Ohio Adm.Code 4731 | Ohio Administrative Code 4731 — State Medical Board

Chapter 4731-1 Limited Branches of Medicine or Surgery

Ohio Adm.Code 4731-1-01 Definition of terms.

(A) "Board" means the state medical board of Ohio.

(B) "Certificate of good standing" means a non-transferable certificate issued by the board to the person or persons signing the application on behalf of a limited branch school, college, or institution which states that it is in good standing with the board, pursuant to section 4731.16 of the Revised Code and this chapter of the Administrative Code.

(C) "Limited branch school, college or institution" means a facility wherein a course of instruction in massage therapy is offered.

(D) "MBLEx" means the massage and bodywork licensing examination as prepared by the federation of state massage therapy boards.

(E) "Distance education" means an instructional delivery system in which students and teachers are in separate locations and in which education and training are delivered through video, audio, computer, multimedia communications or some combination.

(F) "Home study" means a form of correspondence instruction through mail or e-mail in which the institution provides lesson materials for study and completion by a student on his or her own, with completed lessons being returned by the student to the school for evaluation by the school. "Home study" shall not be considered a form of distance education.

Last updated February 28, 2023 at 8:45 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-02 Application of rules governing limited branches of medicine or surgery.

(A) Rules adopted by the board governing the practice of limited branches of medicine apply to practitioners of those limited branches listed in sections 4731.15 and 4731.151 of the Revised Code.

(B) Any person holding a valid license to practice one or more of the limited branches of medicine is subject to disciplinary action by the board, and may additionally be subject to criminal prosecution, if such person performs acts beyond the scope of the limited branch for which the person holds a license or which otherwise violates the rules governing practitioners of limited branches of medicine.

(C) For purposes of division (B)(18) of section 4731.22 of the Revised Code, the code of ethics and standards of practice of the "American Massage Therapy Association" applies to all persons holding a license to practice massage therapy. The code of ethics may be obtained from the medical board's website at med.ohio.gov/.

Last updated November 19, 2025 at 11:19 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-03 General prohibitions.

(A) No person holding a license to practice a limited branch of medicine shall perform or hold himself or herself out as able to perform surgery, or any other act which involves a piercing or puncturing of the skin or membranous tissues of the human body unless specifically permitted under Chapter 4731. of the Revised Code or this chapter of the Administrative Code.

(B) No person holding a license to practice a limited branch of medicine shall prescribe, dispense, personally furnish or administer any drug or medicine.

(C) Except as is specifically permitted under the rules defining the scope of a limited branch of medicine, no person holding such a license shall diagnose or treat infectious, contagious or venereal diseases, or any wound, fracture or bodily injury, infirmity, or disease.

(D) The designation "Dr." or "Doctor" shall not precede the name of the limited practitioner. No person holding a license to practice a limited branch of medicine shall employ, or cause to be employed, the designation "Dr." or "Doctor" without also qualifying such designation by the name or an abbreviation of the limited branch for which the person holds a license. The appropriate designation must follow the name of the limited practitioner (e.g., "John Doe, Doctor of Mechanotherapy" or "John Doe, D.M.") and may be employed or caused to be employed by the limited practitioner only if the limited practitioner has received a degree granting such a title from a school legally empowered to grant the degree.

(E) No person holding a license to practice a limited branch of medicine shall employ, or cause to be employed, the designation "Physician" or "Surgeon" no matter how qualified or how employed in combination with other language.

(F) No person holding a license to practice any limited branch or branches of medicine shall hold himself or herself out as holding a license in or as being able to practice any limited branch of medicine for which that person does not hold a license.

(G) No person holding a license to practice any limited branch or branches of medicine shall conduct such practice under any name or title, either as an individual, company or concern, that is misleading.

Last updated February 28, 2023 at 8:45 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-04 Scope of practice: mechanotherapy.

(A) A practitioner of mechanotherapy shall examine patients only by verbal inquiry, examination of the musculoskeletal system by hand, and visual inspection and observation. A practitioner of mechanotherapy shall specifically not employ any techniques which involve extraction or analysis of body tissue or fluids.

(B) A practitioner of mechanotherapy shall not diagnose a patient's condition except as to whether or not there is a disorder of the musculoskeletal system present.

(C) A practitioner of mechanotherapy, in the treatment of patients, may apply only those techniques listed in this paragraph, but he may apply such techniques only to those disorders of the musculoskeletal system which are amenable to treatment by the listed techniques and which are identifiable by examination and diagnosis as described in this rule:

(1) Advised or supervised exercise;

(2) Massage or manipulation;

(3) Application of air, water, heat, cold, sound or infrared rays; or

(4) Electrical neuromuscular stimulation.

Last updated February 28, 2023 at 8:46 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-05 Scope of practice: massage therapy.

(A) Massage therapy is the treatment of disorders of the human body by the manipulation of soft tissue through the systematic external application of massage techniques including touch, stroking, friction, vibration, percussion, kneading, stretching, compression, and joint movements within the normal physiologic range of motion; and adjunctive thereto, the external application of water, heat, cold, topical preparations, and mechanical devices.

(B) A massage therapist shall not diagnose a patient's condition. A massage therapist shall evaluate whether the application of massage therapy is advisable. A massage therapist may provide information or education consistent with that evaluation, including referral to an appropriate licensed health care professional, provided that any form of treatment advised by a massage therapist falls within the scope of practice of, and relates directly to a condition that is amenable to treatment by, a massage therapist. In determining whether the application of massage therapy is advisable, a massage therapist shall be limited to taking a written or verbal inquiry, visual inspection including observation of range of motion, touch, and the taking of a pulse, temperature and blood pressure.

(C) No person shall use the words or letters "massage therapist," "licensed massage therapist," "L.M.T." or any other letters, words, abbreviations, or insignia, indicating or implying that the person is a licensed massage therapist without a valid license under Chapter 4731. of the Revised Code.

(D) A massage therapist may perform the following services in compliance with the following:

(1) A massage therapist may treat temporomandibular joint dysfunction provided that the patient has been directly referred in writing for such treatment to the massage therapist by a physician currently licensed pursuant to Chapter 4731. of the Revised Code, by a chiropractor currently licensed pursuant to Chapter 4734. of the Revised Code, or a dentist currently licensed pursuant to Chapter 4715. of the Revised Code.

(2) A massage therapist may apply ultrasound, diathermy, electrical neuromuscular stimulation, or substantially similar modalities provided that the patient has been directly referred in writing for such treatment to the massage therapist by a physician or podiatric physician licensed under Chapter 4731. of the Revised Code, physician assistant licensed under Chapter 4730. of the Revised Code, chiropractor licensed under Chapter 4734. of the Revised Code, advanced practice registered nurse licensed under Chapter 4723. of the Revised Code, or physical therapist licensed under Chapter 4755. of the Revised Code, who is acting within the scope of their professional license.

(a) The massage therapist must perform the modality within the minimal standards of care.

(b) If the food and drug administration classifies the device as a prescription device, as that term is defined in 21 CFR 801.109 amended as of June 15, 2016, or a restricted device that can only be sold, distributed, or used upon the order of an authorized healthcare provider, the massage therapist's application of the device must be done under the on-site supervision of the referring practitioner.

(c) If the food and drug administration classifies the device as an over-the-counter device, the massage therapist may apply the device without the on-site supervision of the referring practitioner.

(E) All persons who hold a license to practice massage therapy issued pursuant to section 4731.17 of the Revised Code shall prominently display that license in the office or place where a major portion of the license holder's practice is conducted. If a license holder does not have a primary practice location, the license holder shall at all times when practicing keep either the wall certificate on the holder's person or provide verification of licensure status from the board's internet web site upon request.

(F) Massage therapy does not include:

(1) Colonic irrigation;

(2) The practice of chiropractic, including the application of a high velocity-low amplitude thrusting force to any articulation of the human body;

(3) The use of graded force applied across specific joint surfaces for the purpose of breaking capsular adhesions;

(4) The prescription of therapeutic exercise for the purpose of rehabilitation or remediation of a disorder of the human body;

(5) The treatment of infectious, contagious or venereal diseases;

(6) The prescription, dispensing, personally furnishing or administration of drugs; and

(7) The performance of surgery or practice of medicine in any other form.

(G) As used within this rule:

(1) "External" does not prohibit a massage therapist from performing massage therapy inside the mouth or oral cavity; and

(2) "Mechanical devices" means any tool or device which mimics or enhances the actions possible by the hands that is within the scope of practice as defined in section 4731.04 of the Revised Code and this rule.

Last updated November 19, 2025 at 11:20 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-06 Scope of practice: naprapathy.

Naprapathy is the treatment of diseased spinal connective tissue and ligaments by hand only. A practitioner of naprapathy shall not examine patients except by written and verbal inquiry, visual inspection and observation, and touch. Such practitioners shall not diagnose a patient's condition, but may determine whether or not application of naprapathy is advisable.

Last updated November 19, 2025 at 11:20 AM

History

Effective: December 24, 1992
Promulgated Under: Ch 119.

Ohio Adm.Code 4731-1-12 Application and examination for certificate to practice massage therapy.

(A) No application shall be considered complete until the applicant has complied with the requirements of paragraph (A) of rule 4731-4-02 of the Administrative Code and the board has received the results of criminal records checks and any other forms required to be submitted pursuant to paragraph (A) of rule 4731-4-02 of the Administrative Code.

(B) All applicants seeking a license to practice massage therapy who meet the requirements of section 4731.19 of the Revised Code, shall apply to the board in compliance with section 4731.19 of the Revised Code.

(C) Any person seeking a license to practice massage therapy shall have passed the MBLEx available through the federation of state massage therapy boards.

(1) An applicant for the MBLEx shall apply directly to the federation of state massage therapy boards.

(2) The passing performance for the examination as reported by the federation of state massage therapy boards shall constitute successful completion of the examination.

Last updated February 28, 2023 at 8:46 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-15 Massage therapy educational requirements and determination of standing of school, college or institution.

(A) For purposes of this rule, "hours" as used in section 4731.19 of the Revised Code, means a period of sixty minutes with a minimum of fifty minutes of instruction.

(B) A person seeking a license to practice massage therapy must hold one of the following:

(1) A diploma or certificate from a limited branch school, college or institution located in Ohio that held a certificate of good standing at the time the person obtained the diploma or certificate.

(2) A diploma or certificate from a limited branch school, college, or institution located outside of Ohio that held a certificate of good standing at the time the person obtained the diploma or certificate.

(3) A diploma or certificate from a limited branch school, college, or institution located outside of Ohio that required the completion of a course of instruction meeting the requirements section 4731.19 of the Revised Code. No more than one-half of the course of instruction required by section 4731.19 of the Revised Code may have been provided via distance education.

(4) During the five-year period immediately preceding the date of application, a current license, registration, or certificate in good standing in another state for massage therapy.

(C) A person desiring to have the board determine the standing of a limited branch school, college, or institution shall file an application for a certificate of good standing in the form and manner prescribed by the board. The completed application shall be signed by the owner or owners and shall provide evidence of the following:

(1) If the limited branch school, college or institution is located in this state, that:

(a) It holds a certificate of authorization issued by the Ohio department of higher education pursuant to Chapter 1713. of the Revised Code; or

(b) It holds a valid certificate of registration and a valid program authorization for the program in the limited branch of medicine issued by the state board of career colleges and schools pursuant to Chapter 3332. of the Revised Code; or

(c) It holds a certificate of authorization issued by the Ohio department of education, division of career/technical adult education; and

(d) It offers a course of instruction in compliance with section 4731.19 of the Revised Code. No more than one-half of the course of instruction required by section 4731.19 of the Revised Code may be provided via distance education.

(e) It requires that each student, prior to completing the course of instruction, perform, on a licensed massage therapist, at least one therapeutic massage. The school shall ensure that the student massage is evaluated as to whether the student demonstrates at least minimally acceptable competency.

(2) If the limited branch school, college or institution is located outside this state, that:

(a) It holds a current or valid registration authorizing its operation issued by the appropriate regulatory body in the state of location that is substantially equivalent to the department of higher education, the state board of career colleges and schools, or the department of education in this state; or

(b) Approval or recognition by the state board or agency authorized to regulate the limited branch of medicine in the state in which the limited branch school, college, or institution is located; or

(c) In the event that the limited branch school, college, or institution is located in a state that does not approve or recognize such facilities or educational programs, approval by the federation of state massage therapy boards for purposes of permitting graduates to sit for the MBLEx; and

(D) At or before the time a school, college or institution in this state accepts a student for admission to a massage therapy course of instruction, the school, college or institution shall provide the student with written notice that arrests, charges, or convictions of criminal offenses may be cause to deny or limit licensure or employment opportunities in specific careers and occupations and may limit the student's ability to obtain federal, state, and other financial aid. The notice shall direct students to the explanatory statement and disqualifying offense list on the board's website at www.med.ohio.gov/The-Board/Disqualifying-Criminal-Convictions.

(E) An application for a certificate of good standing shall be signed by all owners and may not be signed by a person who has been found guilty of a felony or a crime involving moral turpitude, or by a person who has been disciplined by the board pursuant to section 4731.22 of the Revised Code.

(F) The board may refuse to issue, suspend, place on probation, revoke, or permanently revoke a certificate of good standing for any one or any combination of the following causes:

(1) Non-compliance with or failure to fulfill the provisions of this chapter of the Administrative Code or applicable provisions of Chapter 4731. of the Revised Code;

(2) Furnishing of false, misleading, or incomplete information requested by the board;

(3) Violation of state or federal laws including discrimination in the acceptance and education of students upon the basis of race, color, religion, sex, or national origin.

(G) If the board refuses to issue, suspend, place on probation, revoke, or permanently revoke a certificate of good standing, the applicant or the certificate holder shall be entitled to a hearing. Notice and hearing requirements will be in compliance with the provisions of Chapter 119. of the Revised Code and any rules adopted by the board.

(H) In determining the effective date of any suspension, revocation, or permanent revocation of a certificate, the board shall take into consideration those students currently enrolled in the course of instruction.

(I) The certificate of good standing issued pursuant to this rule is valid for two years from the date of issuance. It may be renewed upon the holder's submission of evidence demonstrating that the requirements of paragraph (C) of this rule are satisfied as determined by the board.

Last updated February 28, 2023 at 8:46 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-1-17 Instructional staff in Ohio cosmetic therapy and massage therapy programs.

(A) An instructor in limited branch theory or clinical practice shall be a high school graduate or equivalent, shall be currently licensed in Ohio in the applicable limited branch and shall have practiced in the applicable limited branch for a minimum of three years.

(B) A classroom instructor teaching basic science or general education courses shall hold a bachelor's degree with a concentration in the discipline in which that instructor is providing instruction. The requirements of this paragraph may be waived for faculty who, on the date this rule becomes effective, have taught the course for more than one year at a limited branch school that holds a certificate of good standing issued by the board.

(1) Hold at least a bachelor's degree with a concentration in business;

(2) Have experience in a massage therapy business gained as an owner and operator of a massage therapy business for a minimum of three years;

(3) Have experience in a massage therapy business gained as a manager of a massage therapy business for a minimum of three years.

Last updated February 28, 2023 at 8:46 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Chapter 4731-2 Notice of Adoption, Amendment, or Rescission of Rules

Ohio Adm.Code 4731-2-01 Public notice of rules procedures.

(A) Prior to proposing to adopt, amend, or rescind any rule by the state medical board, public notice shall be given at least thirty days prior to the date set for the public hearing , by publication of that notice in the register of Ohio. The notice shall include a statement of the board's intention to consider adopting, amending, or rescinding a rule; a synopsis of the proposed rule, amendment, or rule to be rescinded or a general statement of the subject matter of the proposed rule, amendment or rescission; a statement of the reason or purpose for adopting, amending, or rescinding the rule; and the date, time, and place of the public hearing on the proposed action.

(B) The board may give whatever other notice it reasonably considers necessary including, but not limited to, the following:

(1) The board shall post the notice of the public rules hearing on the board's web site. The board may also post the full text of the proposed rules on its web site.

(2) The board may maintain a mailing list of all persons who have made a prior written request to receive a copy of each public notice provided for in paragraph (A) of this rule, and copies of such notices shall be sent by regular mail or electronic mail to each person on the mailing list at least thirty days prior to the date set for the hearing. Upon request, the board shall also promptly send a copy of any notice provided for in paragraph (A) of this rule by regular mail or electronic mail to any person not appearing on its mailing list. The board may assess a reasonable fee, not to exceed the cost of copying and mailing, for notices sent to persons according to this rule.

(3) Copies of the notice of the public rules hearing and the full text of the proposed rules shall be available at the board's offices at least thirty days prior to the date of the public rules hearing.

(C) Prior to the effective date of a rule, amendment, or rescission, the board shall make a reasonable effort to inform those affected by the rule, amendment, or rescission. The method of notification may include posting the full text of the rule as adopted or amended on the board's web site, publishing the rules in the board's newsletter, and/or sending by regular mail or electronic mail a notice of the action to all persons whose name appears on the mailing list maintained by the board under paragraph (A) of this rule, or to any person or his attorney who provided evidence, oral testimony, and/or a written statement which were made part of the record of the public hearing held under section 119.03 of the Revised Code. The board may assess a reasonable fee, not to exceed the cost of copying and mailing, for notices sent to persons in accordance with this rule.

Last updated February 28, 2023 at 12:48 PM

History

Effective: December 7, 2017
Promulgated Under: 119.03

Chapter 4731-4 Criminal Records Checks

Ohio Adm.Code 4731-4-01 Definitions.

(A) "Applicant for an initial license or certificate to practice" includes a person seeking an initial license or certificate to practice under Chapter 4730., 4731., 4759., 4760. , 4761., 4762., 4774., 4778., or 4796. of the Revised Code.

(B) "Applicant for a restored license or certificate to practice" includes a person seeking restoration of a license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774., or 4778. of the Revised Code.

(C) "Applicant for a reactivated license or certificate to practice" includes a person seeking to reactivate a retired license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774., or 4778. of the Revised Code.

(D) "Criminal records check" has the same meaning as in division (G) of section 109.572 of the Revised Code.

(E) BCI means the "Ohio Bureau of Criminal Identification and Investigation."

(F) "FBI" means the "Federal Bureau of Investigation."

Last updated February 2, 2026 at 8:03 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-4-02 Criminal records checks.

(A) An applicant for an initial license or certificate to practice, for a reactivated license or certificate to practice, or for a restored license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4760, 4761., 4762., 4774., 4778., or 4796. of the Revised Code, shall submit fingerprints, required forms, and required fees to BCI for completion of BCI and FBI criminal records checks.

(1) An applicant who is present in Ohio shall use the services of an entity that has been designated by the Ohio attorney general to participate in the "National WebCheck" program (available at http://www.ohioattorneygeneral.gov/) and pay any processing fee charged by the entity, with the "State Medical Board of Ohio" designated to receive the results:

(2) An applicant who resides in a state or jurisdiction other than Ohio shall either appear in Ohio in order to comply with the requirements of paragraph (A)(1) of this rule or request that the board provide the forms required to complete the criminal records checks.

Upon receipt of the forms, the applicant shall have his or her fingerprints processed and pay any applicable processing fees.

(B) The board shall maintain the criminal records check reports in a manner that ensures the confidentiality of the results, prevents disclosure pursuant to a public records request, and complies with applicable state and federal requirements.

(D) In reviewing the results of criminal records checks to determine whether the applicant should be granted a reactivated or restored license or certificate to practice, the board may consider all of the following:

(1) The nature and seriousness of the crime;

(2) The extent of the applicant's past criminal activity;

(3) The age of the applicant when the crime was committed;

(4) The amount of time that has elapsed since the applicant's last criminal activity;

(5) The conduct and work activity of the applicant before and after the criminal activity;

(6) Whether the applicant has completed the terms of any probation or deferred adjudication;

(7) Evidence of the applicant's rehabilitation;

(8) Whether the applicant fully disclosed the arrest or conviction to the board; and

(9) Any other factors the board considers relevant.

(E) In reviewing the results of criminal records checks to determine whether an applicant should be granted an initial license or certificate to practice, the board shall comply with section 9.79 of the Revised Code.

Last updated February 2, 2026 at 8:03 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Chapter 4731-6 Medical or Osteopathic License

Ohio Adm.Code 4731-6-01 Definitions.

As used in Chapter 4731-6 of the Administrative Code, the following definitions are applicable:

(A) "AOA" means the American osteopathic association.

(B) "Board" means the state medical board of Ohio.

(C) "COMLEX-USA" means the comprehensive osteopathic medical licensing examination prepared by the national board of osteopathic medical examiners.

(D) "COMVEX-USA" means the comprehensive osteopathic medical variable purpose examination prepared by the national board of osteopathic medical examiners.

(E) "ECFMG" means the educational commission for foreign medical graduates.

(F) "FCVS" means the federation credentials verification service.

(G) "Federation" means the federation of state medical boards of the United States, Inc.

(H) "FLEX" means the federation licensing examination as prepared by the federation.

(I) "LCME" means the liaison committee on medical education.

(J) "License" means a license to practice medicine and surgery or osteopathic medicine and surgery issued under section 4731.14 of the Revised Code.

(K) "Medical and osteopathic examinations" means the examinations to determine competency to practice medicine and surgery or osteopathic medicine and surgery under section 4731.09 of the Revised Code.

(L) "SPEX" means the special purpose examination as prepared by the federation.

(M) "TOEFL iBT" means the test of spoken English of the educational testing service.

(N) "Training Program" means an internship, residency, clinical fellowship, or elective clinical rotation that meets the requirements of division (A)(2) of section 4731.291 of the Revised Code.

(O) "USMLE" means the United States medical licensing examination as prepared by the federation and the national board of medical examiners in a joint program.

Last updated November 4, 2025 at 2:15 PM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-02 Preliminary education for medical and osteopathic licensure.

(A) The following constitutes prima facie evidence that an applicant for a license has met the requirements of divisions (A)(2) and (A)(3) of section 4731.09 of the Revised Code.

(1) The applicant holds a diploma from a medical or osteopathic medical school that, at the time the diploma was issued, was a medical school accredited by the LCME or an osteopathic medical school accredited by the AOA; or

(2) The applicant holds certification from the ECFMG.

(B) Sixty semester hours or its equivalent shall be considered two years of undergraduate work as required by division (A)(3) of section 4731.09 of the Revised Code.

Last updated August 14, 2025 at 10:26 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-04 Demonstration of proficiency in spoken English.

Demonstration of proficiency in spoken English, pursuant to section 4731.142 of the Revised Code, requires successful completion of the "Test of English as a Foreign Language, Internet-based Test" ("TOEFL iBT"). Successful completion of the TOEFL iBT requires a total score of ninety or higher and the following minimum scores or higher by section:

(A) Writing: no minimum;

(B) Speaking: twenty-six;

(D) Reading: no minimum.

Last updated February 28, 2023 at 12:48 PM

History

Effective: February 28, 2008
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-05 Medical and osteopathic examination.

(A) The medical and osteopathic examinations shall be all steps of the USMLE or all levels of the COMLEX-USA.

(B) An applicant shall have passed all steps of the USMLE or all levels of the COMLEX-USA within a ten-year period, and achieved a recognized passing performance on each step or level. No applicant may have exceeded the maximum number of attempts for any step or level established by the national board of medical examiners or the national board of osteopathic medical examiners, as effective on the date of application for a license.

(C) The board may waive the requirements of paragraph (B) of this rule, if the applicant meets one or more of the following, as applicable:

(1) Holds current specialty board certification from a member board of the American board of medical specialties or the AOA; or

(2) Demonstrates that a step or level was completed within the maximum number of attempts permitted by the national board of medical examiners or the national board of osteopathic medical examiners, at the time the step or level was successfully completed, provided that the applicant did not exceed six attempts for the step or level.

(3) Demonstrates good cause, as determined by the board, for not having passed all steps or levels with a ten-year period.

(4) Steps or levels of the USMLE and COMLEX-USA cannot be combined to fulfill an acceptable testing sequence as required by this rule.

Last updated January 31, 2022 at 8:52 AM

History

Effective: January 31, 2022
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-14 Eligibility for licensure.

(A) The board shall issue a license to each individual who meets all applicable requirements under section 4731.09 of the Revised Code, and who passes the medical and osteopathic examination in accordance with rule 4731-6-05 of the Administrative Code, or has passed one of the following examinations:

(B)

(1) One of the following examination sequences, with all steps, parts, levels or components having been administered prior to January 2000. The score achieved on each step, part, level or component must have equaled or exceeded the figure established by the USMLE program, the national board of medical examiners, the national board of osteopathic medical examiners or the federation as a passing score for that step, part, level or component, respectively.

(a) Part I of the national board of medical examiners examination or step 1 of the USMLE, part II of the national board of medical examiners examination or step 2 of the USMLE, and part III of the national board of medical examiners examination or step 3 of the USMLE or component 2 of the FLEX; or

(b) Part I of the national board of osteopathic medical examiners examination or level 1 of the COMLEX-USA, part II of the national board of osteopathic medical examiners examination or level 2 of the COMLEX-USA, and part III of the national board of osteopathic medical examiners examination or level 3 of the COMLEX-USA.

(2) Component 1 of the FLEX and step 3 of the USMLE. The component and step must have been administered prior to January 2000. A score of seventy-five or above must have been achieved on component 1. The performance achieved on step 3 must have been recognized by the USMLE program as a recommended passing performance; or

(3) Component 1 and 2 of the FLEX. Both components must have been administered after June 1985 and prior to January 2000. A score of seventy-five or above must have been achieved on each component. Both components must have been passed within a seven year period; or

(4) A written state medical board of the United States licensing examination other than the FLEX, USMLE or COMLEX-USA administered prior to June 1982 without previous or subsequent FLEX, USMLE or COMLEX-USA failure; or

(5) A single three day FLEX administered prior to June 1985. The FLEX-weighted average score must be seventy-five or above for the entire examination, or must be seventy-two or above if the examination was taken during the first two years of a state's administration of the FLEX and such score was accepted by that state as a passing score; or

(6) A written examination provided by the national board of osteopathic medical examiners for an administering state.

Last updated November 4, 2025 at 2:15 PM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-21 Application procedures for license issuance; investigation.

(A) Pursuant to division (B) of section 4731.09 of the Revised Code, all applicants for a license shall submit to the board an application under oath in the manner determined by the board, and provide such other facts and materials as the board requires. No application shall be considered submitted to the board until the appropriate fee has been received by the board.

(B) Except for applicants applying for a license under section 4731.299 of the Revised Code, all applicants for a license shall cause the FCVS to release the applicant's "Physician Information Profile" to the board.

(C) No application submitted to the board shall be considered complete until the applicant has complied with the requirements of paragraph (A) of rule 4731-4-02 of the Administrative Code and the board has received the results of the criminal records checks.

(D) The board reserves the right to thoroughly investigate all materials submitted as part of an application. The board may contact individuals, agencies, or organizations for recommendations or other information about applicants as the board deems necessary. Applicants may be requested to appear before the board or a representative thereof as part of the application process.

Last updated August 14, 2025 at 10:26 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-22 Abandonment and withdrawal of applications.

(A) If an applicant for any license or certificate issued under section 4731.14, 4731.222, 4731.281, 4731.291, 4731.293, 4731.294, 4731.295, 4731.297. 4731.298, or 4731.299, or Chapter 4796. of the Revised Code, or a reactivation from retired status under section 4731.283 of the Revised Code fails to complete the application process within six months of initial application filing, the board may notify the applicant in writing of its intention to consider the application abandoned. If no response to that notice is received by the board within thirty days, the board shall consider the application as abandoned and no further processing shall be undertaken with respect to that application.

(B) If an applicant for a license under section 4731.11 of the Revised Code fails to complete the application process within the timeframe specified in the interstate compact commission rule, the board may notify the applicant in writing of its intention to consider the application abandoned or withdrawn.

(C) If the application process extends for a period longer than six months, the board may require updated information as it deems necessary.

(D) No application being investigated under section 4731.22 of the Revised Code, may be withdrawn without approval of the board.

(E) Application fees are not refundable.

Last updated October 31, 2025 at 7:34 AM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-30 Training certificates.

(A) A training certificate is mandatory for participation in a training program unless the participant holds a license to practice medicine and surgery or osteopathic medicine and surgery. The participation in the programs prior to receiving an acknowledgment letter or a training certificate from the board is the unlicensed practice of medicine pursuant to section 4731.34 of the Revised Code.

(B) An individual may not begin participation in a training program unless the individual has been issued one of the following:

(1) A diploma from an LCME accredited medical school or AOA accredited osteopathic medical school;

(2) An ECFMG certificate or a fifth pathway certificate; or

(3) A fifth pathway certificate.

(C) Evidence that the applicant for a training certificate has been accepted or appointed to a training program meeting the requirements of division (A)(2) of section 4731.291 of the Revised Code must include a certification from the training program of both of the following:

(1) The training program will verify that the applicant has been issued a diploma, ECFMG certificate, or a fifth pathway certificate before permitting the applicant to begin participation in the training program; and

(2) The training program will notify the board if a holder of a training certificate has not been issued a diploma, an ECFMG certificate, or a fifth pathway certificate before the start date of the training program.

(D) The holder of a training certificate shall immediately notify the board in writing if the holder has not been issued a diploma, an ECFMG certificate, or a fifth pathway certificate before the start date of the training program.

(E) Upon the board's receipt of an application for a training certificate, or upon the board's receipt of written notice from an applicant for a license that the applicant intends to participate in a training program, and after verifying that the applicant has paid the appropriate fee, the board may issue to the applicant an acknowledgment letter. Fees are neither refundable nor transferable.

(1) Upon receipt of that acknowledgment letter, the applicant may begin participating in the training program that meets the requirements of section 4731.291 of the Revised Code, and this chapter of the Administrative Code, to which the applicant has been appointed while the application is being processed. The acknowledgment letter will serve as proof that the board has received the application and that the applicant is entitled to continue participation in the training program.

(2) If an applicant has not received an acknowledgment letter or training certificate from the board within forty-five days after submitting an application, then the applicant shall immediately inform the board and the director of his or her training program in writing.

(3) An acknowledgment letter issued under this rule shall authorize participation in a training program for one hundred twenty days, unless prior to that time the board:

(a) Issues the certificate;

(b) Issues an order in accordance with Ohio law suspending without a prior hearing the authority to participate;

(d) Issues a notice of opportunity for hearing in accordance with Chapter 119. of the Revised Code, in which case the authority to participate shall continue until the board's issuance of a final order granting or denying the application, or until the end of the training year, whichever comes first; or

(e) In the case of an applicant for a license, advises the applicant in writing that a substantial question of a violation of this chapter or the rules adopted under it exists and that investigation is continuing, in which case the authority to participate shall continue until one of the following occur:

(i) The board issues a license;

(ii) The board issues a final order in accordance with Chapter 119. of the Revised Code; or

(iii) The training year ends.

Except as provided in this rule, participation in a training program pursuant to an acknowledgment letter cannot be renewed or extended beyond one hundred twenty days.

(F) If at the end of one hundred twenty days following issuance of an acknowledgment letter to an applicant for a training certificate the board has commenced but not yet concluded investigation or inquiry into issues of possible violations of Chapter 4731. of the Revised Code, it shall issue a training certificate to the applicant but shall not be deemed to have waived any issues which would constitute grounds to impose discipline under Chapter 4731. of the Revised Code.

(G) If the applicant or training certificate holder changes training programs, the board must be notified in writing immediately. A new application need not be completed and a new training certificate will not be issued. The training certificate will continue to be valid until its date of expiration.

(H) A person who holds a suspended license to practice medicine and surgery or osteopathic medicine and surgery is not eligible for a training certificate. Such a person must restore that license in accordance with sections 4731.222 and 4731.281 of the Revised Code before beginning postgraduate training in Ohio. A person whose license to practice medicine and surgery or osteopathic medicine and surgery has been permanently revoked or permanently denied is ineligible to participate in a training program in Ohio.

Last updated October 31, 2025 at 7:34 AM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-33 Special activity certificates.

(A) A special activity certificate shall not be issued for purposes of locum tenens.

(B) For purposes of meeting the requirement of division (B)(1)(c) of section 4731.294 of the Revised Code, the applicant must have done one of the following:

(1) Passed step 3 of the USMLE or level 3 of the COMLEX-USA, as applicable. All three steps must have been passed in accordance with rule 4731-6-05 of the Administrative Code; or

(2) Passed the SPEX or the COMVEX-USA.

(C) The determination that an applicant's practice in conjunction with the special activity program or event will be in the public interest and that a special activity certificate can thus be issued shall be made by the secretary of the board or, in his or her absence, by another member designated by the board. In making that determination, the secretary of the board or board designee shall take into consideration the nature and length of the activity, the existence of any information warranting investigation prior to issuance of a certificate, the number of prior special activity certificates issued to the applicant, and any available information regarding prior performance while practicing in this state.

(D) If the application is complete and the secretary or board designee refuses or fails to authorize issuance of a special activity certificate prior to the initial date of the activity program or event, the special activity certificate application shall be deemed converted to an application for a full license to practice medicine and surgery or osteopathic medicine and surgery to be processed under the provisions of Chapter 4731. of the Revised Code and this chapter of the Administrative Code. Failure to submit additional required fees or information required for full licensure may result in the application being considered abandoned as provided under rule 4731-6-22 of the Administrative Code.

(E) An individual may only apply six times within a consecutive two year period for a special activity certificate.

Last updated August 14, 2025 at 10:26 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Ohio Adm.Code 4731-6-34 Volunteer certificates.

(A) For purposes of meeting the requirement of division (C)(3) of section 4731.295 of the Revised Code, good standing means the authority to practice medicine and surgery or osteopathic medicine and surgery without government restriction or limitation.

(B) For purposes of issuance of a volunteer's certificate, an applicant shall be considered retired from practice if the applicant's license has been surrendered or allowed to expire with the intention of ceasing to practice medicine and surgery or osteopathic medicine and surgery for remuneration in this or any other state, without request to do so by the proper licensing authority of the state and without knowledge that the applicant is the subject of an active investigation by the proper licensing authority of the state.

(C) The board may require the applicant to demonstrate present fitness to practice in the manner provided in section 4731.222 of the Revised Code before issuing a volunteer's certificate to an applicant whose license has been in an inactive status for more than two years or who has not been engaged in the active practice of the applicant's profession for more than two years.

Last updated November 4, 2025 at 2:15 PM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Chapter 4731-7 Notice of Meetings

Ohio Adm.Code 4731-7-01 Method of notice of meetings.

(A) Any person may determine the time and place of all regularly scheduled meetings and the time, place, and purpose of all special meetings by:

(1) Writing the state medical board of Ohio (hereinafter, "board") at its business address;

(2) Calling the board at its business office during normal business hours;

(3) Checking the board's public website.

(B) A representative of the news media may obtain notice of all special meetings by requesting that notice be provided and supplying a regular mail or electronic mail address.

(1) If a special meeting not of an emergency nature, the board shall notify all media representatives who have requested notice of the meeting by doing at least one of the following:

(a) Sending written notice, by regular mail or electronic mail, no later than twenty-four hours prior to the special meeting;

(b) Notifying representatives by telephone no later than twenty-four hours prior to the special meeting. Telephone notice shall be complete if a message has been left for the representative, or if, after reasonable effort, the board has been unable to provide telephone notice;

(2) If a special meeting of an emergency nature requiring immediate official action is scheduled, the board shall notify all media representatives who have requested notice of such meeting of the time, place and purpose of the meeting by providing notice as described in paragraph (B)(2) of this rule, or by notifying the clerk of the state house press room. In such event, the notice shall be given immediately upon the meeting date and time being scheduled.

(C) Persons who have requested, in writing, advance notification of all meetings of the board at which specific public matters are scheduled to be discussed shall be placed on the board's agenda mailing list. The board shall, within a reasonable time prior to each meeting, send to those persons on the list either an agenda of the meeting by regular mail or a notice via electronic mail that the agenda is posted on the board's website. The board may assess a reasonable fee, not to exceed the cost of copying and mailing, for notices via regular mail.

Last updated February 11, 2025 at 9:07 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Chapter 4731-8 Personal Information Systems

Ohio Adm.Code 4731-8-01 Personal information systems.

(A) All personal information systems of the state medical board shall be maintained in accordance with Chapter 1347. of the Revised Code.

(B) The executive director of the state medical board shall designate one or more persons to be directly responsible for the personal information systems maintained by the state medical board;

(C) An employee who initiates or otherwise contributes to any disciplinary or other punitive action against any individual who brings to the attention of appropriate authorities, the press, or any member of the public, evidence of unauthorized use of information contained in the medical board's personal information systems shall be disciplined at the discretion of the executive director and in a manner which he or she deems appropriate.

(D) If personal information contained in the medical board's personal information systems is not accurate, relevant, timely, and complete, this fact shall be directed to the attention of the executive director's designee(s), who shall take such action as is deemed appropriate concerning the information system in order to assure fairness in any determination made with respect to the person on the basis of the information.

(E) The state medical board shall collect only personal information that is necessary and relevant to the functions that the board is required to perform by statute, ordinance, code, or rule. The executive director's designee(s) shall eliminate personal information from the system when it is determined that the information is no longer necessary and relevant to those functions.

Last updated August 4, 2026 at 10:38 AM

History

Effective: June 30, 2005
Promulgated Under: 119.03

Ohio Adm.Code 4731-8-02 Definitions.

For the purposes of administrative rules promulgated in accordance with section 1347.15 of the Revised Code, the following definitions apply:

(A) "Access" as a noun means an instance of copying, viewing, or otherwise perceiving whereas "access" as a verb means to copy, view, or otherwise perceive.

(B) "Acquisition of a new computer system" means the purchase of a "computer system," as defined in this rule, that is not a computer system currently in place nor one for which the acquisition process has been initiated as of the effective date of the board rule addressing requirements in section 1347.15 of the Revised Code.

(C) "Computer system" means a "system," as defined by section 1347.01 of the Revised Code, that stores, maintains, or retrieves personal information using electronic data processing equipment.

(D) "Confidential personal information" has the meaning as defined by division (A)(1) of section 1347.15 of the Revised Code and identified by rules promulgated by the board in accordance with division (B)(3) of section 1347.15 of the Revised Code that reference the federal or state statutes or administrative rules that make personal information maintained by the board confidential.

(E) "Employee" means each employee of the board regardless of whether he/she holds an elected or appointed office or position within the board. "Employee" is limited to the specific employing state agency.

(F) "Incidental contact" means contact with the information that is secondary or tangential to the primary purpose of the activity that resulted in the contact.

(G) "Individual" means a natural person or the natural person's authorized representative, legal counsel, legal custodian, or legal guardian.

(H) "Information owner" means the individual appointed in accordance with division (A) of section 1347.05 of the Revised Code to be directly responsible for a system.

(I) "Person" means a natural person.

(J) "Personal information" has the same meaning as defined in division (E) of section 1347.01 of the Revised Code.

(K) "Personal information system" means a "system" that "maintains" "personal information" as those terms are defined in section 1347.01 of the Revised Code. "System" includes manual and computer systems.

(L) "Research" means a methodical investigation into a subject.

(M) "Routine" means commonplace, regular, habitual, or ordinary.

(N) "Routine information that is maintained for the purpose of internal office administration, the use of which would not adversely affect a person" as that phrase is used in division (F) of section 1347.01 of the Revised Code means personal information relating to employees and maintained by the board for internal administrative and human resource purposes.

(O) "System" has the same meaning as defined by division (F) of section 1347.01 of the Revised Code.

(P) "Upgrade" means a substantial redesign of an existing computer system for the purpose of providing a substantial amount of new application functionality, or application modifications that would involve substantial administrative or fiscal resources to implement, but would not include maintenance, minor updates and patches, or modifications that entail a limited addition of functionality due to changes in business or legal requirements.

(Q) "Board" means the "State Medical Board of Ohio."

(R) "Secretary" means the member of the board who is elected under section 4731.02 of the Revised Code to serve as the secretary or a member of the board who is appointed by the board president to act on a temporary basis in lieu of the elected secretary.

(S) "Supervising Member" means the member of the board who is elected under section 4731.02 of the Revised Code to serve as supervising member or a member of the board appointed by the board president to act on a temporary basis in lieu of the elected supervising member.

Last updated August 4, 2026 at 10:38 AM

History

Effective: December 31, 2010
Promulgated Under: 119.03

Ohio Adm.Code 4731-8-03 Procedures for accessing confidential personal information.

For personal information systems, whether manual or computer systems, that contain confidential personal information, the board shall do the following:

(A) Establish criteria for accessing confidential personal information. Personal information systems of the board are managed on a "need-to-know" basis whereby the information owner determines the level of access required for an employee of the board to fulfill his/her job duties. The determination of access to confidential personal information shall be approved by the employee's supervisor and the information owner prior to providing the employee with access to confidential personal information within a personal information system. The board shall establish procedures for determining a revision to an employee's access to confidential personal information upon a change to that employee's job duties including, but not limited to, transfer or termination. Whenever an employee's job duties no longer require access to confidential personal information in a personal information system, the employee's access to confidential personal information shall be removed.

(B) Respond to an individual's request for a list of confidential personal information. Upon the signed written request of any individual for a list of confidential personal information about the individual maintained by the board, the board shall do all of the following:

(1) Verify the identity of the individual by a method that provides safeguards commensurate with the risk associated with the confidential personal information;

(2) Provide to the individual the list of confidential personal information that does not relate to an investigation about the individual or is otherwise not excluded from the scope of Chapter 1347. of the Revised Code; and

(3) Inform the individual that the board has no confidential personal information about the individual that is responsive to the individual's request if all information maintained by the board relates to an investigation about that individual.

(C) Notify an individual whose confidential personal information maintained by the board is accessed for an invalid reason.

(1) Upon discovery or notification that confidential personal information of an individual has been accessed by an employee for an invalid reason, the board shall notify the individual whose information was invalidly accessed as soon as practical and to the extent known at the time. However, the board shall not notify the individual if the information is possessed and maintained pursuant to division (F)(5) of section 4731.22 of the Revised Code.

(a) The board shall delay notification for a period of time necessary to ensure that the notification would not delay or impede an investigation of invalid access or jeopardize homeland or national security.

(b) The board may delay the notification consistent with any measures necessary to determine the scope of the invalid access, including which individuals' confidential personal information invalidly was accessed, and to restore the reasonable integrity of the manual or computer system that contains the confidential personal information that was invalidly accessed.

(2) Notification provided by the board shall inform the individual of the type of confidential personal information accessed and, if known, the date(s) of the invalid access.

(3) Notification may be made by any method reasonably designed to accurately inform the person of the invalid access, including written, electronic, or telephone notice.

(D) Appoint a data privacy point of contact. The executive director of the board shall designate an employee of the board to serve as the data privacy point of contact. The data privacy point of contact shall work with the chief privacy officer within the state of Ohio's office of information technology to assist the board with both the implementation of privacy protections for the confidential personal information that the board maintains and compliance with section 1347.15 of the Revised Code and the rules adopted pursuant to the authority provided by that chapter.

(E) Complete a privacy impact assessment. The data privacy point of contact for the board shall timely complete the privacy impact assessment form developed by the office of information technology.

Last updated July 16, 2026 at 11:04 AM

History

Effective: December 31, 2010
Promulgated Under: 119.03

Ohio Adm.Code 4731-8-04 Valid reasons for accessing confidential person information.

