Med 100-500

CHAPTER Med 100 ORGANIZATION, DEFINITIONS AND PUBLIC INFORMATION

Statutory Authority: RSA 329:9

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 100 on organizational rules, Document #9900 adopted a new rule Med 102.08 defining “Medical Review Subcommittee (MRSC)” and readopted with amendments Med 104.01 and Med 105.03. However, the Joint Legislative Committee on Administrative Rules (JLCAR) had not approved the rules in Document #9900 pursuant to RSA 541-A:13. Therefore, although the rules in Chapter Med 100 in Document #9900 were organizational rules, they expired after 8 years on 4-12-19 pursuant to RSA 541-A:17, as amended through 2009, 232:5.

REVISION NOTE #2:

Document #14021-A, effective 9-8-24, adopted, readopted, repealed, or readopted with amendment various rules in Chapter Med 100. Document #14021-A adopted Med 102.02 defining “clinician licensee panel” and Part Med 107 titled “Clinician Licensee Panel”, containing Med 107.01 titled “Clinician Licensee Panel Requirements.” Document #14021-A also repealed the former Med 102.01 defining “administrator”, Med 102.07 defining “tentative decision”, Med 102.08 defining “Medical Review Subcommittee (MRSC)”, Med 103.03 titled “Staff”, and Med 105.03 titled “Board Decisions”. These actions necessitated the renumbering of other rules as indicated in the source notes.

The prior filings affecting the repealed rules included the following documents. Italics indicate that the rule would have expired only pursuant to RSA 541-A:17, II:

Med 102.01

#4970, eff 11-8-90

#5092, eff 3-13-91

#6554, eff 7-31-97

Med 102.07

#6554, eff 7-31-97

Med 102.08

#9900, eff 4-12-11, EXPIRED 4-12-19

(see Revision Note #1 at chapter heading for Med 100)

#13712, eff 10-1-23

Med 103.03

#4970, eff 11-8-90, EXPIRED 11-8-96

#6554, eff 7-31-97

#10125-A, eff 5-9-12

Med 105.03

#4970, eff 11-8-90, EXPIRED 11-8-96

#6554, eff 7-31-97

#9900, eff 4-12-11, EXPIRED 4-12-19

(see Revision Note #1 at chapter heading for Med 100)

The rules in Document #14021-A will not expire except pursuant to RSA 541-A:17, II.

PART Med 101 PURPOSE AND SCOPE

Med 101.01 Purpose and Scope.

(a) The rules of this title implement the statutory responsibilities of the New Hampshire board of medicine under the following chapters:

(1) RSA 329, physicians and surgeons; and

(2) RSA 328-D, physician assistants.

(b) The board's statutory responsibilities include, but are not limited to:

(1) The examination and licensing of all practitioners listed in (a) above;

(2) The development of ethical and other professional standards to be followed by licensees under those chapters;

(3) Hearing allegations of misconduct and imposing disciplinary sanctions on licensees; and

(4) The development of continuing professional education requirements and other requirements for demonstrating professional competence.

Source. #1136, eff 3-27-78; ss by #2199, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97; ss by #7230, eff 4-11-00; ss by #14021-eff 9-8-24 (See Revision Note #2 at chapter heading for Med 100)

PART Med 102 DEFINITIONS

Med 102.01 "Board" means the New Hampshire board of medicine created under RSA 329:2.

Source. #6554, eff 7-31-97; renumbered by #14021-A (formerly Med 102.02) (see Revision Note #2 at chapter heading for Med 100)

Med 102.02 “Clinician licensee panel” means a panel of licensed clinicians that assists the office of professional licensure and certification (OPLC) in carrying out its investigative obligations under RSA 310:9.

Source. #14021-A, eff 9-8-24 (see Revision Note #2 at chapter heading for Med 100)

Med 102.03 "Licensee" means any person holding a valid license or certification issued by the OPLC in accordance with the rules of the board.

Source. #6554, eff 7-31-97; ss by #14021-A eff 9-8-24 (See Revision Note #2 at chapter heading for Med 100)

Med 102.04 "Practice of Medicine" means the practice of medicine or surgery as defined in RSA 329:1, including procedures which require the use of lasers, provided, however, that activities which may lawfully be performed by health care professionals licensed under other New Hampshire statutes shall not be considered as the practice of medicine.

Source. #6554, eff 7-31-97

Med 102.05 "Physician" means a doctor of medicine or a doctor of osteopathy who holds a current license to practice issued by the board pursuant to RSA 329.

Source. #6554, eff 7-31-97

Med 102.06 "President" means the president of the board chosen pursuant to RSA 329:7.

Source. #6554, eff 7-31-97

PART Med 103 ORGANIZATION

Med 103.01 Composition of the Board. The board consists of 11 members who are appointed by the governor and council and shall meet the eligibility requirements of RSA 329:2, I and RSA 329:4.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97; ss by #10125-A, eff 5-9-12

Med 103.02 Officers.

(a) In December of each year, the board shall elect one member to serve as president and one member to serve as vice president.

(b) The president shall chair the board’s meetings and establish the order of its business.

