or

federal law regulating the labeling of prescription drugs.

     (10) In addition to meeting the requirements of this part, a

dispensing prescriber who dispenses controlled substances shall

comply with section 7303a.

     (11) The board may periodically inspect locations from which

prescription drugs are dispensed.

     (12) The act, task, or function of dispensing prescription

drugs shall be delegated only as provided in section 16215 and this

part and sections 16215, 17048, 17076, 17212, and 17548.

     (13) A supervising physician may delegate in writing to a

pharmacist practicing in a hospital pharmacy within a hospital

licensed under article 17 the receipt of complimentary starter dose

drugs other than controlled substances as defined by article 7 or

federal law. When the delegated receipt of complimentary starter

dose drugs occurs, both the pharmacist's name and the supervising

physician's name shall be used, recorded, or otherwise indicated in

connection with each receipt. A pharmacist described in this

subsection may dispense a prescription for complimentary starter

dose drugs written or transmitted by facsimile, electronic

transmission, or other means of communication by a prescriber.

     (14) As used in this section, "complimentary starter dose"

means a prescription drug packaged, dispensed, and distributed in

accordance with state and federal law that is provided to a

dispensing prescriber free of charge by a manufacturer or

distributor and dispensed free of charge by the dispensing

prescriber to his or her patients.

     Sec. 17757. (1) Upon a request made in person or by telephone,

a pharmacist engaged in the business of selling drugs at retail

shall provide the current selling price of a drug dispensed by that

pharmacy or comparative current selling prices of generic and brand

name drugs dispensed by that pharmacy. The information shall be

provided to the person making the request before a drug is

dispensed to the person. A person who makes a request for price

information under this subsection shall not be obligated to

purchase the drug for which the price or comparative prices are

requested.

     (2) A pharmacist engaged in the business of selling drugs at

retail shall conspicuously display the notice described in

subsection (3) at each counter over which prescription drugs are

dispensed.

     (3) The notice required under subsection (2) shall be in

substantially the following form:

     NOTICE TO CONSUMERS

     ABOUT PRESCRIPTION DRUGS

     Under Michigan law, you have the right to find out the price

of a prescription drug before the pharmacist fills the

prescription. You are under no obligation to have the prescription

filled here and may use this price information to shop around at

other pharmacies. You may request price information in person or by

telephone.

     Every pharmacy has the current selling prices of both generic

and brand name drugs dispensed by the pharmacy.

     Ask your pharmacist if a lower-cost generic drug is available

to fill your prescription. A generic drug contains the same

medicine as a brand name drug and is a suitable substitute in most

instances.

     A generic drug may not be dispensed by your pharmacist if your

doctor has written "dispense as written" or the initials "d.a.w."

on the prescription.

     If you have questions about the drugs which have been

prescribed for you, ask your doctor or pharmacist for more

information.

     To avoid dangerous drug interactions, let your doctor and

pharmacist know about any other medications you are taking. This is

especially important if you have more than 1 doctor or have

prescriptions filled at more than 1 pharmacy.

     (4) The notice required under subsection (2) shall also

contain the address and phone number of the board and the

department. The text of the notice shall be in at least 32-point

bold type and shall be printed on paper at least 11 inches by 17

inches in size. The notice may be printed on multiple pages.

     (5) A copy of the notice required under subsection (2) shall

be provided to each licensee by the department. Additional copies

shall be available if needed from the department. A person may

duplicate or reproduce the notice if the duplication or

reproduction is a true copy of the notice as produced by the

department, without any additions or deletions whatsoever.

     (6) The pharmacist shall furnish to the purchaser of a

prescription drug at the time the drug is delivered to the

purchaser a receipt evidencing the transactions, which contains the

following:

     (a) The brand name of the drug, if applicable.

     (b) The name of the manufacturer or the supplier of the drug,

if the drug does not have a brand name.

     (c) The strength of the drug, if significant.

     (d) The quantity dispensed, if applicable.

     (e) The name and address of the pharmacy.

     (f) The serial number of the prescription.

Senate Bill No. 384 as amended June 8, 2011

     (g) The date the prescription was originally dispensed.

     (h) The name of the prescriber <<or>>, if prescribed under the

prescriber's delegatory authority, <<shall list>> the name of

the delegatee.

     (i) The name of patient for whom the drug was prescribed.

     (j) The price for which the drug was sold to the purchaser.

     (7) Subsection (6)(a), (b), and (c) may be omitted by a

pharmacist only if the omission is expressly required by the

prescriber. The pharmacist shall retain a copy of each receipt for

90 days. The inclusion of subsection (6) on the prescription

container label is a valid receipt to the purchaser. Including

subsection (6) on the written prescription form and retaining the

form constitutes retention of a copy of the receipt.