Pursuant to the requirements of division (B)(2) of section 1347.15 of the Revised Code, this rule contains a list of valid reasons, directly related to the board's exercise of its powers or duties, for which only employees of the board may access confidential personal information regardless of whether the personal information system is a manual system or computer system:

(A) Responding to a public records request;

(B) Responding to a request from an individual for the list of confidential personal information the board maintains on that individual;

(D) Administering a statutory provision or duty;

(E) Administering an administrative rule provision or duty;

(F) Complying with any state or federal program requirements;

(G) Processing or payment of invoices and other financial activities;

(H) Auditing purposes;

(I) Licensure, renewal, or verification of licensure processes;

(J) Investigation or law enforcement purposes;

(K) Administrative hearings or evidentiary review by a hearing examiner;

(L) Litigation, complying with an order of the court, or subpoena;

(M) Human resource matters (e.g., hiring, promotion, demotion, discharge, salary/compensation issues, leave requests/issues, time card approvals/issues, payroll, Federal Medical Leave Act issues, disability issues, employee assistance program issues);

(N) Complying with an executive order or policy;

(O) Complying with a board policy or resolution, or with a state administrative policy or directive issued by the department of administrative services, the office of budget and management or other similar state board;

(P) Complying with a collective bargaining agreement provision;

(Q) Administering a board program;

(R) Facilitating operational efficiencies or responding to complaints about the board's investigative, monitoring, or licensure processes; or

(S) Maintaining data systems or performing information technology responsibilities.

Last updated August 4, 2026 at 10:38 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-8-05 Confidentiality statutes.

With regard to confidential personal information maintained by the board, the following federal statutes or regulations or state statutes and administrative rules make the personal information confidential:

(A) Social security numbers of applicants, licensees, and board employees: 5 U.S.C. 552a., unless the individual was told that the number would be disclosed.

(B) "Bureau of Criminal Investigation and Information" criminal records check results: section 4776.04 of the Revised Code.

(C) Complaints, the names of complainants and patients, and information received in an investigation, including any medical records of the subject of the complaint: division (F) of section 4730.26, division (F) of section 4731.22, division (E) of section 4760.14, division (E) of section 4762.14, and division (E) of section 4774.14 of the Revised Code.

(D) Medical malpractice payouts reported by a professional liability insurer: division (F) of section 4730.32, division (F) of section 4731.224, division (F) of section 4760.16, division (F) of section 4762.16, and division (F) of section 4774.16 of the Revised Code.

(E) Formal disciplinary action reported by a health care facility: division (F) of section 4730.32, division (F) of section 4731.224, division (F) of section 4760.16, division (F) of section 4762.16, and division (F) of section 4774.16 of the Revised Code.

(F) A belief that a violation of law has occurred when reported by a licensee or professional society of licensees: division (F) of section 4730.32, division (F) of section 4731.224, division (F) of section 4760.16, division (F) of section 4762.16, and division (F) of section 4774.16 of the Revised Code.

(G) Medical records of board employees or their family members: "Family Medical Leave Act of 1993," Pub. L. No. 103-3; 29 U.S.C. Sec. 260 as implemented in 29 C.F.R. 825.500; Section I of the "Americans with Disabilities Act of 1990," 42 U.S.C. Sec. 12112(d).

(H) Employee assistance program records: section 124.88 of the Revised Code.

(I) Alcohol and drug treatment records: 42 CFR Part 2; 42 U.S.C. 290dd3.

(J) "Federal Bureau of Investigation" criminal records check results: section 4776.04 of the Revised Code; 28 CFR 20.33(d).

(K) "National Practitioner Data Bank" and "Healthcare and Integrity Protection Data Bank" reports: 45 CFR Part 60.

(L) Residential and familial information for covered licensees: divisions (A)(1)(p), (A)(7), and (A)(8) of section 149.43 of the Revised Code.

Last updated July 16, 2026 at 11:04 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-8-06 Restricting and logging access to confidential personal information in computerized personal information systems.

For personal information systems that are computer systems and contain confidential personal information, the board shall do the following:

(A) Access restrictions. Access to confidential personal information that is kept electronically shall require a password or other authentication measure.

(B) Acquisition of a new computer system. When the board acquires a new computer system that stores, manages or contains confidential personal information, the board shall include a mechanism for recording specific access by employees of the board to confidential personal information in the system.

(C) Upgrading existing computer systems. When the board makes an upgrade to a computer system, as that term is defined in rule 4731-8-02 of the Administrative Code, to an existing computer system that stores, manages or contains confidential personal information, the upgrade shall include a mechanism for recording specific access by employees of the board to confidential personal information in the system.

(D) Logging requirements regarding confidential personal information in existing computer systems.

(1) Employees who access confidential personal information within computer systems shall maintain a log that records that access.

(2) Access to confidential information is not required to be entered into a log under the following circumstances:

(a) The employee is accessing confidential personal information for official board purposes, including research, and the access is not specifically directed toward a specifically named individual or a group of specifically named individuals.

(b) The employee is accessing confidential personal information for routine office procedures and the access is not specifically directed toward a specifically named individual or a group of specifically named individuals.

(c) The employee comes into incidental contact with confidential personal information and the access of the information is not specifically directed toward a specifically named individual or a group of specifically named individuals.

(d) The employee accesses confidential personal information about an individual based upon a request made under either of the following circumstances:

(i) The individual requests confidential personal information about himself/herself; or

(ii) The individual makes a request that the board take some action on that individual's behalf and accessing the confidential personal information is required in order to consider or process that request.

(E) Log management. The board shall issue a policy that specifies the following:

(1) The form or forms for logging;

(2) Who shall maintain the logs;

(3) What information shall be captured in the logs;

(4) How the logs are to be stored; and

(5) How long information kept in the logs is to be retained.

(F) Nothing in this rule limits the board from requiring logging in any circumstance that it deems necessary.

Last updated August 4, 2026 at 10:39 AM

History

Effective: December 31, 2010
Promulgated Under: 119.03

Chapter 4731-9 Recordation of Meetings

Ohio Adm.Code 4731-9-01 Record of board meetings; recording, filming, and photographing of meetings.

(A) The minutes of board meetings, upon approval by the board, shall constitute the official record of its proceedings. Audio recordings of meetings made for the purpose of facilitating the transcription of minutes shall be considered transitory documents.

(B) In order to promote the orderly transaction of business, any party intending to broadcast, televise, record, or photograph any board meeting shall provide written notice to the board within at least twenty-four hours prior to the scheduled meeting. The board shall not refuse permission to broadcast, televise, record, or photograph a meeting based solely upon a determination that prior written notice was not provided in a timely fashion.

(1) The presiding officer of the board or his or her designee shall designate a reasonable location or locations within the meeting room from which broadcasting, televising, recording, or photographing may take place;

(2) Broadcasting, televising, recording, or photographic equipment used at the board meeting shall be silent, unobtrusive, self-contained, and self-powered so as not to interfere with any individual's ability to hear, see or participate in the meeting and so as not to interfere with the orderly transaction of board business; and

(3) The presiding officer or his or her designee may terminate or limit the broadcasting, televising, recording, or photographing if it is determined that it is interfering with the orderly transaction of board business, is inhibiting a participant's presentation to the board, or is interfering with the dignity of the proceedings.

(D) For purposes of this rule, the word "record" includes, but is not limited to, the use of a court reporter or similar method to record the meeting via shorthand, machine (stenotype) shorthand, stenomask methods, or a similar method.

Last updated November 4, 2025 at 2:15 PM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Chapter 4731-10 Licensing; Continuing Education

Ohio Adm.Code 4731-10-01 Definitions.

As used in this chapter of the Administrative Code:

(A) "License" means the legal authorization issued by the board to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery in Ohio.

(B) "CME" means continuing medical education.

(C) "License renewal" means the extension of a current license by fulfilling the requirements of section 4731.281 of the Revised Code, and this chapter of the Administrative Code.

(D) "License reinstatement" means the reactivation of a license which has lapsed or been in a suspended or inactive status for two years or less for any reason.

(E) "License restoration" means the reactivation of a license which has lapsed or been in a suspended or inactive status for more than two years for any reason.

(F) "Licensee" means a person who holds a license to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery in Ohio.

(G) "Registration period" means the period between the granting or renewal of a license and the next scheduled license renewal date.

(H) "Volunteer registration period" means the period between the granting or renewal of a volunteer certificate and the next scheduled renewal date.

(I) "Board" means the state medical board of Ohio.

(J) "CME waiver" means a reduction of CME hours that may be granted by the board on an individual basis to licensees or certificate holders that have been disabled by illness or accident for a minimum of six consecutive months, or absent from United States for a minimum of six consecutive months, during a CME registration period, volunteer registration period, clinical research registration period, or conceded eminence registration period.

(K) "Clinical research registration period" means the period between the granting or renewal of a clinical research faculty certificate and the next scheduled renewal date."

(L) "Conceded eminence registration period" means the period between the granting or renewal of a certificate of conceded eminence and the next scheduled renewal date.

(M) "Certificate holder" means a person that holds a volunteer's certificate, clinical research faculty certificate, or certificate of conceded eminence.

Last updated July 16, 2026 at 11:01 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-10-02 Requisite hours of continuing medical education for license renewal or reinstatement.

(A) During a registration period, a licensee shall be required to complete fifty hours of CME. A licensee must complete a minimum of one hour of CME, approved by the board, on the topic of a licensee's duty to report misconduct under section 4731.224 of the Revised Code. The remainder shall be completed by participating in the following:

(1) Educational activities recognized by the American medical association as category 1 pursuant to its CME categorization system, and

(a) Are certified for category 1 CME credit by the Ohio state medical association;

(b) Are certified for category 1 CME credit by an institution or organization accredited by the Ohio state medical association or the accreditation council for continuing medical education; or

(2) Educational activities recognized by the American osteopathic association as category 1 pursuant to its CME categorization system, and

(a) Are certified for category 1 CME credit by the Ohio osteopathic association;

(b) Are certified for category 1 CME credit by an institution or organization accredited by the Ohio osteopathic association or the American osteopathic association; or

(3) Educational activities certified for category 1 CME credit by the Ohio foot and ankle medical association;

(4) Educational activities certified for continuing education contact hours by a provider approved by the council on podiatric medical education;

(5) Internships, residencies, or fellowships accredited by the accreditation council for graduate medical education, the American osteopathic association, or the council on podiatric medical education. Credit shall be earned at a rate of one hour of CME for each week of participation;

(6) Pursuant to section 4745.04 of the Revised Code, providing health care services in Ohio, as a volunteer, to indigent and uninsured persons.

(B) If a licensee has not completed the requisite hours of CME, a licensee is not eligible for license renewal or license reinstatement until such time as the requisite hours have been completed. Any CME undertaken after the end of a registration period and utilized for purposes of renewing or reinstating a suspended license cannot also be utilized to meet the CME requirement of the current registration period.

(C) Licensees who are not working in the medical profession or who are retired from practice but wish to renew or reinstate their licenses shall meet the CME requirements of section 4731.282 of the Revised Code and this chapter of the Administrative Code.

(D) Licensees residing or practicing out of the state who wish to renew or reinstate their licenses must meet the CME requirements of section 4731.282 of the Revised Code and this chapter of the Administrative Code even though not currently residing or practicing in Ohio.

(E) During a volunteer registration period, every holder of a volunteer's certificate shall be required to complete one hundred fifty hours of CME pursuant to the requirements of section 4731.295 of the Revised Code. Seventy-five hours must meet the criteria established in paragraph (A)(1) of this rule. If a holder of a volunteer's certificate has not completed the requisite hours of CME, a holder is not eligible for certificate renewal until such time as the requisite hours have been completed. Any CME undertaken after the end of a volunteer registration period and utilized for purposes of renewing a suspended certificate cannot also be utilized to meet the CME requirement of the current volunteer registration period.

(F) During a conceded eminence registration period, every holder of a certificate of conceded eminence shall be required to complete fifty hours of CME pursuant to the requirements of section 4731.297. Such hours must meet the criteria established in paragraph (A)(1) of this rule. If a holder of a certificate of conceded eminence has not completed the requisite hours of CME, a holder is not eligible for certificate renewal until such time as the requisite hours have been completed. Any CME undertaken after the end of a conceded eminence registration period and utilized for purposes of renewing a suspended certificate cannot also be utilized to meet the CME requirement of the current conceded eminence registration period.

Last updated August 4, 2026 at 10:39 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-10-03 CME waiver.

For purposes of obtaining a CME waiver, a licensee or certificate holder shall have the burden of establishing that the illness, accident, or absence affected the reasonable opportunity to participate in CME activities. Request for a CME waiver shall be submitted to the board at least sixty days prior to the end of the registration period, volunteer registration period, clinical research registration period, or conceded eminence registration period, as applicable. A licensee or holder of a certificate shall not submit the renewal application prior to receiving approval from the board of the waiver request.

Last updated July 16, 2026 at 11:01 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-10-04 Continuing medical education requirements for restoration of a license.

To be eligible for restoration of a license the licensee shall submit evidence establishing that the licensee has met the requirements of rule 4731-10-02 of the Administrative Code during the twenty four months preceding the board's receipt of the application for restoration. If the licensee has not met the requirements, the licensee must do so as a prerequisite to restoration of the license.

Last updated August 4, 2026 at 10:39 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-10-08 Evidence of continuing medical education.

(A) Each licensee or certificate holder applying for license renewal or license reinstatement shall certify completion of the requisite hours of CME pursuant to the rules in this chapter.

(B) The board may select applications for verification that all CME requirements have been met. Licensees and certificate holders whose applications are selected shall submit additional documentation of compliance with CME requirements as the board may require. Failure to submit the additional documents shall constitute a violation of section 4731.282 of the Revised Code and section 4731.22 of the Revised Code.

(C) Licensees and certificate holders have a continuing obligation to maintain detailed records of CME hours completed. The licensee or certificate holder shall obtain verification of completion of CME activities. At a minimum, verification shall include a description of the CME activity, the date of attendance or completion, and the number of hours completed. Records of all CME undertaken shall be retained by the licensee or certificate holder for two years after the end of the CME period and shall be made available to the board upon request.

(D) Licensees seeking to receive credit pursuant to paragraph (A)(6) of rule 4731-10-02 of the Administrative Code shall maintain a log of their qualifying activities. The log shall indicate the dates the health care services were provided, the number of hours spent providing health care services on those dates, and the location where the health care services were provided.

(E) Notwithstanding the provisions of paragraph (C) of this rule, licensees and certificate holders shall not destroy or otherwise make unavailable written documentation of CME activity after the board has requested verification of CME pursuant to this rule or section 4731.22 of the Revised Code. Upon verification that all CME requirements have been met, the applicant or licensee or certificate holder may destroy the requested records.

(F) Nothing in this rule shall limit the board's authority to investigate and take action under section 4731.22 of the Revised Code.

Last updated July 16, 2026 at 11:01 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Chapter 4731-11 Controlled Substances

Ohio Adm.Code 4731-11-01 Definitions.

As used in Chapter 4731-11 of the Administrative Code:

(A) "Controlled substance" means a drug, compound, mixture, preparation, or substance included in schedule I, II, III, IV, or V pursuant to the provisions of Chapter 3719. of the Revised Code and Chapter 4729:9-1 of the Administrative Code.

(B) "Controlled substance stimulant" means any drug, compound, mixture, preparation, or substance which is classified as a stimulant in controlled substance schedule II, III, or IV listed in Chapter 4729:9-1 of the Administrative Code, or which is classified as a stimulant in controlled substances schedule II, III, or IV pursuant to Chapter 4729:9-1 of the Administrative Code.

(C) "Cross-coverage" means an agreement between an Ohio-licensed physician and another Ohio licensed physician or healthcare provider acting within the scope of their professional license under which the physician provides medical services for an active patient, as that term is defined in paragraph (D) of rule this rule, of the other physician or healthcare provider who is temporarily unavailable to conduct the evaluation of the patient.

(1) This type of agreement includes on-call coverage for after hours and weekends.

(2) The medical evaluation required by paragraph (C) of rule 4731-11-09 of the Administrative Code may be a limited evaluation conducted through interaction with the patient.

(D) For purposes of paragraph (D) of rule 4731-11-09 of the Administrative Code, "active patient" as that term is used in paragraph (C) of this rule, means that within the previous twenty-four months the physician or other healthcare provider acting within the scope of their professional license conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine as that term is defined in 21 C.F.R. 1300.04, in effect as of the effective date of this rule.

(E) "Utilize a controlled substance or controlled substance stimulant" means to prescribe, administer, dispense, supply, sell or give a controlled substance or controlled substance stimulant.

(F) "Recognized contraindication" means any contraindication to the use of a drug which is listed in the United States food and drug administration (hereinafter, "F.D.A.") approved labeling for the drug, or which the board determines to be accepted as a contraindication.

(G) "The board" means the state medical board of Ohio.

(H) "BMI" means body mass index, calculated as a person's weight in kilograms divided by height in meters squared.

(I) "Physician" means an individual holding a certificate under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery and practicing within his or her scope of practice as defined by section 4731.51 of the Revised Code.

(J) "Board certified addictionologist or addiction psychiatrist" means a medical doctor or doctor of osteopathic medicine and surgery who holds one of the following certifications:

(1) Subspecialty board certification in addiction psychiatry from the american board of psychiatry and neurology;

(2) Board certification in addiction medicine from the american board of addiction medicine;

(3) Certification from the American society of addiction medicine;

(4) Subspecialty certification in addiction medicine from the American board of preventive medicine; or

(5) Board certification with additional qualification in addiction medicine from the American osteopathic association.

(K) "Office based opioid treatment (OBOT)" "OBOT" means treatment of opioid addiction utilizing a schedule III, IV or V controlled substance narcotic.

(L) "Acute pain" means pain that normally fades with healing, is related to tissue damage, significantly alters a patient's typical function and is expected to be time limited and not more than six weeks in duration.

(M) "Minor" has the same meaning as in section 3719.061 of the Revised Code.

(N) "Morphine equivalent daily dose (MED)" means a conversion of various opioid analgesics to a morphine equivalent dose by the use of accepted conversion tables provided by the state of Ohio board of pharmacy at: https://www.ohiopmp.gov/ (effective 2017).

(O) "Extended-release or long-acting opioid analgesic" means an opioid analgesic that:

(1) Has United States food and drug administration approved labeling indicating that it is an extended-release or controlled release formulation;

(2) Is administered via a transdermal route; or

(3) Contains methadone.

(P) "Opioid analgesic" has the same meaning as in section 3719.01 of the Revised Code and means a controlled substance that has analgesic pharmacologic activity at the opioid receptors of the central nervous system, including but not limited to the following drugs and their varying salt forms or chemical congeners: buprenorphine, butorphanol, codeine (including acetaminophen and other combination products), dihydrocodeine, fentanyl, hydrocodone (including acetaminophen combination products), hydromorphone, meperidine, methadone, morphine sulfate, oxycodone (including acetaminophen, aspirin, and other combination products), oxymorphone, tapentadol, and tramadol.

(Q) "Hospice care program" has the same meaning as in section 3712.01 of the Revised Code.

(R) "Palliative care" has the same meaning as in section 3712.01 of the Revised Code.

(S) "Terminal condition" means an irreversible, incurable, and untreatable condition caused by disease, illness, or injury from which, to a reasonable degree of medical certainty as determined in accordance with reasonable medical standards by a physician who has examined the patient, both of the following apply:

(1) There can be no recovery.

(2) Death is likely to occur within a relatively short time if life-sustaining treatment is not administered.

(T) "Medication therapy management" has the same meaning as in rule 4729:5-12-01 of the Administrative Code.

(U) "Subacute pain" means pain that has persisted after reasonable medical efforts have been made to relieve it and continues either episodically or continuously for more than six weeks but less than twelve weeks following initial onset of pain. It may be the result of underlying medical disease or condition, injury, medical or surgical treatment, inflammation, or unknown cause.

(V) "Chronic pain" means pain that has persisted after reasonable medical efforts have been made to relieve it and continues either episodically or continuously for twelve or more weeks following initial onset of pain. It may be the result of an underlying medical disease or condition, injury, medical treatment, inflammation, or unknown cause. "Chronic pain" does not include pain associated with a terminal condition or with a progressive disease that, in the normal course of progression, may reasonably be expected to result in a terminal condition.

(W) "Board certification in hospice and palliative care" means either of the following:

(1) Subspecialty certification in hospice and palliative medicine granted by a certification board that is a member of the American board of medical specialties.

(2) Certification of added qualification in hospice and palliative medicine by the American osteopathic association bureau of medical specialties.

(X) "Board certification in hematology" means specialty or subspecialty certification in hematology or a related hematology specialty or subspecialty by a certification board that is a member of the American board of medical specialties or by the American osteopathic association bureau of medical specialties.

(Y) "Board certification in oncology" means specialty or subspecialty certification in oncology or a related oncology specialty or subspecialty by a certification board that is a member of the American board of medical specialties or American osteopathic association bureau of medical specialties.

(Z) "Board certification in pain medicine" means any of the following:

(1) Current subspecialty certification in pain medicine by a member board of the American board of medical specialties, or current certificate of added qualification in pain medicine by the American osteopathic association bureau of osteopathic specialists;

(2) Current board certification by the American board of pain medicine; or

(3) Current board certification by the American board of interventional pain physicians.

Last updated February 2, 2026 at 8:04 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-02 General provisions.

(A) A physician shall not utilize a controlled substance other than in accordance with all of the provisions of this chapter of the Administrative Code.

(B) A physician shall not utilize a controlled substance without taking into account the drug's potential for abuse, the possibility the drug may lead to dependence, the possibility the patient will obtain the drug for a nontherapeutic use or to distribute to others, and the possibility of an illicit market for the drug.

(C) A physician shall complete and maintain accurate medical records reflecting the physician's examination, evaluation, and treatment of all the physician's patients. Patient medical records shall accurately reflect the utilization of any controlled substances in the treatment of a patient and shall indicate the diagnosis and purpose for which the controlled substance is utilized, and any additional information upon which the diagnosis is based.

(D) A physician shall obey all applicable provisions of sections 3719.06, 3719.07, 3719.08 and 3719.13 of the Revised Code and the rules promulgated thereunder, all prescription issuance rules adopted under Chapter 4729. of the Revised Code, and all applicable provisions of federal law governing the possession, distribution, or use of controlled substances.

(E) Violations of this rule:

(1) A violation of any provision of this rule, as determined by the board, shall constitute any or all of the following: "failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code; and "a departure from, or the failure to conform to, minimal standards of care of similar physicians under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(2) A violation of paragraph (C) of this rule shall further constitute "selling, prescribing, giving away, or administering drugs for other than legal and legitimate therapeutic purposes," as that clause is used in division (B)(3) of section 4731.22 of the Revised Code.

Last updated August 4, 2026 at 10:39 AM

History

Effective: December 23, 2018
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-03 Utilization of anabolic steroids, schedule II controlled substance cocaine hydrochloride, and schedule II controlled substance stimulants.

(A) A physician shall not:

(1) Utilize anabolic steroids, growth hormones, testosterone or its analogs, human chorionic gonadotropin ("HCG"), or other hormones for the purpose of enhancing athletic ability.

(2) Utilize the schedule II controlled substance cocaine hydrochloride for a purpose other than one of the following:

(a) As a topical anesthetic in situations in which it is properly indicated; or

(b) For in-office diagnostic testing for pupillary disorders.

(3) Utilize a schedule II controlled substance stimulant in any of the following circumstances:

(a) For purposes of weight reduction or control;

(b) When the physician knows or has reason to believe that a recognized contra-indication to its use exists; or

(c) In the treatment of a patient who the physician knows or should know is pregnant, except if the following criteria are met:

(i) After the physician's medical assessment the physician and patient determine that the benefits of treating the patient with a schedule II controlled substance stimulant outweigh the risks, and

(ii) The basis for the determination is documented in the patient record.

(B) Utilizing a schedule II controlled substance stimulant:

(1) Before initiating treatment utilizing a schedule II controlled substance stimulant, the physician shall perform all of the following:

(a) Obtain a thorough history;

(b) Perform an appropriate physical examination and mental status examination of the patient; and

(c) Rule out the existence of any recognized contra-indications to the use of the controlled substance stimulant to be utilized.

(2) A physician may utilize a schedule II controlled substance stimulant only for one of the following purposes:

(a) The treatment of narcolepsy, idiopathic hypersomnia, and hypersomnias due to medical conditions known to cause excessive sleepiness;

(b) The treatment of attention deficit hyperactivity disorder and/or related disorders;

(c) The treatment of major or mild neurocognitive disorder due to traumatic brain injury or substance/medication-induced major or mild neurocognitive disorder;

(d) The treatment of depression shown to be refractory to other therapeutic modalities, including pharmacologic approaches, such as antidepressants;

(e) As adjunctive therapy in the treatment of chronic pain, as defined in rule 4731-11-01 of the Administrative Code. :

(f) The treatment of binge eating disorder.

(3) Upon ascertaining or having reason to believe that the patient has a history of or shows a propensity for alcohol or drug abuse, or that the patient has consumed or disposed of any controlled substance other than in strict compliance with the treating physician's directions, the physician shall perform both of the following;

(a) Reappraise the desirability of continued utilization of schedule II controlled substance stimulants and shall document in the patient record the factors weighed in deciding to continue their use; and

(b) Actively monitor such patient for signs and symptoms of drug abuse and drug dependency.

(1) "Failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code;

(2) "Selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes," as that clause is used in division (B)(3) of section 4731.22 of the Revised Code;

(3) "A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

Last updated February 28, 2023 at 8:47 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-04 Controlled substances for the treatment of obesity.

(A) A prescriber may utilize a schedule III or IV controlled substance for the treatment of obesity only if it has an F.D.A approved indication for this purpose and then only in accordance with all of the provisions of this rule.

(B) Before initiating treatment for obesity utilizing any schedule III or IV controlled substance, the prescriber shall complete all of the following requirements:

(1) The prescriber shall review the prescriber's own records of prior treatment or review the records of prior treatment by another treating physician, prescriber, dietitian, or weight-loss program to determine the patient's past efforts to lose weight in a treatment program utilizing a regimen of weight reduction based on nutritional counseling, intensive behavioral therapy, and exercise, without the utilization of controlled substances, and that the treatment has been ineffective.

(2) The prescriber shall complete and document the findings of all of the following:

(a) Obtain a thorough history;

(b) Perform an appropriate examination of the patient;

(d) Rule out the existence of any recognized contraindications to the use of the controlled substance to be utilized;

(e) Assess and document the patient's freedom from signs of drug or alcohol abuse, and the presence or absence of contraindications and adverse side effects;

(f) Access OARRS for the patient's prescription history during the preceding twelve month period and document in the patient's record the receipt and assessment of the report received; and

(g) Develop and record in the patient record a treatment plan that includes, at a minimum, a diet and exercise program for weight loss.

(3) The prescriber shall not initiate treatment utilizing a controlled substance for the treatment of obesity upon ascertaining or having reason to believe any one or more of the following:

(a) The patient has a history of or shows a propensity for alcohol or drug abuse, or has made any false or misleading statement to the prescriber physician related to the patient's use of drugs or alcohol;

(b) The patient has consumed or disposed of any controlled substance other than in strict compliance with the treating prescriber's directions;

(d) The patient has a BMI of less than thirty, unless the patient has a BMI of at least twenty seven with comorbid factors, including type 2 diabetes, cardio vascular disease, hypertension, hyperlipidemia, obstructive sleep apnea, nonalcoholic fatty liver disease, osteoarthritis, insulin resistance, metabolic syndrome, pre-diabetes, or major depression;

(e) The patient has any condition that would contraindicate the use of the controlled substance to be utilized;

(f) The prescriber shall document in the patient's record the rationale for initiation or re-initiation of treatment utilizing a controlled substance for chronic obesity.

(C) A prescriber may utilize a schedule III or IV controlled substance that bears appropriate F.D.A. approved labeling for weight loss, in the treatment of obesity as an adjunct, to a lifestyle intervention, such as caloric restriction, provided that:

(1) The prescriber shall assess the patient, at a minimum, once in the first three months of utilization of controlled substances for weight reduction, and shall record in the patient record information demonstrating the patient's continuing efforts to lose weight, the patient's dedication to the treatment program and response to treatment, and the presence or absence of contraindications, adverse effects, and indicators of possible substance abuse that would necessitate cessation of treatment utilizing controlled substances.

(2) The prescriber may personally furnish controlled substances for weight reduction or chronic weight management. For any controlled substance that is personally furnished, the prescriber shall not exceed a total of two thousand five hundred dosage units in any thirty-day period and shall not in any seventy-two hour period, personally furnish an amount that exceeds the amount necessary for the patient's use in a seventy-two hour period. Dosage unit means any of the following:

(a) A single pill, capsule, ampule, or tablet;

(b) In the case of a liquid solution, one milliliter;

(d) Any other form of administration available as a single unit.

(3) The prescriber shall not personally furnish or prescribe additional controlled substances to treat obesity for a patient who has not achieved a weight loss of at least five per cent of the patient's initial weight, during the initial three months of treatment using controlled substances to treat obesity.

(4) The prescriber may personally furnish or prescribe controlled substances to treat obesity when the prescriber observes and records that the patient significantly benefits from the controlled substances and has no serious adverse effects related to the drug regimen. A patient significantly benefits from the controlled substances when weight is reduced or when weight loss is maintained and any existing co-morbidity is reduced.

(a) The prescriber shall assess the patient at least once every three months and shall obtain the patient's weight, blood pressure, and heart rate. The findings shall be entered in the patient's record.

(b) For the continuation of schedule III or IV controlled substances designated as FDA short term use controlled substances beyond three months, the patient must maintain a five per cent weight reduction. The prescriber shall document the patient's weight loss or maintenance in the record.

(d) The prescriber shall access OARRS in accordance with rules 4731-11-11 and 4730-2-10 of the Administrative Code.

(5) The prescriber shall discontinue utilizing all controlled substances for purposes of weight reduction immediately upon ascertaining or having reason to believe:

(a) That the patient has made any false or misleading statement to the prescriber relating to the patient's use of drugs or alcohol;

(b) That the patient has consumed or disposed of any controlled substance other than in strict compliance with the treating physician's directions;

(c) That the patient has not responded by achieving less than five per cent weight reduction after three months while under treatment with a controlled substance or controlled substances;

(d) That the patient has repeatedly failed to comply with the prescriber's treatment recommendations;

(e) That the patient demonstrates any signs that the controlled substance is not safe for or well tolerated by the patient; or

(f) That the prescriber knows or should know the patient is pregnant.

(D) A violation of any provision of this rule, as determined by the board, shall constitute the following:

(1) For a physician:

(a) "Failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code;

(b) "Selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes," as that clause is used in division (B)(3) of section 4731.22 of the Revised Code; and

(c) "A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(2) For a physician assistant:

(a) "A departure from, or failure to conform to, minimal standards of care of similar physician assistants under the same or similar circumstances, regardless of whether actual injury to a patient is established," as that clause is used in division (B)(19) of section 4730.25 of the Revised Code;

(b) "Failure to comply with the requirements of this chapter, Chapter 4731. of the Revised Code, or any rules adopted by the board," as that clause is used in division (B)(2) of section 4730.25 of the Revised Code; and

(c) "Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter, Chapter 4731. of the Revised Code, or the rules adopted by the board," as that clause is used in division (B)(3) of section 4730.25 of the Revised Code.

Last updated February 28, 2023 at 8:47 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-07 Research utilizing controlled substances.

The provisions of this chapter of the Administrative Code shall not apply to or in any way prohibit research conducted under the auspices of an accredited medical school, or research which meets both of the following conditions:

(A) The U.S. food and drug administration has approved an investigational new drug ("IND") application for the research or has notified the researchers that the proposed study is exempt from the "IND" regulations; and

(B) The research is conducted in conformance with the approval granted by either of the following:

(1) An institutional review board of a hospital or medical center accredited by the "Joint Commission," "Healthcare Facilities Accreditation Program" or other accrediting body approved by the board; or

(2) An institutional review board accredited by the association for the accreditation of human research protection programs.

Last updated August 4, 2026 at 10:39 AM

History

Effective: September 30, 2015
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-08 Utilizing controlled substances for self and family members.

(A) Accepted and prevailing standards of care presuppose a professional relationship between a patient and physician when the physician is utilizing controlled substances. By definition, a physician may never have such a relationship with himself or herself. Thus, a physician may not self-prescribe or self-administer controlled substances. This paragraph does not prohibit a physician from obtaining a schedule V controlled substance for personal use in conformance with state and federal laws, in the same manner that a non-physician may obtain a schedule V controlled substance.

(B) Accepted and prevailing standards of care require that a physician maintain detached professional judgment when utilizing controlled substances in the treatment of family members. A physician shall utilize controlled substances when treating a family member only in an emergency situation which shall be documented in the patient's record.

(C) For purposes of this rule, "family member" means a spouse, parent, child, sibling or other individual in relation to whom a physician's personal or emotional involvement may render that physician unable to exercise detached professional judgment in reaching diagnostic or therapeutic decisions.

Last updated August 4, 2026 at 10:40 AM

History

Effective: September 30, 2008
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-09 Controlled substance and telehealth prescribing.

(A) As used in this rule:

(1) "Hospice care" means the care of a hospice patient as that term is defined in section 3712.01 of the Revised Code.

(2) "Palliative care" has the same meaning as in section 3712.01 of the Revised Code.

(3) "Medication assisted treatment" and "substance use disorder" have the same meanings as in rule 4731-33-01 of the Administrative Code.

(4) "Mental health condition" means any mental health condition, illness, or disorder as determined by the diagnostic criteria in the "Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision" (DSM-5-TR). This is a well-known and readily available text. It may be found at libraries, bookstores, on the internet at www.appi.org, or at the state medical board's office.

(5) "Emergency situation" means a situation involving an "emergency medical condition" as that term is defined in section 1753.28 of the Revised Code.

(B) A physician, or a physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall comply with the requirements of federal law governing prescription drugs that are controlled substances to prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug that is a controlled substance to a person.

(C) When the physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority prescribes, personally furnishes, otherwise provides, or causes to be provided a prescription drug that is a controlled substance during the provision of telehealth services, the physician or physician assistant shall comply with all requirements in rule 4731-37-01 of the Administrative Code.

(D) The physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall conduct a physical examination of a new patient as part of an initial in-person visit before prescribing a schedule II controlled substance to the patient except as provided in paragraph (E) of this rule.

(E) As an exception to paragraph (D) of this rule, a physician or physician assistant may prescribe a controlled substance to a new patient as part of the provision of telehealth services for any of the following patient medical conditions and situations:

(1) The medical record of a new patient indicates that the patient is receiving hospice or palliative care;

(2) The patient has a substance use disorder, and the controlled substance is FDA approved for and prescribed for medication assisted treatment or to treat opioid use disorder.

(3) The patient has a mental health condition and the controlled substance prescribed is prescribed to treat that mental health condition;

(4) The physician or physician assistant determines in their clinical judgment that the new patient is in an emergency situation provided that the following occurs:

(a) The physician or physician assistant prescribes only the amount of a schedule II controlled substance to cover the duration of the emergency or an amount not to exceed a three-day supply whichever is shorter;

(b) After the emergency situation ends, the physician or physician assistant conducts the physical examination as part of an initial in-person visit before any further prescribing of a drug that is a schedule II controlled substance; or

(5) The prescribing of a controlled substance through telehealth services is being done under an exception permitted by federal law governing prescription drugs that are controlled substances.

(F) When prescribing a controlled substance through the provision of telehealth services under one of the exceptions in paragraph (E) of this rule, the physician or physician assistant shall document one of the reasons listed in paragraph (E) for the prescribing in the medical record of the new patient in addition to the documentation already required to meet the standard of care in rule 4731-37-01 of the Administrative Code.

(G) Nothing in this rule shall be construed to imply that one in-person physician or physician assistant examination demonstrates that a prescription has been issued for a legitimate medical purpose within the course of professional practice.

(H) A violation of any provision of this rule, as determined by the board, shall constitute any or all of the following:

(1) For a physician:

(a) "Failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code;

(c) "A departure from or the failure to conform to minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(2) For a physician assistant:

(I) This rule shall not apply to any prescribing situations specifically authorized by the Revised Code or Administrative Code.

Last updated February 28, 2023 at 8:47 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-11 Standards and procedures for review of "Ohio Automated Rx Reporting System" (OARRS).

(A) For purposes of this rule:

(1) "Delegate" means an authorized representative who is registered with the Ohio board of pharmacy to obtain an OARRS report on behalf of a physician;

(2) "OARRS" means the "Ohio Automated Rx Reporting System" drug database established and maintained pursuant to section 4729.75 of the Revised Code.

(3) "OARRS report" means a report of information related to a specified patient generated by the drug database established and maintained pursuant to section 4729.75 of the Revised Code.

(4) "Personally furnish" means the distribution of drugs by a prescriber to the prescriber's patients for use outside the prescriber's practice setting.

(5) "Reported drugs" means all the drugs listed in rule 4729:8-2-01 of the Administrative Code that are required to be reported to the drug database established and maintained pursuant to section 4729.75 of the Revised Code, including controlled substances in schedules II, III, IV, and V.

(B) Standards of care:

(1) The accepted and prevailing minimal standards of care require that when prescribing or personally furnishing a reported drug, a physician shall take into account all of the following:

(a) The potential for abuse of the reported drug;

(b) The possibility that use of the reported drug may lead to dependence;

(c) The possibility the patient will obtain the reported drug for a nontherapeutic use or distribute it to other persons; and

(d) The potential existence of an illicit market for the reported drug.

(2) In considering whether a prescription for or the personally furnishing of a reported drug is appropriate for the patient, the physician shall use sound clinical judgment and obtain and review an OARRS report consistent with the provisions of this rule.

(C) A physician shall obtain and review an OARRS report to help determine if it is appropriate to prescribe or personally furnish an opioid analgesic, benzodiazepine, or reported drug to a patient as provided in this paragraph and paragraph (F) of this rule:

(1) A physician shall obtain and review an OARRS report before prescribing or personally furnishing an opiate analgesic or benzodiazepine to a patient, unless an exception listed in paragraph (G) of this rule is applicable.

(2) A physician shall obtain and review an OARRS report when a patient's course of treatment with a reported drug other than an opioid analgesic or benzodiazepine has lasted more than ninety days, unless an exception listed in paragraph (G) of this rule is applicable.

(3) A physician shall obtain and review an OARRS report when any of the following red flags pertain to the patient:

(a) Selling prescription drugs;

(b) Forging or altering a prescription;

(d) Increasing the dosage of reported drugs in amounts that exceed the prescribed amount;

(e) Suffering an overdose, intentional or unintentional;

(f) Having a drug screen result that is inconsistent with the treatment plan or refusing to participate in a drug screen;

(g) Having been arrested, convicted, or received diversion or intervention in lieu of conviction for a drug related offense while under the physician's care;

(h) Receiving reported drugs from multiple prescribers, without clinical basis;

(i) Traveling with a group of other patients to the physician's office where all or most of the patients request controlled substance prescriptions;

(j) Traveling an extended distance or from out of state to the physician's office;

(k) Having a family member, friend, law enforcement officer, or health care professional express concern related to the patient's use of illegal or reported drugs;

(l) A known history of chemical abuse or dependency;

(m) Appearing impaired or overly sedated during an office visit or exam;

(n) Requesting reported drugs by street name, color, or identifying marks;

(o) Frequently requesting early refills of reported drugs;

(p) Frequently losing prescriptions for reported drugs;

(q) A history of illegal drug use;

(r) Sharing reported drugs with another person; or

(s) Recurring visits to non-coordinated sites of care, such as emergency departments, urgent care facilities, or walk-in clinics to obtain reported drugs.

(D) A physician who decides to utilize an opioid analgesic, benzodiazepine, or other reported drug in any of the circumstances within paragraphs (C)(2) and (C)(3) of this rule, shall take the following steps prior to issuing a prescription for or personally furnishing the opioid analgesic, benzodiazepine, or other reported drug:

(1) Review and document in the patient record the reasons why the physician believes or has reason to believe that the patient may be abusing or diverting drugs;

(2) Review and document in the patient's record the patient's progress toward treatment objectives over the course of treatment;

(3) Review and document in the patient record the functional status of the patient, including activities for daily living, adverse effects, analgesia, and aberrant behavior over the course of treatment;

(4) Consider using a patient treatment agreement including more frequent and periodic reviews of OARRS reports and that may also include more frequent office visits, different treatment options, drug screens, use of one pharmacy, use of one provider for the prescription or personally furnishing of reported drugs, and consequences for non-compliance with the terms of the agreement. The patient treatment agreement shall be maintained as part of the patient record; and

(5) Consider consulting with or referring the patient to a substance abuse specialist.

(E) Frequency for follow-up OARRS reports:

(1) For a patient whose treatment with an opioid analgesic or benzodiazepine lasts more than ninety days, a physician shall obtain and review and OARRS report for the patient at least every ninety days during the course of treatment, unless an exception listed in paragraph (G) of this rule is applicable.

(2) For a patient who is treated with a reported drug other than an opioid analgesic or benzodiazepine for a period lasting more than ninety days, the physician shall obtain and review and OARRS report for the patient at least annually following the initial OARRS report obtained and reviewed pursuant to paragraph (C)(2) of this rule until the course of treatment utilizing the reported drug has ended, unless an exception in paragraph (G) of this rule is applicable.

(F) When a physician or their delegate requests an OARRS report in compliance with this rule, a physician shall document receipt and review of the OARRS report in the patient record, as follows:

(1) Initial reports requested shall cover at least the twelve months immediately preceding the date of the request:

(2) Subsequent reports requested shall, at a minimum, cover the period from the date of the last report to present;

(3) If the physician practices primarily in a county of this state that adjoins another state, the physician or their delegate shall also request a report of any information available in the drug database that pertains to prescriptions issued or drugs furnished to the patient in the state adjoining that county; and

(4) If an OARRS report regarding the patient is not available, the physician shall document in the patient's record the reason that the report is not available and any efforts made in follow-up to obtain the requested information.

(G) A physician shall not be required to review and assess an OARRS report when prescribing or personally furnishing an opioid analgesic, benzodiazepine, or other reported drug under the following circumstances, unless a physician believes or has reason to believe that a patient may be abusing or diverting reported drugs:

(1) The reported drug is prescribed or personally furnished to a hospice patient in a hospice care program as those terms are defined in section 3712.01 of the Revised Code, or any other patient diagnosed as terminally ill;

(2) The reported drug is prescribed for administration in a hospital, nursing home, or residential care facility;

(3) The reported drug is prescribed or personally furnished in an amount indicated for a period not to exceed seven days;

(4) The reported drug is prescribed or personally furnished for the treatment of cancer or another condition associated with cancer; and

(5) The reported drug is prescribed or personally furnished to treat acute pain resulting from a surgical or other invasive procedure or a delivery.

Last updated September 30, 2021 at 8:34 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-13 Prescribing of opiate analgesics for acute pain.

(A) For the treatment of acute pain, the physician shall comply with the following:

(1) Extended-release or long-acting opioid analgesics shall not be prescribed for treatment of acute pain;

(2) Before prescribing an opioid analgesic, the physician shall first consider non-opioid treatment options. If opioid analgesic medications are required as determined by a history and physical examination, the physician shall prescribe for the minimum quantity and potency needed to treat the expected duration of pain, with a presumption that a three-day supply or less is frequently sufficient and that limiting the duration of opioid use to the necessary period will decrease the likelihood of subsequent chronic use or dependence;

(3) In all circumstances where opioid analgesics are prescribed for acute pain:

(a) Except as provided in paragraph (B) of this rule, the duration of the first opioid analgesic prescription for the treatment of an episode of acute pain shall be:

(i) For adults, not more than a seven-day supply with no refills;

(ii) For minors, not more than a five-day supply with no refills. A physician shall comply with section 3719.061 of the Revised Code, including but not limited to obtaining from the parent, guardian, or another adult who is authorized to consent to the minor's medical treatment written consent prior to prescribing an opioid analgesic to a minor;

(iii) The seven-day limit for adults and five-day limit for minors may be exceeded for pain that is expected to persist for longer than seven days based on the pathology causing the pain. In this circumstance, the reason that the limits are being exceeded and the reason that a non-opioid medication was not appropriate to treat the patient's conditions shall be documented in the patient's medical record. The number of days of the prescription shall not exceed the amount required to treat the expected duration of the pain as noted in paragraph (A) (2) of this rule; and

(iv) If a patient is allergic to or otherwise unable to tolerate the initially prescribed opioid medication, a prescription for a different, appropriate opioid may be issued at any time during the initial seven or five-day dosing period and shall be subject to all other provisions of this rule. The allergy and/or intolerance shall be documented in the patient's medical record. The patient or the minor patient's parent, guardian or another adult who is authorized to consent to the minor's medical treatment must be provided education of the safe disposal of the unused medication.