(d) If neither the president or vice-president are in attendance at a meeting another board member shall be appointed to serve as acting president.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97; ss by #10125-A, eff 5-9-12; ss by #14021-A, eff 9-8-24 (see Revision Note at chapter heading for Med 100)

PART Med 104 PUBLIC INFORMATION

Med 104.01 Access to Public Records.

(a) Requests for information and access to public records shall be available as described in Plc 103.

(b) Minutes of all board and committee meetings shall be taken and shall be available for inspection during the OPLC’s regular business hours within 144 hours of the date of the meeting or vote in questions, unless the 72-hour availability requirements of RSA 91-A:3, III is applicable.

(c) Board records which contain both public and confidential information shall be provided with the confidential information deleted.

(d) Final orders in disciplinary matters shall be retained indefinitely by the OPLC.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97; ss by #9900, eff 4-12-11, EXPIRED 4-12-19 (see Revision Note #1 at chapter heading for Med 100)

New. #13712, eff 10-1-23; ss by #14021-A, eff 9-8-24 (see Revision Note #2 at chapter heading for Med 100)

PART Med 105 MEETINGS, DELIBERATIONS AND DECISIONS

Med 105.01 Meetings. The board shall meet monthly and at such additional times as shall be called for by the president or by vote of the board.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97

Med 105.02 Necessary Quorum. Except as otherwise provided by law, a quorum shall not be required to conduct a hearing or receive information, but final decisions shall be made only by the affirmative vote of a majority of the board members eligible to participate in the matter in question.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97

PART Med 106 APPOINTMENT OF SUBCOMMITTEES

Med 106.01 Committees.

(a) A committee, appointed by the board to investigate and make recommendations on matters within the statutory authority of the board, shall consist of one or more members and shall be chaired by a member of the board.

(b) When expressly authorized by the board, the authority of a committee shall include:

(1) The retention of qualified non-board members to serve as members of the committee; and

(2) The retention of paid advisors or consultants pursuant to Med 329:18 II.

Source. #4970, eff 11-8-90, EXPIRED 11-8-96

New. #6554, eff 7-31-97

PART Med 107 CLINICIAN LICENSEE PANEL

Med 107.01 Clinician Licensee Panel Requirements.

(a) A panel of clinician licensees shall be established to work in conjunction with the OPLC in carrying out its investigation obligations under RSA 310:9.

(b) The panel shall consist of a minimum of 3 members, appointed by the executive director of the OPLC, that meet the following criteria:

(1) Hold an active New Hampshire license;

(2) Have no disciplinary actions taken against their license in any state or jurisdiction;

(3) Have no pending disciplinary actions on their license in any state or jurisdiction;

(4) Hold an active board certification issued by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA); and

(5) Have practiced as a physician, physician assistant, or surgeon for at least 5 years post residency.

(c) Preferential consideration shall be given to those interested in being appointed to the panel who have prior peer review experience.

(d) The panel shall meet once a month or as necessary to meet their statutory obligations under RSA 329:9, XVII.

Source. #14021-A, eff 9-8-24 (see Revision Note #2 at chapter heading for Med 100)

CHAPTER Med 200 RULES OF PRACTICE AND PROCEDURE

REVISION NOTE #1:

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 200, Document #9900 readopted with amendments selected rules in Parts Med 201, 204, 205, and 206, and readopted with amendments rules Med 201.01 and Med 202.02. Document #9900 also amended Med 208.01(a). Document #9900 repealed Med 210 on nonadjudicatory investigations and adopted a new rule Med 205.03 on investigations. Document #9900 replaces all prior filings for rules in the former Med 210. The prior filings affecting Med 210 include the following documents:

#4970, effective 11-8-90, EXPIRED 11-8-96

#6517, effective 5-30-97, EXPIRED 5-30-05

#8662, INTERIM, effective 6-16-06, EXPIRED 12-13-06

#8944-B, effective 7-18-07

Document #9900 also renumbered, but did not readopt, the existing rule Med 205.03 as Med 205.04. The repeal of Med 210 by Document #9900 necessitated the renumbering of existing Parts Med 211, Med 212, and Med 213 as, respectively, Med 210, Med 211, and Med 212.

REVISION NOTE #2:

Document #13764, effective 10-5-23, repealed Part Med 201 through Part Bar 212 in Chapter Med 200, titled “Practice and Procedure”, and renamed the chapter as “Rules of Practice and Procedure”. Document #13764 also adopted a new Part Med 201 titled “Applicability and Waiver of Substantive Rules”, containing rule Med 201.01 titled “Applicability of Plc 200” and rule Med 201.02 titled “Waiver of Administrative Rules.”

Document #13764 replaces all prior filings affecting the rules in the former Chapter Med 200. The prior filings included the following documents. Italics indicate the rules were subject to expiration only pursuant to RSA 541-A:17, II:

#4970, effective 11-8-90, EXPIRED 11-8-96

#5223, effective 9-12-91

#5402, effective 5-22-92

#5785, effective 2-4-94

#5838, effective 6-17-94

#6517, effective 5-30-97, EXPIRED 5-30-05

#8662, INTERIM, effective 6-16-06, EXPIRED 12-13-06

#8944-A, effective 7-18-07

#8944-B, effective 7-18-07

#9900, effective 4-12-11

#10125-A, effective 5-9-12

As practice and procedure rules, the rules in Document #13764 will not expire except pursuant to RSA 541-A:17, II.