     (8) The board may promulgate rules to implement this section.

     Sec. 18048. (1) Except as otherwise provided in this section

and section 18049(5), a podiatrist who is a sole practitioner or

who practices in a group of podiatrists and treats patients on an

outpatient basis shall not supervise more than 4 physician's

assistants. If a podiatrist described in this subsection supervises

physician's assistants at more than 1 practice site, the podiatrist

shall not supervise more than 2 physician's assistants by a method

other than the podiatrist's actual physical presence at the

practice site.

     (2) A podiatrist who is employed by or under contract or

subcontract to or has privileges at a health facility licensed

under article 17 may supervise more than 4 physician's assistants

at the health facility or agency.

     (3) The department may promulgate rules for the appropriate

delegation and utilization of a physician's assistant by a

podiatrist, including, but not limited to, rules to prohibit or

otherwise restrict the delegation of certain podiatric services or

require higher levels of supervision if the board determines that

such these services require extensive training, education, or

ability or pose serious risks to the health or safety of patients.

     Sec. 18049. (1) In addition to the other requirements of this

section and subject to subsection (5), a podiatrist who supervises

a physician's assistant is responsible for all of the following:

     (a) Verification of the physician's assistant's credentials.

     (b) Evaluation of the physician's assistant's performance.

     (c) Monitoring the physician's assistant's practice and

provision of podiatric services.

     (2) Subject to section 16215 or 18048, as applicable, a

podiatrist who supervises a physician's assistant may only delegate

to the physician's assistant the performance of podiatric services

for a patient who is under the case management responsibility of

the podiatrist, if the delegation is consistent with the

physician's assistant's training. A podiatrist shall only supervise

a physician's assistant in the performance of those duties included

within his or her scope of practice.

     (3) A podiatrist who supervises a physician's assistant is

responsible for the clinical supervision of each physician's

assistant to whom the physician delegates the performance of

podiatric services under subsection (2).

     (4) Subject to subsection (5), a podiatrist who supervises a

physician's assistant shall keep on file in the physician's office

or in the health facility or agency in which the podiatrist

supervises the physician's assistant a permanent, written record

that includes the podiatrist's name and license number and the name

and license number of each physician's assistant supervised by the

podiatrist.

     (5) A group of podiatrists practicing other than as sole

practitioners may designate 1 or more podiatrists in the group to

fulfill the requirements of subsections (1) and (4).

     Sec. 20201. (1) A health facility or agency that provides

services directly to patients or residents and is licensed under

this article shall adopt a policy describing the rights and

responsibilities of patients or residents admitted to the health

facility or agency. Except for a licensed health maintenance

organization, which shall comply with chapter 35 of the insurance

code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, the policy

shall be posted at a public place in the health facility or agency

and shall be provided to each member of the health facility or

agency staff. Patients or residents shall be treated in accordance

with the policy.

     (2) The policy describing the rights and responsibilities of

patients or residents required under subsection (1) shall include,

as a minimum, all of the following:

     (a) A patient or resident shall not be denied appropriate care

on the basis of race, religion, color, national origin, sex, age,

disability, marital status, sexual preference, or source of

payment.

     (b) An individual who is or has been a patient or resident is

entitled to inspect, or receive for a reasonable fee, a copy of his

or her medical record upon request in accordance with the medical

records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except

as otherwise permitted or required under the health insurance

portability and accountability act of 1996, Public Law 104-191, or

regulations promulgated under that act, 45 CFR parts 160 and 164, a

third party shall not be given a copy of the patient's or

resident's medical record without prior authorization of the

patient or resident.

     (c) A patient or resident is entitled to confidential

treatment of personal and medical records, and may refuse their

release to a person outside the health facility or agency except as

required because of a transfer to another health care facility, as

required by law or third party payment contract, or as permitted or

required under the health insurance portability and accountability

act of 1996, Public Law 104-191, or regulations promulgated under

that act, 45 CFR parts 160 and 164.

     (d) A patient or resident is entitled to privacy, to the

extent feasible, in treatment and in caring for personal needs with

consideration, respect, and full recognition of his or her dignity

and individuality.

     (e) A patient or resident is entitled to receive adequate and

appropriate care, and to receive, from the appropriate individual

within the health facility or agency, information about his or her

medical condition, proposed course of treatment, and prospects for

recovery, in terms that the patient or resident can understand,

unless medically contraindicated as documented by the attending

physician in the medical record by the attending physician or a

physician's assistant to whom the physician has delegated the

performance of medical care services.