(b) The patient, or a minor's parent or guardian, shall be advised of the benefits and risks of the opioid analgesic, including the potential for addiction, and the advice shall be documented in the patient's medical record; and

(c) The total morphine equivalent dose (MED) of a prescription for opioid analgesics for treatment of acute pain shall not exceed an average of thirty MED per day, except when all of the following apply:

(i) The patient suffers from medical conditions, surgical outcomes or injuries of such severity that pain cannot be managed within the thirty MED average limit as determined by the treating physician based upon prevailing standards of medical care, such as:

(a) Traumatic crushing of tissue;

(b) Amputation;

(d) Severe burns

(ii) The physician determines that exceeding the thirty MED average limit is necessary based on the physician's clinical judgment and the patient's needs.

(iii) The physician shall document in the patient's medical record the reason for exceeding the thirty MED average and the reason it is the lowest dose consistent with the patient's medical condition.

(iv) Only the prescribing physician for the conditions in paragraph (A)(3)(c)(i) of this rule may exceed the thirty MED average. The prescribing physician shall be held singularly accountable for prescriptions that exceed the thirty MED average.

(v) In circumstances when the thirty MED average is exceeded, the dose shall not exceed the dose required to treat the severity of the pain as noted in paragraph (A)(2) of this rule.

(d) Prescriptions that exceed the five or seven day supply or thirty MED average daily dose are subject to additional review by the state medical board. The dosage, days supplied, and condition for which the opioid analgesic is prescribed will be considered as part of this additional review.

(B) The requirements of paragraph (A) of this rule apply to treatment of acute pain and do not apply when an opioid analgesic is prescribed:

(1) To an individual who is a hospice patient or in a hospice care program;

(2) To an individual receiving palliative care;

(3) To an individual who has been diagnosed with a terminal condition; or

(4) To an individual who has cancer or another condition associated with the individual's cancer or history of cancer.

(C) This rule does not apply to prescriptions for opioid analgesics for the treatment of opioid addiction utilizing a schedule III, IV or V controlled substance narcotic that is approved by the federal drug administration for opioid detoxification or maintenance treatment.

(D) This rule does not apply to inpatient prescriptions as defined in Chapter 4729. of the Revised Code.

Last updated November 19, 2025 at 11:20 AM

History

Effective: August 31, 2017
Promulgated Under: 119.03

Ohio Adm.Code 4731-11-14 Prescribing for subacute and chronic pain.

(A) Prior to treating, or continuing to treat subacute or chronic pain with an opioid analgesic, the physician shall first consider and document non-medication and non-opioid treatment options.

(1) If opioid analgesic medications are required as determined by a history and physical examination, the physician shall prescribe for the minimum quantity and potency needed to treat the expected duration of pain and improve the patient's ability to function.

(2) The physician shall comply with the requirements of rule 4731-11-02 of the Administrative Code.

(B) Before prescribing an opioid analgesic for subacute or chronic pain, the physician shall complete or update and document in the patient record assessment activities to assure the appropriateness and safety of the medication including:

(1) History and physical examination including review of previous treatment and response to treatment, patient's adherence to medication and non-medication treatment, and screening for substance misuse or substance use disorder;

(2) Laboratory or diagnostic testing or documented review of any available relevant laboratory or diagnostic test results. If evidence of substance misuse or substance use disorder exists, diagnostic testing shall include urine drug screening;

(3) Review the results of an OARRS check in compliance with rule 4731-11-11 of the Administrative Code;

(4) A functional pain assessment which includes the patient's ability to engage in work or other purposeful activities, the pain intensity and its interference with activities of daily living, quality of family life and social activities, and the physical activity of the patient;

(5) A treatment plan based upon the clinical information obtained, to include all of the following components:

(a) Diagnosis;

(b) Objective goals for treatment;

(d) Planned duration of treatment and steps for further assessment and follow-up.

(6) Discussion with the patient or guardian regarding:

(a) Benefits and risks of the medication, including potential for addiction and risk of overdose; and

(b) The patient's responsibility to safely store and appropriately dispose of the medication.

(7) The physician shall offer a prescription for an overdose reversal drug to the patient receiving an opioid analgesic prescription under any of the following circumstances:

(a) The patient has a history of prior opioid overdose;

(b) The dosage prescribed exceeds a daily average of eighty MED or at lower doses if the patient is co-prescribed a benzodiazepine, sedative hypnotic drug, carisprodol, tramadol, or gabapentin; or

(C) Prior to increasing the opioid dosage to a daily average of fifty MED or greater the physician shall complete and document the following in the patient's medical record:

(1) The physician shall review and update the assessment completed in paragraph (B) of this rule, if needed. The physician may rely on an appropriate assessment completed within a reasonable time if the physician is satisfied that he or she may rely on that information for purposes of meeting the further requirements of this chapter of the Administrative Code;

(2) The physician shall update or formulate a new treatment plan, if needed;

(3) The physician shall obtain from the patient or the patient's guardian written informed consent which includes discussion of all of the following:

(a) Benefits and risks of the medication, including potential for addiction and risk of overdose.

(b) The patient's responsibility to safely store and appropriately dispose of the medication.

(4) Except when the patient was prescribed an average daily dosage that exceeded fifty MED before the effective date of this rule, the physician who is neither a specialist in the area of the body affected by the pain nor a pain management specialist shall document consideration of the following:

(a) Consultation with a specialist in the area of the body affected by the pain;

(b) Consultation with a pain management specialist;

(d) Consultation with a specialist in addiction medicine or addiction psychiatry, if aberrant behaviors indicating medication misuse or substance use disorder are noted.

(5) The physician shall consider offering a prescription for an overdose reversal drug to mitigate risk of overdose.

(D) Prior to increasing the opioid dosage to a daily average of eighty MED or greater, the physician shall complete all of the following:

(1) Enter into a written pain treatment agreement with the patient that outlines the physician's and patient's responsibilities during treatment and requires the patient or patient guardian's agreement to all of the following provisions:

(a) Permission for drug screening and release to speak with other practitioners concerning the patient's condition or treatment;

(b) Cooperation with pill counts or other checks designed to assure compliance with the treatment plan and to minimize the risk of misuse or diversion;

(c) The understanding that the patient shall only receive opioid medications from the physician treating the chronic pain unless there is written agreement among all of the prescribers of opioids outlining the responsibilities and boundaries of prescribing for the patient; and

(d) The understanding that the dosage may be tapered if not effective or if the patient does not abide by the treatment agreement.

(2) Offer a prescription for an overdose reversal drug to the patient as described in paragraph (B) of this rule.

(3) Except when the patient was prescribed an average daily dosage that exceeded eighty MED before the effective date of this rule, the physician who is neither a specialist in the area of the body affected by the pain nor a pain management specialist shall obtain at least one of the following based upon the patient's clinical presentation:

(a) Consultation with a specialist in the area of the body affected by the pain;

(b) Consultation with a pain management specialist;

(d) Consultation with a specialist in addiction medicine or addiction psychiatry if aberrant behavior indicating medication misuse or substance use disorder may be present.

(E) The physician shall not prescribe a dosage that exceeds an average of one hundred twenty MED per day. This prohibition shall not apply in the following circumstances:

(1) The physician holds board certification in pain medicine, board certification in hospice and palliative care, board certification in hematology, or board certification in oncology;

(2) The physician has received a written recommendation for a dosage exceeding an average of one hundred twenty MED per day from a board certified pain medicine physician or board certified hospice and palliative care physician who based the recommendation on a face-to-face visit and examination of the patient. The prescribing physician shall maintain the written recommendation in the patient's record; or

(3) The patient was receiving an average daily dose of one hundred twenty MED or more prior to the effective date of this rule. The physician shall follow the steps in paragraph (E)(2) of this rule prior to escalating the patient's dose.

(F) During the course of treatment with an opioid analgesic at doses below the average of fifty MED per day, the physician shall provide periodic follow-up assessment and documentation of the patient's functional status, the patient's progress toward treatment objectives, indicators of possible addiction, drug abuse or drug diversion and the notation of any adverse drug effects.

(G) During the course of treatment with an opioid analgesic at doses at or above the average of fifty MED per day, the physician shall complete and document in the patient record the following no less than every three months:

(1) Review of the course of treatment and the patient's response and adherence to treatment.

(2) The assessment shall include a review of any complications or exacerbation of the underlying condition causing the pain through appropriate interval history, physical examination, any appropriate diagnostic tests, and specific treatments to address the findings.

(3) The assessment of the patient's adherence to treatment including any prescribed non-pharmacological and non-opioid treatment modalities;

(4) Rationale for continuing opioid treatment and nature of continued benefit, if present.

(5) The results of an OARRS check in compliance with rule 4731-11-11 of the Administrative Code.

(6) Screening for medication misuse or substance use disorder. Urine drug screen should be obtained based on clinical assessment of the physician with frequency based upon presence or absence of aberrant behaviors or other indications of addiction or drug abuse.

(7) Evaluation of other forms of treatment and the tapering of opioid medication if continued benefit cannot be established.

(H) This rule does not apply to the physician who prescribes an opioid in any of the following situations:

(1) The medication is for a patient in hospice care.

(2) The patient has terminal cancer or another terminal condition, as that term is defined in rule 4731-11-01 of the Administrative Code.

(I) This rule does not apply to inpatient prescriptions or medication orders as defined in paragraph (J) of rule 4729:5-9-01 of the Administrative Code.

Last updated February 2, 2026 at 8:04 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Chapter 4731-12 Podiatry Licensure

Ohio Adm.Code 4731-12-01 Definitions.

(A) "APMLE" means the American podiatric medical licensing examination prepared by the national board of podiatric medical examiners.

(B) "Board" means the state medical board of Ohio.

(D) "Examination in podiatric medicine and surgery" means the examination to determine competency to practice podiatric medicine and surgery under section 4731.52 of the Revised Code.

(E) "License" means a license to practice podiatric medicine and surgery issued under section 4731.56 of the Revised Code.

(F) "NBPME" means the national board of podiatric medical examiners

(G) "PMLexis" means the podiatric medical licensing examination prepared by the national board of podiatric medical examiners.

(H) "Training Program" means an internship, residency, or clinical fellowship program that meets the requirements of division (A)(2) of section 4731.573 of the Revised Code.

Last updated February 28, 2023 at 8:47 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-12-02 Preliminary education for licensure and standing of colleges of podiatric surgery and medicine.

(A) For the purposes of sections 4731.52 and 4731.572 of the Revised Code, and rule 4731-12-07 of the Administrative Code, a college of podiatric medicine and surgery in the United States shall be defined as being in good standing if, at the time the diploma was issued, the institution was accredited by the CPME or its predecessor accrediting organizations.

(B) Production of a diploma from a college of podiatric medicine and surgery in good standing, at the time the diploma was issued, constitutes prima facie evidence that an applicant for a license has met the requirements of divisions (A)(1)(b) and (A)(1)(c) of section 4731.52 of the Revised Code. An applicant producing a diploma from a college of podiatric medicine and surgery located outside the United States must present evidence sufficient to establish to the board's satisfaction that the educational program met or exceeded the standards established by the CPME.

Last updated February 28, 2023 at 8:48 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-12-03 Podiatric examination.

The examination in podiatric medicine and surgery shall be all parts of the APMLE. An applicant shall have passed all parts and achieved a recognized passing performance on each part.

Last updated February 28, 2023 at 8:48 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-12-04 Eligibility for licensure.

The board shall issue a license to each individual who meets all applicable requirements under section 4731.52 of the Revised Code, and who passes the examination in podiatric medicine and surgery in accordance with rule 4731-12-03 of the Administrative Code, or has passed one of the following examinations:

(A) The "PMLexis" administered between June 12, 1990 and December 4, 2000, in addition to the holding of a passing status or diplomate status with the NBPME.

(B) An examination of a state of the United States, United States territory, or district administered before June 12, 1990, that was, in part, a written examination and

(1) Taken without previous or subsequent failure of the examination offered by the NBPME; and

(2) Taken without previous or subsequent failure of the PMLexis or part III of the APMLE.

Last updated February 28, 2023 at 8:48 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-12-05 Application procedures for licensure in podiatric medicine and surgery; investigation.

(A) Pursuant to division (A) of section 4731.52 of the Revised Code, all applicants for a license shall submit to the board an application under oath in the manner determined by the board, and provide such other facts and materials as the board requires. No application shall be considered submitted to the board until the appropriate fee has been received by the board.

(B) No application shall be considered complete until the applicant has complied with the requirements of paragraph (A) of rule 4731-4-02 of the Administrative Code and the board has received the results of the criminal records checks.

(C) The board reserves the right to thoroughly investigate all materials submitted as part of an application . The board may contact individual agencies or organizations for recommendations or other information about applicants as the board deems necessary. Applicants may be requested to appear before the board or a representative thereof as part of the application process.

(D) If an applicant for any license or certificate issued under section 4731.56, 4731.572, or 4731.573 of the Revised Code, fails to complete the application process within six months of initial application filing, the board may notify the applicant in writing of its intention to consider the application abandoned. If no response to that notice is received by the board within thirty days, the board shall consider the application as abandoned and no further processing shall be undertaken with respect to that application.

(E) If the application process extends for a period longer than six months, the board may require updated information as it deems necessary.

(F) No application being investigated under section 4731.22 of the Revised Code, may be withdrawn without approval of the board.

(G) Application fees are not refundable.

Last updated February 28, 2023 at 8:48 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-12-07 Podiatric training certificates.

(A) A training certificate is mandatory for participation in a training program unless the participant holds a license to practice podiatric medicine and surgery. The participation in the program prior to receiving an acknowledgment letter or a training certificate from the board is the unlicensed practice of medicine pursuant to section 4731.34 of the Revised Code.

(B) An individual may not begin participation in a training program unless the individual has been issued a diploma from a college of podiatric medicine and surgery in good standing.

(C) Evidence that the applicant for a training certificate has been accepted or appointed to a training program meeting the requirements of division (A)(2) of section 4731.573 of the Revised Code must include a certification from the training program of both of the following:

(1) The training program will verify that the applicant has been issued a diploma before permitting the applicant to begin participation in the training program; and

(2) The training program will notify the board if a holder of a training certificate has not been issued a diploma before the start date of the training program.

(D) The holder of a training certificate shall immediately notify the board in writing if the holder has not been issued a diploma before the start date of the training program.

(1) Upon receipt of that acknowledgment letter, the applicant may begin participating in the training program that meets the requirements of section 4731.573 of the Revised Code, and this chapter of the Administrative Code, to which the applicant has been appointed while the application is being processed. The acknowledgment letter will serve as proof that the board has received the application and that the applicant is entitled to continue participation in the training program.

(3) An acknowledgment letter issued under this rule shall authorize participation in a training program for one hundred twenty days, unless prior to that time the board:

(a) Issues the certificate; or

(b) Issues an order in accordance with Ohio law suspending without a prior hearing the authority to participate; or

(i) The board issues a license; or

(ii) The board issues a final order in accordance with Chapter 119. of the Revised Code; or

(iii) The training year ends.

Except as provided in this rule, participation in a training program pursuant to an acknowledgment letter cannot be renewed or extended beyond one hundred twenty days.

(H) A person who holds a suspended license to practice podiatric medicine and surgery is not eligible for a training certificate. Such a person must restore that license in accordance with sections 4731.222 and 4731.281 of the Revised Code before beginning postgraduate training in Ohio. A person whose license to practice podiatric medicine and surgery has been permanently revoked or permanently denied is ineligible to participate in a training program in Ohio.

Last updated February 28, 2023 at 8:49 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Chapter 4731-13 Hearings

Ohio Adm.Code 4731-13-01 Representatives; appearances.

(A) As used in this chapter of the Administrative Code:

(1) "Respondent" means a person who is requesting or has requested a hearing as provided in Chapter 119. of the Revised Code.

(2) "Representative of record" means one person designated by each party to be the party's agent for purposes of receipt of service pursuant to this chapter of the Administrative Code.

(3) "Hearing" means the adjudication hearing held pursuant to Chapter 119. of the Revised Code when a hearing is requested by an applicant or licensee for whom the Board has proposed formal action under section 4730.25, 4731.22, 4759.07, 4760.13, 4761.09, 4762.13, 4774.13, or 4778.14 of the Revised Code.

(4) "Summary Suspension" means the pre-hearing suspension of the license under division (G) of section 4730.25, 4731.22, 4759.07, 4760.13, 4761.09, 4762.13, 4774.13, or 4778.14 of the Revised Code.

(B) The respondent may represent himself or herself or may be represented by an attorney or attorneys who shall be admitted to the practice of law in Ohio. Each attorney representing the respondent shall enter his or her appearance in writing. The respondent may authorize his or her attorney or attorneys to represent the respondent in all facets of a hearing before the board.

(C) If the respondent is self represented, he or she shall be deemed the representative of record for purposes of service pursuant to this chapter of the Administrative Code. If the respondent is represented by one attorney, that attorney shall be deemed the representative of record for purposes of service pursuant to this chapter of the Administrative Code. If the respondent is represented by more than one attorney, the respondent shall designate one of those attorneys as the representative of record for purposes of service pursuant to this chapter of the Administrative Code.

(D) Each representative from the office of the attorney general shall enter his or her appearance in writing. The office of the attorney general shall identify one attorney from that office as the representative of record for purposes of service pursuant to this chapter of the Administrative Code.

(E) The respondent shall not be required to appear personally at any hearing provided he or she has not been subpoenaed. If a respondent has not been subpoenaed to appear at hearing, a respondent may present his or her position, arguments or contentions in writing.

(F) An attorney who has filed notice of appearance with the board shall withdraw his or her representation of a respondent by filing a written notice of withdrawal with the board. A written notice of withdrawal should include (1) current address and telephone number of respondent, and (2) an attestation from the attorney that the respondent has been provided copies of all filings and has been specifically notified of all dates and deadlines.

(G) An attorney who has been designated as a respondent's representative of record for purposes of service pursuant to this chapter of the Administrative Code shall remain the representative of record for that party until a representative of that party files a written notice designating another attorney or the respondent as the representative of record.

(H) Except as otherwise provided under Chapter 119. of the Revised Code, communications from the board or its hearing examiner shall be sent to the representative of record for each party.

Last updated August 2, 2021 at 9:26 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-02 Filing request for hearing.

(A) In order to request a hearing pursuant to Chapter 119. of the Revised Code, the respondent or the respondent's attorney or attorneys shall file a written request for a hearing in accordance with rule 4731-13-08 of the Administrative Code. The request shall be filed within thirty days of the date of mailing of the board's notice of opportunity for hearing upon which service is perfected, of the date of personal service of the board's notice of opportunity for hearing or of the date of publication of the board's notice of opportunity for hearing in accordance with Chapter 119. of the Revised Code, whichever occurs first. The date of mailing of the board's notice of opportunity for hearing shall be the date postmarked on the certified mail receipt.

(B) A respondent properly filing a request for a hearing, whether personally or by attorney or attorneys, shall be entitled to such hearing within fifteen days but not sooner than seven days after such request has been filed unless both parties agree otherwise or a continuance is granted pursuant to section 119.09 of the Revised Code and rule 4731-13-06 of the Administrative Code.

Last updated February 28, 2023 at 12:50 PM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-03 Authority and duties of hearing examiners.

(A) Hearings shall be conducted before hearing examiner pursuant to section 4731.23 of the Revised Code.

(B) All hearings shall be open to the public, but the hearing examiner conducting a hearing may close the hearing to the extent necessary to protect compelling interests and rights or to comply with statutory requirements. In the event the hearing examiner determines to close the hearing, the hearing examiner shall state the reasons in the public record.

(C) The hearing examiner shall conduct hearings in such a manner as to prevent unnecessary delay, maintain order and ensure the development of a clear and adequate record.

(D) The authority of the hearing examiner shall include, but not be limited to, authority to:

(1) Administer oaths and affirmations;

(2) Order issuance of subpoenas and subpoenas duces tecum to require the attendance of witnesses at hearings and depositions in lieu of live testimony and to require the production of evidence for hearings and depositions in lieu of live testimony;

(3) Examine witnesses and direct witnesses to testify;

(4) Make rulings on the admissibility of evidence;

(5) Make rulings on procedural motions, whether such motions are oral or written;

(6) Hold prehearing conferences;

(7) Request briefs before, during or following the hearing;

(8) Prepare entries, proposed findings, proposed orders or reports and recommendations pursuant to rule 4731-13-15 of the Administrative Code;

(9) Make rulings on requests to broadcast, record, televise or photograph the hearing;

(10) Take such other actions as may be necessary to accomplish the purposes of paragraph (C) of this rule; and

(11) Determine the order in which any hearing shall proceed.

(E) The authority of the hearing examiner shall not include authority to grant motions for dismissal of charges, or modify, compromise or settle charges or allegations.

(F) The hearing examiner shall have such other powers, duties, and authority as are granted by statutes or rules.

(G) All rulings on evidence and motions and on any other procedural matters shall be subject to review by the board upon presentation of the proposed findings of facts and conclusions of law of the hearing examiner. When such rulings warrant, the board may remand the matter to the attorney hearing examiner.

(H) The hearing examiner may assist the board by reviewing the evidence in matters that have been subject to a notice of opportunity for hearing but for which no timely hearing request has been filed. In such matters the hearing examiner may prepare proposed findings and a proposed order for the board's consideration.

(I) Briefs provided under paragraph (D)(7) of this rule shall comply with the requirements set forth in rule 4731-13-07.1 of the Administrative Code.

(J) Upon the motion of a party, or upon the hearing examiner's own motion, the hearing examiner shall have the authority to conduct hearings by use of a live, real-time video-conferencing system. Such a system must provide a means, through the use of software that is widely accessible to the general public without charge, for the hearing examiner, attorneys, the respondent, witnesses, and a court reporter, along with any other necessary participants, to see and converse with each other and to display documentary and physical evidence. Further, the video-conferencing system must also provide a means by which members of the public may view and listen to the hearing.

Last updated August 2, 2021 at 9:26 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-04 Consolidation.

Upon motion by either party, or upon the initiative of the hearing examiner, the hearing examiner may consolidate two or more hearings into a single hearing, unless either party objects for good cause.

Last updated February 28, 2023 at 12:50 PM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-05 Intervention.

Petitions to intervene shall not be permitted.

Last updated October 9, 2026 at 8:44 AM

History

Effective: June 30, 1989
Promulgated Under: Ch 119.

Ohio Adm.Code 4731-13-06 Continuance of hearing.

(A) Except in matters of summary suspension, the board or the board through its hearing examiner, shall continue the initially scheduled hearing upon its own motion in order to more efficiently and effectively conduct its business unless the circumstances establish that a continuance would not serve the interest of justice. The new hearing date shall be set according to the case management schedule approved by the board for the type of violation alleged and available from the board's website at http://med.ohio.gov/. In setting the new hearing date, the hearing examiner shall make a reasonable attempt to obtain input from the parties. Upon motion of at least one of the parties demonstrating extraordinary circumstances, the hearing examiner may approve a special case management schedule.

(B) A hearing shall be continued only with the approval of the board or its hearing examiner based upon a written motion of a party or upon the initiative of the hearing examiner.

(1) Before granting any continuance, consideration shall be given to harm to the public which may result from delay in proceedings.

(2) In no event will a motion for a continuance requested less than fourteen days prior to the scheduled date of the hearing be granted unless it is demonstrated that good cause exists which would justify the granting of a continuance.

(D) No continuance of a hearing for a summary suspension shall be granted without the written agreement of the respondent or the respondent's attorney or attorneys and of the board through its secretary and supervising member.

(E) If a continuance is granted, the entry granting the continuance shall specify the dates to which the hearing is continued and shall be set in accordance with the case management schedule. Upon motion of at least one of the parties demonstrating extraordinary circumstances, the hearing examiner may approve a special case management schedule.

(F) Hearings shall not be continued due to the unavailability of a subpoenaed witness without approval of the hearing examiner.

(1) The hearing examiner may hold the record open to accept a deposition in lieu of live testimony of a subpoenaed witness.

(2) The procedures set forth in rules 4731-13-20 and 4731-13-20.1 of the Administrative Code shall apply to any deposition in lieu of live testimony taken pursuant to this rule.

Last updated August 2, 2021 at 9:26 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-07 Motions.

(A) Except as otherwise provided under Chapter 4731-13 of the Administrative Code or Chapter 119. of the Revised Code, all motions, unless made upon the record at hearing, shall be made in writing. A written motion shall state with particularity the relief or order sought, shall be accompanied by a memorandum setting forth the grounds therefore, and shall be filed in compliance with rule 4731-13-08 of the Administrative Code. Except in cases of summary suspensions pursuant to division (G) of section 4731.22 of the Revised Code, all prehearing motions except motions for continuance pursuant to rule 4731-13-06 of the Administrative Code and motions to quash pursuant to paragraph (F) of rule 4731-13-13 of the Administrative Code, shall be made no later than fourteen days before the date of hearing unless express exception is granted by the hearing examiner or by this chapter.

(1) If filed by email, motions and supporting or opposing memoranda shall be filed as pdf attachments to emails, and not be incorporated into the body of the email itself.

(2) All supporting or opposing memoranda shall comply with rule 4731-13-07.1 of the Administrative Code.

(B) All motions, together with any supporting documentation, shall be served as provided in rule 4731-13-09 of the Administrative Code.

(C) Any response to a prehearing motion shall be filed within ten days after service of that motion, or at such other time as is fixed by the hearing examiner. A movant may reply to a response only with the permission of the hearing examiner.

(D) Before ruling upon a written motion, the hearing examiner shall consider all memoranda and supporting documents filed. The hearing examiner shall enter a written ruling and shall issue copies to each representative of record. The ruling on all motions made at hearing shall be included in the hearing transcript except where the hearing examiner elects to take the motion under advisement and issue a written ruling at a later time. The hearing examiner shall include in each written ruling on a motion a statement of the reasons therefore.

(E) Except as otherwise provided in this chapter or Chapter 119. of the Revised Code, rulings on all motions filed subsequent to the issuance of the report and recommendation shall be rendered by the board or, if the board is not in session, by its president or the vice president if the president is unavailable acting on its behalf.

(1) Responses to motions shall be filed no later than three days after service of the motion as set forth in the certificate of service attached to the served copy of the motion. A movant may reply to a response only with the permission of the board through its president or vice president if the president is unavailable, and only under extraordinary circumstances, such as an assertion that a material inaccuracy of fact or law was provided in the response.

(2) Motions for extension of time for filing objections shall be filed on or prior to the deadline for filing the objections. A motion for extension of time for filing objections filed after the deadline will not be considered absent extraordinary circumstances, as determined by the board through its president or vice president if the president is unavailable.

Last updated August 2, 2021 at 9:26 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-07.1 Form and page limitations for briefs and memoranda.

(A) All hearing briefs provided under paragraph (D)(7) of rule 4731-13-03 of the Administrative Code and memoranda filed under rule 4731-13-07 of the Administrative Code shall be provided or filed subject to the following requirements:

(1) The body text of a brief or memorandum shall be set in a legible typeface of at least twelve points, either single-spaced or double-spaced.

(2) A brief or memorandum shall not exceed fifteen pages exclusive of the certificate of service and the appendix unless an exception is granted in advance pursuant to paragraph (A)(3) of this rule.

(3) Upon motion by either party, or upon the initiative of the hearing examiner, the hearing examiner may authorize briefs or memoranda that exceed fifteen pages, up to a maximum of thirty pages exclusive of the certificate of service and the appendix, in matters that involve complex legal issues. Unless made upon the record at hearing, a motion for such a determination shall be filed no later than seven days prior to the deadline for filing the brief or memorandum.

(4) If a reply memorandum is authorized pursuant to paragraph (C) of rule 4731-13-07 of the Administrative Code, that memorandum shall not exceed seven pages exclusive of the certificate of service and the appendix.

(B) Briefs and memoranda provided in contravention of the requirements set forth in paragraph (A) of this rule will be accepted for filing, however, pages beyond the fifteen page limit shall not be considered.

Last updated August 2, 2021 at 9:26 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-08 Filing.

(A) A document is "filed" when it is received and time stamped in the offices of the board. For documents received via e-mail or through any electronic filing system implemented by the board, the time stamp provided by the board's computer shall be the time of receipt. Documents received after five p.m. eastern standard time shall not be considered for filing until the next business day.

(B) An original of any document required to be served by Chapter 4731-13 of the Administrative Code shall be filed with the board not more than three days after service.

Last updated August 2, 2021 at 9:27 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-09 Service.

To be considered by the board and its hearing examiner, any document required by Chapter 4731-13 of the Administrative Code to be served shall:

(A) Be served either personally, by regular mail, by facsimile, by e-mail, or through any electronic filing system which provides automatic notice to parties utilized by the board. Service is complete on the date of mailing, e-mailing, facsimile or personal service of the document.

(B) Contain the name, address, and telephone number of the person submitting the document and shall be appropriately captioned to indicate the name of the respondent.

(1) The date of service;

(2) The method by which service was made;

(3) The address where service was made; and

(4) The name of the person or authority who was served.

Last updated August 2, 2021 at 9:27 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-10 Computation and extension of time.

(A) The date of occurrence of the event causing time to run is not counted in the computation of any time limit under Chapter 4731-13 of the Administrative Code. The last day of the period is included in the computation of the time limit. If the last day of a period is not a regular business day, the time period runs through the end of the next regularly scheduled business day.

(B) The board or its hearing examiner may extend the time for filing or responding to motions and briefs.

(1) Requests for extension of time shall be made in writing and filed as provided in rule 4731-13-08 of the Administrative Code prior to the expiration of any applicable time limit.

(2) Requests for extension of time shall be addressed to the attention of the board's hearing unit.

(3) Requests for extension of time shall be served as provided in rule 4731-13-09 of the Administrative Code.

Last updated October 9, 2026 at 8:44 AM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-11 Notice of hearings.

Notice specifying the date, time and place set for hearing shall be mailed by certified mail to the representatives of record, except that notice of changes to the date, time or place set for hearing shall be mailed by regular mail, e-mail or facsimile if a representative of each party participated in the selection of the new date, time or place.

Last updated February 28, 2023 at 12:51 PM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-12 Transcripts.

(A) Duplicate transcripts of the stenographic record taken of hearings may be obtained directly from the court reporter at the requestor's expense prior to receipt of the original transcript by the board, except as otherwise restricted by 4731-13-31 of the Administrative Code.

(B) Upon request made to the board's hearing unit, a copy of the original hearing transcripts may be reviewed at the board offices. Additional copies may be prepared at the requestor's expense and shall be provided by the board within a reasonable period of time.

(D) Any portion of a hearing transcript which contains information that is required to be kept confidential pursuant to any state or federal law shall be sealed and made part of the hearing record. Confidential portions of hearing transcripts shall be provided only to agents of the parties for purposes of the administrative hearing and shall not be disseminated to any other persons.

Last updated February 28, 2023 at 12:51 PM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-13 Subpoenas for purposes of hearing.

(A) Upon written request, the board shall issue subpoenas for purposes of hearing to compel the attendance and testimony of witnesses and production of books, records and papers. Each subpoena shall indicate on whose behalf the witness is required to testify. Copies of such subpoenas shall be issued to each representative of record.

(B) For purposes of a hearing conducted pursuant to Chapter 119. of the Revised Code, subpoena requests shall specify the name and address of the individual to be served and the date and time at which the individual is to appear. With respect to the production of books, records and papers, such request shall set a compliance date in accordance with the exchange deadlines established by the hearing examiner in rule 4731-13-18.

(C) Except upon leave of the board or its hearing examiner, subpoena requests are to be filed with the board as provided in rule 4731-13-08 of the Administrative Code at least twenty-one days in advance of the requested date of compliance in order to allow sufficient time for preparation and service of the subpoenas.

(D) In the event that the number of subpoenas requested appears to be unreasonable, the board or its hearing examiner may require a showing of necessity therefore and, in the absence of such showing, may limit the number of subpoenas. Absent such a limitation, subpoenas shall be issued within seven days of request. Failure to issue subpoenas within this time may constitute sufficient grounds for the granting of a continuance.

(E) After the hearing has commenced the hearing examiner may order the issuance of subpoenas for purposes of hearing to compel the attendance and testimony of witnesses and production of books, records and papers. Copies of such subpoenas shall be issued to each representative of record.

(F) Upon motion and for good cause, the hearing examiner may order any subpoena be quashed. Motions to quash shall be made in the manner provided in rules 4731-13-07 and 4731-13-08 of the Administrative Code, except that motions to quash shall be filed at least seven days prior to the date of compliance. The non-moving party may file a response no later than five days after service of the motion to quash or at least one day prior to the date of compliance whichever is earlier. Unless a motion to quash has been granted, a witness shall attend the hearing to which he or she was subpoenaed. The board shall make a reasonable attempt to contact any witness whose subpoena has been quashed.

(G) Witnesses shall not be subpoenaed to prehearing conferences.

Last updated August 2, 2021 at 9:27 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-14 Mileage reimbursement and witness fees.

(A) Mileage shall be paid in the same manner as that allowed in the court of common pleas in criminal cases in the county of hearing.

(B) The respondent shall not subpoena him or her self.

(C) Mileage and witness fees shall be returned by anyone who fails to appear at the hearing for which he or she was subpoenaed.

Last updated February 28, 2023 at 12:51 PM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-15 Reports and recommendations.

(A) Within thirty days following the close of a hearing conducted under Chapter 119. of the Revised Code, the hearing examiner shall submit a written report setting forth proposed findings of fact and conclusions of law and a recommendation of the action to be taken by the board. The hearing shall not be considered closed until such time as the record is complete, as determined by the hearing examiner.

(B) A copy of such written report shall be issued to each representative of record. The copy issued to the respondent's representative of record shall be accompanied by notice of the date the report and recommendation is to be considered by the board.

(C) Either representative of record may, within ten days of receipt of the hearing examiner's report and recommendation, file written objections to the report and recommendation. Only those objections filed in a timely manner shall be considered by the board before approving, modifying, or disapproving the hearing examiner's recommendation, unless otherwise determined by the board.

(D) Upon written request, the board may grant extensions of the time within which to file objections to the report and recommendation. In the event that the board is not in session, the president of the board may grant such extensions.

(E) Unless otherwise determined by the board based upon written motion of a party, the board shall consider the hearing examiner's report and recommendation and any objections thereto at its next regularly scheduled meeting after the time for filing objections has passed. At that time, the board may do any or all of the following: order additional testimony to be taken: permit the introduction of further documentary evidence; or act upon the report and recommendation. For purposes of taking such additional testimony or documentary evidence, the board may remand to the hearing examiner.

(F) Any motion to reopen the hearing record for purposes of introducing newly discovered material evidence that with reasonable diligence, could not have been discovered and produced at the hearing shall be filed in the manner provided in rules 4731-13-07 and 4731-13-08 of the Administrative Code. Such motion to reopen shall be filed not later than fourteen days prior to the scheduled consideration by the board of the hearing examiner's report and recommendation, unless the newly discovered material evidence, with reasonable diligence, could not have been discovered earlier than fourteen days prior to the scheduled consideration by the board. The other party shall have an opportunity to file, not later than seven days prior to the scheduled consideration by the board of the hearing examiner's report and recommendation, a memorandum contra to said motion.

Any submission of documentation or evidence received by the board after the close of the record and prior to the date of consideration of the hearing examiner's report and recommendation by the board shall be deemed a motion to reopen the record pursuant to this rule. If such motion is filed prior to the issuance of the hearing examiner's report and recommendation, the hearing examiner shall rule on the motion. If such motion is filed subsequent to the issuance of the hearing examiner's report and recommendation, the board shall rule on the motion. All submitted materials must be accompanied by an affidavit from the moving party that sets forth how the evidence is material, how the evidence is newly discovered, and why it could not have been produced at hearing. The affidavit must also show that the party made a reasonably diligent effort to obtain the material prior to hearing. Failure to comply with the requirements of this rule shall result in the exclusion of the submitted material unless the moving party shows good cause and the board votes to admit the document or evidence.

(G) Without leave of the board, no party shall be permitted to address the board at the time of consideration of the hearing examiner's report and recommendation. Any request for such leave shall be filed by motion no less than seven days prior to the date the report and recommendation is to be considered by the board. No such leave shall be granted unless the opposing representative of record has been actually notified of the request, unless otherwise determined by the board.

(H) If a request to address the board is granted, the opposing party may also address the board.

Last updated August 2, 2021 at 9:28 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-16 Reinstatement or restoration of certificate.

Any disciplinary action taken by the board which results in a suspension from practice shall either lapse by its own terms or contain a written statement of the conditions under which the certificate may be reinstated or restored, unless terms for reinstatement or restoration are otherwise governed by statute.

Such conditions may include but are not limited to:

(A) Submission of a written application for reinstatement or restoration;

(B) Payment of all appropriate fees, civil penalties, and fines as provided in Chapter 4731. of the Revised Code;

(D) Additional education or training;

(E) Reexamination;

(F) Practice limitations;

(G) Participation in counseling programs;

(H) Demonstration that the respondent can resume practice in compliance with acceptable and prevailing standards.

Last updated August 2, 2021 at 9:28 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-17 Settlements, dismissals, and voluntary surrenders.

(A) Settlement shall be negotiated on behalf of the board by the secretary and supervising member of the board. Any settlement agreement containing terms not in conformity with the disciplinary guidelines adopted by the board must have the concurrence of the board's president prior to execution.

(B) Any matter which is the subject of a hearing may be settled by the parties. If settlement negotiations continue after the final day of hearing, the parties shall, within ten days of the final day of hearing, jointly present the hearing examiner with written notice specifying a period of time, not to exceed thirty days, during which the record shall be held open for purposes of negotiation.

(1) If the hearing record has closed or closes during the period of time specified in the parties' joint notice, such notice shall toll the hearing examiner's thirty-day time period for issuance of findings of fact and conclusions of law pursuant to section 4731.23 of the Revised Code.

(2) If, at the conclusion of the time period specified by the parties' joint notice, the hearing examiner has not received appropriate written notice that a settlement agreement has been executed, the tolling of the hearing examiner's thirty-day period for issuance of findings of fact and conclusions of law shall cease, no further settlement negotiations shall be undertaken, and no settlement agreement shall be executed in lieu of the filing of a report and recommendation by the hearing examiner and the issuance of a final order by the board.

(C) Before being submitted to the board for ratification, all settlement agreements shall be in writing and shall be signed by the respondent and by the respondent's attorney, if any. Counsel for the board shall sign the settlement agreement as follows:

(1) If the settlement agreement was negotiated prior to the issuance of a notice of opportunity for hearing, an appropriate board staff attorney shall sign the agreement.

(2) If the settlement agreement was negotiated subsequent to the issuance of a notice of opportunity for hearing, an attorney from the office of the attorney general shall sign the agreement.

(D) Signed settlement agreements shall be submitted to the board for ratification.

(E) If the board ratifies a settlement agreement, the secretary and supervising member of the board shall sign the ratified agreement.

(F) A notice of dismissal may be entered at any time prior to the filing of the report and recommendation. If negotiations continue after the final day of hearing, the procedures in paragraph (B) of this rule shall be followed. A notice of dismissal shall be authorized and signed by the board's secretary and supervising member.

(G) This rule shall neither apply to nor limit the authority granted the board under division (M) of section 4731.22 of the Revised Code with regard to the surrender of a license or certificate or the withdrawal of an application for a license or certificate.

(H) In the event that the board issues an amended notice of opportunity for hearing, the original notice of opportunity for hearing is automatically superseded by the amended notice. To request a hearing pursuant to Chapter 119. of the Revised Code, the respondent must file a new hearing request in response to the amended notice of opportunity for hearing. For purposes of this chapter of the Administrative Code, "amended cite" means a cite in which there has been a substantive alteration to one or more factual allegations or statutory charges, other than correction of a clerical or technical error, that relates to the allegations set forth in the original notice.

Last updated August 2, 2021 at 9:28 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-18 Exchange of documents and witness lists.

(A) At the time the hearing examiner schedules the hearing with input from the parties, a case management schedule shall be created which will include the deadline dates for each party to provide a list of both the witnesses and the documents intended to be introduced at hearing.

(B) Upon motion of any party, failure without good cause to provide the list of witnesses and documents by the deadline date established in the case management schedule may result in exclusion from the hearing of such testimony or documents.

(C) The hearing examiner shall set, in the case management schedule, the deadline dates by which the parties shall exchange hearing exhibits, identify lay and expert witnesses and exchange written reports from expert witnesses.

(1) Absent extraordinary circumstances, the failure of a party to produce an exhibit under the terms of the case management schedule shall result in the exclusion of that exhibit from evidence at hearing.

(2) Absent extraordinary circumstances, the failure of a party to identify a lay or expert witness under the terms of the case management schedule shall result in the exclusion of that witness' testimony at hearing.

(3) Absent extraordinary circumstances, the failure of a party to produce a written report from an expert witness under the terms of the case management schedule shall result in the exclusion of the witness' expert testimony at hearing.

(D) A party shall notify the hearing examiner of any deficiency in the materials provided by the other party within a reasonable period of time after discovery of the deficiency.

(E) A party shall notify the hearing examiner of any failure by the other party to comply with a deadline imposed pursuant to this rule within seven days of the failure to comply.

(F) Any witness who intends to testify as an expert, including the respondent, must submit a written report. A written report by an expert shall set forth the opinions to which the expert witness will testify and the bases for such opinions. This paragraph will not preclude the respondent from testifying as a fact witness.

(G) Any exhibit exchanged by the parties which is a patient record or which contains information that is required to be kept confidential pursuant to any state or federal law may be provided only to agents of the parties for purposes of the administrative hearing and shall not be disseminated to any other person or entity.

Last updated February 28, 2023 at 1:02 PM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-20 Depositions in lieu of live testimony.

(A) Upon written motion of any party, and upon service of that motion to the other party's representative of record, the hearing examiner may order that the testimony of a prospective witness be taken by deposition in lieu of live testimony. The hearing examiner may grant the motion if it appears probable that:

(1) The prospective witness will be unavailable to attend or will be prevented from attending a hearing;

(2) The testimony of the prospective witness is material; and

(3) In the case of an expert witness, a showing of the unavailability of the expert to attend shall not be necessary for the hearing examiner's consideration of the motion to take a deposition in lieu of live testimony.

(B) The testimony shall be taken under such conditions and terms as the hearing examiner shall set forth. Moreover, the hearing examiner may order the production of any designated books, papers, documents or tangible objects, so long as not privileged, at the same time and place.

(C) The parties shall agree to the time and place for taking the deposition in lieu of live testimony. Depositions in lieu of live testimony shall be conducted in the same county in which the hearing is conducted unless otherwise agreed to by the parties. If the parties are unable to agree, the hearing examiner shall set the time or fix the place of deposition.

(D) At a deposition in lieu of live testimony taken under this rule, each party shall have the right, as at hearing, to fully examine witnesses.

(E) The transcript of a deposition in lieu of live testimony taken under this rule shall be offered into evidence at hearing. The cost of preparing a transcript of any testimony taken by deposition in lieu of live testimony which is submitted as evidence at the hearing shall be borne by the board.

(F) The expense of any video deposition shall be borne by the requestor.

Last updated October 9, 2026 at 8:44 AM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-20.1 Electronic Testimony.