PART Med 201 APPLICABILITY AND WAIVER OF SUBSTANTIVE RULES

Med 201.01 Applicability of Plc 200. The Plc 200 rules shall govern with regards to all procedures for:

(a) Adjudicatory proceedings;

(b) Rulemaking submissions, considerations, and disposition of rulemaking petitions;

(d) Declaratory rulings;

(e) All statements of policy and interpretation;

(f) Explanation of adopted rules;

(g) Voluntary surrender of licenses; and

(h) Petitions for waiver of rule.

Source. (See Revision Notes #1 and #2 at chapter heading for Med 200) #13764, eff 10-5-23

Med 201.02 Waiver of Administrative Rules.

(a) The board shall initiate a waiver of a substantive rule upon its own motion by providing affected parties with notice and opportunity to be heard and issuing an order which finds that waiver would be necessary to advance the purpose of RSA 329.

(b) Individuals who wish to request a waiver of a rule shall submit a written request to the board, which includes:

(1) The rule for which a waiver is requested;

(2) The anticipated length of time the requested waiver will be needed;

(3) The reason for requesting the waiver;

(4) Evidence of how the waiver will provide for the health and safety of the consumer or licensee;

(5) A time-limited written compliance plan which sets forth plans to achieve compliance including an estimated date of compliance; and

(6) The signature of the applicant.

(1) If adherence to the rule would cause the petitioner unnecessary or undue hardship;

(2) If the requested waiver is necessary because of any neglect or misfeasance on the part of the practitioner;

(3) If enforcement of the rule would injure a third person(s); and

(4) If waiver of the rule would injure a third person(s).

(d) The board shall approve a waiver of an administrative rule request only if:

(1) Granting a waiver does not have the effect of waiving or modifying a provision of RSA 329;

(2) The petitioner has shown good cause exists pursuant to (c) above to waive the rule.; and

(3) The board determines that the individual’s plans for compliance with the rule includes an estimated date of compliance and eventual compliance.

(e) The board, after receiving and reviewing a request for a waiver requires further information or documents to determine granting or denying the waiver shall:

(1) Notify the applicant in writing within 30 days; and

(2) Specify the information or document the board requires.

(f) The board shall issue a written approval or denial of the waiver within 60 days of the date that the request is received, unless additional information or documentation is required. If additional information and documentation is required, then the board shall issue a written approval or denial within 60 days of receiving the requested information or documentation.

Source. (See Revision Notes #1 and #2 at chapter heading for Med 200) #13764, eff 10-5-23

CHAPTER Med 300 LICENSURE REQUIREMENTS

REVISION NOTE:

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 300, Document #9900 readopted with amendments Med 301.01 through Med 301.03, and Parts Med 302, 303, and 306. Document #9900 also adopted Med 305.03 on administrative licenses, and readopted with amendments and renumbered Med 305.03 as Med 305.04. The source note for Med 305.04 indicates the former rule number Med 305.03, and the document numbers and effective dates apply to the rule under the former number.

PART Med 301 APPLICATION REQUIREMENTS

Med 301.01 Definitions.

(a) “Administrative license” means a license to engage in professional, managerial, or administrative activities related to the practice of medicine or to the delivery of health care services, but does not include the practice of clinical medicine.

(b) "Applicant" means a physician on whose behalf an application has been filed.

(c) "Board certified" means a physician who is currently certified by a medical specialty board recognized by the American Board of Medical Specialties (ABMS) or by the American Osteopathic Association (AOA).

(d) "Clearance" means a document received directly from a state licensing authority which verifies whether or not a person has ever been granted a license by that state, the dates during which that license was valid and whether the licensing authority has ever taken disciplinary action against that license.

(e) “Clinical medicine” means medical practice that includes but is not limited to:

(1) Direct involvement in patient evaluation, diagnosis, and treatment;

(2) Prescribing any medication;

(3) Delegating medical acts or prescription authority;

(4) The supervision of physicians, physician assistants, or registered nurses in the practice of clinical medicine; or

(5) Direct involvement in medical decisions impacting population health.

(f) "Courtesy license" means a license, issued pursuant to RSA 329:14, VII, which shall not exceed 100 calendar days and is restricted to specific dates and location(s) as indicated on the license. The term includes “locum tenens license.”

(g) "Federation Credentials Verification Service (FCVS)" means the service provided by the Federation of State Medical Boards which verifies and maintains a permanent collection of original source documentation of physician educational, examination and identification documents.

(h) "Special license" means a license, issued pursuant to RSA 329:14, VI which is restricted to specific dates and location(s) as indicated on the license, in the following categories::

(1) “Camp license” as described in Med 305.02(a); and

(2) “Visiting professor license” as described in Med 305.02(b).