     (f) A patient or resident is entitled to refuse treatment to

the extent provided by law and to be informed of the consequences

of that refusal. If a refusal of treatment prevents a health

facility or agency or its staff from providing appropriate care

according to ethical and professional standards, the relationship

with the patient or resident may be terminated upon reasonable

notice.

     (g) A patient or resident is entitled to exercise his or her

rights as a patient or resident and as a citizen, and to this end

may present grievances or recommend changes in policies and

services on behalf of himself or herself or others to the health

facility or agency staff, to governmental officials, or to another

person of his or her choice within or outside the health facility

or agency, free from restraint, interference, coercion,

discrimination, or reprisal. A patient or resident is entitled to

information about the health facility's or agency's policies and

procedures for initiation, review, and resolution of patient or

resident complaints.

     (h) A patient or resident is entitled to information

concerning an experimental procedure proposed as a part of his or

her care and has the right to refuse to participate in the

experimental procedure without jeopardizing his or her continuing

care.

     (i) A patient or resident is entitled to receive and examine

an explanation of his or her bill regardless of the source of

payment and to receive, upon request, information relating to

financial assistance available through the health facility or

agency.

     (j) A patient or resident is entitled to know who is

responsible for and who is providing his or her direct care, is

entitled to receive information concerning his or her continuing

health needs and alternatives for meeting those needs, and to be

involved in his or her discharge planning, if appropriate.

     (k) A patient or resident is entitled to associate and have

private communications and consultations with his or her physician

or a physician's assistant to whom the physician has delegated the

performance of medical care services, attorney, or any other person

of his or her choice and to send and receive personal mail unopened

on the same day it is received at the health facility or agency,

unless medically contraindicated as documented by the attending

physician in the medical record by the attending physician or a

physician's assistant to whom the physician has delegated the

performance of medical care services. A patient's or resident's

civil and religious liberties, including the right to independent

personal decisions and the right to knowledge of available choices,

shall not be infringed and the health facility or agency shall

encourage and assist in the fullest possible exercise of these

rights. A patient or resident may meet with, and participate in,

the activities of social, religious, and community groups at his or

her discretion, unless medically contraindicated as documented by

the attending physician in the medical record by the attending

physician or a physician's assistant to whom the physician has

delegated the performance of medical care services.

     (l) A patient or resident is entitled to be free from mental

and physical abuse and from physical and chemical restraints,

except those restraints authorized in writing by the attending

physician or a physician's assistant to whom the physician has

delegated the performance of medical care services for a specified

and limited time or as are necessitated by an emergency to protect

the patient or resident from injury to self or others, in which

case the restraint may only be applied by a qualified professional

who shall set forth in writing the circumstances requiring the use

of restraints and who shall promptly report the action to the

attending physician or physician's assistant. In case of a chemical

restraint, a physician shall be consulted within 24 hours after the

commencement of the chemical restraint.

     (m) A patient or resident is entitled to be free from

performing services for the health facility or agency that are not

included for therapeutic purposes in the plan of care.

     (n) A patient or resident is entitled to information about the

health facility or agency rules and regulations affecting patient

or resident care and conduct.

     (o) A patient or resident is entitled to adequate and

appropriate pain and symptom management as a basic and essential

element of his or her medical treatment.

     (3) The following additional requirements for the policy

described in subsection (2) apply to licensees under parts 213 and

217:

     (a) The policy shall be provided to each nursing home patient

or home for the aged resident upon admission, and the staff of the

facility shall be trained and involved in the implementation of the

policy.

     (b) Each nursing home patient may associate and communicate

privately with persons of his or her choice. Reasonable, regular

visiting hours, which shall be not less than 8 hours per day, and

which shall take into consideration the special circumstances of

each visitor, shall be established for patients to receive

visitors. A patient may be visited by the patient's attorney or by

representatives of the departments named in section 20156, during

other than established visiting hours. Reasonable privacy shall be

afforded for visitation of a patient who shares a room with another

patient. Each patient shall have reasonable access to a telephone.

A married nursing home patient or home for the aged resident is

entitled to meet privately with his or her spouse in a room that

assures privacy. If both spouses are residents in the same

facility, they are entitled to share a room unless medically

contraindicated and documented by the attending physician in the

medical record by the attending physician or a physician's

assistant to whom the physician has delegated the performance of

medical care services.

     (c) A nursing home patient or home for the aged resident is

entitled to retain and use personal clothing and possessions as

space permits, unless to do so would infringe upon the rights of

other patients or residents, or unless medically contraindicated as

documented by the attending physician in the medical record by the

attending physician or a physician's assistant to whom the

physician has delegated the performance of medical care services.