(A) Upon written motion of any party, and upon service of that motion to the other party's representative of record, the hearing examiner may order that the testimony of a prospective witness be taken by telephonic or real-time video testimony. The hearing examiner may grant the motion if it appears probable that:

(1) The prospective witness will be unavailable to attend or will be prevented from attending a hearing; and

(2) The testimony of the prospective witness is material.

Last updated October 9, 2026 at 8:44 AM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-21 Prior action by the state medical board.

The hearing examiner shall admit evidence of any prior action entered by the board against the respondent. Such evidence shall include a certified copy of the final order in that prior action, and may also include other certified documents pertaining to that action.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-22 Stipulation of facts.

Parties may, by stipulation, agree on any or all facts involved in proceedings before the hearing examiner. The hearing examiner may thereafter require development of any fact the hearing examiner deems necessary.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-23 Witnesses.

(A) All witnesses at any hearing before the hearing examiner shall testify under oath or affirmation.

(B) A witness may be accompanied and advised by legal counsel. Participation by counsel for a witness other than the respondent is limited to protection of that witness's rights, and that legal counsel may neither examine nor cross-examine any witnesses.

(C) The board may institute contempt proceedings pursuant to section 119.09 of the Revised Code, if a witness refuses to answer a question ruled proper at a hearing or disobeys a subpoena.

(D) For purposes of this chapter:

(1) A sitting board member is an individual who is currently a member of the board.

(2) A presiding board member is a sitting board member who has a decisive role in the outcome of the matter in question and who is neither the secretary nor the supervising member as appointed pursuant to Chapter 4731. of the Revised Code.

(3) A non-presiding board member is a sitting board member who does not have a decisive role in the outcome of the matter in question due to recusal, absence or other reason.

(4) A presiding hearing examiner is a hearing examiner who is assigned to the matter in question pursuant to section 4731.23 of the Revised Code.

(5) A non-presiding hearing examiner is a hearing examiner who is not assigned to the matter in question pursuant to section 4731.23 of the Revised Code.

(E) Neither a presiding board member nor a presiding hearing examiner shall be a competent witness in any adjudication proceeding. Evidence from other persons relating to the mental processes of a presiding board member or a presiding hearing examiner shall not be admissible.

(F) Unless the testimony of a non-presiding board member or a non-presiding hearing examiner is material to the factual allegations set forth in the notice of opportunity for hearing, neither a non-presiding board member nor a non-presiding hearing examiner shall be a competent witness in any adjudication proceeding.

(G) A sitting board member shall not be subpoenaed to provide expert testimony.

(H) Any party may move for a separation of witnesses. Expert witnesses shall not be separated.

(I) Upon commencement of a hearing, each party shall inform the hearing examiner of the identity of each potential witness for his or her cause who is present in the hearing room. Failure to so identify potential witnesses may be grounds for their later disqualification as witnesses.

(J) A witness may, in the discretion of the attorney hearing examiner, testify as to an ultimate issue of fact. An expert witness may testify regarding the appropriate treatment for impairment.

Last updated October 9, 2026 at 8:44 AM

History

Effective: September 30, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-24 Conviction of a crime.

A certified copy of a plea of guilty to, or a judicial finding of guilt of any crime in a court of competent jurisdiction is conclusive proof of the commission of all of the elements of that crime.

Last updated February 28, 2023 at 1:03 PM

History

Effective: June 30, 1989
Promulgated Under: Ch 119.

Ohio Adm.Code 4731-13-25 Evidence.

(A) The "Ohio Rules of Evidence" may be taken into consideration by the board or its hearing examiner in determining the admissibility of evidence, but shall not be controlling. The "Ohio Rules of Evidence" are readily available to attorneys and may be found at libraries, bookstores and on the internet at www.supremecourt.ohio.gov/LegalResources/Rules/evidence/evidence.pdf.

(B) The hearing examiner may permit the use of electronic or photographic means for the presentation of evidence.

Last updated February 28, 2023 at 1:03 PM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-26 Broadcasting and photographing administrative hearings.

If the hearing examiner determines that broadcasting, televising, recording or taking of photographs in the hearing room would not distract participants, impair the dignity of the proceedings or otherwise materially interfere with the achievement of a fair administrative hearing, the broadcasting, televising, recording or taking of photographs during hearing proceedings open to the public may be permitted under the following conditions and upon request:

(A) Requests for permission for the broadcasting, televising, recording or taking of photographs in the hearing room shall be made in writing to the hearing examiner prior to the commencement of the hearing, and shall be made a part of the record of the proceedings;

(B) Permission is expressly granted prior to commencement of the hearing in writing by the hearing examiner and is made a part of the record of the proceedings;

(C) If the permission is granted, the hearing examiner shall specify the place or places in the hearing room where operators and equipment are to be positioned;

(D) The filming, videotaping, recording or taking of photographs of witnesses who object thereto shall not be permitted.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-27 Sexual misconduct evidence.

In those cases where sexual misconduct has been alleged:

(A) Evidence of specific instances of the victim's sexual activity, opinion evidence of the victim's sexual activity, and reputation evidence of the victim's sexual activity shall not be admitted unless it involves evidence of the origin of semen, pregnancy, or disease, or the victim's sexual activity with the offender, and only to the extent that the evidence is material to a fact at issue in the case and that its inflammatory or prejudicial nature does not outweigh its probative value.

(B) Prior to taking testimony or receiving evidence of any sexual activity of the victim, the hearing examiner shall resolve the admissibility of the proposed evidence in a closed hearing. The victim may be represented by counsel in that hearing or other proceedings to resolve the admissibility of evidence upon approval by the hearing examiner.

(C) Nothing in this rule shall be construed as limiting the authority of the hearing examiner to close a hearing as provided under paragraph (B) of rule 4731-13-03 of the Administrative Code.

Last updated February 28, 2023 at 1:03 PM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-28 Supervision of hearing examiners.

The hearing examiners shall perform their duties under the supervision and direction of the board's executive director, provided that the board, other than the secretary and supervising member, shall have exclusive authority to impose discipline based on the substance of the hearing examiners' reports and recommendations.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-30 Prehearing conference.

With or without written motion from any party, the hearing examiner may schedule a prehearing conference to address any matter related to preparation for or conduct of a hearing. The prehearing conference may be in person or by telephone. No witness testimony shall be taken during a prehearing conference. Any documents presented at the prehearing conference shall be made part of the hearing record. If a transcript of the proceeding is prepared, the transcript shall be made part of the hearing record.

Last updated February 28, 2023 at 1:04 PM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-31 Transcripts of prior testimony.

(A) Any transcript of prior testimony of a witness may be used for the purpose of refreshing the recollection, contradicting the testimony or impeaching the credibility of that witness. If only a part of a transcript is offered into evidence by a party, the other party may offer any other part.

(B) A transcript of testimony and exhibits from a prior proceeding may be introduced for any purpose if that prior proceeding concerns the basis for the board's allegations against the respondent. Upon offering part of a transcript or exhibit from a prior proceeding, the offering party may be required by the other party to present any other part of the offered item which should in fairness be considered contemporaneously with it.

(C) Nothing in this paragraph shall be construed to permit the taking of depositions for purposes other than those set forth in rule 4731-13-20 of the Administrative Code.

(D) Nothing in this rule shall be construed to limit the use of a prior statement by a respondent as set forth in rule 4731-13-32 of the Administrative Code.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-32 Prior statements of the respondent.

Prior statements of the respondent shall not be excluded on the basis of hearsay.

Last updated October 9, 2026 at 8:44 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-33 "Physicians' Desk Reference".

The board or its hearing examiner may utilize the "Physicians' Desk Reference" (PDR) for information regarding the FDA approved labeling for dangerous drugs. The edition(s) of the PDR utilized shall be the edition(s) contemporaneous with the allegations set forth in the notice of opportunity for hearing upon which the hearing is based. The "PDR" is a well-known and readily available text. It may be found at libraries, bookstores or on the internet at www.pdr.net. The board or its hearing examiner may also utilize the US national library of medicine at medlineplus.gov.

Last updated August 2, 2021 at 9:28 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-34 Ex parte communication.

(A) The members of the board shall base their decisions on any matter subject to hearing only on the evidence of record. No information acquired by a member of the board in any way other than by review of the evidence of record shall be considered by such member in that member's decision on a matter subject to hearing. The receipt of information about a matter subject to hearing outside the evidence of record shall not disqualify the member from participating in the decision on that matter unless the member excuses himself or herself from participation in the decision on the ground that he or she cannot restrict his or her decision on the matter to the evidence of record.

(B) Except as otherwise provided under this chapter or by statute, no hearing examiner or member of the board shall initiate or consider ex parte communications concerning a substantive matter related to a pending hearing. Nothing contained herein, however, shall preclude the hearing examiner from nonsubstantive ex parte communications on procedural matters and matters affecting the efficient conduct of adjudicatory hearings.

(C) The hearing examiner and members of the board shall disclose on the public record the source of any ex parte or attempted ex parte communications pertaining to a substantive issue. If the recipient of the ex parte communication determines that he or she can no longer render an impartial decision, the recipient shall recuse himself or herself from further participation in consideration of the matter.

(D) If requested by any party, the recipient of the ex parte communication shall file with the board an affidavit setting forth the substance of the ex parte communication. The affidavit shall be sealed, held as proffered material and maintained with the hearing record.

Last updated October 9, 2026 at 8:44 AM

History

Effective: July 31, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-35 Severability.

(A) Except as otherwise provided under this chapter or by statute, a rule promulgated under this chapter shall apply only to those administrative proceedings for which the notice of opportunity for hearing was mailed to respondent, or his representative, on or after the effective date of the particular rule.

(B) If any provision of the rules in this chapter of the Administrative Code or if the application of any provision of the rules in this chapter of the Administrative Code is held invalid, the invalidity shall not affect any other provision of the rules in this chapter, or the application of any other provision of the rules in this chapter, that can be given effect without the invalid provision or application, and, to this end, the provisions of the rules in this chapter are hereby declared severable.

Last updated February 28, 2023 at 1:04 PM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-13-36 Disciplinary actions.

For purposes of Chapters 4730., 4731., 4759., 4760., 4761., 4762., 4774., and 4778. of the Revised Code and Chapters 4730., 4731., 4774., and 4778. of the Administrative Code:

(A) "Permanent revocation" means the permanent loss of a certificate to practice in Ohio and the inability, at any time, to reapply for or hold any certificate to practice in Ohio. An individual whose certificate has been permanently revoked shall forever thereafter be ineligible to hold any certificate to practice, and the board shall not accept from that individual an application for reinstatement or restoration of the certificate or for issuance of any new certificate.

(B) "Revocation" means the loss of a certificate to practice in Ohio. An individual whose certificate has been revoked shall be eligible to submit an application for a new certificate. The application for a new certificate shall be subject to all requirements for certification in effect at the time the application is submitted. In determining whether to grant such an application, the board may consider any violations of Chapters 4730., 4731., 4759., 4760., 4761., 4762., 4774., and 4778. of the Revised Code, whichever is applicable, that were committed by the individual before or after the revocation of the individual's certificate, including those that formed the basis for the revocation. All disciplinary action taken by the board against the revoked certificate shall be made a part of the board's records for any new certificate granted under this rule.

(C) "Suspension" means the temporary loss of a certificate to practice in Ohio. A suspension shall be imposed for either a definite term or an indefinite term.

(1) An order for a definite term of suspension shall specify the time period of the suspension. A certificate which has been suspended for a definite term shall be reinstated at the conclusion of the specified time period.

(2) An order for an indefinite term of suspension shall contain a written statement of the conditions under which the certificate may be reinstated. Such conditions may include, but are not limited to, the following:

(a) A minimum time period of suspension;

(b) Submission of a written application for reinstatement;

(c) Payment of all appropriate fees, civil penalties, and fines as provided in Chapters 4730., 4731., 4759., 4760., 4761., 4762., 4774., and 4778. of the Revised Code;

(d) Mental or physical examination;

(e) Additional education or training;

(f) Reexamination;

(g) Participation in counseling programs;

(h) Demonstration that the certificate holder can resume practice in compliance with acceptable and prevailing standards;

(i) Satisfactory completion of all terms, conditions or limitations placed upon the certificate holder through a board-approved consent agreement or board order;

(j) Passage of an examination to determine present fitness to resume practice, pursuant to section 4731.222 of the Revised Code; and

(k) Acceptance of conditions of probation or practice limitations.

(D) "Limitation" means to preclude the certificate holder from engaging in a particular conduct or activity, to impose conditions on the manner in which that conduct or activity may be performed, or to require the certificate holder to abide by specific conditions in order to continue practicing medicine. A limitation shall be either temporary or permanent.

(E) "Probation" means a situation whereby the certificate holder shall continue to practice only under conditions specified by the board. Failure of the certificate holder to comply with the conditions of probation may result in further disciplinary action being imposed by the board. The probation period shall be for either a definite or an indefinite term. If probation is for an indefinite term, the board shall establish a minimum probation period and the board shall release the certificate holder from the conditions of probation upon completion of the minimum probation period and upon the board's determination that the purpose of probation has been fulfilled.

(F) "Reprimand" means the certificate holder is formally and publicly reprimanded in writing.

(G) "No Further Action" means that the board finds that a violation occurred but declines to impose any disciplinary sanction. No further action shall be ordered by the board under circumstances where the board finds that all necessary remedial measures have been completed by the certificate holder, future monitoring is unnecessary and reprimand is not warranted.

(H) "Dismissal" means that the board finds that no violation occurred.

(I) "Grant of Application for Certificate" means that the board grants an application for a certificate to practice. In matters where disciplinary violations have been alleged against an applicant for a certificate, the grant of an application for certificate may be accompanied by a suspension, limitation, probation, reprimand or no further action.

(J) "Permanent Denial" and "Permanent Refusal to Register or Reinstate" mean the permanent denial of an application for a certificate to practice in Ohio. An individual whose application for a certificate has been permanently denied shall forever thereafter be ineligible to apply to the board for any certificate to practice, and the board shall not accept from that individual an application for issuance of any certificate.

(K) "Denial" and "Refusal to Register to Reinstate" mean the denial of an application for a certificate to practice in Ohio. An individual whose application for a certificate has been denied shall be eligible to submit a new application for a certificate. The new application shall be subject to all requirements for certification in effect at the time the new application is submitted. In determining whether to grant a new application, the board may consider any violations of Chapters 4730., 4731., 4759., 4760., 4761., 4762., 4774., and 4778. of the Revised Code, whichever is applicable, that were committed by the individual before or after the denial of the individual's previous application, including those that formed the basis for the denial.

Last updated August 2, 2021 at 9:29 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Chapter 4731-14 Pronouncement of Death

Ohio Adm.Code 4731-14-01 Pronouncement of death.

(A) Only an individual holding one of the following current certificates or licenses may pronounce a person dead:

(1) A certificate to practice medicine and surgery or osteopathic medicine and surgery issued under section 4731.14 of the Revised Code;

(2) A training certificate issued under section 4731.291 of the Revised Code;

(3) A clinical research faculty certificate issued under section 4731.293 of the Revised Code;

(4) A special activities certificate issued under section 4731.294 of the Revised Code;

(5) A license to practice as a certified nurse practitioner or clinical nurse specialist issued under section 4723.42 of the Revised Code, when the holder acts in compliance with section 4723.36 of the Revised Code;

(6) A license to practice as a registered nurse issued under section 4723.09 of the Revised Code, when the holder acts in compliance with section 4723.36 of the Revised Code.

(7) A license to practice as a physician assistant issued under section 4730.12 of the Revised Code, when the holder acts in compliance with section 4730.202 of the Revised Code;

(8) A certificate of conceded eminence issued under section 4731.297 of the Revised Code;

(9) A certificate to practice podiatric medicine and surgery issued under section 4731.56 of the Revised Code.

(B) A physician holding a current certificate to practice medicine or surgery or osteopathic medicine and surgery issued under section 4731.14 of the Revised Code may pronounce a person dead without personally examining the body of the deceased only if a competent observer has recited the facts of the deceased's present medical condition to the physician and the physician is satisfied that death has occurred.

(1) A licensed practical nurse holding a current license issued under Chapter 4723. of the Revised Code;

(2) An EMT-Basic holding a current certificate issued under section 4765.30 of the Revised Code;

(3) An EMT-intermediate holding a current certificate issued under section 4765.30 of the Revised Code;

(4) A EMT - paramedic holding a current certificate issued under section 4765.30 of the Revised Code;

(5) A chiropractor holding a current certificate issued under Chapter 4734. of the Revised Code;

(6) An individual authorized to pronounce a person dead under paragraph (A) of this rule;

(7) A coroner's investigator as referenced in section 313.05 of the Revised Code.

Last updated July 16, 2026 at 11:02 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Chapter 4731-15 Reporting Requirements

Ohio Adm.Code 4731-15-01 Licensee reporting requirement; exceptions.

(A) As used in this chapter of the Administrative Code:

(1) "The board" means the state medical board of Ohio;

(2) "Confidential monitoring program" means a confidential non-disciplinary program for the evaluation and treatment of practitioners and applicants who are, or may be impaired under sections 4731.25 to 4731.255 of the Revised Code.

(3) "Impaired" or "Impairment" has the same meaning as used in divisions (A)(2)(a) to (A)(2)(b) of section 4731.25 of the Revised Code. Impairment includes inability to practice in accordance with such standards without appropriate treatment, monitoring, or supervision.

(4) "Monitoring organization" means an entity that meets the requirements of division (B) of section 4731.25 of the Revised Code and enters into a contract with the board for the operation of the confidential monitoring program for impaired practitioners and applicants, review and approval of evaluators and treatment providers in section 4731.251 of the Revised Code, and assists the board with monitoring impaired practitioners who are subject to formal disciplinary action by the board under division (C) of section 4731.251 of the Revised Code.

(5) "Licensee" means any of the following:

(a) An individual authorized under Chapter 4730. of the Revised Code to practice as a physician assistant;

(b) An individual authorized under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, podiatric medicine and surgery, or a limited branch of medicine;

(d) An individual authorized under Chapter 4760. of the Revised Code to practice as an anesthesiologist assistant;

(e) An individual authorized under Chapter 4761. of the Revised Code to practice respiratory care;

(f) An individual licensed under Chapter 4762. of the Revised Code to practice as an acupuncturist;

(g) An individual licensed under Chapter 4774. of the Revised Code to practice as a radiologist assistant; or

(h) An individual licensed under Chapter 4778. of the Revised Code to practice as a genetic counselor.

(6) "Duty to report" includes the obligation to report violations of laws and rules under section 4730.32 of the Revised Code, section 4731.224 of the Revised Code, section 4759.13 of the Revised Code, section 4760.16 of the Revised Code, section 4761.19 of the Revised Code, section 4762.16 of the Revised Code, section 4774.16 of the Revised Code, section 4778.17 of the Revised Code and this chapter of the Administrative Code.

(7) "Malpractice reporting statutes" includes the obligation to report malpractice payments under division (D) of section 4730.32 of the Revised Code, division (D) of section 4731.224 of the Revised Code, division (D) of section 4760.16 of the Revised Code, division (D) of section 4762.16 of the Revised Code, and division (D) of section 4774.16 of the Revised Code.

(B) Licensees of the board shall be required to report as listed below, subject to paragraph (C) of this rule:

(1) Any individual licensed under Chapter 4731. of the Revised Code or any association or society of individuals licensed under Chapter 4731. of the Revised Code shall report to the board a belief that a violation of Chapter 4730., Chapter 4731., Chapter 4759., Chapter 4760., Chapter 4761., Chapter 4762., Chapter 4774., or Chapter 4778. of the Revised Code, or any rule of the board has occurred.

(2) Any physician assistant or any association or society of physician assistants shall report to the board a belief that a violation of Chapter 4730. or 4731. of the Revised Code, or any rule of the board has occurred.

(3) Any dietitian or any association or society of dietitians shall report to the board a belief that a violation of Chapter 4731. or Chapter 4759. of the Revised Code, or any rule of the board has occurred.

(4) Any anesthesiologist assistant or any association or society of anesthesiologist assistants shall report to the board a belief that a violation of Chapter 4731. or 4760. of the Revised Code, or any rule of the board has occurred.

(5) Any respiratory care professional or any association or society of respiratory care professionals shall report to the board a belief that a violation of Chapter 4731. or 4761. of the Revised Code, or any rule of the board has occurred.

(6) Any acupuncturist or any association or society of acupuncturists shall report to the board a belief that a violation of Chapter 4731. or 4762. of the Revised Code, or any rule of the board has occurred.

(7) Any radiologist assistant or any association of radiologist assistants shall report to the board a belief that a violation of Chapter 4731. or 4774. of the Revised Code, or any rule of the board has occurred.

(8) Any genetic counselor or any association of genetic counselors shall report to the board a belief that a violation of Chapter 4731. or 4778. of the Revised Code or any rule of the board has occurred.

(C) An individual, association or society shall be relieved of the obligation to report under paragraph (B) of this rule if one of the following requirements is met:

(1) The individual or organization is an approved treatment provider under section 4731.251 of the Revised Code, or the individual is an employee, agent, or representative of an approved treatment provider, and

(a) The licensee or applicant has been referred to the monitoring organization that conducts the confidential monitoring program;

(b) The licensee or applicant cooperates with the requirements of the confidential monitoring program and the treatment plan; and

(c) There is no reason to believe that the licensee has violated any provision of Chapter 4730., Chapter 4731., Chapter 4759., Chapter 4760., Chapter 4761., Chapter 4762, Chapter 4774., or Chapter 4778. of the Revised Code or any rule of the board other than impairment of ability to practice.

(2) The individual is a member of an impaired practitioner committee, or the equivalent, established by a hospital or its medical staff, or is a representative or agent of a committee or program sponsored by a professional association of individuals licensed under Chapter 4731. of the Revised Code to provide peer assistance to impaired practitioners, and

(a) The practitioner has been referred to the monitoring organization that conducts the confidential monitoring program under section 4731.25 of the Revised Code;

(b) The practitioner co-operates with requirements of the confidential monitoring program; and

(c) There is no reason to believe that the practitioner has violated any provision of Chapter 4730., Chapter 4731., Chapter 4759., Chapter 4760., Chapter 4761., Chapter 4762., Chapter 4774., or Chapter 4778. of the Revised Code, or any rule of the board, other than impairment of ability to practice .

(3) The individual reasonably believes all of the following:

(a) The practitioner has been referred to the monitoring organization that conducts the monitoring program under section 4731.25 of the Revised Code;

(b) The practitioner co-operates with the requirements of the confidential monitoring program; and

(4) The individual is a member of a review committee described in section 2305.25 of the Revised Code and the sole source for the belief that a violation has occurred is derived from evidence or other matters produced or presented during the proceedings of such committee.

(5) The individual is otherwise prohibited from reporting to the board by a superseding state or federal law.

(D) For purposes of section 4730.32, section 4731.224, section 4759.13, section 4760.16, section 4761.19, section 4762.16, section 4774.16, or section 4778.17 of the Revised Code, and this rule, "reason to believe" or "belief" does not require absolute certainty or complete unquestioning acceptance, but only an opinion that a violation may have occurred based upon firsthand knowledge or reliable information.

(E) Any report required under paragraph (B) of this rule shall be made to the board within forty-eight hours. Reporting of any belief that a violation has occurred to a review committee as described in section 2305.251 of the Revised Code or any entity other than the board does not discharge the duty or obligation to report to the board. In cases where the secretary and supervising member determined that peer review is being conducted by a review committee as described in section 2305.251 of the Revised Code for purposes of denying, determining, changing, or modifying the scope of the licensee's clinical privileges, they may defer further investigation by the board while awaiting the outcome of that peer review. An individual, association, or society making a report of a violation of law or rule may remain anonymous by complying with all of the following actions:

(1) The individual, association, or society shall request and shall be assigned a confidential identifying number by the board.

(2) The individual, association, or society shall be responsible for notifying the board that he or she is a licensee or is an association or society of licensees and shall be responsible for maintaining the confidential identifying number in order to verify compliance with the reporting obligations of section 4730.32 of the Revised Code, section 4731.224 of the Revised Code, section 4759.13 of the Revised Code, section 4760.16 of the Revised Code, section 4761.19 of the Revised Code, section 4762.16 of the Revised Code, or section 4774.16 or section 4778.17 of the Revised Code and this chapter.

(F) Each report pursuant to this rule shall include:

(1) The name of the practitioner or other individual in violation;

(2) The violation which is believed to have occurred; and

(3) The date(s) of and place(s) of occurrence(s), if known.

Last updated November 30, 2023 at 8:22 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-15-02 Healthcare facility reporting requirement.

(A) The chief administrator or executive officer of any healthcare facility as defined in section 3702.51 of the Revised Code, including a hospital, healthcare facility operated by a health insuring corporation, ambulatory surgical facility, or similar facility, shall report to the board any formal disciplinary action against any individual licensed by the board within sixty days after its completion.

(B) "Formal disciplinary action" means any procedure resulting in the revocation, restriction, reduction, or termination of clinical privileges for violations of professional ethics, or for reasons of medical incompetence, medical malpractice, misconduct, or impairment. Clinical privileges mean the authorization by the healthcare facility to a person licensed by the board for the provision of health care services.

(1) Summary actions, actions that take effect notwithstanding any appeal rights that may exist and actions that result in an individual surrendering clinical privileges while under investigation during proceedings regarding the action being taken or in return for not being investigated or having proceedings held, resulting in revocation, restriction, reduction, or termination of privileges for the violations or reasons set forth in paragraph (B) of this rule; and

(2) Actions resulting in refusal or denial of clinical privileges for the violations or reasons set forth in paragraph (B) of this rule;

(D) Formal disciplinary actions shall not include any action taken for the sole reason of failure to maintain records on a timely basis, failure to pay dues, or failure to attend staff, department, or section meetings.

(E) Formal disciplinary actions need not be reported if:

(1) The practitioner has been referred to the monitoring organization that conducts the confidential monitoring program for examination by an approved treatment program;

(2) The practitioner cooperates with the requirements of the confidential monitoring program; and

(3) There is no reason to believe that the practitioner has violated any laws or rules of the board.

(F) Each report shall include:

(1) The name and address of the facility reporting;

(2) The practitioner's name and license number;

(3) The action taken by the facility;

(4) The date of the action taken by the facility;

(5) The effective date of the action taken by the facility; and

(6) A summary of the underlying facts leading to the action.

(G) A facility's timely filing with the board of a copy of the national practitioner data bank adverse action report shall satisfy the reporting requirement of this rule when, upon contact by the board, the reporting facility verifies that the filing of the report has been approved by the peer review committee which reviewed the case or by the governing board of the facility.

(H) Any request for patient records by the board as provided under division (A) of section 4730.32 of the Revised Code, division (A) of section 4731.224 of the Revised Code, division (A) of section 4760.16 of the Revised Code, division (A) of section 4762.16 of the Revised Code, or division (A) of section 4774.16 of the Revised Code shall be directed to the chief administrator or executive officer of the facility. Failure to provide the board with the requested certified copies of patient records within thirty days of receipt of that request shall constitute a failure to comply with the applicable reporting requirements unless the board has granted a prior extension in writing.

Last updated November 30, 2023 at 8:22 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-15-03 Malpractice reporting requirement.

(A) Any insurer providing professional liability insurance or any other entity that seeks to indemnify the professional liability of any person holding a valid license shall notify the board within thirty days after the final disposition of any written claim for damages where such disposition results in a payment which exceeds twenty-five thousand dollars.

(B) For purposes of the malpractice reporting statutes and this rule:

(1) The amount of payment shall mean the aggregate gross settlement, not including court costs or other litigation costs;

(2) The present value of future payments shall be utilized in calculating the aggregate gross settlement in cases of structured payments;

(3) In cases involving multiple defendants where payment exceeds twenty-five thousand dollars but no specific allocation is made in the disposition of the claim, a report shall be filed with the board for each of the defendants upon whose behalf the payment is made;

(4) Payments made solely for damages not arising from patient care need not be reported;

(5) The waiver of an outstanding debt is not construed as a payment.

(1) The name and address of the person submitting the notification;

(2) The identity of the insurer or other indemnifying entity;

(3) The name and address of the insured who is the subject of the claim;

(4) The name of the person filing the written claim;

(5) The date of final disposition;

(6) The amount of payment;

(7) If applicable, the identity of the court in which the final disposition took place.

(D) An insurer that reports a medical malpractice payment to the national practitioner data bank may satisfy the reporting requirement of this rule by timely filing a copy of the national practitioner data bank medical malpractice report with the board.

(E) The reports received under the malpractice reporting statutes, and this rule may be investigated for possible violations of any law or rule of the board.

Last updated November 30, 2023 at 8:22 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-15-04 Professional society reporting.

(A) Any professional association or society composed primarily of doctors of medicine and surgery, doctors of osteopathic medicine and surgery, doctors of podiatric medicine and surgery, practitioners of the limited branches of medicine, dietitians, anesthesiologist assistants, respiratory care professionals, physician assistants, acupunctruists, radiologist assistants, or genetic counselors that suspends or revokes an individual's membership in that society for violations of professional ethics or for reasons of professional incompetence or professional malpractice shall report that action to the board within sixty days after a final decision.

(B) Each report shall include:

(1) The licensee's name and license number;

(2) The action taken; and

(3) A summary of the underlying facts leading to the action.

(C) A professional association or society that reports an adverse action to the national practitioner data bank (NPDB) may satisfy the reporting requirement of this rule by timely filing a copy of the NPDB adverse action report with the board.

Last updated November 30, 2023 at 8:22 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Chapter 4731-16 Impaired Practitioners

Ohio Adm.Code 4731-16-01 Definitions.

As used in this chapter of the Administrative Code:

(A) "Applicant" has the same meaning as used in division (A) of section 4731.25 of the Revised Code.

(B) "Approved evaluator or treatment provider" means an evaluator or treatment provider approved by the monitoring organization pursuant to section 4731.251 of the Revised Code and this chapter of the Administrative Code.

(D) "Confidential monitoring program" means a confidential non-disciplinary program for the evaluation and treatment of practitioners and applicants who are, or may be impaired under sections 4731.25 to 4731.255 of the Revised Code.

(E) "Continuing care" or "Aftercare" means regular treatment sessions following the successful completion of primary treatment which are facilitated by a licensed healthcare provider to address ongoing recovery issues and are provided by a treatment provider approved by the monitoring organization.

(F) "Impaired" or "Impairment" has the same meaning as used in divisions (A)(2)(a) and (A)(2)(b) of section 4731.25 of the Revised Code. Impairment includes the inability to practice according to acceptable and prevailing standards of care by reason of mental illness, mental disorder, or physical illness, including but not limited to physical deterioration that adversely affects cognitive, motor, or perceptive skills. Impairment includes the inability to practice in accordance with such standards without appropriate treatment, monitoring, or supervision.

(G) "Impaired physician committee" includes health committees, physician assistance committees, peer support committees, and similar bodies.

(H) "Monitoring organization" means an entity that meets the requirements of division (B) of section 4731.25 of the Revised Code and enters into a contract with the board for the operation of the confidential monitoring program for impaired practitioners and applicants, review and approval of evaluators and treatment providers in section 4731.251 of the Revised Code, and assists the board with monitoring impaired practitioners who are subject to formal disciplinary action by the board under division (C) of section 4731.251 of the Revised Code.

(I) "Practitioner" has the same meaning as used in section 4731.25(A)(3) of the Revised Code.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-02 General procedures in impairment cases.

(A) Should the board have reason to believe that any practitioner or applicant is impaired, it shall refer the individual to the monitoring organization. In addition, upon notification by the monitoring organization that the practitioner or applicant is not eligible for the confidential monitoring program, the board may compel the individual to submit to a mental or physical examination, or both.

(1) Such examinations shall be undertaken by an evaluator or treatment provider under contract with the board and on the approved list maintained by the monitoring organization.

(2) The notice issued ordering the individual to submit to examination shall delineate acts, conduct or behavior committed or displayed which establish reason to believe that the individual is impaired.

(3) Failure to submit to examination ordered by the board constitutes an admission of impairment unless the failure is due to circumstances beyond the individual's control.

(B) In cases where the only potential disciplinary violation is based on impairment, the board may do the following:

(1) Upon identification by the board of reason to believe that a practitioner or applicant is impaired and not eligible for the confidential monitoring program, it may require an examination or examinations as set forth in paragraph (A) of this rule. The examination must meet all requirements of rule 4731-16-05 of the Administrative Code.

(a) If the examination or examinations fail to disclose impairment, the board shall not issue discipline based on impairment unless other investigation produces reliable, substantial, and probative evidence demonstrating impairment.

(b) If the examination or examinations disclose impairment, or if the board has other reliable, substantial, and probative evidence demonstrating impairment, the board may initiate proceedings to suspend the license or deny the applicant. The board may issue an order of summary suspension.

(2) The presence of one or more of the following circumstances shall constitute independent proof of impairment and shall support license suspension or denial without the need for an examination:

(a) The individual has relapsed during or following treatment and the individual is not under a current monitoring agreement with the monitoring organization;

(b) The individual has applied for or requested treatment in lieu of conviction of a criminal charge or intervention in lieu of conviction of a criminal charge, or has applied for or requested entry into a similar diversion or drug intervention program and the individual is not eligible for the confidential monitoring program;

(c) The individual has pled guilty to or has had a judicial finding of guilt of a criminal offense that involved the individual's personal use or abuse of any controlled substance, and the individual is not eligible for the confidential monitoring program.

(3) Before being eligible to apply for reinstatement of a license suspended under this paragraph the impaired individual must demonstrate to the board that the individual can resume practice in compliance with acceptable and prevailing standards of care under the provisions of the individual's license. Such demonstrations shall include but shall not be limited to the following:

(a) Certification from a treatment provider approved by the monitoring organization under section 4731.251 of the Revised Code that the individual has successfully completed all required treatment as determined by the treatment provider and the medical director or designee of the monitoring organization. The treatment may include withdrawal management, inpatient, residential, extended residential, partial hospitalization, intensive outpatient, outpatient, continuing care, or other therapy or treatment.

(b) Evidence of continuing full compliance with any aftercare or continuing care contract as determined by the treatment provider and the medical director or designee of the monitoring organization and with any consent agreement or order of the board then in effect;

(c) Two written reports indicating that the individual's ability to practice has been assessed and that the individual has been found capable of practicing according to acceptable and prevailing standards of care. The reports shall be made by individuals or providers approved by the board or monitoring organization for making such assessments and shall describe the basis for this determination. A physician who is the medical director of a treatment provider approved by the monitoring organization under section 4731.251 of the Revised Code may perform such an assessment without prior board approval.

(4) The board may reinstate a license suspended under this paragraph after the demonstration described in paragraph (B)(3) of this rule and after the individual has entered into a written consent agreement which conforms to the requirements set forth in rule 4731-16-06 of the Administrative Code, or after the board has issued a final order in lieu of a consent agreement.

(5) When the impaired individual resumes practice after license reinstatement, the board shall require continued monitoring of the individual. This monitoring, which may be completed by the monitoring organization at the discretion of the board, shall include but not be limited to compliance with the written consent agreement entered into before reinstatement or compliance with conditions imposed by board order after a hearing, if applicable.

(C) In cases where the board has initiated a disciplinary action for violations other than for impairment and the practitioner or applicant is participating in the confidential monitoring program or is under a board order or consent agreement for impairment, the general pattern of action described in paragraph (B) of this rule will be followed with the following exceptions:

(1) If the board permanently revokes a license, the individual shall not be eligible for further consideration for licensure or license reinstatement;

(2) If the board imposes a period of ineligibility for licensure, the individual shall not be eligible for licensure or license reinstatement until the period of ineligibility has lapsed;

(3) If the board imposes an indefinite period of ineligibility, licensure or license reinstatement shall depend upon successful completion of the requirements in paragraphs (B)(3) and (B)(4) of this rule and determination by the board that the period of suspension or ineligibility served is commensurate with the violations found.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-04 Other violations.

For purposes of board disciplinary action for violations of any board rule or law, impairment shall not excuse acts which result in a plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a felony, a misdemeanor committed in the course of practice, or a misdemeanor involving moral turpitude, the commission an act that constitutes a felony, misdemeanor in the course of practice, or misdemeanor of moral turpitude, in this state, or which might, as determined by the board, have an adverse impact on other individuals. Such acts shall constitute independent basis for disciplinary action.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-05 Examinations.

(A) Any impairment examination of an applicant or practitioner ordered by the board and performed by an evaluator or treatment provider approved by the monitoring organization and under contract with the board shall include all of the following:

(1) Comprehensive evaluation pertinent to the reasons for referral, including:

(a) Routine laboratory tests;

(b) Psychiatric evaluation, if applicable;

(d) Physical examination, if applicable.

(2) For individuals referred for examination related to substance use disorder, the evaluation shall also include:

(a) Urine, hair or blood toxicology testing, or any other appropriate toxicology testing, with legal chain of custody and forensic capability protocol;

(b) Corroborating interviews of at least two persons who are close to the individual; and

(3) The duration and type of the examination shall be determined by the evaluator or treatment provider based upon the individual's condition and based on an assessment of the impact of the potential impairment on patient safety.

(B) A diagnosis made by an approved evaluator or treatment provider based on an examination ordered by the board shall be made solely for the purpose of providing evidence for use by the board. A practitioner or applicant who undergoes an examination ordered by the board but who refuses to authorize the evaluator or treatment provider to release reports or information to the board shall be deemed to have failed to submit to the examination due to circumstances within the individual's control, and a default and final order may be entered without the taking of testimony or presentation of evidence.

(C) The report issued pursuant to an examination ordered by the board shall be submitted to the board within five days following completion of the examination.

(D) The board may require the practitioner or applicant to submit to a drug toxicology screen at the time it serves its order to submit to an examination or at any time after it issues the examination order and before the examination is completed.

(1) The drug toxicology screen shall be considered part of the examination.

(2) Refusal to submit to the drug toxicology screen immediately upon such request shall constitute failure to submit to an examination ordered by the board and shall constitute an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual's control. A default and final order may be entered without the taking of testimony or presentation of evidence.

(E) An individual ordered by the board to an examination who refuses to authorize the evaluator or treatment provider to contact any person identified by the evaluator or treatment provider as being appropriate for the purpose of conducting a corroborating interview as part of the examination shall be deemed to have failed to submit to the examination due to circumstances within the individual's control, and a default and final order may be entered into without the taking of testimony or presentation of evidence.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-06 Consent agreements and orders for reinstatement of impaired applicants and practitioners.

(A) The written consent agreement for impaired practitioners or applicants prior to reinstatement of a suspended license, or any board order entered in lieu of a consent agreement, shall require, at a minimum, the following probationary and limiting terms:

(1) Obedience of all federal, state, and local laws, and all rules governing practice in Ohio;

(2) Submission of quarterly declarations attesting whether there has been compliance with all conditions of the consent agreement;

(3) Periodic appearances before the board, its representatives, or the monitoring organization as requested;

(4) Notification to the board of departures or absences from Ohio. Periods of departure or absence shall not reduce the probationary term, unless otherwise determined by the secretary or the supervising member of the board, in instances where the board can be assured that probationary monitoring is otherwise being performed;

(5) Maintenance of a log of all controlled substances, and other drugs as directed by the board, which the practitioner prescribes, orders, personally furnishes, or administers, where appropriate;

(6) Prohibition of authority to prescribe, administer, personally furnish, order, or possess controlled substances and as directed by the board, other substances which may impair ability to practice, where appropriate;

(7) Abstinence from the use of alcohol, where appropriate;

(8) Abstinence from the use or personal possession of drugs, except those prescribed, administered, or dispensed by another person so authorized by law who has knowledge of the patient's history and of substance use disorder, where appropriate;

(9) Submission of urine, blood, or other toxicology samples upon request of the board or the monitoring organization, and without prior notice, where appropriate;

(10) Undertaking and maintaining participation in a self-help support group acceptable to the board or the monitoring organization, such as alcoholics anonymous or narcotics anonymous, where appropriate, with evidence of compliance to be provided in each quarterly report;

(11) Undertaking psychiatric evaluation, and, where appropriate, continuing treatment acceptable to the board or the monitoring organization, with evidence of compliance to be provided in each quarterly report;

(12) Monitoring physical medical condition, where appropriate;

(13) Monitoring of progress and status by a physician or other licensed healthcare professional approved by the board or the monitoring organization, with reports to be provided in each quarterly report, where appropriate;

(14) Prior approval by the board of any practice arrangements or any health care field employment, where appropriate;

(15) Copies of the agreement to be provided by the individual to all of the following during the effective period of the agreement or board order:

(a) All employers or prospective employers, entities with which the individual contracts or seeks to contract to provide health services or receive training, the chief of staff at each hospital where the individual has or applies for privileges, and all persons and entities that provide the individual treatment or monitoring; and

(b) The proper licensing authority of any state or jurisdiction in which the individual holds or applies for any professional license.

(16) Contacting the monitoring organization to arrange for monitoring services, where appropriate;

(17) Continuing compliance with the terms of any aftercare or continuing care contract entered into with the treatment provider or healthcare provider, provided, that where terms of the aftercare or continuing care contract conflict with the terms of the consent agreement or board order, the terms of the consent agreement or board order shall control;

(18) Continuing authorization, through appropriate written consent forms, for disclosure by the evaluator or treatment provider to the board, to treating and monitoring physicians, the monitoring organization and to others involved in the monitoring process, of information necessary for them to fulfill their respective duties and obligations;

(19) Appropriate minimum probationary term;

(20) Periods during which the probationer is not in compliance with all probationary terms, or during which all probationary monitoring provisions have not yet been implemented, as determined by the secretary of the board, may result in the extension of the term of probation;

(21) No requests by the probationer for modifications to probationary terms for at least one year; and

(22) Prohibition of consumption of poppy seeds or any other food or liquid that may produce false results in a toxicology screen, where appropriate.

(B) A violation of any term of the consent agreement or board order described in this rule shall constitute grounds to take disciplinary action in accordance with Chapter 119. of the Revised Code.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-08 Criteria for approval for evaluators and treatment providers.

(A) In order to be approved as an evaluator or treatment provider for impaired applicants or practitioners, the evaluator or treatment provider must submit an application to the monitoring organization, which includes information regarding the areas of expertise and services provided, accreditation status, staffing composition, treatment approaches utilized, census and financial information, and other information as requested by the monitoring organization.

(B) The monitoring organization shall review individuals and entities providing evaluations and treatment to licensees and applicants who are impaired or potentially impaired.

(1) As part of the review the monitoring organization shall determine whether the individual or entity has the capability to evaluate impaired or potentially impaired practitioners or applicants for conditions which impair the ability to practice in accordance with acceptable and prevailing standards of care, including mental or physical illness, including substance use disorder.

(2) As part of the review, the monitoring organization shall determine whether the individual or entity has the capability to provide treatment to impaired practitioners or applicants, which may include withdrawal management, inpatient, residential, extended residential, partial hospitalization intensive outpatient, outpatient, continuing care, or other therapy or treatment.

(3) Evaluators or treatment providers which are facilities providing substance use disorder evaluation or treatment shall hold accreditation from one of the following:

(a) Commission on accreditation of rehabilitation facilities;

(b) American society of addiction medicine; or

(4) Evaluators or treatment providers which are facilities providing mental health disorder evaluation or treatment shall hold accreditation from one of the following:

(a) Commission on accreditation of rehabilitation facilities; or

(b) The joint commission.

(5) Evaluators or treatment providers who are individual physicians or other licensed healthcare professionals shall provide evidence of education, training, and experience treating the relevant diseases or conditions.

(C) The monitoring organization shall prepare of list of approved evaluators and treatment providers and make that available to practitioners or applicants referred to the monitoring organization.

(D) The monitoring organization shall provide annual training to evaluators and treatment providers regarding the eligibility requirements for the confidential monitoring program, the board's statutes, rules, and policies regarding impairment, and evaluator and treatment provider reporting requirements.