(i) “Special training license” means a license, issued pursuant to RSA 329:14, V which is restricted to specific dates and location(s) as indicated on the license. The term includes “resident training license.”.

(j) “Temporary license” means an unrestricted license valid for only 6 months pending the applicant’s receipt of an unrestricted permanent license.

(k) “Unrestricted permanent license” means a license granted pursuant to RSA 329:14, III that expires biennially on June 30.

Source. #4970, eff 11-8-90; ss by #5908, eff 10-7-94; ss by #6576, eff 9-15-97; amd by #8068, eff 4-10-04; ss by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 301.02 Application Process.

(a) Persons wishing to practice medicine in New Hampshire shall submit both the Federation of State Medical Boards’ Uniform Application, available on the board’s website, and a “State Addendum,” revised 11/2019, which contains the information specified in Med 301.03, and the application fee specified in Table 3.6.1. in Med 306.01.

(b) An application which is not signed by the applicant shall not be accepted and shall be returned to the applicant.

(c) The board shall acknowledge receipt of an application within 60 days and shall notify the applicant of any deficiencies in the application, including the absence of the application fee, or any further information needed to clarify the applicant's qualifications. Failure to remedy the deficiencies within 52 weeks of the board’s initial receipt of the application shall result in dismissal of the application.

(d) Applications shall be granted by the board pursuant to the requirements set forth in RSA 329:14, II.

(e) If the application is denied, the applicant shall be provided an opportunity to request a hearing for reconsideration pursuant to Med 208 on the deficiency issues identified by the board. Any such request shall be received by the board within 30 days.

Source. #4970, eff 11-8-90; ss by #5908, eff 10-7-94; ss by #6576, eff 9-15-97, EXPIRED: 9-15-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 301.03 Application for an Unrestricted Permanent License.

(a) Applicants for an unrestricted permanent license shall provide, or cause to be provided, the following on a form supplied by the board:

(1) The applicant's name, including any names previously used;

(2) The applicant's residence and business addresses and telephone numbers, business e-mail address and business fax number;

(3) The applicant's date of birth, place of birth and social security number required pursuant to 45 CFR Part 60.8 and RSA 161-B:11, VI-a. The applicant shall furnish his or her social security number on the line provided below the following preprinted statement:

"The board will deny licensure if you refuse to submit your social security number (SSN). Your professional license will not display your SSN. Your SSN will not be made available to the public. The board is required to obtain your social security number for the purpose of child support enforcement and in compliance with RSA 161-B:11. This collection of your social security number is mandatory."

(4) The applicant's educational history including the names of all institutions attended, the dates of attendance and the degree awarded;

(5) A certification of medical education received directly from and verified by FCVS;

(6) If the applicant graduated from a medical school outside the United States or Canada:

a. Certified copies of an official transcript of grades and proof of graduation with certified English translation received directly from and verified by FCVS; and

b. Verification received directly from FCVS that the applicant holds a current certification from the Educational Commission of Foreign Medical Graduates (ECFMG);

(7) A listing of all institutions in which the applicant has pursued post graduate training and a written verification received directly from FCVS that the applicant has completed at least 2 years of training which meet the requirements of Med 302.01;

(8) Verification received directly from FCVS that the applicant has passed one of the licensure examinations listed under Med 303.01;

(9) A listing of every state in which the applicant holds or has ever held a license and clearances of those licenses received directly from the licensure authority;

(10) Disclosure of whether the applicant is board certified and if so, a certified copy of that certification;

(11) Disclosure of whether the applicant has ever lost or been denied board certification and if so, an explanation for the circumstances;

(12) Disclosure of whether the applicant has ever been subject to a claim for malpractice and if so, the circumstances of that claim;

(13) Disclosure of whether the applicant has ever taken an examination or applied for licensure under a different name;

(14) Disclosure of whether the applicant has ever failed any medical licensing examination or been denied the privilege of finishing or been accused of cheating or improper conduct during any required examination, and, if so, the circumstances involved;

(15) Disclosure of whether the applicant has ever been denied a medical license and, if so, the circumstances of that denial;

(16) Disclosure of whether the applicant has ever had hospital privileges, employment, or appointment at any health care institution denied, limited, suspended, or revoked or whether the applicant has ever resigned in lieu of such actions and if so, the circumstances involved;

(17) Disclosure of whether the applicant is currently under investigation or whether any disciplinary action has been taken against the applicant during the past 10 years by any governmental authority, hospital, or health care facility or by any professional medical association, and, if so, the circumstances involved;

(18) Disclosure of whether the applicant has ever voluntarily surrendered a license to practice medicine in lieu of facing disciplinary action or ever withdrawn an application for licensure, hospital privileges or appointment for any reason and if so the circumstances involved;

(19) Disclosure of whether the applicant has ever been a defendant in a criminal proceeding and the circumstances of that criminal proceeding;

(20) Disclosure of whether the applicant has ever lost the privilege to possess, dispense, or prescribe controlled substances or been investigated by any state or federal drug enforcement agencies;