Each nursing home patient or home for the aged resident shall be

provided with reasonable space. At the request of a patient, a

nursing home shall provide for the safekeeping of personal effects,

funds, and other property of a patient in accordance with section

21767, except that a nursing home is not required to provide for

the safekeeping of a property that would impose an unreasonable

burden on the nursing home.

     (d) A nursing home patient or home for the aged resident is

entitled to the opportunity to participate in the planning of his

or her medical treatment. A The attending physician or a

physician's assistant to whom the physician has delegated the

performance of medical care services shall fully inform the nursing

home patient shall be fully informed by the attending physician of

the patient's medical condition unless medically contraindicated as

documented by a physician in the medical record by a physician or a

physician's assistant to whom the physician has delegated the

performance of medical care services. Each nursing home patient

shall be afforded the opportunity to discharge himself or herself

from the nursing home.

     (e) A home for the aged resident may be transferred or

discharged only for medical reasons, for his or her welfare or that

of other residents, or for nonpayment of his or her stay, except as

provided by title XVIII or title XIX. A nursing home patient may be

transferred or discharged only as provided in sections 21773 to

21777. A nursing home patient or home for the aged resident is

entitled to be given reasonable advance notice to ensure orderly

transfer or discharge. Those actions shall be documented in the

medical record.

     (f) A nursing home patient or home for the aged resident is

entitled to be fully informed before or at the time of admission

and during stay of services available in the facility, and of the

related charges including any charges for services not covered

under title XVIII, or not covered by the facility's basic per diem

rate. The statement of services provided by the facility shall be

in writing and shall include those required to be offered on an as-

needed basis.

     (g) A nursing home patient or home for the aged resident is

entitled to manage his or her own financial affairs, or to have at

least a quarterly accounting of personal financial transactions

undertaken in his or her behalf by the facility during a period of

time the patient or resident has delegated those responsibilities

to the facility. In addition, a patient or resident is entitled to

receive each month from the facility an itemized statement setting

forth the services paid for by or on behalf of the patient and the

services rendered by the facility. The admission of a patient to a

nursing home does not confer on the nursing home or its owner,

administrator, employees, or representatives the authority to

manage, use, or dispose of a patient's property.

     (h) A nursing home patient or a person authorized by the

patient in writing may inspect and copy the patient's personal and

medical records. The records shall be made available for inspection

and copying by the nursing home within a reasonable time, not

exceeding 1 week, after the receipt of a written request.

     (i) If a nursing home patient desires treatment by a licensed

member of the healing arts, the treatment shall be made available

unless it is medically contraindicated, and the medical

contraindication is justified in the patient's medical record by

the attending physician or a physician's assistant to whom the

physician has delegated the performance of medical care services.

     (j) A nursing home patient has the right to have his or her

parents, if a minor, or his or her spouse, next of kin, or

patient's representative, if an adult, stay at the facility 24

hours a day if the patient is considered terminally ill by the

physician responsible for the patient's care or a physician's

assistant to whom the physician has delegated the performance of

medical care services.

     (k) Each nursing home patient shall be provided with meals

that meet the recommended dietary allowances for that patient's age

and sex and that may be modified according to special dietary needs

or ability to chew.

     (l) Each nursing home patient has the right to receive

representatives of approved organizations as provided in section

21763.

     (4) A nursing home, its owner, administrator, employee, or

representative shall not discharge, harass, or retaliate or

discriminate against a patient because the patient has exercised a

right protected under this section.

     (5) In the case of a nursing home patient, the rights

enumerated in subsection (2)(c), (g), and (k) and subsection

(3)(d), (g), and (h) may be exercised by the patient's

representative.

     (6) A nursing home patient or home for the aged resident is

entitled to be fully informed, as evidenced by the patient's or

resident's written acknowledgment, before or at the time of

admission and during stay, of the policy required by this section.

The policy shall provide that if a patient or resident is

adjudicated incompetent and not restored to legal capacity, the

rights and responsibilities set forth in this section shall be

exercised by a person designated by the patient or resident. The

health facility or agency shall provide proper forms for the

patient or resident to provide for the designation of this person

at the time of admission.

     (7) This section does not prohibit a health facility or agency

from establishing and recognizing additional patients' rights.

     (8) As used in this section:

     (a) "Patient's representative" means that term as defined in

section 21703.

     (b) "Title XVIII" means title XVIII of the social security

act, 42 USC 1395 to 1395hhh 1395kkk-1.

     (c) "Title XIX" means title XIX of the social security act, 42

USC 1396 to 1396v 1396w-5.