(E) The monitoring organization shall periodically review the operations and outcomes of the evaluators and treatment providers to determine whether the standard of care is being met. If the monitoring organization determines that any evaluators or treatment providers no longer meet the standard of care, the monitoring organization may remove the evaluator or treatment provider from the list provided to impaired or potentially impaired licensees and applicants.

(F) The approved evaluator or treatment provider shall do the following:

(1) Develop an individualized treatment plan for every practitioner or applicant who enters treatment including any required supervision or restrictions of practice during treatment;

(2) Require a practitioner to suspend practice as required by the treatment provider or the monitoring organization medical director or designee;

(3) Report to the monitoring organization any instances of violations of this chapter, including any practitioner or applicant who due to impairment present an imminent danger to oneself or the public and any practitioner or applicant who is unwilling or unable to complete or comply with the terms of evaluation, treatment, or monitoring;

(4) Report to the monitoring organization the resumption of practice of any impaired practitioner before the treatment provider and medical director or designee of the monitoring organization has made a clear determination that the practitioner is capable of practicing according to acceptable and prevailing standards of care;

(5) Fulfill all recordkeeping requirements applicable under state and federal laws, including completing and maintaining records for each practitioner and applicant seen for evaluation and treatment; and

(6) Require every practitioner or applicant who submits for an evaluation or enters treatment to execute a release with respect to issuance of the required reports to the monitoring organization.

(G) Each quarter, the evaluator or treatment provider shall provide to the monitoring organization information regarding licensees or applicants seen for evaluation or treatment under the confidential monitoring program, as determined by the monitoring organization.

(H) The evaluator or treatment provider shall notify the monitoring organization of the following changes prior to the effective date:

(1) Transfer of ownership of program;

(2) Change in location of the program; or

(3) Change in medical director.

(I) The evaluator or treatment provider shall not report to the board the identity of a practitioner or applicant who has been referred for evaluation or treatment by a party other than the board, so long as the practitioner or applicant maintains participation in accordance with requirements of the confidential monitoring program under section 4731.25 of the Revised Code.

(J) Nothing in this rule relieves licensees of the board of their duty to report violations of laws and rules to the board.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-17 Requirements for confidential monitoring program.

(A) Practitioners and applicants of the board who may be impaired in the ability to practice in accordance with acceptable and prevailing standards of care and who want to participate in the confidential monitoring program shall complete the following requirements:

(1) The practitioner or applicant shall contact the monitoring organization under contract with the board and obtain a list of the approved evaluators and treatment providers;

(2) If the practitioner or applicant reports directly to an approved treatment provider, the practitioner or applicant licensee shall contact the monitoring organization upon referral from the approved evaluator or treatment provider; and

(3) The practitioner or applicant shall participate in an evaluation conducted by an evaluator or treatment provider in accordance with the recommendation of the monitoring organization.

(B) The evaluator or treatment provider shall provide the information regarding the diagnosis and eligibility determination to the monitoring organization for confirmation of eligibility.

(C) If the practitioner or applicant is determined to be impaired and not to be eligible for the confidential monitoring program, the practitioner or applicant and the monitoring organization shall report this information to the board.

(D) Once a practitioner or applicant is determined to be eligible for the confidential monitoring program, the practitioner or applicant shall report to an approved treatment provider for treatment within the timeframe recommended by the monitoring organization. The treatment provider shall develop an individualized treatment plan that may include a combination of inpatient, residential, partial hospitalization, outpatient or intensive outpatient treatment.

(1) The practitioner or applicant shall be required to immediately suspend practice if it is recommended by the evaluator or treatment provider or the medical director or designee of the monitoring organization. The practitioner or applicant shall suspend practice until determined to be able to practice according to acceptable and prevailing standards by the evaluator or treatment provider and the medical director or designee of the monitoring organization.

(2) The monitoring organization shall notify the board of any practitioner who returns to work prior to obtaining the release from the treatment provider and the monitoring organization medical director or designee. The board shall proceed in accordance with rule 4731-16-02 of the Administrative Code.

(3) The monitoring organization shall notify the board of any practitioner or applicant who does not successfully complete the prescribed treatment. The board shall proceed in accordance with rule 4731-16-02 of the Administrative Code.

(4) The monitoring organization shall ensure that the practitioner or applicant has entered into an agreement with an approved continuing care provider if continuing care is recommended by the treatment provider. If continuing care is recommended, the monitoring organization shall confirm that the practitioner or applicant completes continuing care sessions in accordance with the recommendation until released by the continuing care provider and the medical director or designee of the monitoring organization.

(E) In order to continue participation in the confidential monitoring program, after successful completion of any recommended treatment, the practitioner or applicant shall enter into an agreement with the monitoring organization. The agreement may include the following provisions:

(1) Random toxicology testing, if applicable;

(2) Attendance at drug and alcohol support group meetings (e.g., alcoholics anonymous or narcotics anonymous) or other support group, as directed by the monitoring organization, if applicable;

(3) Treatment and therapy plan;

(4) Continuing care participation, if applicable;

(5) Case management;

(6) Duration of monitoring. Relapses and other failure to comply with terms of the agreement may result in a longer period of monitoring;

(7) Releases for information or records related to the practitioner's impairment, including but not limited to family, peers, health care personnel, employers, and treatment providers;

(8) Grounds for dismissal from participation in the confidential monitoring program for failure to comply with program requirements. An individual who chooses not to continue in the confidential monitoring program shall be referred to the board for further investigation or disciplinary action; and

(9) Any required fees associated with participation in the confidential monitoring program, including but not limited to fees for toxicology testing.

(F) The practitioner or applicant shall be released from monitoring by the medical director or designee of the monitoring organization upon successful completion of monitoring.

(G) The board shall develop guidelines in collaboration with the monitoring organization for the reporting of non-compliance with conditions of the confidential monitoring program. Non-compliance shall be reported to the board by the practitioner or applicant and the medical director of the monitoring organization.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-19 Monitoring organization for confidential monitoring program.

(A) The board shall enter into a contract with a monitoring organization to monitor applicants and practitioners participating in the confidential monitoring program.

(1) The monitoring organization shall provide practitioners and applicants with a list of treatment providers approved to provide evaluations and treatment for the confidential monitoring program.

(2) The medical director or designee of the monitoring organization shall, along with the medical director of the treatment provider, review and determine whether an individual is able to practice according to acceptable and prevailing standards of care.

(3) The medical director or designee of the monitoring organization shall, along with the continuing care provider, review and determine whether an individual is eligible for release from continuing care, if applicable.

(4) At the request of the board, the medical director of the monitoring organization, or designee, shall provide testimony in any disciplinary proceeding involving a practitioner or applicant reported to the board by the monitoring organization.

(B) The agreements between the monitoring organization and practitioner or applicant shall establish the monitoring terms, including the minimum duration and the events which could lead to a longer duration.

(C) The medical director or designee of the monitoring organization shall review each individual and make a determination as to whether the individual is released from monitoring.

(D) The monitoring organization shall, within seventy-two hours, report to the board any of the following:

(1) Any practitioner or applicant referred to the confidential monitoring program who was found to be impaired and ineligible to participate in the program;

(2) Any practitioner or applicant who fails to attend an evaluation recommended by the monitoring organization;

(3) Any practitioner or applicant found to be impaired who fails to enter or complete treatment as recommended by the treatment provider and the monitoring organization;

(4) Any practitioner or applicant found to be impaired who fails to enter or complete continuing care as recommended by the treatment provider and the monitoring organization;

(5) Any practitioner or applicant found to be impaired who fails to enter into a monitoring agreement as recommended by the monitoring organization;

(6) Any practitioner or applicant who fails to comply with a monitoring agreement and that failure results in an imminent risk of harm to the public or the practitioner;

(7) Any practitioner or applicant who presents an imminent danger to the public or the practitioner, as a result of the practitioner's or applicant's impairment; and

(8) Any practitioner or applicant whose impairment has not been substantially alleviated by participation in the program.

(E) The monitoring organization shall provide annual and quarterly reports to the board regarding the confidential monitoring program.

(F) The monitoring organization, in consultation with the board, shall provide education to the practitioners, applicants, evaluators, treatment providers and continuing care providers regarding eligibility criteria for the confidential monitoring program and the statutes, rules and policies of the board regarding impairment.

(G) The monitoring organization shall notify the board of any individual who returns to work prior to obtaining the release from the treatment provider and the monitoring organization medical director or designee.

(H) The monitoring organization shall notify the board of any individual who does not successfully complete the prescribed treatment.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-16-20 Evaluators and treatment providers in the confidential monitoring program.

(A) The evaluator or treatment provider shall perform an evaluation appropriate to the practitioner or applicant's condition to determine the degree of impairment of the practitioner or applicant and shall develop an individualized treatment plan. The individualized treatment plan may include a combination of in-patient, residential, partial hospitalization, intensive outpatient treatment, outpatient treatment, or other appropriate therapy or treatment appropriate to the practitioner or applicant's condition.

(B) The evaluator or treatment provider may recommend that the practitioner immediately suspend practice upon determination of impairment. Clearance from the treatment provider and monitoring organization medical director or designee are required for return to practice. Failure of the practitioner or applicant to follow the recommendation shall be reported to the board by the treatment provider and the monitoring organization.

(C) The evaluator or treatment provider shall notify the monitoring organization of the determination of impairment and the treatment plan.

(D) The treatment plan shall include group therapy with other patients who work in similar disciplines as the licensee or other professionals, as appropriate.

(E) The treatment plan shall include education regarding the statutes, rules, and policies of the board with respect to impairment.

(F) The treatment plan may include education to assist the practitioner to transition back to work, if applicable.

Last updated November 30, 2023 at 10:50 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03

Chapter 4731-17 Exposure-Prone Invasive Procedure Precautions

Ohio Adm.Code 4731-17-01 Definitions.

For purposes of this chapter of the Administrative Code:

(A) "Licensee" means any person holding or practicing pursuant to a certificate issued by the board under Chapter 4730., 4731., 4760., 4761., 4762., or 4774. of the Revised Code.

(B) "Invasive procedure" means any of the following:

(1) Surgical or procedural entry into tissues, cavities, or organs or repair of major traumatic injuries associated with any of the following: an operating or delivery room, emergency department, or outpatient setting, including physicians' offices; cardiac catheterization and angiographic procedures; a vaginal or cesarean delivery or other invasive obstetric procedure during which bleeding may occur; or the manipulation, cutting, or removal of any oral or perioral tissues, including tooth structure, during which bleeding occurs or the potential for bleeding exists.

(2) Any entry into the hair follicle using an electric modality for the purpose of hair removal.

(3) The practice of acupuncture as defined in section 4762.01 of the Revised Code.

(4) The performance of fluoroscopic procedures pursuant to section 4774.08 of the Revised Code.

(5) The performance of cosmetic procedures, such as the injection of botulinum toxin, dermal fillers, permanent makeup at a location that is not licensed under the rules in Chapter 3701-9 of the Administrative Code, laser hair removal, and hair replacement procedures.

(6) The performance of respiratory care procedures involving blood and gas sampling, administering medical gases, aerosols and medications, performing aspiration, and the use of artificial airways, ventilators and other life support equipment.

(D) "EPA" means the United States environmental protection agency.

Last updated July 16, 2026 at 11:05 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-02 Universal precautions.

Licensees who perform or participate in invasive procedures shall, in the performance of or participation in any such procedures or functions, be familiar with, observe and rigorously adhere to the acceptable and prevailing standards for universal blood and body fluid precautions to minimize the risk of being exposed to or exposing others to the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the human immunodeficiency virus (HIV). The acceptable and prevailing universal blood and body fluid precautions which the licensee follows shall include at least the following:

(A) Appropriate use of hand washing;

(B) Effective disinfection and sterilization of equipment;

(D) Appropriate barrier techniques including wearing and disposal of gloves and other protective garments and devices.

Last updated August 4, 2026 at 10:40 AM

History

Effective: November 30, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-03 Hand washing.

Licensees who perform or participate in invasive procedures shall follow acceptable and prevailing standards for hand washing which shall include at least the following:

(A) Hands shall be washed appropriately prior to performing or participating in an invasive procedure and after performing or participating in an invasive procedure;

(B) Hands and other skin surfaces shall be washed immediately and thoroughly if contaminated with blood or other body fluids; and

Last updated August 4, 2026 at 10:40 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-04 Disinfection and sterilization.

Instruments and other equipment classified by the FDA as reusable, used by licensees who perform or participate in invasive procedures shall be appropriately disinfected and sterilized according to acceptable and prevailing standards for disinfection and sterilization which shall include at least the following:

(A) Instruments and devices that enter the patient's vascular system or other normally sterile areas of the body shall be sterilized before being used for each patient;

(B) Instruments and devices that touch intact mucous membranes but do not penetrate the patient's body surfaces shall be sterilized when possible, or undergo high-level disinfection if they cannot be sterilized before using for each patient;

(C) Instruments and devices that are able to withstand repeated exposure to heat shall be heat sterilized. Sterilization shall be accomplished by autoclave, dry heat, unsaturated chemical vapor, ethylene oxide, hydrogen peroxide gas plasma, or any other FDA/EPA-approved method;

(D) Instruments and items that cannot withstand heat sterilization shall be subjected to a high level disinfection process, including compliance with any manufacturer's instructions for disinfection;

(E) Heat sterilizing devices shall be tested for proper function on a weekly basis by means of a biological monitoring system that indicates microorganism kill. Documentation shall be maintained either in the form of a log reflecting dates and person(s) conducting the testing or copies of reports from an independent testing entity. The documentation shall be maintained for a period of at least two years. In the event of a positive biological spore test, the licensee must take immediate remedial action to ensure that heat sterilization is being accomplished;

(F) Surface disinfection:

(1) Environmental surfaces that are contaminated by blood or other body fluids shall be disinfected with a chemical germicide that is registered with the environmental protection agency as a "hospital disinfectant" or sodium hypochlorite and is mycobactericidal at use-dilution. The disinfection process shall be followed before each patient; and

(2) Impervious backed paper, aluminum foil or plastic wrap shall be used to cover surfaces that may be contaminated by blood or other body fluids and that are difficult or impossible to disinfect. The cover shall be removed, discarded and then replaced between patients.

(G) Single use items used in treating a patient, which have become contaminated by blood or other body fluids, shall be discarded and not reused, unless sterilized and reused in accordance with current guidelines established by the FDA. Single use items being reused in treating a patient shall be adequately cleaned and sterilized. Single use items shall not be reused if the items' physical characteristics and quality have been adversely affected or if the items are incapable of being reused safely and effectively for their intended use.

Last updated August 4, 2026 at 10:40 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-05 Handling and disposal of sharps and wastes.

(A) To prevent injuries, no licensee performing or participating in invasive procedures shall recap needles, or purposely bend or break needles or other sharp instruments or items by hand.

(B) After a licensee who is performing or participating in an invasive procedure uses disposable needles, syringes, scalpel blades or other sharp items, the licensee shall place the disposable sharp items used in a puncture-resistant container for disposal. The puncture-resistant container shall be located as close as practicable to the use area.

(C) All sharp items and contaminated wastes shall be disposed of according to requirements established by federal, local and state environmental or regulatory agencies.

Last updated August 4, 2026 at 10:40 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-06 Barrier techniques.

All licensees who perform or participate in invasive procedures shall routinely use appropriate barrier precautions to prevent skin and mucous-membrane contact with blood and other body fluids of all patients. The barrier techniques to be followed are:

(A) All licensees shall wear disposable gloves when performing or participating in invasive procedures. Hands shall be washed when gloves are removed. Before performing or participating in invasive procedures on another patient, the licensee shall wash hands and reglove with another pair of disposable gloves. If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove used as promptly as patient safety permits. The needle or instrument involved in the incident shall be removed from the sterile field. Disposable gloves shall not be washed or reused for any purpose.

(B) All licensees shall wear masks and protective eyewear when performing or participating in invasive procedures if during the procedure there is likely to be spattering or splashing of blood or other body fluids.

(C) Gowns or aprons made of materials that provide an effective barrier shall be worn by all licensees who are performing or participating in invasive procedures if during the procedure there is likely to be spattering or splashing of blood or other body fluids.

Last updated August 4, 2026 at 10:40 AM

History

Effective: February 28, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-17-07 Violations.

(A) A physician assistant who violates any provision of this chapter shall be subject to discipline pursuant to divisions (B)(2), (B)(3), (B)(19) and (B)(21) of section 4730.25 of the Revised Code.

(B) An anesthesiologist assistant who violates any provision of this chapter shall be subject to discipline pursuant to divisions (B)(2), (B)(3), (B)(4) and (B)(19) of section 4760.13 of the Revised Code.

(C) An acupuncturist who violates any provision of this chapter shall be subject to discipline pursuant to divisions (B)(2), (B)(3), (B)(4) and (B)(20) of section 4762.13 of the Revised Code.

(D) A radiologist assistant who violates any provision of this chapter shall be subject to discipline pursuant to divisions (B)(2), (B)(3), (B)(4), and (B)(19) of section 4774.13 of the Revised Code.

(E) Any other licensee who violates any provision of this chapter shall be subject to discipline pursuant to divisions (B)(6), (B)(20) and (B)(29) of section 4731.22 of the Revised Code.

(F) A respiratory care professional or limited permit holder who violates any provision of this chapter shall be subject to discipline pursuant to division (B)(10) of section 4761.09 of the Revised Code.

Last updated July 16, 2026 at 11:05 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Chapter 4731-18 Surgery Standards

Ohio Adm.Code 4731-18-01 Definitions.

As used in this chapter of the Administrative Code:

(A) "Light based medical device " means any device that can be made to produce or amplify electromagnetic radiation at wavelengths equal to or greater than one hundred eighty nm but less than or equal to 1.0 X 10 6nm [ten to the sixth power] and that is manufactured, designed, intended or promoted for irradiation of any part of the human body for the purpose of affecting the structure or function of the body.

(B) "Phototherapy" means the following:

(1) For paragraph (A) of rule 4731-18-04 of the Administrative Code, phototherapy means the application of light for the treatment of hyperbilirubinemia in neonates.

(2) For paragraphs (B) and (C) of rule 4731-18-04 of the Administrative Code, phototherapy means the application of ultraviolet light for the treatment of psoriasis and similar skin diseases. This application can occur with any device cleared or approved by the United States food and drug administration for the indicated use that can be made to produce irradiation with broadband ultraviolet B (290-320nm), narrowband ultraviolet B (311-313 nm), excimer light based (308nm), ultraviolet A1 (340-400nm), or UVA (320-400nm) plus oral psoralen called PUVA.

(C) "Photodynamic therapy" means light therapy involving the activation of a photosensitizer by visible light in the presence of oxygen, resulting in the creation of reactive oxygen species, which selectively destroy the target tissue.

(D) "Ablative dermatologic procedure" means a dermatologic procedure that is expected to excise, burn, or vaporize the skin below the dermo-epidermal junction.

(E) "Non-ablative dermatologic procedure" means a dermatologic procedure that is not expected or intended to excise, burn, or vaporize the epidermal surface of the skin.

(F) "Physician" means a person authorized to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery under Chapter 4731. of the Revised Code and acting within the scope of their practice.

(G) "Delegation" means the assignment of the performance of a service to a person who is not a physician.

(H) "On-site supervision" means the physical presence of the supervising physician is required in the same location (i.e., the physician's office suite) as the delegate of the light based medical device but does not require the physician's presence in the same room.

(I) "Direct physical oversight" means the physical presence of the supervising physician is required in the same room to directly observe the delegate of the light based medical device.

(J) "Vascular laser" means light-based medical devices including lasers and intense pulsed light apparatuses whose primary cutaneous target structures are telangiectasia, venulectasia, and superficial cutaneous vascular structures. In general, these lasers have wavelengths that correspond to the hemoglobin absorption spectrum.

Last updated May 1, 2023 at 8:41 AM

History

Effective: April 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-18-02 Use of light based medical devices.

(A) The application of light based medical devices to the human body is the practice of medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery.

(B) A physician shall not delegate the application of light based medical devices for ablative procedures.

(C) A physician may delegate the application of a vascular laser for non-ablative dermatologic procedures according to the requirements in paragraph (A) of rule 4731-18-03 of the Administrative Code.

(D) A physician may delegate the application of light based medical devices for the purpose of hair removal according to the requirements of section 4731.33 of the Revised Code.

(E) A physician may delegate the application of phototherapy for the treatment of hyperbilirubinemia in neonates according to the requirements in paragraph (A) of rule 4731-18-04 of the Administrative Code.

(F) A physician may delegate the application of phototherapy and photodynamic therapy only for dermatologic purposes according to the requirements of paragraphs (B) and (C) of rule 4731-18-04 of the Administrative Code.

(G) A violation of paragraph (B) of this rule shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code and "violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provisions of this chapter or any rule promulgated by the board," as that clause is used in division (B)(20) of section 4731.22 of the Revised Code, to wit: section 4731.41 of the Revised Code.

Last updated May 1, 2023 at 8:41 AM

History

Effective: April 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-18-03 Delegation of the use of light based medical devices for specified non-ablative procedures.

(A) A physician may delegate the application of a vascular laser for non-ablative dermatologic procedures only if all the following conditions are met:

(1) The vascular laser has been specifically cleared or approved by the United States food and drug administration for the specific intended non-ablative dermatologic procedure;

(2) The use of the vascular laser for the specific non-ablative dermatologic use is within the physician's normal course of practice and expertise;

(3) The physician has seen and evaluated the patient to determine whether the proposed application of the specific vascular laser is appropriate;

(4) The physician has seen and evaluated the patient following the initial application of the specific vascular laser, but prior to any continuation of treatment in order to determine that the patient responded well to the initial application of the specific vascular laser;

(5) The person to whom the delegation is made is one of the following:

(a) A physician assistant licensed under Chapter 4730. of the Revised Code with whom the physician has an effective supervision agreement; or,

(b) A registered nurse or licensed practical nurse licensed under Chapter 4723. of the Revised Code;

(6) For a physician assistant, the authorization must meet the requirements of section 4730.21 of the Revised Code.

(7) For a registered nurse or licensed practical nurse, the physician must ensure that the person to whom the delegation is made has received adequate education and training to provide the level of skill and care required including;

(a) Eight hours of basic education that must include the following topics: light based procedure physics, tissue interaction in light based procedures, light based procedure safety including use of proper safety equipment, clinical application of light based procedures, pre and post-operative care of light based procedure patients, and reporting of adverse events;

(b) Observation of fifteen procedures for each specific type of vascular laser non-ablative procedure delegated. The procedures observed must be performed by a physician for whom the use of this specific vascular laser procedure is within the physician's normal course of practice and expertise; and

(c) Performance of twenty procedures under the direct physical oversight of the physician on each specific type of vascular laser non-ablative procedure delegated. The physician overseeing the performance of these procedures must use this specific vascular laser procedure within the physician's normal course of practice and expertise;

(d) Satisfactory completion of training shall be documented and retained by each physician delegating and the delegate. The education requirement in paragraph (A)(7)(a) of this rule must only be completed once by the delegate regardless of the number of types of specific vascular laser procedures delegated and the number of delegating physicians. The training requirements in paragraphs (A)(7)(b) and (A)(7)(c) of this rule must be completed by the delegate once for each specific type of vascular laser procedure delegated regardless of the number of delegating physicians;

(8) For delegation to a registered nurse or licensed practical nurse, the physician provides on-site supervision at all times that the person to whom the delegation is made is applying the vascular laser; and,

(9) For delegation to a registered nurse or licensed practical nurse, the physician supervises no more than two persons pursuant to this rule at the same time.

(B) A physician may delegate the application of light based medical devices for the purpose of hair removal in accordance with the requirements of section 4731.33 of the Revised Code.

(C) The physician assistant, registered nurse or licensed practical nurse shall immediately report to the supervising physician any clinically significant side effect following the application of the light based medical device or any failure of the treatment to progress as was expected at the time the delegation was made. The physician shall see and personally evaluate the patient who has experienced the clinically significant side effect or whose treatment is not progressing as expected as soon as practicable.

(D) A violation of paragraph (A), (B), or (C) of this rule by a physician shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(E) A violation of division (A)(5) of this rule shall constitute "violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provisions of this chapter or any rule promulgated by the board," as that clause is used in division (B)(20) of section 4731.22 of the Revised Code, to wit: section 4731.41 of the Revised Code.

(F) A violation of paragraph (C) of this rule by a physician assistant shall constitute "a departure from, or failure to conform to, minimal standards of care of similar physician assistants under the same or similar circumstances, regardless of whether actual injury to patient is established," as that clause is used in division (B)(19) of section 4730.25 of the Revised Code.

Last updated May 1, 2023 at 8:41 AM

History

Effective: April 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 4731-18-04 Delegation of phototherapy and photodynamic therapy.

(A) A physician may delegate to any appropriate person the application of light based medical devices cleared or approved by the United States food and drug administration for phototherapy in treatment of hyperbilirubinemia in neonates only if all the following conditions are met:

(1) The use of the light based medical device for this treatment is within the physician's normal course of practice and expertise.

(2) The delegation and application of light based medical devices for phototherapy for this treatment is performed pursuant to hospital rules, regulations, policies, and protocols.

(B) A physician may delegate the application of a light based medical device that is a phototherapy device that is cleared or approved by the United States food and drug administration for treatment of psoriasis and similar skin diseases only if all the following conditions are met:

(1) The use of the light based medical device for this treatment is within the physician's normal course of practice and expertise.

(2) The person to whom the delegation is made is one of the following:

(a) A physician assistant licensed under Chapter 4730. of the Revised Code with whom the physician has an effective supervision agreement;

(b) A registered nurse or licensed practical nurse licensed under Chapter 4723. of the Revised Code; or

(c) A certified medical assistant who has successfully completed and documented the completion of basic training on psoriasis and similar skin diseases and clinical training in the administration of the phototherapy device for the specific skin disease being treated; and

(3) For physician assistants, the authorization shall meet the requirements of section 4730.21 of the Revised Code;

(4) For registered nurses, licensed practical nurses, and certified medical assistants, the physician has seen and evaluated the patient to determine whether the proposed application of phototherapy is appropriate

(5) For registered nurses, licensed practical nurses, and certified medical assistants, the physician provides on-site supervision at all times that the person to whom the delegation is made is applying the phototherapy.

(C) A physician may delegate the application of light based medical devices cleared or approved by the United States food and drug administration for photodynamic therapy for dermatologic purposes only if all the following conditions are met:

(1) The use of the light based medical device for this treatment is within the physician's normal course of practice and expertise.

(2) The person to whom the delegation is made is one of the following:

(a) A physician assistant licensed under Chapter 4730. of the Revised Code with whom the physician has an effective supervision agreement; or,

(b) A registered nurse or licensed practical nurse licensed under Chapter 4723. of the Revised Code;

(3) For physician assistants, the authorization shall meet the requirements of section 4730.21 of the Revised Code;

(4) For registered nurses and licensed practical nurses, the physician has seen and evaluated the patient to determine whether the proposed application of photodynamic therapy is appropriate;

(5) For registered nurses and licensed practical nurses the person to whom the delegation is made completes basic training on photodynamic therapy and clinical training in the administration of photodynamic therapy for the specific disease or disorder being treated and the completion of this training is documented by the person to whom the delegation is made; and

(6) For registered nurses and licensed practical nurses, the physician provides on-site supervision at all times that the person to whom the delegation is made is applying the photodynamic therapy.

(D) Any person to whom a lawful delegation of phototherapy or photodynamic therapy has been made shall immediately report to the supervising physician any clinically significant side effect following the application of the phototherapy or photodynamic therapy device or any failure of the treatment to progress as was expected at the time the delegation was made. The physician shall see and personally evaluate the patient who has experienced the clinically significant side effect or whose treatment is not progressing as expected as soon as practicable.

(E) A violation of paragraph (A), (B), (C), or (D) of this rule by a physician shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code. A violation of paragraph (A)(2), (B)(2), or (C)(2) of this rule shall constitute "violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provisions of this chapter or any rule promulgated by the board," as that clause is used in division (B)(20) of section 4731.22 of the Revised Code, to wit: section 4731.41 of the Revised Code.

(F) A violation of paragraph (D) of this rule by a physician assistant shall constitute "a departure from, or failure to conform to, minimal standards of care of similar physician assistants under the same or similar circumstances, regardless of whether actual injury to patient is established," as that clause is used in division (B)(19) of section 4730.25 of the Revised Code.

Last updated August 4, 2026 at 10:41 AM

History

Effective: July 31, 2021
Promulgated Under: 119.03

Chapter 4731-20 Surgery Privileges of Podiatrist

Ohio Adm.Code 4731-20-01 Definition of foot.

"Foot," as used in section 4731.51 of the Revised Code, means the terminal appendage of the lower extremity and includes the ankle joint which consists of the tibial plafond, its posterolateral border (posterior malleolus), the medial malleolus, distal fibula (lateral malleolus) and the talus.

Last updated February 7, 2024 at 9:20 AM

History

Effective: May 31, 2018
Promulgated Under: 119.03

Ohio Adm.Code 4731-20-02 Surgery: ankle joint.

(A) A podiatric physician may perform surgery on the ankle joint, when both of the following requirements are met:

(1) The podiatric physician holds privileges to perform surgery on the ankle joint from one or more of the following entities:

(a) A college of podiatric medicine and surgery approved by the board pursuant to section 4731.51 of the Revised Code;

(b) A hospital approved by the "Joint Commission" or the "American Osteopathic Association"; or

(c) An ambulatory surgical facility approved by the department of health pursuant to its authority under Chapter 3702. of the Revised Code; and

(2) The podiatric physician can demonstrate adequate education, training and experience needed to conform to minimal standards of care of similar practitioners under the same or similar circumstances by meeting either of the following criteria:

(a) Having attained board qualified status from the "American Board of Foot and Ankle Surgery" and having successfully completed at least a twenty-four month residency in podiatric surgery approved by the "Council on Podiatric Medical Education," or

(b) Holding privileges to perform surgery on the ankle joint from an institution meeting criteria under paragraph (A)(1) of this rule, providing that such privileges were granted prior to January 30, 1997.

(B) A podiatric physician who performs surgery on the ankle joint other than in accordance with all the terms of this rule violates divisions (B)(6) and (B)(20) of section 4731.22 of the Revised Code.

Last updated February 7, 2024 at 9:20 AM

History

Effective: May 31, 2018
Promulgated Under: 119.03

Chapter 4731-22 Retired License Status

Ohio Adm.Code 4731-22-01 Retired license status.

(A) For purposes of this chapter:

(1) "Active registration with the federal drug enforcement administration" means any active registration with the federal drug enforcement administration in any state.

(2) "Licensee" means a person holding an active license with the medical board under Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774., or 4778. of the Revised Code except physician training certificate holders or limited permit holders in dietetics or respiratory care.

(3) "Retired" means that a licensee of the board has retired from the practice of the licensed profession in this state and is not practicing that licensed profession in this state under any circumstances.

(B) To obtain retired license status, a licensee shall file the appropriate application with the board that complies with all requirements in section 4730.141, 4731.283, 4759.064, 4760.062, 4761.062, 4762.062, 4774.062, or 4778.072 of the Revised Code. This includes an attestation that the licensee has retired voluntarily from practice in the licensed profession and, if applicable, that the licensee does not hold an active registration with the federal drug enforcement administration.

(C) Any person holding current emeritus registration status before October 3, 2023, shall automatically be converted to retired license status on that date. Those persons shall comply with the requirements in divisions (C) and (D) of section 4731.283 of the Revised Code to maintain the retired license status. To reactivate a license after it has been converted to retired status, those persons shall comply with the requirements in divisions (E) and (F) of section 4731.283 of the Revised Code for reactivating a license placed in retired status.

Last updated November 26, 2025 at 11:22 AM

History

Effective: February 29, 2024
Promulgated Under: 119.03

Chapter 4731-23 Delegation of Medical Tasks

Ohio Adm.Code 4731-23-01 Definitions.

As used in Chapter 4731-23 of the Administrative Code:

(A) "Administer" means the direct application of a drug, whether by injection, inhalation, ingestion, or any other means to a person.

(B) "Delegate" means to transfer authority for the performance of a medical task to an unlicensed person.

(C) "On-site supervision" means that the physical presence of the physician is required in the same location (e.g., the physician's office suite) as the unlicensed person to whom the medical task has been delegated while the medical task is being performed. "On-site supervision" does not require the physician's presence in the same room.

(D) "Physician" means an individual authorized by Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery.

(E) "Task" includes, but is not limited to, a routine medical service not requiring the special skills of a licensed provider.

(F) "Unlicensed person" means an individual who is not licensed or otherwise specifically authorized by the Revised Code to perform the delegated medical task.

(G) "Drug" means the same as in division (E) of section 4729.01 of the Revised Code.

Last updated August 4, 2026 at 10:41 AM

History

Effective: November 30, 2016
Promulgated Under: 119.03

Ohio Adm.Code 4731-23-02 Delegation of medical tasks.

(A) A physician shall not delegate the performance of a medical task unless that physician has complied with all of the requirements of this chapter of the Administrative Code and the delegation otherwise conforms to minimal standards of care of similar physicians under the same or similar circumstances.

(B) Prior to a physician's delegation of the performance of a medical task, that physician shall determine each of the following:

(1) That the task is within that physician's authority;

(2) That the task is indicated for the patient;

(3) The appropriate level of supervision;

(4) That no law prohibits the delegation;

(5) That the person to whom the task will be delegated is competent to perform that task; and,

(6) That the task itself is one that should be appropriately delegated when considering the following factors:

(a) That the task can be performed without requiring the exercise of judgment based on medical knowledge;

(b) That results of the task are reasonably predictable;

(d) That the task can be performed without a need for complex observations or critical decisions;

(e) That the task can be performed without repeated medical assessments; and,

(f) That the task, if performed improperly, would not present life threatening consequences or the danger of immediate and serious harm to the patient.

(C) When a physician delegates the administration of drugs, that physician shall provide on-site supervision, except in the following situations:

(1) When the physician has transferred responsibility for the on-site supervision of the unlicensed person who is administering the drug to another physician and that physician has knowingly accepted that responsibility on a patient-by-patient basis; or

(2) In the routine administration of a topical drug, such as a medicated shampoo.

(3) When written policies and procedures have been adopted for the distribution of drugs by an unlicensed person to individuals incarcerated in state correctional institutions as defined in division (A) of section 2796.01 of the Revised Code, other correctional facilities including county and municipal jails, workhouses, minimum security jails, halfway houses, community residential centers, regional jails and multi-county jails, or any other detention facility as defined in division (F) of section 2921.01 of the Revised Code.

(D) This chapter of the Administrative Code shall not apply if the rules contained herein:

(1) Prevent an individual from engaging in an activity performed for a handicapped child as a service needed to meet the educational needs of the child, as identified in the individualized education program developed for the child under Chapter 3323. of the Revised Code;

(2) Conflict with any provision of the Revised Code that specifically authorizes an individual to perform a particular task;

(3) Conflict with any rule adopted pursuant to the Revised Code that is in effect on the effective date of this section, as long as the rule remains in effect, specifically authorizing an individual to perform a particular task;

(4) Prohibit a perfusionist from administering drugs intravenously while practicing as a perfusionist.

(E) Physician delegation is prohibited in all settings specified in section 5123.42 of the Revised Code.

Last updated July 16, 2026 at 11:07 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-23-03 Prohibitions.

(A) A physician shall not delegate the practice of medicine as defined in section 4731.34 of the Revised Code unless specifically authorized to do so in the Revised Code or by an administrative rule adopted pursuant to the Revised Code and which became effective prior to April 10, 2001. Nothing in this chapter of the Administrative Code shall prohibit the performance of emergency medical tasks.

(B) A physician shall not delegate a task to an unlicensed person if the task is beyond that person's competence. In a hospital, as defined in section 3727.01 of the Revised Code, or an ambulatory care center affiliated with the hospital (if the center meets the same credentialing, quality assurance, and utilization review standards as the hospital) wherein unlicensed persons are employed or otherwise authorized by the governing authority of the institution to perform specific medical tasks, one factor the physician shall take into account is the policies by which the employer or the governing authority of the institution seeks to ensure that competent persons will be performing the delegated tasks.

(C) A physician shall not delegate a medical task that is not within the authority of that physician or is beyond the physician's training, expertise, or normal course of practice.

(D) A physician shall not transfer his or her responsibility for supervising an unlicensed person in the performance of a delegated medical task, except to another physician who has knowingly accepted that responsibility.

(E) A physician shall not authorize or permit an unlicensed person to whom a medical task is delegated to delegate the performance of that task to another person.

(F) Except as provided in divisions (D)(4) to (D)(8) of section 4731.053 of the Revised Code, a physician shall not delegate to an unlicensed person the administration of anesthesia, controlled substances, or drugs administered intravenously.

(G) The supervising physician retains responsibility for the manner in which the delegated task is carried out.

Last updated July 16, 2026 at 11:07 AM

History

Effective: May 31, 2002
Promulgated Under: 119.03

Ohio Adm.Code 4731-23-04 Violations.

(A) A violation of any provision of any rule in this chapter of the Administrative Code, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(B) A violation of any provision of any rule in this chapter of the Administrative Code that pertains to the administration of drugs, as determined by the board, shall constitute "failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code.

Last updated August 4, 2026 at 10:41 AM

History

Effective: September 30, 2001
Promulgated Under: Ch 119.

Chapter 4731-24 Anesthesiologist Assistants

Ohio Adm.Code 4731-24-01 Definitions.

As used in Chapter 4731-24 of the Administrative Code:

(A) "Administer" means to apply directly a drug, whether by injection, inhalation, ingestion, or any other means, and the infusion of blood, blood products and supportive fluids.

(B) "Assist" means to carry out procedures as requested by the supervising anesthesiologist, provided that the requested procedure is within the anesthesiologist assistant's training and scope of practice, is authorized by the practice protocol adopted by the supervising anesthesiologist, and is not prohibited by Chapter 4731. or 4760. of the Revised Code, or by any provision of agency 4731 of the Administrative Code.

(D) "Direct supervision, and in the immediate presence of" means the following:

(1) The supervising anesthesiologist shall remain physically present and available for immediate diagnosis and treatment of emergencies;

(2) The supervising anesthesiologist shall be physically present in the anesthetizing area or operating suite, as defined by the hospital or ambulatory surgical facility, and accessible by page, telephone, or overhead page, such that he or she is immediately available to participate directly in the care of the patient with whom the anesthesiologist assistant and the supervising anesthesiologist are jointly involved;

(3) The supervising anesthesiologist shall personally participate in the most demanding procedures in the anesthesia plan, which shall include induction and emergence; and

(4) "Direct supervision and the in immediate presence of" shall not be interpreted to:

(a) Require the supervising anesthesiologist's presence in the same room as the anesthesiologist assistant for the duration of the anesthetic management; or

(b) Prohibit the supervising anesthesiologist from addressing an emergency of short duration, administering labor analgesia, or performing duties of short duration as required of a perioperative specialist in another location in the hospital or ambulatory surgical facilty.

(E) "Enhanced supervision" means the following:

(1) The supervising anesthesiologist shall require regular, documented quality assurance interactions between the supervising anesthesiologist and the anesthesiologist assistant.

(a) The regularly scheduled quality assurance interactions shall occur in greater number and with greater frequency during the first four years of an anesthesiologist assistant's practice than would be required for quality assurance purposes for anesthesiologist assistants in practice for more than four years and shall take place no less frequently than once every three months.

(b) The anesthesiologist assistant shall be required to file on a monthly basis during the first two years of practice a separate record of the cases of anesthetic management in which he or she participated. The record shall be reviewed by a supervising anesthesiologist as a component of the quality assurance interactions.

(c) The reviewing supervising anesthesiologist shall file a report of each quality assurance interaction with the appropriate committee.

(2) The supervising anesthesiologist shall make direct observations of the anesthesiologist assistant during the course of each case of anesthetic management.

(a) During the first year of an anesthesiologist assistant's practice, the direct observations of each case of anesthetic management shall be made more frequently than for comparable procedures for anesthesiologist assistants practicing beyond their first year, and include direct observation of induction and emergence.

(b) The supervising anesthesiologist shall document the enhanced supervision in the anesthetic record.

(3) The period of enhanced supervision for an anesthesiologist assistant who has practiced in another state prior to beginning practice in Ohio shall be determined as follows:

(a) The anesthesiologist assistant shall be given credit for the time practiced in another state.

(b) The credit shall be on a year-for-year basis, except that the supervising anesthesiologist shall provide enhanced supervision as defined in this rule for the first three months of the anesthesiologist assistant's practice in Ohio.

Last updated November 5, 2025 at 8:50 AM

History

Effective: October 31, 2025
Promulgated Under: 119.03

Ohio Adm.Code 4731-24-02 Anesthesiologist assistants: supervision.

(A) A supervising anesthesiologist shall supervise an anesthesiologist assistant within the terms, conditions, and limitations set forth in a written practice protocol that is consistent with section 4760.08 of the Revised Code and this chapter of the Administrative Code. The supervision shall be direct supervision and in the immediate presence of the anesthesiologist assistant, as that term is defined in rule 4731-24-01 of the Administrative Code.

(B) An anesthesiologist assistant shall only perform those tasks assigned on a case-by-case basis by the supervising anesthesiologist. The anesthesiologist assistant shall implement the personalized plan for a patient as individually prescribed by the supervising anesthesiologist after the physician has completed a specific assessment of the patient.

(C) In determining which anesthetic procedures to assign to an anesthesiologist assistant, a supervising anesthesiologist shall consider all of the following:

(1) The education, training, and experience of the anesthesiologist assistant;

(2) The anesthesiologist assistant's scope of practice as defined in section 4760.09 of the Revised Code and this chapter of the Administrative Code;

(3) The conditions on the practice of the anesthesiologist assistant set out in the written practice protocol;

(4) The physical status of the patient according to the physical status classification system of the American society of anesthesiologists, as in effect at the time the assignment of procedures is made. The classification system is available from the American society of anesthesiologists and shall be posted on the board's website at med.ohio.gov.

(5) The invasiveness of the anesthetic procedure;

(6) The level of risk of the anesthetic procedure;

(7) The incidence of complications of the anesthetic procedure;

(8) The physical proximity of the supervising anesthesiologist and the anesthologist assistant or assistants being supervised concurrently; and

(9) The number of patients whose care is being supervised concurrently by the supervising anesthesiologist.

(D) During the first four years of an anesthesiologist assistant's practice, the supervising anesthesiologist shall provide enhanced supervision as defined in this chapter of the Administrative Code.

(E) The supervising anesthesiologist shall retain responsibility for the anesthetic management in which the anesthesiologist assistant has participated.

Last updated August 14, 2025 at 10:26 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Chapter 4731-25 Office Based Surgery

Ohio Adm.Code 4731-25-01 Definition of terms.