(21) Disclosure of whether the applicant is currently suffering from any condition, mental or physical, that impairs the applicant’s judgment or that would otherwise adversely affect his or her ability to practice medicine in a competent, ethical, and professional manner;

(22) Disclosure of whether the applicant is currently or has in the past been monitored or treated by a private, state, medical society or hospital physician health program, other than through the NH board approved physician health program;

(23) Disclosure of whether the applicant has not been actively engaged in the practice of clinical medicine within the past 12 months;

(24) A certified copy of the applicant's birth certificate or passport received directly from FCVS;

(25) A listing of all professional activities pursued including the dates of such activities since the applicant graduated from medical school;

(26) Original letters of reference, on letterhead and addressed to the board, from:

a. The chief medical officer or president of the medical staff in every hospital in which the applicant currently holds staff privileges; or

b. Letters of reference from 2 practicing physicians;

(27) A recent, full face, 2 x 3 inch photograph of the applicant;

(28) The applicant's notarized signature attesting to the accuracy of the information provided; and

(29) If applicable, a copy of the applicant's current Drug Enforcement Administration (DEA) certificate.

(b) Applicants shall include the application fee required in Table 3.6.1 in Med 306.01.

(c) A temporary license, valid for only 6 months, shall be issued pursuant to RSA 329:14, III only to applicants for a full New Hampshire license who have met the requirements of Med 301.03(a) and (b) above, excluding Med 301.03(a)(5), Med 301.03(a)(6), Med 301.03(a)(7), Med 301.03(a)(8) and Med 301.03(a)(24). Applicants shall not begin to practice until such time as they receive a temporary license.

(d) Applicants for temporary license shall also provide, or cause to be provided, the following:

(1) Evidence of qualifications as follows:

a. Proof of a full, unrestricted medical license in another state received directly from the state licensing authority indicating that the applicant’s license covers the dates in which he or she is practicing in New Hampshire; or

b. Certified copies of a medical degree diploma, proof of 2 years of postgraduate training which meet the requirements of Med 302.01, and proof that the applicant has passed one of the licensure examinations listed under Med 303.01;

(2) Proof that the applicant has applied to the FCVS with full intent to complete the FCVS process; and

(3) The temporary license fee specified in Table 3.6.1 in Med 306.01.

Source. #4970, eff 11-8-90; ss by #5908, eff 10-7-94; ss by #6576, eff 9-15-97; amd by #7591, eff 11-14-01; amd by #8068, eff 4-10-04; amd by #8096, eff 6-5-04; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a)(1)-(27) and (b)); ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 301.04 Late Renewal and Reinstatement of License.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6576, eff 9-15-97; amd by #7949, eff 9-6-03; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (c)-(e)); ss by #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; moved by #11048 (see Med 401.04)

PART Med 302 QUALIFICATIONS

Med 302.01 Educational Requirements.

(a) Applicants who have graduated from medical schools located in the United States or Canada shall confirm that the medical school is accredited by the Liaison Committee for Medical Education (LCME).

(b) Applicants from medical schools located outside the United States or Canada shall maintain the academic standard recognized by the United Nations World Health Organization (UNWHO) and have their studies confirmed by the Educational Commission for Foreign Medical Graduates (ECFMG).

(c) Applicants shall have completed at least 2 years of postgraduate medical training, postgraduate year 1, postgraduate year 2, in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), or its equivalent which shall include, at a minimum, the following:

(1) Board certification in the applicant's area of specialty; or

(2) Completion of 10 or more years of practice combined with proof of 2 years of post-graduate training outside the United States or Canada.

(d) Applicants who have not completed 2 years of postgraduate training in an institution accredited by ACGME or AOA shall petition the board pursuant to Med 205.01 to determine if the applicant's qualifications meet the requirements of (d) above. Such petitions shall provide any information in addition to that specified in (d) above which the applicant wishes the board to consider in making a determination of equivalency.

Source. #4970, eff 11-8-90; ss by #5908, eff 10-7-94; ss by #6576, eff 9-15-97, EXPIRED: 9-15-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

PART Med 303 EXAMINATIONS

Med 303.01 Examination Requirements.

(a) Applicants for licensure shall have passed one of the following series of examinations:

(1) National Board of Medical Examiners (NBME), parts I, II, and III;

(2) The Federation Licensing Examination (FLEX), components 1 and 2;

(3) The United States Medical Licensing Examination (USMLE), steps 1, 2, Clinical Knowledge and Clinical Skills, and 3;

(4) National Board of Osteopathic Examiners (NBOE) parts I, II, and III; or

(5) The Medical Council of Canada Qualifying Examination (MCCQE).

(b) Applicants who completed one of the following combinations of examinations on or before December 31, 1999, shall be exempt from the requirements of (a) above:

(1) One of each of the following:

a. NBME part I, NBOE part I, or USMLE step 1;

b. NBME part II, NBOE part II, or USMLE step 2 (Clinical Knowledge) and step 2 (Clinical Skills); and

c. NBME part III, NBOE part III, or USMLE step 3;

(2) FLEX component 1 and USMLE step 3; or

(3) One of each of the following:

a. NBME part I, NBOE part I, or USMLE step 1;

b. NBME part II, NBOE part II, or USMLE step 2 (Clinical Knowledge) and step 2 (Clinical Skills); and

c. FLEX Component 2.