As used in rules 4731-25-02 to 4731-25-07 of the Administrative Code:

(A) "Anesthesia services" means administration of any drug or combination of drugs with the purpose of creating deep sedation/analgesia, regional anesthesia or general anesthesia. Anesthesia services shall not include the administration of topical or local anesthesia or moderate sedation/analgesia;

(B) "Certified copy of a patient record" means a copy of the patient record with a separate statement, signed by the person making the copy and notarized, attesting that the copy is a "true and accurate copy of the complete patient record";

(C) "Deep sedation/analgesia" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained;

(D) "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired;

(E) "Local anesthesia" means the injection of a drug or combination of drugs to stop or prevent a painful sensation in a circumscribed area of the body where a painful procedure is to be performed. Local anesthesia includes local infiltration anesthesia, digital blocks and pudendal blocks. Local anesthesia does not involve any systemic sedation;

(F) "Minimal sedation (anxiolysis)" means a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. "Minimal sedation" shall not include sedation achieved through intravenous administration of drugs;

(G) "Minor surgery" means surgery that can safely and comfortably be performed under topical or local anesthesia without more than minimal oral or intramuscular preoperative sedation. Minor surgery includes, but is not limited to, surgery of the skin, subcutaneous tissue and other adjacent tissue, the incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, arthrocentesis and closed reduction of simple fractures or small joint dislocations;

(H) "Moderate sedation/analgesia" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is maintained;

(I) "Office setting" means an office or portion thereof which is utilized to provide medical and/or surgical services to the physician's own patients. Office setting does not include an office or portion thereof licensed as an ambulatory surgical facility by the department of health pursuant to division (E)(1) of section 3702.30 of the Revised Code, a hospital licensed by the department of health pursuant to section 3722.02 of the Revised Code, including those locations of the hospital identified in the licensure application of the hospital that are providing outpatient surgical services as described in rule 3701-22-03 of the Administrative Code, or an emergency department located within such a hospital;

(J) "Regional anesthesia" means the administration of a drug or combination of drugs to interrupt nerve impulses without loss of consciousness and includes epidural, caudal, spinal, axillary, stellate ganglion blocks, regional blocks (such as axillary, bier, retrobulbar, peribulbar, interscalene, subarachnoid, supraclavicular, and infraclavicular), and brachial anesthesia. Regional anesthesia does not include digital or pudendal blocks;

(K) "Special procedure" means a diagnostic or therapeutic procedure which is not surgery which requires entering the body with instruments in a potentially painful manner, or which requires the patient to be immobile, and which requires the provision of anesthesia services. Special procedures include, but are not limited to, diagnostic or therapeutic endoscopy that explores existing channels and involves no transverse of a body wall; invasive radiologic procedures; pediatric magnetic resonance imaging; manipulation under anesthesia; or endoscopic examination with the use of general anesthesia;

(L) "Surgery" means the excision or resection, partial or complete, destruction, incision or other structural alteration of human tissue by any means, including through the use of lasers, performed upon the body of a living human being for the purposes of preserving health, diagnosing or curing disease, repairing injury, correcting deformity or defects, prolonging life, relieving suffering, or for aesthetic, reconstructive or cosmetic purposes, to include, but not be limited to: incision or curettage of tissue or an organ; suture or other repair of tissue or organ, including a closed or an open reduction of a fracture; extraction of tissue, including premature extraction of the products of conception from the uterus; and, insertion of natural or artificial implants. Surgery shall not include the suturing of minor lacerations;

(M) "Topical anesthesia" means the application of a drug or combination of drugs directly or by spray to the skin or mucous membranes which is intended to produce a transient and reversible loss of sensation to a circumscribed area.

(N) "Tumescent local anesthesia" means subcutaneous infiltration of high volumes of crystalloid fluid containing low concentrations of lidocaine and epinephrine. For purposes of this chapter of the Administrative Code, "tumescent local anesthesia" shall be considered "local anesthesia" as that term is defined in paragraph (E) of this rule.

(O) "Informed consent" to a special procedure or surgery in the office setting means a process of communication between a patient or, if applicable, the patient's legal representative and the physician discussing the risks and benefits of the special procedure or surgery itself and the performance of that special procedure or surgery in the office setting, as well as alternatives to performing the special procedure or surgery in the office setting that results in the signed authorization for the special procedure or surgery in the office setting by the patient or, if applicable the patient's legal representative.

(P) Level I of the American society of anesthesiologists physical status classification system means that a patient is in good health.

(Q) Level II of the American society of anesthesiologists physical status classification system means that a patient has mild systemic disease or condition that is well managed and does not substantively limit the patient's bodily functions.

Last updated September 30, 2026 at 7:40 AM

History

Effective: September 30, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-02 General provisions.

(A) Anesthesia services in the office setting shall be provided only by physicians and osteopathic physicians licensed pursuant to Chapter 4731. of the Revised Code; podiatric physicians licensed pursuant to Chapter 4731. of the Revised Code and practicing within the scope of practice for podiatric physicians; and certified registered nurse anesthetists licensed pursuant to Chapter 4723. of the Revised Code and practicing within the scope of practice for certified registered nurse anesthetists; and only in accordance with Chapter 4731-25 of the Administrative Code.

(B) Nothing in this chapter of the Administrative Code shall be interpreted to permit a podiatric physician to perform surgery or special procedures in an office setting using general anesthesia.

(C) Nothing in this chapter of the Administrative Code shall be interpreted to prohibit a registered nurse with the appropriate education and training from carrying out a physician's order to maintain a patient within an intensive care unit of a hospital at the level of sedation determined by the physician to be appropriate and necessary for that patient's care, so long as the patient remains within the intensive care unit with appropriate monitoring and so long as the physician's order is written in compliance with all applicable laws.

(D) A physician or podiatric physician shall not perform on more than one patient at the same time special procedures or surgery using moderate sedation/analgesia or anesthesia services.

(E) A certified registered nurse anesthetist providing moderate sedation/analgesia or anesthesia services in the office setting shall be under the direction of a podiatric physician acting within the podiatric physician's scope of practice in accordance with section 4731.51 of the Revised Code or a physician, and, when administering anesthesia, the certified registered nurse anesthetist shall be in the immediate presence of the podiatric physician or physician. For purposes of this chapter of the Administrative Code, a physician shall not be considered to have supervised the administration and monitoring of moderate sedation/analgesia or anesthesia services if the moderate sedation/analgesia or anesthesia services were administered and monitored by a physician anesthesiologist.

(F) "Surgery" shall not be interpreted so as to prohibit a registered nurse from performing tasks that are within the scope of practice of the registered nurse, so long as the registered nurse's activities are in accordance with Chapter 4723. of the Revised Code.

(G) This chapter of the Administrative Code shall not apply to surgeries or special procedures in which the level of anesthesia is limited to minimal sedation as that term is defined in this chapter of the Administrative Code, or which use only local or topical anesthetic agents, and which are performed in an office setting except that liposuction procedures performed under tumescent local anesthesia shall be subject to the provisions of rule 4731-25-05 of the Administrative Code.

(H) Special procedures or surgery utilizing moderate sedation/analgesia or anesthesia services shall be performed in the office setting only on patients who are evaluated as level P1 or P2 according to the American society of anesthesiologists physical status classification system current at the effective date of this rule.

(I) A special procedure or surgery that is prohibited by rule of the Administrative Code or law of the Revised Code to be performed in a hospital or ambulatory surgical facility shall not be performed in an office setting.

Last updated June 10, 2024 at 11:55 AM

History

Effective: May 18, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-03 Standards for surgery using moderate sedation/analgesia.

(A) A physician or podiatric physician performing special procedures or surgery in the office setting during which moderate sedation/analgesia is administered shall:

(1) Demonstrate sufficient education, training and experience needed to conform to the minimal standards of care of similar practitioners under the same or similar circumstances by meeting at least one of the following criteria:

(a) Holding current privileges at a local hospital accredited by the joint commission on accreditation of healthcare organizations or the American osteopathic association or at a local ambulatory surgical facility licensed by the department of health for the special procedure or surgery being performed;

(b) Being board certified by a specialty board recognized by the American board of medical specialties or the American osteopathic association or, if a podiatric physician, is board certified by the American board of podiatric surgery; and the surgery or special procedure being performed is generally recognized as being within the usual course of practice of that specialty;

(c) Having successfully completed a residency training program approved by the accreditation council for graduate medical education of the American medical association or the American osteopathic association or, if a podiatric physician, having successfully completed at least a twelve month residency in podiatric surgery approved by the council on podiatric medical education; and the surgery or special procedure being performed is generally recognized as being within the usual course of practice of that specialty; or

(d) Having successfully completed a didactic course supplemented by direct hands-on, monitored experience in the surgery or procedure being performed, and the surgery or special procedure being performed is generally recognized as being within the usual course of practice of the specialty of the physician.

(2) Have current (within the immediately previous two years) advanced cardiac life support/advanced trauma life support training, or, in the case of pediatric patients under the age of thirteen, have current (within the immediately previous two years) pediatric advanced life support training.

(3) Ensure that assisting personnel are competent to administer and monitor moderate sedation/analgesia and to manage emergencies such as loss of airway, compromise of cardiovascular functions or anaphylaxis.

(4) A physician or podiatric physician performing surgeries or special procedures using moderate sedation/analgesia in the office setting shall:

(a) Hold privileges to provide moderate sedation/analgesia from a local hospital accredited by the joint commission on accreditation of healthcare organizations or the American osteopathic association or from a local ambulatory surgical facility licensed by the department of health; or

(b) Have documented evidence of having completed at least five hours of category I continuing medical education relating to the delivery of moderate sedation/analgesia during the current or most recent past biennial registration period.

(B) Moderate sedation/analgesia may be administered in the office setting by only the following:

(1) A physician who holds privileges to provide moderate sedation/analgesia from a local hospital accredited by the joint commission on accreditation of healthcare organizations or the American osteopathic association or from a local ambulatory surgical facility licensed by the department of health;

(2) A certified registered nurse anesthetist who is acting under the supervision of and in the immediate presence of a physician or podiatric physician;

(3) A registered nurse who is acting under the supervision and in the immediate presence of a physician or podiatric physician, provided that such registered nurse shall only administer specifically prescribed doses of drugs selected by the physician or podiatric physician who shall be continuously present in the anesthetizing location during the administration of those drugs.

(C) The person administering and monitoring the moderate sedation/analgesia shall be at all times present in the anesthetizing location with the patient and cannot be the practitioner while performing the surgery or procedure. Further, the person administering and monitoring the moderate sedation/analgesia shall meet the training requirements of paragraph (A)(2) of this rule.

(D) A violation of any provision of this rule, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

History

Effective: May 31, 2018
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-04 Standards for surgery using anesthesia services.

(A) A physician or podiatric physician performing special procedures or surgery in the office setting during which anesthesia services are provided shall:

(2) Have current (within the immediately previous two years) advanced cardiac life support/advanced trauma life support training or, in the case of pediatric patients under the age of thirteen, have current (within the immediately previous two years) pediatric advanced life support training.

(3) Ensure that assisting personnel are competent to administer and monitor anesthesia services and to manage emergencies.

(4) A physician or podiatric physician performing surgeries or special procedures using anesthesia services in the office setting shall:

(a) Hold privileges to provide anesthesia services from a local hospital accredited by the joint commission on accreditation of healthcare organizations or the American osteopathic association or from a local ambulatory surgical facility licensed by the department of health; or

(b) Have successfully completed a residency training program approved by the accreditation council for graduate medical education of the American medical association or the American osteopathic association in anesthesia; or

(c) Have documented evidence of having completed at least twenty hours of category I continuing medical education relating to the delivery of anesthesia services during the current or most recent past biennial registration period.

(B) Anesthesia services may be administered in the office setting by only the following:

(1) A physician who holds privileges to provide anesthesia services from a local hospital accredited by the joint commission on accreditation of healthcare organizations or the American osteopathic association or from a local ambulatory surgical facility licensed by the department of health;

(2) A physician who has successfully completed a residency training program approved by the accreditation council for graduate medical education of the American medical association or the American osteopathic association in anesthesia and who is actively and directly engaged in the clinical practice of medicine as an anesthesiologist;

(3) A certified registered nurse anesthetist who is acting under the supervision and in the immediate presence of a physician or podiatric physician.

(C) The person administering and monitoring the anesthesia services shall be at all times present in the anesthetizing location with the patient and shall not function in any other capacity during the surgery or special procedure. Further, the person administering and monitoring the anesthesia services shall meet the training requirements of paragraph (A)(2) of this rule.

(D) Whenever general anesthesia is being administered to a patient in the office setting, the office shall have sufficient equipment and supplies to appropriately manage malignant hyperthermia.

(E) A violation of any provision of this rule, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

History

Effective: May 31, 2018
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-05 Liposuction in the office setting.

(A) A physician performing liposuction in the office setting shall meet the training requirements set forth in paragraph (A) of rule 4731-25-03 of the Administrative Code and must be in compliance with this rule.

(B) Liposuction in the office setting shall be performed in compliance with rules 4731-25-03 and 4731-25-04 of the Administrative Code as appropriate to the level of sedation being administered and in compliance with the following standards:

(1) The cannula utilized shall be no larger than 4.5 millimeters in diameter;

(2) The concentration of lidocaine in the solution shall not be greater than 0.1 per cent and the total dosage of lidocaine received by the patient during the procedure shall not exceed fifty milligrams per kilogram of body weight;

(3) The concentration of epinephrine in the solution shall not be greater than 1.5:1,000,000 and the total dosage of epinephrine received by the patient during the procedure shall not exceed fifty micrograms per kilogram of body weight;

(4) Intravenous access shall be maintained if the total aspirate is less than or equal to one hundred milliliters;

(5) If the total aspirate is more than one hundred milliliters, an intravenous line shall be running at a rate sufficient to prevent hypovolemia and must be monitored appropriately;

(6) Appropriate monitoring shall be performed. Such monitoring shall include:

(a) Recording the baseline vital signs, including blood pressure and heart rate, both preoperatively and postoperatively.

(b) If more than one hundred milliliters of aspirate is to be removed, a second person who is a health care professional as that term is defined in section 2305.234 of the Revised Code and who is acting within that health care professional's scope of practice shall be continuously within the room to monitor the patient. Continuous blood pressure monitoring and cardiac monitoring with pulse oximetry shall be performed and documented; supplemental oxygen shall be available.

(c) Patients who receive oral anxiolytics, sedatives, narcotic analgesics, moderate sedation or anesthesia services shall be monitored postoperatively until fully recovered and ready for discharge.

(7) Liposuction in the office setting shall be performed only on patients who are evaluated as level P1 or P2 according to the version of the American society of anesthesiologists physical status classification system current at the effective date of this rule;

(8) Liposuction shall not be performed in an office setting in combination with other procedures except as specifically authorized in paragraph (F) of this rule.

(C) Liposuction performed in an office setting shall not exceed four thousand five hundred milliliters of total aspirate.

(D) Liposuction using moderate sedation/analgesia or anesthesia services performed in an office shall be accredited in accordance with rule 4731-25-07 of the Administrative Code.

(E) The written discharge instructions given to the patient shall include specific information concerning the symptoms of lidocaine toxicity, the period of time during which such symptoms might appear and specific instructions for the patient to follow should the patient experience such symptoms.

(F) Nothing in this rule shall be interpreted to prohibit a physician from performing in the office setting procedures involving a focused, local small liposuction that is a routine part of the main procedure, provided that the physician complies with all other applicable rules.

(G) A violation of any provision of this rule, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

History

Effective: January 1, 2004
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-07 Accreditation of office settings.

(A) No physician or podiatric physician shall perform special procedures or surgery using moderate sedation/analgesia or anesthesia services in an office setting unless that office setting is accredited by an accrediting agency approved by the board, except in compliance with both of the following requirements:

(1) Prior to performing special procedures or surgery in the office setting that is not accredited, the physician or podiatric physician shall file an application for accreditation with an accrediting agency listed in paragraph (B) of this rule.

(2) Upon receipt of provisional accreditation, the physician or podiatric physician may perform special procedures or surgery in the office setting in accordance with the rules in Chapter 4731-25 of the Administrative Code until full accreditation is received or for one year from the date application for accreditation was filed, which ever is sooner.

(B) Accrediting agencies approved by the board include the following:

(1) The joint commission on accreditation of healthcare organizations;

(2) The accreditation association for ambulatory health care, inc.;

(3) The American association for accreditation of ambulatory surgery facilities, inc.; or

(4) The healthcare facilities accreditation program of the American osteopathic association.

(C) A violation of paragraph (A) of this rule, as determined by the board, shall constitute "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

Last updated September 30, 2026 at 7:40 AM

History

Effective: September 30, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-25-08 Standards for surgery.

(A) The surgeon of record in an operative case shall personally:

(1) Evaluate the patient sufficiently to formulate an appropriate preoperative diagnosis;

(2) Select the operation to be performed in consultation with the patient or with a person authorized to act on the patient's behalf;

(3) Determine, based on the surgeon's own evaluation, and, as necessary, on consultation with other physicians involved in the patient's care, that the patient is a fit candidate for the operation to be performed;

(4) Assure that the patient or a person authorized to act on the patient's behalf gives informed consent before the surgery begins;

(5) Comply with division (B)(6) of section 4731.22 of the Revised Code; and

(6) Perform or personally supervise the surgery, except those portions of the surgery, if any, which are performed or supervised by another qualified surgeon with the informed consent of the patient.

(B) Management of postoperative medical care is the responsibility of the surgeon of record. The surgeon of record shall fulfill this responsibility in one of the following ways:

(1) Personally performing the postoperative medical care;

(2) Delegating postoperative medical care to another physician or physicians who are qualified by training and experience to provide the level of care required, provided that the surgeon of record shall remain primarily responsible for the patient's overall care unless the patient and the other physician have agreed in advance to shift that responsibility to the other physician;

(3) Delegating defined aspects of the intra-operative and perioperative care to an appropriately trained, supervised and/or credentialed physician assistant, nurse, or allied health care personnel in compliance with applicable standards, provided that the surgeon of record shall retain personal responsibility for the quality of the care rendered by personnel who are under his supervision and control. The surgeon of record shall obtain the patient's fully informed consent, or the consent of a person authorized to act on the patient's behalf, in advance of surgery, before delegating aspects of patient care to a physician assistant, nurse, or allied health care personnel under this paragraph. The surgeon of record need not obtain the patient's informed consent for aspects of care to which the patient has already consented, such as consent to treatment and care by hospital personnel under an informed consent form signed upon the patient's admission to the hospital; or

(4) Delegating defined aspects of the intra-operative and perioperative care to licensees of other health regulatory boards who are licensed to provide the scope of practice and the level of care required, provided that the surgeon of record shall remain primarily responsible for the patient's overall care and must examine the patient during the postoperative period.

(C) This rule shall not be read to transfer any responsibility which currently rests with any other physician, physician assistant with whom the surgeon of record does not have a supervision agreement, nurse, allied health care provider, or institution to the surgeon of record.

(D) This rule shall not be read to prohibit or interfere with the appropriate training of medical students and physicians in post-graduate training programs, or other personnel.

(E) The provisions of this rule requiring consultation with or obtaining the informed consent of the patient or a person legally authorized to act on the patient's behalf do not apply to the extent they would prevent the performance of surgery or other procedures under emergency circumstances.

Last updated September 30, 2026 at 7:40 AM

History

Effective: September 30, 2026
Promulgated Under: 119.03

Chapter 4731-26 Current Best Practices

Ohio Adm.Code 4731-26-01 Definitions.

For purposes of Chapter 4731-26 of the Administrative Code:

(A) "Licensee" means any of the following:

(1) An individual holding a license to practice as a physician assistant under Chapter 4730. of the Revised Code;

(2) An individual holding a license to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery under Chapter 4731. of the Revised Code;

(3) An individual holding a license to practice a limited branch of medicine under Chapter 4731. of the Revised Code;

(4) An individual holding a license or limited permit to practice dietetics under Chapter 4759. of the Revised Code.

(5) An individual holding a license of registration as an anesthesiologist assistant under Chapter 4760. of the Revised Code;

(6) An individual holding a license or limited permit to practice respiratory care under Chapter 4761. of the Revised Code.

(7) An individual holding a license to practice as an acupuncturist under Chapter 4762. of the Revised Code;

(8) An individual holding a license to practice as a radiologist assistant under Chapter 4774. of the Revised Code; or

(9) An individual holding a license to practice as a genetic counselor under Chapter 4778. of the Revised Code.

(B) "Health care services" means examination, consultation, health care, treatment, or other services provided by a licensee under the legal authority conferred by a license, certificate, or registration issued by the board.

(C) "Patient" means a person for whom the licensee has provided health care services, whether provided by mutual consent or implied consent, or provided without consent pursuant to a court order. Once a licensee-patient relationship is established, a person remains a patient until the relationship is terminated. Patient includes any of the following:

(1) A person who is receiving or has received health care services from the licensee without termination of the licensee-patient relationship; or

(2) A person who meets the criteria of a key third party, as that term is defined in paragraph (D) of this rule.

(D) "Key third party" means an individual closely involved in the patient's decision-making regarding health care services, including but not limited to, the patient's spouse or partner, parents, child, sibling, or guardian. For purposes of this chapter, an individual's status as a key third party ceases upon the termination of the licensee-patient relationship or upon termination of the individual's relationship with the patient.

(E) "Chaperone" means a third person who, with the patient's consent, is present during a medical examination.

(F) "Former patient" means one of the following:

(1) A person for whom the licensee has not rendered health care services since the licensee-patient relationship was terminated; or

(2) A person who has otherwise been admitted, discharged, or referred to another licensee for care subsequent to receipt of health care services by a licensee in an emergency setting or on an episodic basis, and such action has been recorded in the person's medical record or chart.

(G) "Intimate examination" means an examination of the pelvic area, genitals, rectum, breast, or prostate.

(H) "Sexual misconduct" means conduct that exploits the licensee-patient relationship in a sexual way, whether verbal or physical, and may include the expression of thoughts, feelings, or gestures that are sexual or that reasonably may be construed by a patient as sexual. Sexual misconduct includes sexual impropriety, sexual contact, or sexual interaction as follows:

(1) "Sexual impropriety" means conduct by the licensee that is seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, including but not limited to, the following:

(a) Neglecting to employ disrobing or draping practices respecting the patient's privacy;

(b) Subjecting a patient to an intimate examination in the presence of a third party, other than a chaperone, without the patient's consent or in the event such consent has been withdrawn;

(c) Making comments that are not clinically relevant about or to the patient, including but not limited to, making sexual comments about a patient's body or underclothing, making sexualized or sexually demeaning comments to a patient, criticizing the patient's sexual orientation, or making comments about potential sexual performance;

(d) Soliciting a date or romantic relationship with a patient;

(e) Participation by the licensee in conversation regarding the sexual problems, sexual preferences, or sexual fantasies of the licensee;

(f) Requesting details of the patient's sexual history, sexual problems, sexual preferences, or sexual fantasies when not clinically indicated for the type of health care services; and

(g) Failing to offer the patient the opportunity to have a third person or chaperone in the examining room during an intimate examination and/or failing to provide a third person or chaperone in the examining room during an intimate examination upon the request of the patient.

(2) "Sexual contact" includes, but is not limited to, the following:

(a) Touching a breast or any body part that has sexual connotation for the licensee or patient, for any purpose other than appropriate health care services, or where the patient has refused or has withdrawn consent; and

(b) Examining or touching of the patient's genitals without the use of gloves.

(3) "Sexual interaction" means conduct between a licensee and patient, whether or not initiated by, consented to, or participated in by a patient, that is sexual or may be reasonably interpreted as sexual, including but not limited to, the following:

(a) Sexual intercourse, genital to genital contact;

(b) Oral to genital contact;

(d) Kissing in a romantic or sexual manner;

(e) Encouraging the patient to masturbate in the presence of the licensee or masturbation by the licensee while the patient is present;

(f) Offering to provide health care services, such as drugs, in exchange for sexual favors; and

(g) Performing an intimate examination without clinical justification.

(h) Conduct that is sexually demeaning to a patient or which demonstrates a lack of respect for the patient's privacy.

(4) Conduct described in paragraphs (H)(1)(a), (H)(1)(b), (H)(1)(g), and (H)(2)(b) of this rule does not constitute sexual misconduct when all of the following criteria are met:

(a) The conduct occurred during the rendering of health care services in an emergency setting;

(b) The health care services rendered were clinically necessary;

(d) The patient's clinical condition required immediate action and the licensee's violation of the provisions of paragraph (H)(1)(a), (H)(1)(b), (H)(1)(g), or (H)(2)(b) of this rule, as applicable, was due to circumstances not within the licensee's control.

(I) "Emergency setting" means an emergency department.

(J) "Board" means the state medical board of Ohio.

(K) "Conduct" includes, but is not limited to the following:

(1) Behaviors, gestures, or expressions, whether verbal or physical; or

(2) The creation, receipt, exchange, saving, or sending of images or communications, whether verbal or written, via a telecommunications device.

Last updated September 30, 2021 at 8:36 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-26-02 Prohibitions.

Sexual misconduct, as that term is defined in paragraph (H) of rule 4731-26-01 of the Administrative Code, between a licensee and a patient is never diagnostic or therapeutic.

(A) A licensee shall not engage in sexual misconduct with a patient or key third party, as that term is defined in paragraph (C) of rule 4731-26-01 of the Administrative Code.

(B) Conduct included within the definition of sexual misconduct occurring between a licensee and a former patient constitutes sexual misconduct and is prohibited if it meets any of the following criteria:

(1) The conduct occurred within ninety days after the licensee-patient relationship was terminated;

(2) The conduct occurred between a psychiatrist and a person to whom the psychiatrist formerly provided psychiatric or mental health services, and the conduct is in violation of the code of ethics of the "American Psychiatric Association"; or

(3) The board determines that the conduct constitutes sexual misconduct upon consideration of the following factors:

(a) The duration of the licensee-patient relationship;

(b) The nature of the health care services provided;

(d) The extent to which the former patient confided personal or private information to the licensee;

(e) The degree of emotional dependence that the former patient has or had on the licensee; and

(f) The extent to which the licensee used or exploited the trust, knowledge, emotions, or influence derived from the previous licensee-patient relationship.

Last updated September 30, 2021 at 8:36 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-26-03 Violations, miscellaneous.

(A) Except as provided in paragraph (C) of this rule, a violation of rule 4731-26-02 of the Administrative Code, as determined by the board, shall constitute the following:

(1) For a physician or massage therapist, "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(2) For a physician assistant, "a departure from, or failure to conform to, minimal standards of care of similar physician assistants under the same or similar circumstances, regardless of whether actual injury to a patient is established, as that clause is used in division (B)(19) of section 4730.25 of the Revised Code.

(3) For a dietitian, "a departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established" as that clause is used in division (A)(11) of section 4759.07 of the Revised Code.

(4) For an anesthesiologist assistant, "a departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances whether or not actual injury to the patient is established," as that clause is used in division (B)(4) of section 4760.13 of the Revised Code.

(5) For a respiratory care professional or limited permit holder, "a departure from, or a failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established", as that clause is used in division (A)(10) of section 4761.09 of the Revised Code.

(6) For an acupuncturist, a "departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances whether or not actual injury to the patient is established," as that clause is used in division (B)(4) of section 4762.13 of the Revised Code.

(7) For a radiologist assistant, a "departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances whether or not actual injury to the patient is established," as that clause is used in division (B)(4) of section 4774.13 of the Revised Code.

(8) For a genetic counselor, a "departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances whether or not actual injury to the patient is established," as that clause is used in division (B)(4) of section 4778.14 of the Revised Code.

(B) Where the alleged conduct does not in itself constitute sexual misconduct, as defined in paragraph (H) of rule 4731-26-01 of the Administrative Code, the board may consider expert testimony or other evidence in making its determination as to whether the conduct of the licensee constitutes sexual misconduct.

(C) Nothing in this rule shall limit the board's authority to investigate and take action under section 4730.25, 4731.22, 4759.07, 4760.13, 4761.09, 4762.13, 4774.13 or 4778.14 of the Revised Code.

Last updated September 30, 2021 at 8:36 AM

History

Effective: September 30, 2021
Promulgated Under: 119.03

Chapter 4731-27 Termination of Physician-Patient Relationship

Ohio Adm.Code 4731-27-01 Definitions.

As used in section 4731.228 of the Revised Code and this chapter:

(A) "Health care entity" has the same meaning as in section 4731.228 of the Revised Code.

(B) "Termination" has the same meaning as in section 4731.228 of the Revised Code. Pursuant to division (B) of section 4731.228 of the Revised Code termination does not include a physician leaving employment with a health care entity but continuing to provide medical services for patients of the health care entity on an independent contractor basis.

(C) "Retiring" means the relinquishing of all clinical privileges and either expiration of medical liability insurance by lapse of the policy or conversion of the policy to extended reporting period coverage only.

(D) "Terminate" means to put an end to.

(E) "Resignation" as that term is used in division (D) of section 4731.228 of the Revised Code means the provision of notice by a physician to a health care entity that the physician will no longer be an employee of the health care entity as of the date stated in the notice or a determination by the health care entity that the physician has resigned.

Last updated February 11, 2025 at 9:07 AM

History

Effective: December 31, 2013
Promulgated Under: 119.03

Ohio Adm.Code 4731-27-02 Dismissing a patient from the medical practice.

A physician-patient relationship is established when the physician provides service to a person to address medical needs, whether the service was provided by mutual consent or implied consent, or was provided without consent pursuant to a court order. Once a physician-patient relationship is established, a person remains a patient until the relationship is terminated.

(A) Except as provided in paragraph (B) of this rule, a physician shall comply with the following requirements in order to dismiss a patient from the medical practice:

(1) Send notice to the patient that includes all of the following:

(a) A statement that the physician-patient relationship is terminated;

(b) Except where the patient, or patient's repressentative, has displayed disruptive or threatening behavior toward the physician, office staff, or other patients, statement that the physician will continue to provide emergency treatment and access to services for up to thirty days from the date the letter was mailed, to allow the patient to secure care from another licensee; and

(2) The notice shall be sent in one of the following ways:

(a) A letter sent via certified mail, return receipt requested, to the last address for the patient on record, with a copy of the letter, the certified mail receipt, and the mail delivery receipt maintained in the patient record;

(b) An electronic message sent via a HIPAA compliant electronic medical record system or HIPAA compliant electronic health record system that provides a means of electronic communication between the health care entity and the patient, is capable of sending the patient a notification that a message has been received and is in the patient's portal, and is capable of notifying the sender that a message has not been viewed or has been viewed;

(c) If a notice sent via an electronic message as authorized in paragraph (A)(2)(b) of this rule is not viewed within ten days of having been sent, a letter sent in accordance with paragraph (A)(2)(a) of this rule.

(B) The requirements of paragraph (A) of this rule do not apply to the following:

(1) The physician rendered medical service to the person on an episodic basis or in an emergency setting and the physician should not reasonably expect that related medical service will be rendered to the patient in the future;

(2) The physician formally transferred the patient's care to another health care provider who is not in the same practice group;

(3) The physician is leaving a practice, selling a practice, retiring from medical practice, or whose employment with a health care entity has ended for any reason;

(4) The patient terminated the relationship, either verbally or in writing, or has transferred care to another physician for the same or a related condition, and the physician maintains documentation in the patient record of the patient's action terminating the relationship.

(D) A physician's dismissal of a patient from a medical practice other than in accordance with the provisions of this rule, as determined by the state medical board of Ohio, shall constitute "a departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(E) Nothing in this rule shall limit the board's authority to investigate and take action under section 4731.22 of the Revised Code.

Last updated February 11, 2025 at 9:08 AM

History

Effective: May 31, 2019
Promulgated Under: 119.03

Ohio Adm.Code 4731-27-03 Notice of termination of physician employment or physician leaving a practice, selling a practice, or retiring from the practice of medicine.

(A) When pursuant to section 4731.228 of the Revised Code a health care entity provides to patients a notice of the termination of a physician's employment, the notice shall be provided in one of the following ways:

(1) A letter sent via regular mail to the last address for the patient on record, with the date of mailing of the letter documented;

(2) An electronic message sent via a HIPAA compliant electronic medical record system or HIPAA compliant electronic health record system that provides a means of electronic communication between the health care entity and the patient and is capable of sending the patient a notification that a message has been received and is in the patient's portal.

(B) When pursuant to section 4731.228 of the Revised Code a health care entity provides the physician whose employment has been terminated for any reason with a list of patients treated and the patient contact information, the physician shall provide the notice required by section 4731.228 of the Revised Code by one of the ways authorized by paragraph (A)(1) or (A)(2) of this rule. In addition, the physician may, but is not required to, publish a notice in a newspaper of greatest circulation in the county in which the physician has practiced and in a local newspaper that serves the immediate practice area.

(C) Except as provided in paragraph (D) of this rule, a physician who is an independent contractor, who provides physician services as an employee or an owner at a medical practice that is not a health care entity, as that term is used in section 4731.228 of the Revised Code, or who has an ownership interest in a health care entity, as that term is defined in section 4731.228 of the Revised Code, shall provide notice in compliance with the following requirements when leaving, selling, or retiring from the health care entity or other medical practice entity where the physician has provided physician services:

(1) The notice shall be sent to all patients who received physician services from the physician within the two-years immediately preceding the physician's last date for seeing patients;

(2) The notice shall be provided as authorized in paragraph (A)(1) or (A)(2) of this rule.

(a) The notice shall be sent no later than thirty days prior to the last date the physician will see patients or upon actual knowledge that the physician will be leaving, selling, or retiring from the health care entity, whichever is earlier.

(b) A physician shall make a good faith effort to comply with paragraph (C)(2)(a) of this rule. However, a physician who because of acute illness or unforeseen emergency is unable to provide the notice thirty days prior to the last date of seeing patients shall provide the notice required by paragraph (C) of this rule no later than thirty days after it is determined that the physician will not be returning to the health care entity.

(3) The notice shall include all of the following:

(a) A statement that the physician will no longer be practicing medicine at the health care entity;

(b) The date on which the physician ceased or will cease to provide medicine services at the health care entity;

(c) If the physician will be practicing medicine in another location, contact information for the physician subsequent to leaving the health care entity;

(d) Contact information for an alternative physician or physicians employed by the health care entity or contact information for a group practice that can provide care for the patient;

(e) Contact information that enables the patient to obtain information on the patient's medical records.

(D) The requirements of paragraphs (A), (B) and (C) of this rule do not apply to the following:

(1) A physician who rendered medical service to a person on an episodic basis or in an emergency department or urgent care center, when it should not be reasonably expected that related medical service will be rendered by the physician to the patient in the future;

(2) A medical director or other physician providing services in a similar capacity to a medical director to patients through a hospice care program licensed pursuant to section 3712.04 of the Revised Code;

(3) Medical residents, interns, and fellows who work in hospitals, health systems, federally qualified health centers, and federally qualified health center look-alikes as part of their medical education and training;

(4) A physician providing services to a patient through a community mental health agency certified by the director of mental health under section 5119.611 of the Revised Code or an alcohol and drug addiction program certified by the department of alcohol and drug addiction services under section 3793.06 of the Revised Code;

(5) A physician providing services to a patient through a federally qualified health center or a federally qualified health center look-alike.

(E) A physician's failure to provide notice in accordance with the provisions of paragraph (B) or (C) of this rule, as determined by the state medical board of Ohio, shall constitute "a departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(F) Nothing in this rule shall limit the board's authority to investigate and take action under section 4731.22 of the Revised Code.

Last updated February 11, 2025 at 9:08 AM

History

Effective: May 31, 2019
Promulgated Under: 119.03

Chapter 4731-29 Pain Management Clinics

Ohio Adm.Code 4731-29-01 Standards and procedures for the operation of a pain management clinic.

(A) For the purposes of this rule:

(1) "Board" means state medical board of Ohio.

(2) "Chronic pain" means pain that has persisted after reasonable medical efforts have been made to relieve the pain or cure its cause and that has continued, either continuously, or episodically, for longer than three continuous months. "Chronic pain" does not include pain associated with a terminal condition or with a progressive disease that, in the normal course of progression, may reasonably be expected to result in a terminal condition.

(3) "Hospital" means an institution or facility that provides inpatient medical or surgical services for a continuous period longer than twenty-four hours as defined in section 3722.01 of the Revised Code.

(4) "Informed consent" means a process of communication between a patient and physician that results in the patient's signed authorization or agreement to undergo a specific medical intervention after all of the following subjects are discussed:

(a) The patient's diagnosis;

(b) The nature and purpose of the proposed treatment or procedure;

(d) Alternatives regardless of their costs or the extent to which the treatment options are covered by health insurance;

(e) The risks and benefits of the alternative treatment or procedure; and

(f) The risks and benefits of not receiving or undergoing a treatment or procedure.

(5) "Owner" means each person included on the list maintained under division (B)(6) of section 4729.552 of the Revised Code.

(6) "Pain management clinic" means a facility in which the majority of patients of the prescribers at the facility are provided treatment for chronic pain that includes the use of controlled substances. In determining whether the facility meets the requirements of this paragraph:

(a) Calculation of the majority of patients will be based upon the number of patients treated in a calendar month;

(b) Patients receiving controlled substances for treatment of an injury or illness that lasts or is expected to last thirty days or less shall not be considered in the calculation of the majority.

(7) "Pain management clinic" does not include the following:

(a) A hospital;

(b) A facility operated by a hospital for the treatment of pain or chronic pain;

(c) A physician practice owned or controlled, in whole or in part, by a hospital or by an entity that owns or controls, in whole or in part, one or more hospitals;

(d) A school, college, university, or other educational institution or program to the extent that it provides instruction to individuals preparing to practice as physicians, podiatrists, dentists, nurses, physician assistants, optometrists, or veterinarians or any affiliated facility to the extent that it participates in the provision of that instruction;

(e) A hospice program licensed under Chapter 3712. of the Revised Code;

(f) An ambulatory surgical facility licensed under section 3702.30 of the Revised Code;

(g) An interdisciplinary pain rehabilitation program with three-year accreditation from the commission on accreditation of rehabilitation facilities;

(h) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision certified under section 3721.09 of the Revised Code; or

(i) A facility conducting only clinical research that may use controlled substances in studies approved by a hospital-based institutional review board or an institutional review board accredited by the association for the accreditation of human research protection programs.

(8) "Physician" means an individual authorized under chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(9) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code.

(B) In the operation of a pain management clinic, the following requirements shall be met:

(1) The pain management clinic shall be owned and operated by one or more physicians. Each physician owner of a pain management clinic shall complete at least twenty hours of category I continuing medical education in pain medicine every two years, to include one or more courses addressing the potential for addiction. The courses completed in compliance with this rule shall be accepted toward meeting the category I requirement for certificate of registration renewal for the physician.

(2) Each physician owner of a pain management clinic must meet one of the following requirements:

(a) Hold current subspecialty certification in pain medicine by the American board of medical specialties, or hold a current certificate of added qualification in pain medicine by the American osteopathic association bureau of osteopathic specialists; or

(b) Hold current subspecialty certification in hospice and palliative medicine by the American board of medical specialties, or hold a current certificate of added qualification in hospice and palliative medicine by the American osteopathic association bureau of osteopathic specialists; or

(d) Hold current board certification by the American board of interventional pain physicians; or

(e) Meet both of the following:

(i) Hold current board certification in anesthesiology, psychiatry, neurology, physical medicine and rehabilitation, occupational medicine, or rheumatology by the American board of medical specialties or hold current primary certification in anesthesiology, psychiatry, neurology, physical medicine and rehabilitation, occupational medicine, or rheumatology by the American osteopathic association bureau of osteopathic specialists.

(ii) Demonstrate conformance with the minimal standards of care.

(3) To demonstrate conformance with the minimal standards of care pursuant to paragraph (B)(2)(e)(ii) of this rule, the board shall conduct an inspection of the facility pursuant to division (E) of section 4731.054 of the Revised Code.

(4) The pain management clinic shall be licensed as a category III terminal distributor of dangerous drugs with a pain management clinic classification under section 4729.552 of the Revised Code.

(5) The pain management clinic shall be operated in compliance with Chapters 3719., 4729., 4730., and 4731. of the Revised Code, and all applicable provisions of federal law governing the possession, distribution or use of controlled substances.

(6) The pain management clinic shall have proper equipment, materials, and personnel on premises to provide appropriate medical treatment, as required by the minimal standards of care.

(C) Each physician who provides care at a pain management clinic shall complete at least twenty hours of category I continuing medical education in pain medicine every two years, to include one or more courses addressing the potential for addiction. The courses completed in compliance with this rule shall be accepted toward meeting the category I requirement for certificate of registration renewal for the physician.

(D) No physician owner of a pain management clinic, employee of the clinic, or person with whom the clinic contracts for services shall:

(1) Have ever been denied a license to prescribe, dispense, administer, supply, or sell a controlled substance by the drug enforcement administration or appropriate issuing body of any state or jurisdiction, based, in whole or in part, on the prescriber's inappropriate prescribing, dispensing, administering, supplying or selling a controlled substance or other dangerous drug.

(2) Have held a license issued by the drug enforcement administration or a state licensing agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply or sell a controlled substance, that has ever been restricted, based, in whole or in part, on the prescriber's inappropriate prescribing, dispensing, administering, supplying, or selling a controlled substance or other dangerous drug.

(3) Have been subject to disciplinary action by any licensing entity that was based, in whole or in part, on the prescribers inappropriate prescribing, dispensing, diverting, administering, supplying or selling a controlled substance or other dangerous drug.

(E) In providing supervision, direction, and control of individuals at a pain management clinic the physician owner shall establish and ensure compliance with the following:

(1) A requirement that a log of patients be maintained for each day the clinic is in operation.

(a) Each log sheet shall contain the month, day, and year;

(b) Each log entry shall include the legible first and last name of each patient;

(d) Patient logs shall be maintained for seven years.

(2) A requirement that providers obtain informed consent for each patient prior to the commencement of treatment.

(3) An on-going quality assurance program that objectively and systematically monitors and evaluates the quality and appropriateness of patient care, evaluates methods to improve patient care, identifies and corrects deficiencies within the clinic, and provides the opportunities to improve the clinic's performance and quality of care.

(4) A requirement that the background, training, certification, and licensure of all clinical staff be documented. Verification of certification and licensure shall be made on an annual basis.

(5) A requirement that adequate billing records are maintained for all patients and made available to the board, immediately upon request.

(a) Billing records shall include the amount paid, method of payment, description of services, sufficient information to identify the patient, and the amounts charged to the patient for each date of service,

(b) Billing records shall be maintained for seven years from the last date of treatment of the patient.

(6) A requirement that adequate patient records are maintained for all patients and made available to the board, immediately upon request.

(a) Patient records shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum:

(i) Patient history and physical examination, including history of drug abuse or dependence;

(ii) Diagnostic, therapeutic, and laboratory results, including drug testing results;

(iii) Reports of evaluations, consultations, and hospitalizations;

(iv) Treatment objectives, including discussion of risks and benefits;

(v) Records of drugs prescribed, dispensed or administered, including the date, type, and dosage;

(vi) Treatments;

(vii) Receipt and assessment of drug database or prescription monitoring program reports;

(viii) Copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. Records provided by the patient shall be designated as such.

(b) Patient records shall be maintained for seven years from the last date of treatment of the patient.

(c) In the treatment of chronic pain the patient records shall contain the information required in rule 4731-11-14 of the Administrative Code in lieu of the requirements of paragraphs (E)(6)(a)(i) to (E)(6)(a)(vi) of this rule.

Last updated February 2, 2026 at 8:04 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Chapter 4731-30 State Medical Board Metrics

Ohio Adm.Code 4731-30-01 Definitions.

(A) "Board" means the state medical board of Ohio.

(B) "Case" means a matter that has been assigned to investigation, enforcement, or the hearing unit of the board relating to a potential violation of Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774., or 4778. of the Revised Code.

(C) "Hearing" means a hearing held pursuant to Chapter 119. of the Revised Code, which involves the adjudication of a license to practice or an application for a license to practice issued under Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774, or 4778. of the Revised Code.

(D) "Hearing unit" means the subunit of the board staff which administers and conducts hearings on behalf of the board.

(E) "Enforcement section" means the subunit of the board staff that coordinates, develops and /or evaluates a case regarding possible disciplinary action.

(F) "Investigation section" means the subunit of the board staff which conducts the initial and follow-up investigation of a case.

(G) "License" means a license to practice issued under Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774, or 4778. of the Revised Code.

(H) "License application" means an application for a license to practice issued under Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4774, or 4778. of the Revised Code.

Last updated September 30, 2025 at 7:29 AM

History

Effective: September 30, 2025
Promulgated Under: 111.15

Ohio Adm.Code 4731-30-02 Board metrics.

As set forth in this rule, the board shall prepare and publish metrics of the board's operations for each fiscal year.