(c) Applicants shall pass each examination section within 4 attempts. This examination requirement shall be waived for any applicant who is board certified by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).

(d) A passing grade in each of the required examinations shall be the passing score as defined by each entity that administers the examination.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6576, eff 9-15-97; amd by #8188, eff 10-12-04; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a)(1), (4), and (5)); ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #10125-B, eff 5-9-12; ss by #14070, eff 9-5-24

Med 303.02 Candidates for USMLE Step 3.

(a) Examination candidates who wish to take USMLE step 3 in New Hampshire shall apply directly to the Federation of State Medical Boards (FSMB).

(b) Examination candidates shall not be eligible for licensure until they have met the requirements of Med 302 and Med 303 and filed an application for licensure pursuant to Med 301.03.

(1) Have graduated from a medical school accredited by the LCME or have completed their medical education from an institution located outside the United States and have such studies confirmed by the ECFMG;

(2) Have begun the first academic year of postgraduate training at an institution accredited by the ACGME, the Royal College of Physicians and Surgeons of Canada (RCPSC) or the AOA; and

(3) Have passed USMLE step 1, step 2 (Clinical Knowledge) and step 2 (Clinical Skills) or one of the acceptable combinations of examinations noted in Med 303.01 (b).

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6576, eff 9-15-97; amd by #6906, eff 12-4-98; amd by #8188, eff 10-12-04; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a) and (b)); ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

PART Med 304 - RESERVED

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96; rpld by #6576, eff 9-15-97

PART Med 305 SPECIAL, COURTESY, AND TRAINING LICENSES

Med 305.01 Locum Tenens Licenses.

(a) Applicants who currently hold a full, unrestricted medical license in another state, and who wish to practice in New Hampshire for a limited period of time may apply for a restricted license.

(b) Locum tenens licenses shall be issued by the board subject to the following limitations:

(1) No locum tenens license shall be valid for a period in excess of 100 consecutive calendar days;

(2) Locum tenens licenses shall be valid for practice only at the location specified on the face of the license;

(3) Only one locum tenens license shall be issued to any applicant during any 12 month period; and

(4) Locum tenens licenses shall be posted at the location specified on the face of the license at all times during the period of licensure.

(c) Applicants for locum tenens licensure shall provide, or cause to be provided, the following on or attached to an “Application for Locum Tenens License,” revised 11/2019:

(1) The applicant's name, gender, and residence address;

(2) The address(es) and telephone number(s) of the applicant's prior 3-year practice location(s);

(3) The applicant's date and place of birth;

(4) The name of the institution where the applicant graduated from medical school and the date of graduation;

(5) The name of the institutions where the applicant completed his or her post graduate training and the dates of that training;

(6) Disclosure of whether the applicant has ever previously applied for licensure in New Hampshire and if so, the date of that application;

(7) Disclosure of whether the applicant has ever been subject to disciplinary action by any licensing or certifying agency or by any hospital or health care institution and if so, the dates and circumstances of that action;

(8) Disclosure of whether the applicant has had any medical malpractice suit brought against him or her or has had any claim settled on his or her behalf in the last 10 years;

(9) The state in which the applicant holds current licensure and clearance of that license received directly from the state licensing authority indicating that the applicant’s license covers the dates in which he or she is practicing in New Hampshire;

(10) The name and address of the New Hampshire health care facility at which the applicant will be practicing;

(11) The dates during which the applicant will be practicing and verification of those dates received directly from the New Hampshire healthcare facility at which the applicant will be practicing;

(12) The signature of the applicant; and

(13) Original letters of reference, on letterhead and addressed to the board, from:

a. The chief medical officer or president of the medical staff in every hospital in which the applicant currently holds staff privileges; or

b. Letters of reference from 2 practicing physicians.

(d) Applicants shall include the application fee required in Table 3.6.1 in Med 306.01.

Source. #4970, eff 11-8-90; amd by #5838, eff 6-17-94; amd by #5908, eff 10-7-94; ss by #6576, eff 9-15-97; amd by #6906, eff 12-4-98; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a), (c), and (d)); ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 305.02 Special Camp and Visiting Professor License.

(a) Physicians wishing to practice medicine at a New Hampshire licensed camp facility shall apply for a camp license by submitting an “Application for a Special License/Camp,” revised 11/2019, which includes the information contained in (e) below.

(b) A holder of a camp license is limited to:

(1) Practice only at the specified licensed camp facility;

(2) Practice only on specific dates; and

(3) Practice which does not include holding hospital privileges in New Hampshire.

(c) Physicians wishing to practice medicine, perform surgery, or do other procedures for the education and enlightenment of the medical community shall apply for a visiting professor license by submitting an “Application for Special License/Visiting Professor,” revised 11/2019, which includes the information contained in (e) below.