(A) Licensure and renewal metrics:

(1) The total number of licenses issued by the board broken down by license type.

(2) The median and/or average number of days to issue a license for all license applications.

(3) The number of renewals processed by license type.

(B) Investigation metrics:

(1) The total number of reports of investigation completed.

(2) The total number of subpoenas issued by the investigation section.

(1) The total number of cases assigned to the enforcement section.

(2) The total number of cases completed by the enforcement section.

(3) The total number of subpoenas issued by the enforcement section.

(4) The total number of depositions conducted by the enforcement section.

(5) The total number of interrogatories generated by the enforcement section.

(D) Outreach metrics:

The total number of presentations provided by board staff, broken down by topic.

(E) Public records request metrics:

The total number of public records requests processed by board staff.

(F) Complaint metrics:

(1) The total number of complaints received by the board.

(2) The total number of complaints closed.

(3) The median and/or average number of calendar days from the date that each complaint was received by the board until the date that the complaint was closed.

(G) Fiscal metrics:

(1) Fiscal year expenditures by major activities.

(2) Fiscal year revenue by major activity and license type.

(3) The board's travel reimbursements by fiscal year.

(H) Hearing metrics:

(1) The median and/or average number of calendar days for all cases assigned to the board hearing unit from the date that a written request for hearing is received by the board until a hearing begins.

(2) The median and/or average number of calendar days for all cases assigned to the board hearing unit from the date that the hearing has been concluded until a written report and recommendation has been issued from the board hearing unit.

(3) The median and/or average number of calendar days for all cases from the date that the written report and recommendation has been issued until the board issues an order disposing of the case.

Last updated September 30, 2025 at 7:29 AM

History

Effective: September 30, 2025
Promulgated Under: 111.15

Ohio Adm.Code 4731-30-03 Approval of licensure applications.

(A) For purposes of this rule, routine authorization means issuance of a license or certificate to an individual pursuant to an application that meets the following criteria:

(1) The applicant meets eligibility requirements for the license or certificate under the applicable provisions of the Revised Code and Administrative Code;

(2) If applicable, the secretary of the board has granted to the applicant a waiver of, or a determination of equivalency to, any eligibility requirement, as may be provided for under the applicable provisions of the Revised Code and Administrative Code;

(3) If applicable, the secretary of the board has determined that the applicant has demonstrated fitness to resume practice due to inactivity under the applicable provisions of the Revised Code and Administrative Code;

(4) The application presents no grounds for discipline under the applicable provisions of the Revised Code or Administrative Code.

(B) The board authorizes the secretary of the board to issue the following routine authorizations under the provisions of the Revised Code and Administrative Code, without prior consultation or approval by the board:

(1) Certificate of conceded eminence pursuant to section 4731.297 of the Revised Code;

(2) Clinical research faculty certificate pursuant to section 4731.293 of the Revised Code;

(3) Visiting clinical professional development certificate pursuant to section 4731.298 of the Revised Code;

(4) Special activity certificate pursuant to section 4731.294 of the Revised Code;

(5) Special activity license to practice as a genetic counselor pursuant to section 4778.09 of the Revised Code;

(6) Certificate to recommend medical use of marijuana pursuant to section 4731.30 of the Revised Code.

(C) The board authorizes the deputy director of licensure, or the deputy director's designee, to issue the following routine authorizations under the provisions of the Revised Code and Administrative Code, without prior consultation or approval by the board:

(1) License to practice as a physician assistant pursuant to section 4730.12 of the Revised Code;

(2) License to practice medicine and surgery or osteopathic medicine and surgery pursuant to section 4731.14 of the Revised Code;

(3) License to practice a limited branch of medicine pursuant to section 4731.17 of the Revised Code;

(4) Training certificate pursuant to section 4731.291 of the Revised Code;

(5) Volunteer's certificate pursuant to section 4731.295 of the Revised Code;

(6) License to practice podiatric medicine and surgery pursuant to section 4731.56 of the Revised Code;

(7) Visiting podiatric faculty certificate pursuant to section 4731.572 of the Revised Code;

(8) Podiatric training certificate pursuant to section 4731.573 of the Revised Code;

(9) License to practice dietetics and limited permit to practice dietetics pursuant to section 4759.06 of the Revised Code;

(10) Certificate to practice as an anesthesiologist assistant pursuant to section 4760.04 of the Revised Code;

(11) License to practice respiratory care and limited permit to practice respiratory care pursuant to section 4761.05 of the Revised Code;

(12) License to practice as an acupuncturist pursuant to section 4762.03 of the Revised Code;

(13) License to practice as a radiologist assistant pursuant to section 4774.04 of the Revised Code;

(14) License to practice as a genetic counselor pursuant to section 4778.05 of the Revised Code;

(15) Supervised practice license as a genetic counselor pursuant to section 4778.08 of the Revised Code;

(16) Temporary expedited license for members of the military and spouses who are licensed in another jurisdiction pursuant to section 4743.04 of the Revised Code.

(17) Licenses, certificates, and permits applied for under Chapter 4796. of the Revised Code.

(D) The board authorizes the secretary of the board to do the following:

(1) Grant a waiver pursuant to the provisions of rule 4731-6-05 of the Administrative Code;

(2) Determine graduate medical education equivalency pursuant to section 4731.09 of the Revised Code;

(3) Determine whether an applicant has demonstrated fitness to resume practice due to inactivity under the applicable provisions of the Revised Code and Administrative Code;

(4) Pursuant to the provisions of Chapter 4796. of the Revised Code, grant a waiver of the requirement that an applicant has been actively engaged in the practice of the profession, occupation, or occupational activity for the applicable minimum time period immediately preceding the date of application.

(5) Pursuant to the provisions of Chapters 4730., 4731., 4759., and 4761. of the Revised Code and any applicable administrative rules, grant a waiver or pro rata reduction of continuing education hours.

(E) In the interest of operational efficiency, the secretary and supervising member of the board may approve the use of protocols whereby, if the deputy director of licensure, or the deputy director's designee, finds that the parameters of an approved protocol are met:

(1) A waiver pursuant to the provisions of rule 4731-6-05 of the Administrative Code may be deemed granted.

(2) It may be deemed that an applicant's education, post-graduate medical training, experience, or other qualifications, is equivalent to the graduate medical education requirements set forth in section 4731.09 of the Revised Code.

(3) It may be deemed that an applicant has demonstrated fitness to resume practice due to inactivity under the applicable provisions of the Revised Code and Administrative Code.

(4) A waiver pursuant to the provisions of Chapter 4796. of the Revised Code may be deemed granted.

(F) An application for a license or certificate that is ineligible for routine authorization under this rule will be referred to the board for determination of whether an applicant shall be granted a license. An affirmative vote of not fewer than six members of the board is necessary for issuance of a license or certificate pursuant to an application that is not eligible for routine authorization.

(G) Notwithstanding the provisions of this rule, the board may designate the referral of any class of applications to the board for approval. The secretary or deputy director for licensure may refer any individual application to the board for approval.

Last updated September 30, 2025 at 7:29 AM

History

Effective: September 30, 2025
Promulgated Under: 111.15

Ohio Adm.Code 4731-30-04 Maintenance of list of disqualifying criminal offenses.

(A) For purposes of this rule, "list of disqualifying criminal offenses" is the list of specific criminal offenses authorized by section 9.79 of the Revised Code for which a conviction, judicial finding of guilt, or plea of guilty may disqualify an individual from obtaining an initial license to practice under Chapter 4730., 4731., 4759., 4760., 4761., 4762., 4772., 4774., or 4778. of the Revised Code.

(B) For purposes of this rule, "board" means the state medical board of Ohio, a licensing authority under division (A) of section 9.79 of the Revised Code.

(C) At least once per calendar year, the board shall review the list of disqualifying criminal offenses. As part of the review, the board may approve the addition, deletion or modification of specific criminal offenses on the list of disqualifying criminal offenses.

(D) The board shall make the list of disqualifying criminal offenses available to the public on the board's website.

Last updated July 31, 2026 at 9:11 AM

History

Effective: July 31, 2026
Promulgated Under: 111.15

Chapter 4731-31 Return of Athlete to Practice or Competition

Ohio Adm.Code 4731-31-01 Requirements for assessing and granting clearance for return to practice or competition.

(A) A physician holding a current license to practice medicine and surgery or osteopathic medicine and surgery issued under Chapter 4731. of the Revised Code meets the minimum education requirements to assess and clear athletes for return to practice or competition under section 3313.539 or 3707.511 of the Revised Code.

(1) A physician shall diagnose and treat concussions and determine the return-to-play protocol for athletes under section 3313.539 or 3707.511 of the Revised Code in accordance with the "Consensus statement on concussion in sport issued by the 6th international conference on concussion in sport held in Amsterdam in October 2022" (Available from the website of the state medical board of Ohio at: med.ohio.gov.)

(2) A physician shall use the model form developed by the Ohio youth sports concussion and head injury return-to-play guidelines committee to document written clearance for the return to practice or competition. The model form may be found on the state medical board of Ohio's website at med.ohio.gov.

(B) A physician assistant holding a current license issued under Chapter 4730. of the Revised Code may assess and clear a youth to return to practice or competition under section 3313.539 or 3707.511 of the Revised Code if all of the following requirements are met:

(1) The physician assistant is authorized to provide assessment and clearance services by a supervising physician whose normal course of practice includes the assessment and clearance of youth to return to practice or competition under section 3313.539 or 3707.511 of the Revised Code and under whose supervision the physician assistant will provide the services:

(2) The physician assistant has completed education and training in the detection of concussion, its clinical features, assessment techniques, and the principles of safe return to play protocols consistent with the consensus statement referenced in paragraph (A)(1) of this rule.

(3) The physician assistant has maintained competency through completion of continuing education in the detection of concussion, its clinical features, assessment techniques, and the principles of safe return to play protocols consistent with the consensus statement referenced in paragraph (A)(1) of this rule; and

(4) The physician assistant uses the medical clearance return to play form referenced in paragraph (A)(2) of this rule.

Last updated April 30, 2025 at 5:12 PM

History

Effective: April 30, 2025
Promulgated Under: 119.03

Chapter 4731-32 Medical Marijuana

Ohio Adm.Code 4731-32-01 Definition of terms.

(A) "Annual report" means the annual compilation of information a physician holding a certificate to recommend medical marijuana must submit to the board that describes the physician's observation regarding the efficacy of treatment with medical marijuana.

(B) "Board" means the state medical board of Ohio.

(C) "Caregiver" means an individual registered under section 3796.08 of the Revised Code to assist a registered patient in the use or administration of medical marijuana.

(D) "Certificate to recommend medical marijuana" means the certificate issued by the board authorizing a physician to recommend treatment with medical marijuana.

(E) "Drug database" means the database established and maintained by the board of pharmacy pursuant to section 4729.75 of the Revised Code.

(F) "Marijuana" means marihuana as defined in section 3719.01 of the Revised Code.

(G) "Medical marijuana" means marihuana that is cultivated, processed, dispensed, tested, possessed, or used for a medical purpose. Medical marijuana is a schedule II controlled substance pursuant to division (B) of section 3796.01 of the Revised Code.

(H) "Medical marijuana entity" means a medical marijuana cultivator, processor, or testing laboratory licensed by the department of commerce under section 3796.09 of the Revised Code, or a retail dispensary licensed by the division of marijuana control under section 3796.10 of the Revised Code.

(I) "Patient" means an individual diagnosed with a qualifying medical condition as defined in division (A) of section 3796.01 of the Revised Code and who is seeking to use medical marijuana.

(J) "Physician" means an individual authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

Last updated March 1, 2024 at 8:08 AM

History

Effective: February 29, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-32-02 Certificate to recommend medical marijuana.

(A) Eligibility for a certificate to recommend medical marijuana requires that all of the following requirements be met:

(1) The applicant holds an active, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery under section 4731.14, 4731.11, or 4731.299 of the Revised Code;

(2) The applicant has been granted access to and is not under any prohibition for access to the drug database established and maintained by the board of pharmacy pursuant to section 4729.75 of the Revised Code.

(3) The applicant holds an active registration with the drug enforcement administration

(4) The applicant has not been denied a license to prescribe, possess, dispense, administer, supply, or sell a controlled substance by the drug enforcement administration or appropriate issuing body of any state or jurisdiction, based, in whole or in part, on the applicant's inappropriate prescribing, personally furnishing, dispensing, administering, supplying or selling a controlled substance or other dangerous drug.

(5) The applicant has not held a license issued by the drug enforcement administration or a state licensing administration in any jurisdiction, under which the person may prescribe, personally furnish, dispense, possess, administer, supply or sell a controlled substance, that has ever been restricted, based, in whole or in part, on the applicant's inappropriate prescribing, dispensing, administering, supplying, or selling a controlled substance or other dangerous drug.

(6) The applicant has not been subject to disciplinary action by any licensing entity that was based, in whole or in part, on the applicant's inappropriate prescribing, personally furnishing, dispensing, diverting, administering, supplying or selling a controlled substance or other dangerous drug.

(7) The applicant has completed at least two hours of continuing medical education in a course or courses certified by the Ohio state medical association or the Ohio osteopathic association that assist physicians in both of the following:

(a) Diagnosing qualifying medical conditions as defined in section 3796.01 of the Revised Code;

(b) Treating qualifying medical conditions with medical marijuana, including the characteristics of medical marijuana and possible drug interactions.

(8) The applicant has no ownership or investment interest in or compensation agreement with any medical marijuana entity licensed or applicant seeking licensure under Chapter 3796. of the Revised Code.

(B) An applicant for a certificate to recommend medical marijuana shall file an application under oath with the board in compliance with section 4731.30 of the Revised Code.

(1) An application shall be considered complete when all the following requirements are met:

(a) Evidence of all the requirements in paragraph (A) of this rule are received by the board.

(b) The board is not conducting an investigation pursuant to section 4731.22 of the Revised Code of evidence appearing to show that the applicant has violated section 4731.22 or 4731.30 of the Revised Code or applicable rules adopted by the board.

(2) The application shall be processed in accordance with the following:

(a) All application materials submitted to the board will be thoroughly investigated. The board may contact individuals, agencies, or organizations for information about applicants as the board deems necessary. As part of the application process, an applicant may be requested to appear before the board or a board representative to answer questions or provide additional information.

(b) Any applicant to whom the board proposes to deny certificate issuance shall be entitled to a hearing on the issue of such proposed denial in compliance with the provisions of Chapter 119. of the Revised Code and the rules in Chapter 4731-13 of the Administrative Code.

(3) The following processes apply when an application is not complete within six months of the date the application is received by the board:

(a) If the application is not complete because required information, facts, or other materials have not been received by the board, the board may notify the applicant that it intends to consider the application abandoned if the application is not completed.

(i) The notice shall specifically identify the information, facts, or other materials required to complete the application and inform the applicant that the information, facts, or other materials must be received by the specified deadline date. The notice shall also inform the applicant that if the application remains incomplete at the close of business on the deadline date the application may be deemed to be abandoned.

(ii) If all of the information, facts, or other materials are received by the board by the deadline date and the application is determined to be complete, the board shall process the application and may require updated information as it deems necessary.

(b) If the application is not complete because the board is investigating, pursuant to section 4731.22 of the Revised Code, evidence appearing to show that the applicant has violated Chapter 4731. of the Revised Code or applicable rules adopted by the board, the board shall do both of the following:

(i) Notify the applicant that although otherwise complete, the application will not be processed pending completion of the investigation; and

(ii) Upon completion of the investigation and the determination that the applicant is not in violation of statute or rule, process the application, including requiring updated information as it deems necessary.

(C) The certificate to recommend shall be renewed when the holder's license to practice as a physician or osteopathic physician is renewed or restored, conditioned upon the holder's certification of having met all of the following requirements:

(1) The requirements in paragraphs (A)(1) to (A)(6) and (A)(8) of this rule; and

(2) The annual completion of at least two hours of continuing medical education in a medical marijuana course or courses approved by the board by meeting both of the following requirements:

(a) The course assists physisicans holding certificates to recommend in both diagnosing qualifying medical conditions as defined in section 3796.01 of the Revised Code and treating the qualifying medical conditions with medical marijuana; and

(b) The requirements of paragraph (A)(1) or (A)(2) of rule 4731-10-02 of the Administrative Code.

(D) The board shall notify the division of marijuana control if a physician's certificate to recommend is lapsed, surrendered, suspended, revoked or otherwise not renewed.

Last updated March 1, 2024 at 8:08 AM

History

Effective: February 29, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-32-03 Standard of care.

In order to practice within the minimal standards of care when recommending treatment with medical marijuana, a physician shall comply with all of the following requirements:

(A) The physician shall establish and maintain a bona fide physician-patient relationship with the patient for the provision of medical services that is established through an examination of the patient by the physician either in-person or through the use of telehealth services that complies with this rule and for which there is an expectation that the physician will provide care to the patient on an ongoing basis.

(B) The physician shall create and maintain a medical record that documents the provision of medical services. The documentation shall include all of the following:

(1) Patient's name and date or dates of office or telehealth visits or treatments;

(2) A description of the patient's current medical condition;

(3) Documented assessment of the patient's medical history, including relevant prescription history and any history of substance use disorder;

(4) Documented review of any available relevant diagnostic test results;

(5) Documented review of prior treatment and the patient's response to the treatment;

(6) Documented review of the patient's current medication to identify possible drug interactions, including benzodiazepines and opioids.

(7) Documented review that standard medical treatment has been attempted or considered. If standard medical treatment is not attempted, the physician must document the reasons that standard medical treatment is not appropriate for this patient;

(8) Based on evidence or behavioral indications of addiction or drug abuse, the physician may obtain a drug screen on the patient. It is within the physician's discretion to decide the nature of the screen and which type of drug to be screened;

(9) The physician's performance of an appropriate examination relevant to the patient's current medical condition;

(10) The physician's diagnosis of the patient's medical condition; and

(11) If the patient has been previously diagnosed with a qualifying medical condition as defined in section 3796.01 of the Revised Code, by a physician licensed to practice medicine under section 4731.14, 4731.11, or 4731.299 of the Revised Code, the physician may confirm the diagnosis so long as the physician obtains a copy of the medical records or a detailed written summary indicating the diagnosis and the physician is satisfied that he or she can rely on those records to confirm diagnosis of a qualifying condition. The practitioner shall maintain a copy of any record or report of any physician on which the physician relied for purposes of meeting the requirements under this paragraph.

(C) If the physician diagnoses or confirms the diagnosis of a qualifying medical condition, as that term is defined in section 3796.01 of the Revised Code, the physician shall document in the medical record compliance with all of the following actions when recommending treatment with medical marijuana:

(1) Development of a treatment plan, including consideration of whether treatment with medical marijuana is complementary to standard medical treatment.

(2) The review of the report concerning the patient obtained from the drug database established and maintained by the board of pharmacy pursuant to section 4729.75 of the Revised Code. The report shall cover at least the twelve months immediately preceding the date of the report.

(3) Discussion with the patient regarding any indicators of possible abuse or diversion of controlled substances that are reflected on the drug database report obtained from the board of pharmacy.

(4) The explanation of the risks and benefits of treatment with medical marijuana as it pertains to the patient's qualifying medical condition and medical history.

(5) The patient's consent prior to completing a recommendation for treatment with medical marijuana. If the patient is a minor, the physician shall obtain the consent of the patient's parent or legal representative prior to completing a recommendation for treatment with medical marijuana for the patient.

(6) Whether the patient needs a caregiver to assist in the use or administration of medical marijuana. If the patient needs a caregiver, the physician shall document the name of the caregiver designated by the patient or the patient's legal representative.

(D) In recommending treatment with medical marijuana, the physician or the physician's delegate shall determine from the medical marijuana patient registry maintained by the division of marijuana control whether the patient has an active registration for medical marijuana.

(1) If the patient is not registered or if the patient's registration will expire within thirty days, the physician or physician's delegate shall submit the patient's application for registration or renewal in compliance with the requirements of section 3796.08 of the Revised Code and the rules of the division of marijuana control adopted under section 3796.03 of the Revised Code.

(2) The recommendation for treatment with medical marijuana shall include a statement from the physician certifying the following:

(a) A bona fide physician-patient relationship exists between the physician and patient;

(b) The patient has been diagnosed with at least one qualifying medical condition;

(c) Description of the qualifying medical condition(s) and indication whether the qualifying condition is a terminal illness for which the patient has a life expectancy of six months or less;

(d) The physician or physician's delegate has requested from the drug database a report of information related to the patient that covers at least the twelve months immediately preceding the date of the report; and

(e) The physician has informed the patient of the risks and benefits of medical marijuana as it pertains to the patient's qualifying medical condition and medical history.

(E) A physician who recommends treatment with medical marijuana shall be available to provide follow-up care and treatment to the patient, including appropriate examinations relevant to the patient's condition to determine the efficacy of medical marijuana in treating the patient's qualifying medical condition. If the qualifying condition was indicated as a terminal illness in the prior six months, the physician shall confirm whether the patient's condition continues to be a terminal illness.

(F) The physician shall terminate or decline to issue a new recommendation for medical marijuana under any of the following circumstances:

(1) The patient no longer has the diagnosis of or symptoms of the qualifying medical condition.

(2) The physician no longer has a valid certificate to recommend medical marijuana.

(3) Based on the physician's clinical judgement, the patient or caregiver is abusing or diverting medical marijuana.

(4) The patient is deceased.

(G) The records required for the recommendation of medical marijuana may be kept with the patient's other medical records and shall be retained for at least three years following the last visit by the patient.

(H) The physician shall submit to the board an annual report describing the physician's observations regarding the effectiveness of medical marijuana in treating patients. The report shall not contain patient-identifying information.

Last updated March 1, 2024 at 8:08 AM

History

Effective: February 29, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-32-04 Suspension and revocation of certificate to recommend.

(A) The board may suspend or revoke a certificate to recommend treatment with medical marijuana or impose one or more of the other disciplinary actions authorized by section 4731.22 of the Revised Code for one or more of the applicable reasons in that section. The action shall be a disciplinary matter and shall be conducted in compliance with section 4731.22 of the Revised Code and the rules in Chapter 4731-13 of the Administrative Code.

(B) When a certificate to recommend treatment with medical marijuana is suspended it may be reinstated pursuant to conditions stated in the board order or consent agreement that imposed the suspension. The conditions for reinstatement may include, but are not limited to the following:

(1) Submission of a written application for reinstatement of the certificate to recommend medical marijuana that meets the requirements of rule 4731-32-02 of the Administrative Code;

(2) Payment of all appropriate fees, civil penalties, and fines as provided in Chapter 4731. of the Revised Code;

(3) Successful completion of specified additional education or training;

(4) Reexamination;

(5) Practice limitations;

(6) Demonstration that the respondent can resume practice in compliance with acceptable and prevailing standards.

Last updated December 6, 2023 at 11:52 AM

History

Effective: September 8, 2017
Promulgated Under: 119.03

Ohio Adm.Code 4731-32-05 Petition to request additional qualifying condition or disease.

(A) A petition to request the approval of a condition or disease to be designated as a qualifying medical condition shall be submitted to the board in the manner required by the board.

(B) No later than October fifteenth of each year, the board shall designate a period during which petitions will be accepted in the next calendar year. Petitions will not be accepted after the expiration of the acceptance period.

(1) The name and contact information for the person submitting the petition.

(2) The specific disease or condition requested to be added as a qualifying condition;

(3) Information from experts who specialize in the study of the disease or condition;

(4) Relevant medical or scientific evidence pertaining to the disease or condition;

(5) Consideration of whether conventional medical therapies are insufficient to treat or alleviate the disease or condition;

(6) Evidence supporting the use of medical marijuana to treat or alleviate the disease or condition, including journal articles, peer-reviewed studies, and other types of medical or scientific documentation;

(7) Letters of support provided by physicians with knowledge of the disease or condition. This may include a letter provided by the physician treating the petitioner, if applicable.

(D) The state medical board shall not consider a petition seeking to add a broad category of diseases or conditions.

(E) In making its decision, the board shall review the petitions and supporting material.

(1) The board may consolidate the review of two or more petitions submitted for the same or similar diseases or conditions.

(2) The board may establish a limit on the number of petitions to be considered in a calendar year.

(3) The board shall consult with one or more experts who specialize in the disease or condition.

(4) The board shall review any relevant medical or scientific evidence pertaining to the disease or condition.

(5) The board shall consider whether conventional medical therapies are insufficient to treat or alleviate the disease or condition.

(6) The board shall review evidence supporting the use of medical marijuana to treat or alleviate the disease or condition.

(7) The board shall review any letters of support provided by physicians with knowledge of the disease or condition, including any letter provided by a physician treating the petitioner, if applicable.

(8) The board shall review any other relevant evidence regarding the disease or condition.

(F) The board will issue a written decision no later than one hundred eighty days after the acceptance period closes unless the board determines that good cause exists to allow an extension. The board shall notify the petitioner of its decision and publish the decision on the medical marijuana control program website.

(G) Any petition for a condition that has been previously reviewed by the board and rejected will not be considered by the board unless new scientific research that supports the request is offered.

Last updated December 6, 2023 at 11:52 AM

History

Effective: September 8, 2017
Promulgated Under: 119.03

Chapter 4731-33 Opioid Treatment

Ohio Adm.Code 4731-33-01 Definitions.

(A) "Office-based opioid treatment" or "OBOT" means pharmacotherapy in a private office or public sector clinic that is not otherwise regulated by practitioners authorized to prescribe outpatient supplies of medications approved by the United States food and drug administration for the treatment of opioid use disorder. OBOT includes treatment with all controlled substance medications approved by the United States food and drug administration for such treatment. OBOT does not include treatment that occurs in the following settings:

(1) A state or local correctional facility, as defined in section 5163.45 of the Revised Code;

(2) A hospital, as defined in section 3727.01 of the Revised Code;

(3) A provider certified to provide residential and inpatient substance use disorder services, including withdrawal management, by the Ohio department of mental health and addiction services;

(4) An opioid treatment program certified by SAMHSA and accredited by an independent SAMHSA-approved accrediting body;

(5) A youth services facility, as defined in section 103.75 of the Revised Code; and

(6) An emergency medical services agency as authorized under Chapter 4729. of the Revised Code.

(B) "SAMHSA" means the United States substance abuse and mental health services administration.

(C) "Addiction specialist physician" means a physician who holds one of the following medical subspecialty certifications:

(1) Subspecialty board certification in addiction medicine by the American board of preventative medicine ("ABPM");

(2) Subspecialty board certification in addiction psychiatry by the American board of psychiatry and neurology ("ABPN");

(3) Subspecialty board certification in addiction medicine by the American osteopathic association ("AOA"); or

(4) Certification by the American board of addiction medicine ("ABAM")

(D) "Medications for Opioid Use Disorder" or "MOUD" refers to all medications approved by the United States food and drug administration for the treatment of opioid use disorder.

(E) "Substance use disorder" indicates a problematic pattern of substance use leading to clinically significant impairment or distress as determined by application of the diagnostic criteria in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Text Revision" or "DSM-5-TR."

(F) "OARRS" means the "Ohio Automated Rx Reporting System" drug database established and maintained pursuant to section 4729.75 of the Revised Code.

(G) For purposes of the rules in this chapter:

(1) "Qualified behavioral healthcare provider" means the following healthcare providers practicing within the scope of the professional license:

(a) Addiction medicine specialist physician, or board-certified psychiatrist, licensed under Chapter 4731. of the Revised Code;

(b) Psychologist, as defined in division (A) of section 4732.01 of the Revised Code, licensed under Chapter 4732. of the Revised Code;

(c) Licensed independent chemical dependency counselor-clinical supervisor, licensed independent chemical dependency counselor, licensed chemical dependency counselor III, licensed chemical dependency counselor II, or licensed chemical dependency counselor assistant licensed under Chapter 4758. of the Revised Code;

(d) Professional clinical counselor, licensed professional counselor, licensed independent social worker, licensed social worker, or marriage and family therapist, licensed under Chapter 4757. of the Revised Code;

(e) Advanced practice registered nurse, licensed as a clinical nurse specialist under Chapter 4723. of the Revised Code, who holds certification as a psychiatric mental health clinical nurse specialist issued by the American nurses credentialing center;

(f) Advanced practice registered nurse, licensed as a nurse practitioner under Chapter 4723. of the Revised Code, who holds certification as a psychiatric mental health nurse practitioner issued by the American nurses credentialing center; and

(g) An advanced practice registered nurse, licensed under Chapter 4723. of the Revised Code, who holds subspecialty certification as a certified addiction registered nurse-advanced practice issued by the addictions nursing certification board.

(2) Nothing in this paragraph shall be construed to prohibit a physician assistant licensed under Chapter 4730. of the Revised Code who practices under a supervision agreement with a board-certified addiction psychiatrist, board certified addiction medicine specialist, or psychiatrist who is licensed as a physician under Chapter 4731. of the Revised Code, from providing services within the normal course of practice and expertise of the supervising physician, including addiction services, other mental health services, and physician delegated prescriptive services in compliance with Ohio and federal laws and rules.

(H) "Community addiction services provider" has the same meaning as in section 5119.01 of the Revised Code.

(I) "Community mental health services provider" has the same meaning as in section 5119.01 of the Revised Code

(J) "Induction phase" means the phase of MOUD during which the patient is started on an FDA-approved medication for substance use disorder treatment.

(K) "Stabilization phase" means the period of time following the induction phase, when medication doses are adjusted to target a reduction in substance use disorder symptoms.

(L) "Maintenance phase" means the ongoing period of time when the patient's medication dose reaches a therapeutic level, allowing the patient to focus on other recovery activities.

(M) "Withdrawal management" is a set of medical interventions aimed at managing the acute physical symptoms of intoxication and withdrawal. Withdrawal management occurs when the patient has a substance use disorder and either evidence of the characteristic withdrawal syndrome produced by withdrawal from that substance or evidence that supports the expectation that such a syndrome would develop without the provision of medical withdrawal management services. Withdrawal management alone does not constitute completed substance use disorder treatment or rehabilitation.

(N) "Ambulatory withdrawal management" means withdrawal management delivered in a medical office, public sector clinic, or urgent care facility by a physician authorized to prescribe outpatient supplies of drugs approved by the United States food and drug administration for the treatment of substance use disorder. Ambulatory withdrawal management is the provision of medically supervised evaluation, treatment, and referral services without extended onsite monitoring. For the purpose of rule 4731-33-02 of the Administrative Code, ambulatory withdrawal management does not include withdrawal management that occurs in the following settings:

(1) A state or local correctional facility, as defined in section 5163.45 of the Revised Code;

(2) In-patient treatment in a hospital, as defined in section 3727.01 of the Revised Code;

(3) A provider certified to provide residential and inpatient substance use disorder services, including withdrawal management, by the Ohio department of mental health and addition services;

(4) An opioid treatment program certified by SAMHSA and accredited by an independent SAMHSA-approved accrediting body;

(5) A youth services facility, as defined in section 103.75 of the Revised Code; and

(6) An emergency medical services agency as authorized under Chapter 4729. of the Revised Code.

Last updated October 31, 2024 at 8:46 AM

History

Effective: October 31, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-33-02 Standards and procedures for withdrawal management for substance use disorder.

(A) A physician who provides withdrawal management, as that term is defined in rule 4731-33-01 of the Administrative Code, shall comply with all federal and state laws and rules applicable to prescribing.

(B) Prior to providing ambulatory withdrawal management for any substance use disorder the physician shall inform the patient that ambulatory withdrawal management alone is not complete treatment for a substance use disorder. If the patient prefers continuing treatment for a substance use disorder, the physician shall comply with the requirements of section 3719.064 of the Revised Code.

(C) The physician shall provide accurate, objective and complete documentation of all patient encounters, including referrals, test results, and significant changes to the treatment plan.

(D) When providing withdrawal management for opioid use disorder the physician may use a medical device that is approved by the United States food and drug administration as an aid in the reduction of opioid withdrawal symptoms.

(E) Ambulatory withdrawal management for opioid use disorder.

(1) The physician shall provide ambulatory withdrawal management only when the following conditions are met:

(a) The patient has adequate social, medical, and psychiatric stability to engage in and safely complete ambulatory withdrawal management; and

(b) There is little risk of medication diversion.

(2) The physician shall provide ambulatory withdrawal management under a defined set of policies and procedures or medical protocols, with patient placement in outpatient or residential settings consistent with American society of addiction medicine's level of care criteria. Such services are designed to treat the patient's level of clinical severity, to achieve safe and comfortable withdrawal from a drug, and to effectively facilitate the patient's transition into treatment and recovery. In the event that ambulatory withdrawal management is unsafe or inappropriate for a patient, referral to a higher level of care, such as inpatient hospitalization shall be completed. The ASAM criteria can be obtained from the website of the American society of addiction medicine at https://www.asam.org/. A copy of the ASAM criteria may be reviewed at the medical board office, 30 East Broad street, third floor, Columbus, Ohio, during normal business hours.

(3) Prior to providing ambulatory withdrawal management, the physician shall perform an assessment of the patient to gather sufficient information and data to justify the use of this treatment intervention. The assessment shall include a thorough medical history and physical examination sufficient to assure safety in commencing ambulatory withdrawal management and shall include a review of the patient's prescription history in OARRS. The assessment must focus on signs and symptoms associated with opioid use disorder and include assessment with a nationally recognized scale, such as one of the following:

(a) "Objective Opioid Withdrawal Scale" (OOWS);

(b) "Clinical Opioid Withdrawal Scale" (COWS); or

(4) If any part of the assessment cannot be completed prior to the initiation of treatment, the physician shall complete as soon as possible following initiation of treatment.

(5) The physician shall inform the patient about the following before treatment for opioid withdrawal is initiated:

(a) The withdrawal management process and importance of subsequent treatment for substance use disorder, including information about all medications approved by the United States food and drug administration for use in MOUD treatment;

(b) The risk of relapse and lethal overdose following completion of withdrawal without entry into continuation of MOUD treatment;

(6) The physician shall not establish standardized regimens of medications for management of substance withdrawal symptomatology but shall formulate an individualized treatment plan based on the needs of the specific patient.

(7) For persons projected to be involved in withdrawal management for six months or less, the physician shall offer the patient counseling as described in paragraph (D) of rule 4731-33-03 of the Administrative Code.

(8) The physician shall require the patient to undergo urine and/or other toxicological screenings during withdrawal management in order to assess for use of licit and/or illicit drugs. The physician shall consider revising the treatment plan or referring a patient who has a positive toxicological screening result to a higher level of care.

(9) The physician shall comply with the following requirements for the use of medication:

(a) The physician may treat the patient's withdrawal symptoms with any of the following medications as determined to be most appropriate for the patient.

(i) A medication that is specifically FDA approved for the alleviation of withdrawal symptoms. Methadone may only be utilized with strict adherence to the stipulations of 21 C.F.R. 1306.07(b).

(ii) An alpha-2 adrenergic agent along with other non-narcotic medications as recommended in the American society of addiction medicine's "National Practice Guideline" (https://www.asam.org/), which is available on the medical board's website at: https://www.med.ohio.gov;

(iii) A combination of buprenorphine and low dose naloxone (buprenorphine/naloxone combination product), unless contraindicated, in which case buprenorphine mono-product may be utilized.

(b) The physician shall not use anesthetic agents to treat the patient's withdrawal symptoms.

(i) Treatment with a buprenorphine product must be in compliance with the United States food and drug administration approved "Risk Evaluation and Mitigation Strategy" for buprenorphine products, which can be found on the United States food and drug administration website at the following address: https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm.

(ii) The physician shall determine on an individualized basis the appropriate dosage of medication to ensure stabilization during withdrawal management.

(a) The dosage level shall be that which is effective in suppressing withdrawal symptoms and is well tolerated by the patient.

(b) The dosage level shall be consistent with the currently accepted standards of care.

(iii) In withdrawal management programs of thirty days or less duration, the physician shall not prescribe nor dispense more than one week of unsupervised or take-home medications for the patient.

(10) The physician shall offer the patient a prescription for an overdose reversal drug, directly provide them with the overdose reversal drug, or direct the patient to an easily accessible source to obtain the overdose reversal drug, such as http://www.naloxone.ohio.gov, a local health department, or other agency or facility that provides overdose reversal drugs.

(a) The physician shall ensure that the patient and, if possible, those residing with the patient receive instruction on the drug's use including, but not limited to, recognizing the signs and symptoms of opioid overdose and calling 911 in an overdose situation.

(b) The physician shall offer the patient a new prescription for an overdose reversal drug upon expiration or use.

(c) The physician shall be exempt from this requirement if the patient refuses the prescription. If the patient refuses the prescription the physician shall provide the patient with information on where to obtain the overdose reversal drug without a prescription.

(11) The physician shall take steps to reduce the risk of medication diversion by doing one or more of the following: frequent office visits, pill counts, urine drug screening, and frequent checks of OARRS.

(F) The physician who provides ambulatory withdrawal management for benzodiazepines or other sedatives shall comply with paragraphs (A), (B), and (C) of this rule and "TIP 45, A Treatment Improvement Protocol for Detoxification and Substance Abuse Treatment" by the substance abuse and mental health services administration available from the substance abuse and mental health services administration website at the following link: https://store.samhsa.gov/ (search for "TIP 45") and available on the medical board's website at: https://med.ohio.gov.

(1) The physician shall provide ambulatory withdrawal management for benzodiazepines with medication only when a patient has sufficient social, medical, and psychiatric stability when their use of benzodiazepines was primarily in therapeutic dose ranges and when they do not have polysubstance dependence. The patient should exhibit no more than mild to moderate withdrawal symptoms, have no comorbid medical condition or severe psychiatric disorder, and no history of withdrawal seizures or withdrawal delirium.

(2) Prior to providing ambulatory withdrawal management, the physician shall perform an assessment of the patient that focuses on signs and symptoms associated with benzodiazepine or other sedative use disorder and include assessment with a nationally recognized scale, such as the "Clinical Institute Withdrawal Assessment for Benzodiazepines" ("CIWA-B").

(3) Prior to providing ambulatory withdrawal management, the physician shall conduct a biomedical and psychosocial evaluation of the patient to gather sufficient information and data to justify the use of this treatment intervention.

(4) The physician shall instruct the patient about the following before treatment for benzodiazepine withdrawal management is initiated:

(a) Not to drive or operate dangerous machinery during treatment;

(b) The withdrawal management process and importance of subsequent treatment for substance use disorder, including information about all medications approved by the United States food and drug administration for use in substance use disorder treatment;

(c) The risk of relapse and lethal overdose following completion of withdrawal without entry into continuation of treatment for substance use disorder; and

(d) The safe storage and disposal of prescribed medications.

(5) During the ambulatory withdrawal management, the physician shall regularly assess the patient so that medication dosage can be adjusted if needed.

(a) The physician shall require the patient to undergo urine and/or other toxicological screenings during withdrawal management in order to assess for the use of licit and/or illicit drugs.

(b) The physician shall consider revising the treatment plan or referring the patient who has a positive toxicology screening to a higher level of care.

(c) The physician shall take steps to reduce the risk of diversion by doing one or more of the following: frequent office visits, pill counts, urine drug screening and frequent checks of OARRS.

(G) The physician who provides ambulatory withdrawal management for withdrawal from alcohol shall comply with paragraphs (A), (B), and (C) of this rule and "Clinical Practice Guideline on Alcohol Withdrawal Management" by the American society of addiction medicine available from the American society of addiction medicine website at the following link: https://www.asam.org/quality-care/clinical -guidelines/alcohol- withdrawal-management-guideline.

(1) The physician shall provide ambulatory withdrawal from alcohol only when:

(a) The patient has sufficient social, medical, and psychiatric stability to adhere to prescribed treatments and successfully complete withdrawal with minimal risk of complications;

(b) The patient is not at risk for serious withdrawal from substances other than alcohol; and

(2) Prior to providing ambulatory withdrawal management, the physician shall perform an assessment of the patient. The assessment must focus on signs and symptoms associated with alcohol use disorder and include assessment with a nationally recognized scale, such as the "Clinical Institute Withdrawal Assessment for Alcohol-revised" ("CIWA-AR").

(3) Prior to providing ambulatory withdrawal management, the physician shall perform a biomedical and psychosocial evaluation to gather sufficient information and data to justify the use of this treatment intervention.

(4) During the ambulatory withdrawal management, the physician shall regularly assess the patient so that the dosage can be adjusted if needed.

(a) The physician shall require the patient to undergo toxicological screenings in order to assess for the presence of alcohol metabolites, licit or illicit drugs;

(b) The physician shall consider revising the treatment plan or referring a patient who has a positive toxicological screening test to a higher level of care; and

(c) The physician shall take steps to reduce the risk of diversion by doing one or more of the following: frequent office visits, pill counts, urine drug screening and frequent checks of OARRS.

Last updated October 31, 2024 at 8:46 AM

History

Effective: October 31, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-33-03 Office-based opioid treatment.

(A) A physician who provides office-based opioid treatment ("OBOT") shall comply with the following requirements:

(1) Before initiating OBOT, the physician shall comply with section 3719.064 of the Revised Code;

(2) Comply with all federal and state laws and regulations governing the prescribing of the medication;

(3) Complete at least eight hours of "Category 1" continuing medical education relating to substance use disorder and addiction every two years. Courses completed in compliance with this requirement shall be accepted toward meeting the physician's "Category 1" continuing medical education requirement for biennial renewal of the physician's license;

(4) The physician who provides OBOT shall perform an assessment of the patient to gather sufficient information and data to justify the use of this treatment intervention. The assessment shall include a thorough medical history, examination and laboratory testing. If any part of the assessment cannot be completed prior to the initiation of OBOT, the physician shall complete as soon as possible following initiation of treatment; and

(5) The physician shall provide accurate, objective and complete documentation of all patient encounters, including referrals, test results, and significant changes to the treatment plan.

(B) The physician who provides OBOT shall establish a treatment plan that includes the following:

(1) The physician's rationale for selection of the specific drug to be used in the treatment based upon discussion of all MOUDs and non-medication options with the patient;

(2) Patient education;

(3) Random urine-drug screens;

(4) A signed treatment agreement that outlines the responsibilities of the patient and the physician, and documents the patient's consent for treatment;

(5) Documentation regarding psychosocial interventions, pursuant to paragraph (D) of this rule; and

(6) The treatment plan shall be revised if the patient does not show improvement with the original plan.

(C) The physician shall provide OBOT in accordance with an acceptable treatment protocol for assessment, induction, stabilization, maintenance, and tapering. Acceptable protocols are any of the following:

(1) TIP 63 "Medications for Opioid Use Disorder" (2021) available from the https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use- Disorder-Full-Document/PEP21-02-01-002.

(2) "ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update" available from the website of the American society of addiction medicine at https://www.asam.org/quality-care/clinical-guidelines /national-practice-guideline.

(D) The physician shall do the following with respect to psychosocial treatment for patients receiving OBOT:

(1) Assess for psychosocial treatment needs in addition to medication;

(2) Offer psychosocial interventions or referrals for psychosocial interventions to all patients, but OBOT should not be declined or discontinued if the patient is unable or unwilling to engage in psychosocial interventions;

(3) Ensure that psychosocial interventions are person-centered and tailored to the patient's insight, motivation, and stage of recovery;

(4) Focus the psychosocial interventions on retaining the patient in treatment, stabilizing the patient and assisting with progress in the patient's treatment and recovery;

(5) If the psychosocial interventions are not available or if the patient declines to participate, the physician shall continue to treat the patient with OBOT provided that the patient adheres to all other treatment requirements;

(6) Psychosocial treatment or intervention includes the following:

(a) Cognitive behavioral treatment;

(b) Community reinforcement approach;

(d) Motivational interviewing;

(e) Behavioral couples counseling;

(f) Twelve-step facilitation; and

(g) Other therapies based on the patient's individual needs;

(7) When necessary, the physician may make referrals for psychosocial treatment to qualified behavioral healthcare providers, community addiction services or community mental health services providers as defined in rule 4731-33-01 of the Administrative Code; and

(8) The physician may also refer patients for treatment with non-licensed paraprofessionals such as case managers and peer support specialists if the physician determines such intervention would benefit the patient.