(d) A holder of a visiting professor license is limited to:

(1) Practice only at a specified licensed New Hampshire hospital in an educational capacity, whether or not direct patient care is provided;

(2) Practice only on specific dates; and

(3) Practice for which the patient is not being charged, provided that:

a. The hospital or facility may charge the patient for its services and for the services of other health professionals;

b. The hospital or facility shall not charge the patient for the services rendered by the visiting professor; and

c. The physician abides by the American Medical Association (AMA) Code of Ethics Rule 6.10 on billing with multiple providers.

(e) Applicants for either a camp or visiting professor license shall provide, or cause to be provided, the following on or attached to the applicable form above:

(1) The applicant's name and residence address;

(2) The address(es) and telephone number(s) of the applicant's practice locations for the previous 3 years;

(3) The applicant's date of birth, place of birth, and social security number;

(4) The name of the institution where the applicant graduated from medical school and the date of graduation;

(5) The name of the institutions where the applicant completed his or her post graduate training and the dates of that training;

(6) Disclosure of whether the applicant has ever previously applied for licensure in New Hampshire and if so, the date of that application;

(8) Disclosure of whether the applicant is board certified and if so, the specialty in which that certification is held;

(9) The name of the New Hampshire licensed facility at which the applicant will be practicing;

(10) The dates during which the applicant will practice and verification of those dates received directly from the New Hampshire licensed facility;

(11) The state in which the applicant currently holds a license and clearance of that license received directly from the state licensing authority indicating that the applicant’s license covers the dates in which he or she is practicing in New Hampshire; and

(12) The signature of the applicant.

(f) Applicants shall include the application fee for special license required in Table 3.6.1. in Med 306.01.

Source. #4970, eff 11-8-90; ss by #5838, eff 6-17-94; ss by #6576, eff 9-15-97, EXPIRED: 9-15-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 305.03 Administrative License.

(a) An applicant for an administrative license shall complete the same application and meet the same requirements as an applicant for unrestricted permanent licensure. However, the applicant for an administrative license shall not be required to show that the applicant has been engaged in the practice of clinical medicine.

(b) The holder of an administrative license shall not engage in clinical medicine.

(c) The holder of an administrative license shall pay the same fees and meet all other requirements for issuance and renewal of that license as a licensee with a unrestricted permanent license.

Source. #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

Med 305.04 Resident Training License.

(a) The board shall issue training licenses, pursuant to RSA 329:14, V, to persons pursuing post graduate training in a health facility approved for this purpose by the ACGME or the AOA.

(b) Training licenses shall only be valid for the practice of medicine when limited to:

(1) Practice under the auspices of the training program and in healthcare facilities which are affiliated with that program;

(2) Practice under the direct supervision of a medical officer of the training program who shall be a physician licensed in New Hampshire; and

(3) Practice during the dates specified by the training license, or until such time as the licensee separates from the training program for any reason.

(c) Applicants for resident training license shall provide, or cause to be provided, the following on or attached to the “Application for Training License Resident and Graduate Fellows,” revised 11/2019:

(1) Name and current residence address and telephone number of the applicant;

(2) Date and place of birth;

(3) Name of the medical school attended, the dates attended, and the year of graduation;

(4) Name of the hospital where the applicant will be training;

(5) Name of the ACGME or AOA accredited training program in which the applicant is enrolled and the signature of the director of graduate medical education certifying that the applicant is currently enrolled and that the information on the application matches that on file with the training program;

(6) Beginning and ending dates of the training program in which the applicant is enrolled and the signature of the program director certifying that the applicant is approved for entry into that specific program;

(7) Certified copy of the ECFMG certificate held by the applicant if the applicant graduated from a medical school outside the United States or Canada;

(8) Certification received directly from the NBME that the applicant has taken and passed USMLE steps 1, step 2 (Clinical Knowledge), and 2 (Clinical Skills);

(9) Disclosure of whether the applicant has ever previously resigned from a graduate medical education program or been reprimanded, sanctioned, restricted or disciplined in any way by such a program;

(10) Disclosure of whether the applicant has ever held a license in any state and if so, clearance of that license received directly from the licensing authority;

(11) Disclosure of whether the applicant has ever been convicted of a felony, and if so the circumstances involved;

(12) Disclosure of whether the applicant has ever been dependent on alcohol or drugs and if so, a description of the treatment program pursued; and

(13) The signature of the applicant.

(d) Applicants shall include the resident training license fee required in Table 3.6.1. in Med 306.01.

(e) Resident training licenses shall expire 4 years from the date of issuance.

(f) Holders of training licenses shall notify the board immediately upon separation from the residency program if training is discontinued prior to the expected termination date specified in (c)(6) above.