(E) The physician who provides OBOT shall offer the patient a prescription for an overdose reversal drug, directly provide the patient with the overdose reversal drug, or direct the patient to an easily accessible source to obtain overdose reversal drugs, such as http://www.naloxone.ohio.gov, a local health department, or other agency or facility that provides overdose reversal drugs.

(1) The physician shall ensure that the patient and, if possible, those residing with the patient, receive instruction on the overdose reversal drug's use including, but not limited to, recognizing the signs and symptoms of opioid overdose and calling 911 in an overdose situation.

(2) The physician shall offer the patient a new prescription for an overdose reversal drug upon expiration or use.

(3) The physician shall be exempt from this requirement if the patient refuses the prescription. If the patient refuses the prescription the physician shall provide the patient with information on where to obtain overdose reversal drugs without a prescription.

(F) In addition to paragraphs (A) to (E) of this rule, the physician who provides OBOT using buprenorphine products shall comply with the following requirements:

(1) Treatment with a buprenorphine product must be in compliance with the United States food and drug administration approved "Risk Evaluation and Mitigation Strategy" for buprenorphine products, which can be found on the United States food and drug administration website at the following address: https://www.accessdata.fda.gov/scripts/cder/rems/index.cfm. With the exception of those conditions listed in paragraph (G)(2) of this rule, a physician who treats the opioid use disorder with a buprenorphine product shall only prescribe buprenorphine/naloxone combination products for use in OBOT.

(2) The physician may prescribe buprenorphine without naloxone (buprenorphine mono-product) only in the following situation:

(a) When a patient is pregnant or breast-feeding;

(b) When converting a patient from buprenorphine mono-product to buprenorphine/naloxone combination product;

(c) In formulations other than tablet or film form for indications approved by the United States food and drug administration; or

(d) When the patient has a genuine allergy to or intolerance of a buprenorphine/naloxone combination product.

(3) Due to a higher risk of fatal overdose when buprenorphine is prescribed with other opioids, benzodiazepines, sedative hypnotics, carisoprodol, gabapentin, or tramadol, the physician shall only co-prescribe these substances when it is medically necessary.

(a) The physician shall verify the diagnosis for which the patient is receiving the other drug and coordinate care with the prescriber for the other drug, including whether acceptable alternative treatments are available and whether it is possible to lower the dose or discontinue the drug. If the physician prescribing buprenorphine is the prescriber of the other drug, the physician shall also consider these options and consider consultation with another healthcare provider. The physician shall educate the patient about the serious risks of the combined use.

(b) The physician shall document the rationale for discontinuing, lowering, or continuing the medication given potential risks and benefits.

(4) During the induction phase the physician shall not prescribe a dosage that exceeds the recommendation in the United States food and drug administration approved labeling, except for medically indicated circumstances as documented in the patient record. The physician shall see the patient at least once a week during this phase.

(5) During the maintenance phase, the physician shall prescribe a dosage of buprenorphine that avoids intoxication or sedation, prevents withdrawal, and suppresses significant drug craving. For the first twelve months of treatment, the physician shall prescribe no more than a one-month supply of the buprenorphine product unless utilizing a formulation with duration of action exceeding one month, such as injections or implants.

(6) The physician shall reduce the risk of buprenorphine diversion by using the lowest effective dose, and by using one or more of the following: scheduling appropriate frequency of office visits, conducting random pill counts, checking OARRS and utilizing drug testing, serum medication levels, and oral fluid testing to assess for patient adherence to prescribed buprenorphine treatment.

(7) When using any sublingual formulation of buprenorphine, the physician shall not prescribe a dosage exceeding twenty-four milligrams of buprenorphine per day, unless the prescriber is an addiction specialist physician, or a consultation has been obtained from such a specialist recommending the higher dose. Dosage shall not exceed thirty-two milligrams of buprenorphine per day.

(8) The physician shall incorporate relapse prevention strategies into counseling or assure that they are addressed by a qualified behavioral healthcare provider, as defined in rule 4731-33-01 of the Administrative Code, who has the education and experience to provide substance use disorder counseling.

(9) The physician may treat a patient using the administration of an extended-release, injectable, or implanted buprenorphine product.

(a) The physician shall strictly comply with any required risk evaluation and mitigation strategy program for the drug.

(b) The physician shall prescribe an extended-release buprenorphine product strictly in accordance with the United States food and drug administration's approved labeling for the drug's use.

(c) The physician shall document in the patient record the rationale for the use of the extended-release buprenorphine product.

(d) The physician who orders or prescribes an extended-release, injectable, or implanted buprenorphine product shall require it to be administered by an Ohio licensed health care professional acting in accordance within the scope of their professional license.

Last updated October 31, 2024 at 8:46 AM

History

Effective: October 31, 2024
Promulgated Under: 119.03

Ohio Adm.Code 4731-33-04 Medication-assisted treatment using naltrexone.

(A) In addition to the requirements of paragraphs (A) to (E) of rule 4731-33-03 of the Administrative Code, the physician using naltrexone to treat opioid use disorder shall comply with the following requirements:

(1) Before initiating naltrexone, the physician shall take measures to ensure that the patient is opioid abstinent for an adequate period of time after completing opioid withdrawal to avoid precipitated withdrawal. The physician shall alert the patient of the risk of potentially lethal opioid overdose if they stop naltrexone and use opioids.

(2) The physician shall use oral naltrexone only for treatment of patients who are highly motivated.

(a) The dosage regime shall strictly comply with the food and drug administration approved labeling for naltrexone hydrochloride tablets.

(b) The patient shall be encouraged to have a support person administer and supervise the medication. Examples of a support person are a family member, close friend, or employer.

(c) The physician shall require urine drug screens, serum medication levels, or oral fluid drug testing at least every three months for the first year of treatment and at least every six months thereafter.

(d) The physician shall incorporate relapse prevention strategies into counseling or assure that they are addressed by a qualified behavioral healthcare provider, as defined in rule 4731-33-01 of the Administrative Code, who has the education and experience to provide substance use disorder counseling.

(B) The physician may treat a patient with extended-release naltrexone for opioid or alcohol dependence or for co-occurring opioid and alcohol use disorders.

(1) The physician should consider treatment with extended-release naltrexone for patients who have difficulties with treatment adherence.

(2) The dosage shall strictly comply with the United States food and drug administration approved labeling for extended-release naltrexone.

(3) The physician shall determine the effectiveness of treatment with extended-release naltrexone by utilizing drug testing, serum medication levels, and oral fluid testing throughout the course of treatment.

(4) The physician shall incorporate relapse prevention strategies into counseling or assure that they are addressed by a qualified behavioral healthcare provider, as defined in rule 4731-33-01 of the Administrative Code, who has the education and experience to provide substance use disorder counseling.

Last updated October 31, 2024 at 8:46 AM

History

Effective: October 31, 2024
Promulgated Under: 119.03

Chapter 4731-34 Standards for Prescribing Dangerous Drugs for Administration by Injection by a Pharmacist

Ohio Adm.Code 4731-34-01 Standards and procedures to be following by physicians when prescribing a dangerous drug that may be administered by a pharmacist by injection.

(A) As used in this rule,

(1) "Physician" means an individual authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(2) "Pharmacist" means an individual licensed under Chapter 4729. of the Revised Code who has met the requirements in section 4729.45 of the Revised Code and rule 4729:1-3-03 of the Administrative Code to administer drugs by injection.

(3) "Pharmacy," except when used in a context that refers to the practice of pharmacy, means any area, room, rooms, place of business, department, or portion of any of the foregoing where the practice of pharmacy is conducted.

(B) Subject to paragraph (C) of this rule, a physician may prescribe any of the following dangerous drugs to be administered by injection by a pharmacist to a patient with whom the physician has an ongoing physician-patient relationship:

(1) An opioid antagonist used for treatment of drug addiction and administered in a long-acting or extended-release form. An opioid antagonist may also be administered for the treatment of alcohol dependence in accordance with approved labeling by the United States food and drug administration.

(2) An antipsychotic drug administered in a long-acting or extended-release form.

(3) Hydroxyprogesterone caproate for pregnant women.

(4) Medroxyprogesterone acetate for non-pregnant women.

(5) Cobalamin, to include: cyanocobalamin, hydroxocobalamin or any other vitamin B12 injection approved by the United States food and drug administration.

(6) Any other dangerous drugs authorized for pharmacist administration pursuant to section 4729.45 of the Revised Code.

(C) If a physician chooses to prescribe the dangerous drugs in paragraph (B) of this rule to be administered by injection by a pharmacist, the physician shall comply with all the following:

(1) Maintain an ongoing physician-patient relationship with the patient to whom the drug is being prescribed.

(2) The physician's scope of practice must include treatment of the condition for which the patient has been prescribed the drug.

(3) The physician's prescription must specify the pharmacy where the drug is to be administered.

(4) The physician may only prescribe a drug to be at administered at a pharmacy where the physician has either:

(a) Written and established a current protocol on file at that pharmacy that meets the requirements in paragraph (E) of this rule and that is appropriate for the patient; or

(b) Obtained and personally reviewed a current physician-established protocol on file at that pharmacy that meets the requirements in paragraph (E) of this rule, and agrees that this protocol is appropriate for the patient.

(5) The physician shall inform the patient that the drug that the physician is prescribing will be administered at a pharmacy that meets the requirements in paragraph (C)(4) of this rule, and obtain patient's consent to have the drug administered at that pharmacy. The patient's consent shall be documented in the medical record. The physician may not prescribe in the manner described in this rule without the patient's consent to both the manner and location of the administration of the prescription.

(6) If a physician chooses to prescribe an opioid antagonist used for treatment of drug addiction and administered in a long-acting or extended-release form to be administered by injection by a pharmacist, the physician shall also comply with all other applicable rules in Chapter 4731. of the Administrative Code for prescribing this type of drug.

(D) A physician may terminate a prescription, which may include refills, with a pharmacy under this rule at any time for any of the following reasons:

(1) The patient or pharmacy is not following the physician-established protocol with the pharmacy;

(2) Failure of the pharmacist that administers the injection at the pharmacy to timely notify the physician within seven days of administration of the injection;

(3) Failure of the pharmacist that administers the injection at the pharmacy to report an adverse event to the physician that occurred during the administration of the injection;

(4) In the case of an opioid antagonist, test results of the patient indicate that it is not appropriate to administer the drug;

(5) Discontinuation of the patient-physician relationship; or

(6) Any other medically appropriate reason.

(E) A physician-established protocol for the administration of the dangerous drugs by injection by a pharmacist must comply with the following:

(1) All requirements listed in section 4729.45 of the Revised Code and paragraph (F) of rule 4729:1-3-03 of the Administrative Code.

(2) The protocol shall be signed and dated by the physician prior to implementation and shall be readily available to the administering pharmacist.

(3) A physician may sign one protocol for multiple locations licensed as terminal distributors of dangerous drugs.

(4) The protocol must be established by a physician who has a scope of practice that includes treatment of the conditions for which drugs administered under the protocol are intended to treat.

(F) The physician-established protocol shall be reviewed and may be renewed by the physician on a biennial basis.

(G) A violation of this rule, as determined by the Board, shall constitute for a physician "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

Last updated February 11, 2025 at 9:08 AM

History

Effective: July 31, 2019
Promulgated Under: 119.03

Chapter 4731-35 Consult Agreements Between Physicians and Pharmacists

Ohio Adm.Code 4731-35-01 Consult agreements.

(A) For purposes of this chapter, practitioner includes the following:

(1) Physician authorized to practice medicine and surgery or osteopathic medicine and surgery under Chapter 4731. of the Revised Code.

(2) Physician assistant who is licensed to practice as a physician assistant under Chapter 4730. of the Revised Code, holds a valid prescriber number issued by the state medical board, and has been granted physician-delegated prescriptive authority.

(B) Requirements of a consult agreement.

(1) A consult agreement shall include all of the following:

(a) Identification of the practitioner(s) and pharmacist(s) authorized to enter into the agreement. They may include:

(i) Individual names of practitioners and pharmacists;

(ii) Practitioner or pharmacist practice groups; or

(iii) Identification based on institutional credentialing or privileging.

(iv) If multiple practitioners are entering the consult agreement, identification of the primary practitioner for the patient.

(b) A description of the patient's consent to drug therapy management pursuant to the consult agreement as set forth in paragraph (E) of rule 4729:1-06-01 of the Administrative Code.

(c) The specific diagnoses and diseases being managed under the agreement, including whether each disease is primary or comorbid.

(d) A description of the drugs or drug categories managed as part of the agreement.

(e) A description of the procedures, decision criteria, and plan the managing pharmacist is to follow in acting under a consult agreement. Such a description should provide a reasonable set of parameters of the activities a managing pharmacist is allowed to perform under a consult agreement.

(f) A description of the types of tests permitted pursuant to section 4729.39 of the Revised Code that may be ordered and evaluated by the managing pharmacist as long as the tests relate directly to the management of drug therapy. This may include specific tests or categories of testing that may be ordered and evaluated.

(g) A description of how the managing pharmacist shall maintain a record of each action taken for each patient whose drug therapy is managed under the agreement. All prescribing, administering, and dispensing of drugs shall be documented using positive identification pursuant to agency 4729 of the Administrative Code.

(h) A description of how communication between a managing pharmacist and practitioner acting under a consult agreement shall take place at regular intervals specified by the practitioner who authorized the agreement. The agreement may include a requirement that the managing pharmacist send a consult report to each consulting practitioner.

(i) A provision that allows a practitioner to override a decision made by the managing pharmacist when appropriate.

(j) An appropriate quality assurance mechanism to ensure that managing pharmacists only act within the scope authorized by the consult agreement.

(k) A description of a continuous quality improvement (CQI) program used to evaluate effectiveness of patient care and ensure positive patient outcomes. The CQI program shall be implemented pursuant to the agreement.

(l) The training and experience criteria for managing pharmacists. The criteria may include privileging or credentialing, board certification, continuing education or any other training requirements. The agreement shall include a process to verify that the managing pharmacists meet the specified criteria.

(m) A statement that the practitioners and pharmacists shall meet minimal and prevailing standards of care at all times.

(n) An effective date and expiration date.

(o) Any other requirements contained in rules 4729:1-6-01, 4729:1-6-02 and 4729:1-6-03 of the Administrative Code.

(2) Institutional or ambulatory outpatient facilities may implement a consult agreement and meet the requirements of paragraphs (A)(1)(c) to (A)(1)(f) of this rule through institutional credentialing standards or policies. Such standards or policies shall be referenced as part of the consult agreement and available to an agent of the board upon request.

(3) The agreement shall be signed by the primary practitioner, which may include a medical director or designee if the designee is licensed pursuant to Chapter 4731. of the Revised Code, and one of the following:

(a) The terminal distributor's responsible person, which may include the responsible person's designee if the designee meets the qualifications of the responsible person pursuant to Chapter 4729. of the Revised Code; or

(b) A managing pharmacist licensed pursuant to Chapter 4729. of the Revised Code.

(4) All amendments to a consult agreement shall be signed and dated by the primary practitioner, which may include a medical director or designee if the designee is licensed pursuant to Chapter 4731. of the Revised Code, and one of the following:

(b) A managing pharmacist licensed pursuant to Chapter 4729. of the Revised Code.

(c) Amendments to the consult agreement are required when the scope of the managing pharmacist's permitted procedures expands past what was contemplated withing the agreement

(5) A consult agreement shall be valid for a period not to exceed two years.

(6) Only the following Ohio licensed practitioners practicing in Ohio and Ohio licensed pharmacists may participate in a consult agreement pursuant to section 4729.39 of the Revised Code.

(a) Physicians

(b) Physician assistants if entering into a consult agreement is authorized by one or more supervising physicians under a supervision agreement under section 4730.19 of the Revised Code; and

(c) Clinical nurse specialists, certified nurse-midwives, or certified nurse practitioners, if entering into a consult agreement is authorized by one or more collaborating physician.

(C) Recordkeeping. The primary practitioner, practitioner group or institution as defined in agency 4729 of the Administrative Code shall maintain a copy of the original consult agreement, and all amendments made thereafter, and a record of actions made in consultation with the managing pharmacist regarding each patient's drug therapy. These records shall be maintained in such a manner that they are readily retrievable for at least three years from the date of the last action taken under the agreement. Such consult agreements shall be considered confidential patient records.

(D) Managing drug therapy.

(1) For the purpose of implementing the management of a patient's drug therapy by an authorized managing pharmacist acting pursuant to a consult agreement, the primary practitioner must:

(a) Provide the managing pharmacist with access to the patient's medical record; and

(b) Establish the managing pharmacist's prescriptive authority as one or both of the following:

(i) A prescriber authorized to issue a drug order in writing, orally, by a manually signed drug order sent via facsimile or by an electronic prescribing system for drugs or combinations or mixtures of drugs to be used by a particular patient as authorized by the consult agreement. For all prescriptions issued by a pharmacist pursuant to this paragraph, the pharmacist shall comply with Chapter 4729:5-5 of the Administrative Code for outpatient and Chapter 4729:5-9 of the Administrative Code for inpatient; and or

(ii) With respect to non-controlled dangerous drugs only, an agent of the consulting practitioner(s). As an agent of the consulting practitioner(s), a pharmacist is authorized to issue a drug order, on behalf of the consulting practitioner(s), in writing, orally, by a manually signed drug order sent via facsimile or by an electronic prescribing system for drugs or combinations or mixtures of drugs to be used by a particular patient as authorized by the consult agreement, and

(i) Change the duration of treatment for the current drug therapy; adjust a drug's strength, dose, dosage form, frequency of administration, route of administration, discontinue a drug, or to prescribe new drugs; and or

(ii) Order tests related to the drug therapy being managed and to evaluate those results, and

(d) Identify the extent to which, and to whom, the managing pharmacist may delegate drug therapy management to other authorized pharmacists under the agreement.

(E) Review of consult agreements. Upon the request of the state medical board, the primary practitioner shall immediately provide a copy of the consult agreement, amendments, and any relating policies or documentation pursuant to this rule and section 4729.39 of the Revised Code. The state medical board may prohibit the execution of a consult agreement, or subsequently void a consult agreement, if the board finds any of the following:

(1) The agreement does not meet the requirements set forth in section 4729.39 of the Revised Code or this division of the administrative code; or

(2) The consult agreement, if executed, would present a danger to patient safety.

Last updated November 19, 2025 at 11:20 AM

History

Effective: December 31, 2021
Promulgated Under: 119.03

Ohio Adm.Code 4731-35-02 Standards for managing drug therapy.

(A) A practitioner may elect to manage the drug therapy of an established patient by entering into a consult agreement with a pharmacist. The agreement is subject, but not limited to, the following standards:

(1) The primary practitioner must ensure that the managing pharmacist has access to the patient's medical record, the medical record is accurate, and that while transferring the medical record, the primary practitioner ensures the confidentiality of the medical record.

(2) The practitioner must have an ongoing practitioner-patient relationship with the patient whose drug therapy is being managed, including an initial assessment and diagnosis by the practitioner prior to the commencement of the consult agreement.

(3) With the exception of inpatient management of patient care at an institutional facility as defined in agency 4729 of the Administrative Code, the practitioner, prior to a pharmacist managing the patient's drug therapy, shall communicate the content of the proposed consult agreement to each patient whose drug therapy is managed under the agreement, in such a manner that the patient or the patient's representative understands scope and role of the managing pharmacist, which includes the following:

(a) That a pharmacist may be utilized in the management of the patient's care;

(b) That the patient or an individual authorized to act on behalf of a patient has the right to elect to participate in and to withdraw from the consult agreement.

(4) The diagnosis by the practitioner must be within the practitioner's scope of practice.

(5) The practitioner shall meet the minimal and prevailing standards of care.

(6) The practitioner must ensure that the pharmacist managing the patient's drug therapy has the requisite training, and experience related to the particular diagnosis for which the drug therapy is prescribed. Practitioners practicing at institutional or ambulatory outpatient facilities may meet this requirement through institutional credentialing standards or policies.

(7) The practitioner shall review the records of all services provided to the patient under the consult agreement.

(B) Quality assurance mechanisms. The following quality assurance mechanisms shall be implemented to verify information contained within the consult agreement, and ensure the managing pharmacist's actions are authorized and meet the standards listed in paragraphs (A) and (B) of this rule:

(1) Verification of ongoing practitioner-patient relationship. A practitioner-patient relationship can be established by detailing criteria set forth in paragraph (A)(2) of this rule, within the consult agreement.

(2) Verification that practitioner diagnosis is within the practitioner's scope of practice. Establishing that a diagnosis is within the practitioner's scope of practice may be established by detailing the criteria set forth in paragraph (A)(4) of this rule, within the consult agreement.

(3) Verification that pharmacist's training and experience is related to the drug therapy. Establishing that a pharmacist's requisite training and experience with a particular drug therapy is related to the diagnosis for which the drug therapy is prescribed, may be established by detailing the criteria set forth in paragraph (A)(6) of this rule, within the consult agreement.

(C) Continuous quality improvement program. The following should be included in the development of a continuous quality improvement program in order to evaluate the effectiveness of patient care and ensure positive patient outcomes:

(1) Notifications to primary practitioner. The managing pharmacist must notify the primary practitioner of the following situations regarding any pharmacist authorized to manage drug therapy under the agreement:

(a) A pharmacist has had their pharmacist license revoked, suspended, or denied by the state board of pharmacy;

(b) If prescribing controlled substances, a pharmacist has failed to renew their controlled substance prescriber registration;

(D) Overriding decisions of managing pharmacist. Any authorized practitioner identified under the consult agreement may override any decision, change, modification, evaluation or other action by any pharmacist acting pursuant to consult agreement or under the direction of the managing pharmacist, that was made with respect to the management of the patient's drug therapy under the consult agreement.

Last updated November 19, 2025 at 11:20 AM

History

Effective: December 31, 2021
Promulgated Under: 119.03

Chapter 4731-36 Military Provisions Related to Education and Experience Requirements for Licensure Applicable to Service Members, Veterans, and Spouses of Service Members and Veterans

Ohio Adm.Code 4731-36-01 Military provisions related to education and experience requirements for licensure.

(A) Definitions

For purposes of this chapter:

(1) "Armed forces" means any of the following:

(a) The armed forces of the United States, including the army, navy, air force, marine corps, and coast guard;

(b) A reserve component of the armed forces listed in paragraph (A)(1)(a) of this rule;

(d) The commissioned corps of the United States public health service;

(e) The merchant marine service during wartime;

(f) Such other service as may be designated by Congress; or

(g) The Ohio organized militia when engaged in full-time national guard duty for a period of more than thirty days.

(2) "Board" means the state medical board of Ohio.

(3) "Service member" means any person who is serving in the armed forces.

(4) "Veteran" means any person who has completed service in the armed forces, including the national guard of any state, or a reserve component of the armed forces, who has been discharged under honorable conditions from the armed forces or who has been transferred to the reserve with evidence of satisfactory service.

(B) Education and service for eligibility for licensure.

(1) In accordance with section 5903.03 of the Revised Code, the following military programs of training, military primary specialties, and lengths of service are substantially equivalent to or exceed the educational and experience requirements for licensure as a physician assistant and for a prescriber number:

(a) An individual serving in a military primary specialty listed in paragraph (B)(1)(b) of this rule must be a graduate of a physician assistant education program approved by the accreditation review commission on education for the physician assistant;

(b) Service in one of the following military primary specialties for at least two consecutive years while on active duty, with evidence of service under honorable conditions, including any experience attained while practicing as a physician assistant at a health care facility or clinic operated by the United States department of veterans affairs, may be substituted for a master's degree for eligibility for a license to practice as a physician assistant pursuant to section 4730.11 of the Revised Code and for a prescriber number pursuant to section 4730.15 of the Revised Code:

(i) Army: MOS 65D;

(ii) Navy: NOBC 0113;

(iii) Air force: AFSC 42G;

(iv) The national guard of Ohio or any state;

(v) Marine: Physician assistant services are provided by navy personnel;

(vi) Coast guard;

(vii) Public health service.

(2) For purposes of section 5903.03 of the Revised Code, the board has determined that there are no military programs of training, military primary specialties, or lengths of service that are substantially equivalent to or that exceed the educational and experience requirements for licensure as a massage therapist.

(3) For purposes of section 5903.03 of the Revised Code, the board has determined that:

(a) A diploma from a military medical school or military osteopathic medical school that at the time the diploma was issued was a medical school accredited by the liaison committee on medical education or an osteopathic medical school accredited by the American osteopathic association are substantially equivalent to the medical educational requirement for licensure to practice medicine and surgery or osteopathic medicine and surgery;

(b) Military graduate medical education that is accredited by the accreditation council for graduate medical education is substantially equivalent to the graduate medical educational requirement for licensure to practice medicine and surgery or osteopathic medicine and surgery; and

(c) There are no military primary specialties or lengths of service that are substantially equivalent to or that exceed the educational and experience requirements for licensure to practice medicine and surgery or osteopathic medicine and surgery.

(4) For purposes of section 5903.03 of the Revised Code, the board has determined that:

(a) A degree from a military college of podiatric medicine and surgery that at the time the degree was granted was a college of podiatric medicine and surgery accredited by the council on podiatric medical education is substantially equivalent to the medical educational requirement for licensure to practice podiatric medicine and surgery;

(b) Military postgraduate training in a podiatric internship, residency, or clinical fellowship program accredited by the council on podiatric medicine is substantially equivalent to the graduate medical educational requirement for licensure to practice podiatric medicine and surgery; and

(5) For purposes of section 5903.03 of the Revised Code, the board recognizes dietetics educational programs offered by branches of the United States military that have been issued accreditation status conferred by the accreditation council for education in nutrition and dietetics or their successor organization that permits dietetics programs offered by the United State military to continue to enroll or graduate students.

(6) For purposes of section 5903.03 of the Revised Code, the board recognizes respiratory care educational programs offered by branches of the United States military that have been issued provisional accreditation, initial accreditation, continuing accreditation or other accreditation status conferred by the commission on accreditation for respiratory care (CoARC) or their successor organization that permits respiratory care programs offered by the United States military to continue to enroll and/or graduate students.

(7) For purposes of section 5903.03 of the Revised Code, the board has determined that there are no military programs of training, military primary specialties, and lengths of service that are substantially equivalent to or exceed the educational and experience requirements for licensure as an acupuncturist.

(8) For the purposes of section 5903.03 of the Revised Code, the board has determined that there are no military programs of training, military primary specialties, or lengths of service that are substantially equivalent to or exceed the educational and experience requirements for licensure as a radiologist assistant.

(9) For the purposes of section 5903.03 of the Revised Code, the board has determined that there are no military programs of training, military primary specialties, or lengths of service that are substantially equivalent to or exceed the educational and experience requirements for licensure as a genetic counselor.

Last updated February 2, 2026 at 8:08 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-36-02 Military provisions related to renewal of license and continuing education.

(A) Renewal of an expired license or certificate to practice without a late fee or re-examination.

(1) An expired license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4761., 4762., 4774., or 4778. of the Revised Code shall be renewed upon payment of the renewal fee provided for in Chapter 4730., 4731., 4759., 4761., 4762., 4774., or 4778. of the Revised Code and without a late fee or re-examination if the holder meets all of the following requirements:

(a) The licensee is not otherwise disqualified from renewal because of mental or physical disability;

(b) The licensee meets the requirements for renewal for the particular license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4761., 4762., 4774., or 4778. of the Revised Code;

(i) The license was not renewed because of the licensee's service in the armed forces; or

(ii) The license was not renewed because the licensee's spouse served in the armed forces, and the service resulted in the licensee's absence from this state.

(d) The licensee or the licensee's spouse, whichever is applicable, has presented satisfactory evidence of the service member's discharge under honorable conditions or release under honorable conditions from active duty or national guard duty within six months after the discharge or release.

(B) Continuing education.

(1) Extension of the continuing education period for the license or certificate to practice pursuant to Chapter 4730., 4731., 4759., 4761., 4762., or 4778. of the Revised Code:

(a) The holder of a license or certificate to practice may apply for an extension of the current continuing education reporting period in the manner provided in section 5903.12 of the Revised Code by submitting both of the following:

(i) A statement that the licensee has served on active duty, whether inside or outside of the United States, for a specified period of time during the current or prior continuing education reporting period.

(ii) Proper documentation certifying the active duty service and the length of that active duty service.

(b) Upon receiving the application and proper documentation, the board shall extend the current continuing education reporting period by an amount of time equal to the total number of months that the licensee spent on active duty during the current continuing education reporting period. Any portion of a month served shall be considered one full month.

(2) The board shall consider relevant education, training, or service completed by a licensee as a member of the armed forces in determining whether a licensee has met the continuing education requirements needed to renew the license.

(3) For purposes of sections 5903.12 and 5903.121 of the Revised Code, anesthesiologist assistants in Chapter 4731. of the Revised Code, acupuncturists in Chapter 4762. of the Revised Code, and radiologist assistants in Chapter 4774. of the Revised Code are not required to report continuing education coursework to the board.

Last updated February 2, 2026 at 8:08 AM

History

Effective: January 31, 2026
Promulgated Under: 119.03

Ohio Adm.Code 4731-36-03 Processing applications from service members, veterans, or spouses of service members or veterans.

(A) The board shall include questions on all applications for licensure, renewal, reinstatement or restoration of licensure for all applicants for licensure or certificate to practice pursuant to Chapters 4730., 4731., 4759., 4761., 4762., 4774., and 4778. that inquire as to whether the applicant is:

(1) A service member;

(2) A veteran; or

(3) The spouse or surviving spouse of a service member or veteran.

(B) If the applicant for licensure, biennial renewal, reinstatement, or restoration of licensure responds affirmatively to any of the questions discussed in paragraph (A) of this rule, the board shall process the application in the following manner:

(1) Route the application to a board staff member who is responsible for monitoring the application and communicating with the applicant regarding the status of the application, including informing the applicant of any documentation needed for the board to process the application;

(2) Expedite the processing of the application, even if the application was received later in time than other applications that are pending processing;

(3) Provide information regarding available continuing education waivers to applicants if the applicant or the applicant's spouse will be imminently deployed; and

(4) Track, on an annual basis, the total number of applications submitted by service members, veterans, spouses or surviving spouses of service members or veterans, and the average number of business days expended by the board to process those applications.

Last updated November 19, 2025 at 11:21 AM

History

Effective: December 31, 2020
Promulgated Under: 119.03

Ohio Adm.Code 4731-36-04 Temporary licensure for members of the military and spouses who are licensed in another jurisdiction.

(A) "Military duty" has the same meaning as in section 4743.041 of the Revised Code.

(B) Pursuant to section 4743.041 of the Revised Code, the state medical board of Ohio shall issue a temporary license or certificate to practice the professions governed by Chapters 4730., 4731., 4759., 4761., 4762., 4774., and 4778. of the Revised Code if the individual demonstrates to the satisfaction of the board all the following:

(1) The individual holds a valid license or certificate to practice the profession issued by any other state or jurisdiction;

(2) The individual is in good standing in the state or jurisdiction of licensure or certification;

(3) The individual or the individual's spouse is on military duty in this state.

(C) An applicant for a temporary license or certificate must certify that, to the best of the applicant's knowledge, the applicant is not under investigation by the licensing agency of any state or jurisdiction.

(D) No application submitted to the board shall be considered complete until the applicant has complied with the requirements of paragraph (A) of rule 4731-4-02 of the Administrative Code and the board has received the results of the criminal records checks.

(E) If an applicant for a temporary license or certificate fails to complete the application process within six months of initial application filing, the board may notify the applicant in writing of its intention to consider the application abandoned. If no response to that notice is received by the board within thirty days, the board shall consider the application as abandoned and no further processing shall be undertaken with respect to that application.

(F) The board shall issue a temporary license or certificate within fourteen days of having received the results of a criminal records check, provided that the application is otherwise complete, and the applicant is not under investigation by the licensing agency of any state or jurisdiction.

(G) The board shall process the application for a temporary license or certificate in accordance with rule 4731-36-03 of the Administrative Code.

(H) The board shall waive all fees associated with the issuance of the temporary license or certificate.

(I) A temporary license or certificate issued under this section shall be valid for a two-year period unless revoked or suspended. A temporary license or certificate may not be renewed and a new temporary license may not be issued.

(J) A holder of a temporary license or certificate may apply for licensure under Chapters 4730., 4731., 4759., 4761., 4762., 4774., and 4778. of the Revised Code at any time before or after expiration of the temporary license. A holder or previous holder of a temporary license or certificate must meet all requirements for licensure under the applicable chapter of the Revised Code and rules adopted thereunder.

Last updated November 19, 2025 at 11:21 AM

History

Effective: May 31, 2021
Promulgated Under: 119.03

Chapter 4731-37 Telehealth

Ohio Adm.Code 4731-37-01 Telehealth.

(A) As used in Chapters 4730, 4731, 4759, 4761, and 4778 of the Administrative Code:

(1) "Telehealth services" means health care services provided through the use of information and communication technology by a health care professional licensed in Ohio, within the professional's scope of practice, who is located at a site other than the site where the patient is receiving the services or the site where another health care professional with whom the provider of the services is formally consulting regarding the patient is located.

(2) "Synchronous communication technology" means audio and/or video technology that permits two-way, interactive, real-time electronic communication between the health care professional and the patient or between the health care professional and the consulting health care professional regarding the patient.

(3) "Asynchronous communication technology", also called store and forward technology, has the same meaning as asynchronous store and forward technologies as that term is defined in 42 C.F.R. 410.78 (effective January 1, 2022).

(4) "Remote monitoring device" means a medical device cleared, approved, or authorized by the United States food and drug administration for the specific purpose which the health care professional is using it and which reliably transmits data electronically and automatically.

(5) "Health care professional" means any of the following:

(a) A physician assistant licensed under Chapter 4730. of the Revised Code;

(b) A physician licensed under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery;

(d) A respiratory care professional licensed under Chapter 4761. of the Revised Code; or

(e) A genetic counselor licensed under Chapter 4778. of the Revised Code.

(6) "Consent for telehealth treatment" means a process of communication between a patient or, if applicable, the patient's legal representative and the health care professional discussing the risks and benefits of, and alternatives to, treatment through a remote evaluation that results in the agreement to treatment that is documented in the medical record or signed authorization for the patient to be treated through an evaluation conducted through appropriate technology, as specified in this rule, when the health care professional is in a location remote from the patient.

(7) "Formal consultation" means when a health care professional seeks the professional opinion of another health care professional regarding the diagnosis or treatment recommended for the patient's medical condition presented, transfers the relevant portions of the patient's medical record to the consulting health care professional, and documents the formal consultation in the patient's medical record.

(B) A health care professional may provide telehealth services to a patient located in this state. The health care professional shall comply with all of the following requirements:

(1) The standard of care for a telehealth visit is the same as the standard of care for an in-person visit.

(2) The health care professional shall follow all standard of care requirements which include but are not limited to the standard of care requirements in paragraph (C) of this rule.

(3) The health care professional may provide the telehealth services through the use of synchronous or asynchronous communication technology provided that the standard of care for an in-person visit can be met for the patient and the patient's medical condition through the use of the technology selected. Telephone calls, as a synchronous communication technology, may only be used for telehealth services when all of the elements of a bona fide health care visit meeting the standard of care are performed. Telephone calls that are routine or simply involve communication of information do not constitute a telehealth service.

(4) If a health care professional determines at any time during the provision of telehealth services that a telehealth visit will not meet the standard of care for the medical condition of the patient or if additional in-person care is necessary, the health care professional shall see the patient in a reasonable timeframe or make the appropriate referral to another health care professional to meet the standard of care.

(a) If the patient needs emergency care, the health care professional shall assist the patient in obtaining emergency care by doing one of the following:

(i) If the patient is able to safely travel or be transported to the emergency department without emergency transport services, help the patient identify the closest emergency department and, if necessary, in the health care professional's discretion, provide notification to the emergency department of the patient's potential arrival;

(ii) If the patient is unable to safely travel or be transported to the emergency department without emergency transport services, advise the patient to call 911 and remain on the videoconference, telephone, or other synchronous communication technology with the patient; or

(iii) If patient is incapacitated, call for emergency services and remain on the videoconference, telephone, or other synchronous communication technology with the patient.

(b) The health care professional shall document the in-person visit or the referral in the patient's medical record.

(C) A health care professional shall comply with all standard of care requirements to provide telehealth services to a patient including but not limited to:

(1) The health care professional shall verify the patient's identity and physical location in Ohio, and communicate the health care professional's name and type of active Ohio license held to the patient if the health care professional has not previously treated the patient. This may be done verbally as long as it is documented by the health care professional in the patient's medical record;

(2) The health care professional shall document the consent for telehealth treatment of the patient or, if applicable, the patient's legal representative;

(3) The health care professional shall provide the telehealth services in a manner that complies with the privacy and security requirements for the patient and their protected health information required by the law of this state and federal law. Also, the health care professional shall ensure that any username or password information and any electronic communications between the health care professional and the patient are securely transmitted and stored;

(4) If applicable, the health care professional shall forward the medical record to the patient's primary care provider, other health care provider, or to an appropriate health care provider to whom the patient is referred as provided in paragraph (B)(4) of this rule;

(5) The health care professional shall, through interaction with the patient, complete a medical evaluation that is appropriate for the patient and the condition with which the patient presents and that meets the minimal standards of care for an in-person visit, which may include portions of the evaluation having been conducted by other Ohio licensed healthcare providers acting within the scope of their professional license;

(6) The health care professional shall establish or confirm, as applicable, a diagnosis and treatment plan, which for those health care professionals designated as prescribers in section 4729.01 of the Revised Code, includes documentation of the necessity for the utilization of a prescription drug. The diagnosis and treatment plan shall include the identification of any underlying conditions or contraindications to the recommended treatment;

(7) The health care professional shall promptly document in the patient's medical record the patient's or, if applicable, the patient's legal representative, consent for telehealth treatment, pertinent history, evaluation, diagnosis, treatment plan, underlying conditions, any contraindications, and any referrals to appropriate health care providers, including primary care providers or health care facilities;

(8) The health care professional shall provide appropriate follow-up care or recommend follow-up care with the patient's primary care provider, other appropriate health care provider, or health care facility in accordance with the minimal standards of care;

(9) The health care professional shall make the medical record of the visit available to the patient or if applicable, the patient's legal representative, upon request.

(D) A health care professional shall comply with the following requirements to provide telehealth services that involve a formal consultation with another health care professional:

(1) The health care professional who seeks a formal consultation shall document the acknowledgement of the patient or if applicable, the patient's legal representative, before seeking the telehealth services formal consultation with the consulting health care professional;

(2) The consulting health care professional shall meet the licensure or certification requirements in division (C) of section 4743.09 of the Revised Code; and

(3) The health care professional who seeks a formal consultation shall send the medical records relevant to the patient's medical condition to the consulting health care professional who shall review the medical records of the patient relevant to the medical condition which is the subject of the consultation before the formal consultation occurs, unless this is not possible due to an emergency situation.

(E) While providing telehealth services, a health care professional that is a physician or a physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall comply with the following requirements regarding prescription drugs:

(1) The physician or physician assistant may only prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug that is not a controlled substance to a patient through the provision of telehealth services by complying with all requirements of this rule;

(2) The physician or physician assistant may only prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug to a patient that is a controlled substance through the provision of telehealth services by complying with the following requirements:

(a) Federal law governing prescription drugs that are controlled substances;

(b) The requirements of this rule; and

(F) A physician or physician assistant may provide telehealth services through the use of remote monitoring devices provided that:

(1) The patient or, if applicable, the patient's legal representative, gives consent to the use of remote monitoring devices;

(2) The medical devices that enable remote monitoring have been cleared, approved, or authorized by the United States food and drug administration for the specific purpose for which the physician or physician assistant are using it for the patient, and the remote monitoring devices otherwise comply with all federal requirements.

(G) A violation of any provision of this rule, as determined by the board, shall constitute any or all of the following:

(1) For a physician:

(a) "Failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code;

(2) For a physician assistant:

(3) For a dietitian:

(a) "Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter or the rules adopted by the board," as that clause is used in division (A)(1) of section 4759.07 of the Revised Code; or

(b) "A departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (A)(11) of section 4759.07 of the Revised Code.

(4) For a respiratory care professional:

(5) For a genetic counselor:

(a) "Failure to comply with the requirements of this chapter, Chapter 4731. of the Revised Code, or any rules adopted by the board." as that clause is used in division (B)(2) of section 4778.14 of the Revised Code;

(b) "Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter, Chapter 4731. of the Revised Code, or the rules adopted by the board," as that clause is used in division (B)(3) of section 4778.14 of the Revised Code; or

(c) "A departure from, or failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances whether or not actual injury to the patient is established," as that clause is used in division (B)(4) of section 4778.14 of the Revised Code.

Last updated February 28, 2023 at 10:16 AM

History

Effective: February 28, 2023
Promulgated Under: 119.03

Chapter 4731-38 Alternate Licensure Pathways

Ohio Adm.Code 4731-38-01 Licenses issued or renewed under the interstate medical licensure compact.

(A) "IMLC" means the interstate medical licensure compact

(B) "IMLCC" means the interstate medical licensure compact commission

(C) An individual applying for a license through the IMLC, shall pay directly to the IMLCC the application fee in the amount described in section 4731.09 of the Revised Code, and any additional fees required by the IMLCC.

(D) A license issued by the board through the IMLC shall be valid for two years, unless suspended or revoked.

(E) An individual renewing a license issued through the IMLC shall pay directly to the IMLCC the biennial renewal fee, reinstatement fee, or restoration fee, as applicable, in the amount described in section 4731.281 of the Revised Code , and any additional fees required by the IMLCC.

(F) An individual renewing a license issued through the IMLC shall provide to the board, in the manner determined by the board, the information described in section 4731.281 of the Revised Code.

Last updated May 31, 2022 at 8:06 AM

History

Effective: May 31, 2022
Promulgated Under: 119.03

Ohio Adm.Code 4731-38-02 Issuance of Licenses to out-of-state licensees or certificate holders.

An individual applying for licensure under Chapter 4796. of the Revised Code shall pay the following application fees:

(A) For a physician assistant, the fee for initial application in the amount described in section 4730.10 of the Revised Code;

(B) For a physician or osteopathic physician, the fee for initial application in the amount described in section 4731.09 of the Revised Code;

(C) For a massage therapist, the fee for initial application in the amount described in section 4731.19 of the Revised Code;

(D) For a podiatrist, the fee for initial application in the amount described in section 4731.52 of the Revised Code;

(E) For a dietitian, the fee for initial application in the amount described in section 4759.08 of the Revised Code;

(F) For a dietitian limited permit holder, the fee for initial application in the amount described in section 4759.08 of the Revised Code;

(G) For an anesthesiologist assistant, the fee for initial application in the amount described in section 4760.03 of the Revised Code;

(H) For a respiratory care professional, the fee for initial application in the amount described in section 4761.07 of the Revised Code;

(I) For a respiratory care professional limited permit holder, the fee for initial application in the amount described in section 4761.07 of the Revised Code;

(J) For an acupuncturist, the fee for initial application in the amount described in section 4762.03 of the Revised Code;

(K) For a radiologist assistant, the fee for initial application in the amount described in rule 4774-1-02 of the Administrative Code;

(L) For a genetic counselor, the fee for initial application in the amount described in section 4778.03 of the Revised Code;

(M) For a genetic counselor supervised practice license, the fee for initial application in the amount described in section 4778.03 of the Revised Code.

Last updated November 30, 2023 at 10:52 AM

History

Effective: November 30, 2023
Promulgated Under: 119.03