Source. #4970, eff 11-8-90; amd by #5223, eff 9-12-91; ss by #6576, eff 9-15-97; amd by #7340, eff 8-3-00; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a), (b), (c)(1)-(4), (c)(6)-(13)and (d)); ss by #8945, eff 7-18-07; ss and renumbered by #9900, eff 4-12-11 (from Med 305.03) (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

PART Med 306 FEES

Med 306.01 Fees. The fees required by the board under RSA 329 shall be as set forth in table 3.6.1 below:

Table 3.6.1 Fees

Type	Fee
Temporary License	$ 50
Application for Unrestricted Permanent Licensure	$300
Renewal Application for Unrestricted Permanent Licensure	$350
Application for Administrative Licensure	$300
Renewal Application for Administrative Licensure	$350
Late Renewal Application for Unrestricted Permanent Licensure or Administrative 000000000000Licensure within 90 days of expiration date pursuant to RSA 329:16-e	$700
Reinstatement Application for Unrestricted Permanent or Administrative Licensure	$350
Application for Courtesy (Locum Tenens) License	$150
Application for Special License	$ 75
Application for Resident Training License	$ 50
Application for Physician Assistant Licensure	$115
Renewal Application for Physician Assistant Licensure	$ 65
Late Renewal Application for Physician Assistant Licensure within 90 days of expiration date	$130
Reinstatement Application for Physician Assistant Licensure	$115

Duplicate license pocketcard	$ 10
Duplicate wall certificate	$ 25
Verification of license	$ 20

Lists of Licensees:
All licensed physicians on paper or labels	$100
All licensed physicians on disk or by e-mail	$ 50
Licensed physicians practicing in N.H. on paper or labels	$ 50
Licensed physicians practicing in N.H. on disk or by e-mail	$ 25
Licensed physicians in just one specialty, county, city or town on paper or labels	$ 20
Licensed physicians in just one specialty, county, city or town on disk or by e-mail	$ 10

Source. #4970, eff 11-8-90; amd by #5223, eff 9-12-91; ss by #5908, eff 10-7-94; ss by #6576, eff 9-15-97, amd by #7312, eff 6-24-00; ss by #7949, eff 9-6-03; ss by #8037, eff 2-10-04; amd by #8068, eff 4-10-04; ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 300); ss by #12972, eff 1-10-20

CHAPTER Med 400 RENEWAL, CONTINUING EDUCATION AND ONGOING REQUIREMENTS

REVISION NOTE #1:

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 400, Document #9900 readopted with amendments selected rules in Parts Med 401, 403, and 412, and readopted with amendments all the rules in Parts Med 402, 407, 408, 409, and 410. Document #9900 also adopted Med 403.03 on notice of action, readopted and renumbered Med 403.03 on noncompliance as Med 403.04, and adopted Part Med 413 on settlement agreements and consent orders. The source note for Med 403.04 indicates the former rule number Med 403.03, and the document numbers and effective dates apply to the rule under the former number.

REVISION NOTE #2:

Document #14021-B, effective 9-8-24, repealed Med 408.01 titled “Initiation of Action” and Med 408.02 titled “Action on Complaints” in Part Med 408 titled “Disciplinary Matters”. Med 408.03 titled “Disciplinary Sanctions” was renumbered, but not readopted, as Med 408.01 by Document #14021-B.

The prior filings affecting the repealed rules included the following documents:

(See Revision Note #1 at chapter heading for Med 500)

#8945, eff 7-18-07

#9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400)

#12972, eff 1-10-20

PART Med 401 RENEWAL OF LICENSE

Med 401.01 Expiration of License. Each license shall automatically expire on July 1 of the year in which the licensee's renewal is set to occur, unless the licensee has applied to the board for renewal of license by June 30 of the year in which the licensee’s renewal is set to occur.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97; ss by #7949, eff 9-6-03; ss by #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 401.02 Renewal of License. Any licensee wishing to renew a license shall submit:

(a) The renewal application supplied by the board on or before June 30 of the year in which the licensee's renewal is set to occur;

(b) The fee specified by Med 306.01; and

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97; amd by #7949, eff 9-6-03; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraph (c)); ss by #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 401.03 Renewal Application.

(a) The licensee shall complete and file a renewal application provided by the board and tender the renewal fee specified by Med 306.01.

(b) The applicant shall include on the renewal form:

(1) The name and business address and telephone number, business e-mail address and business fax number of renewing licensee;

(2) The home address and telephone number of renewing licensee;

(3) Whether the applicant is currently in active practice;

(4) What specialty the licensee practices and whether the applicant is board certified;

(5) A listing of other states in which the licensee currently holds an active license;

(6) A listing of all hospitals in which the applicant currently holds privileges;

(7) The applicant’s US Drug Enforcement Agency (DEA) license number, the state of issuance and the expiration date;

(8) Whether the applicant has been the subject of disciplinary action, or has been denied a license or surrendered a license in any state or jurisdiction during the past 24 months;

(9) Whether the applicant is currently or has in the past been monitored or treated by a private, state, medical society, or hospital physician health program other than through the NH board approved physician health program or has been restricted in any manner by the US Drug Enforcement Agency (DEA);

(10) Whether the applicant is currently suffering from any condition, mental or physical, that impairs the applicant’s judgment or that would otherwise adversely affect his or her ability to practice medicine in a competent, ethical and professional manner;

(11) Whether the applicant has been found guilty or pleaded no contest to any felony or misdemeanor charges during the past 24 months;

(12) Whether the applicant has been found guilty or pleaded no contest to any driving under the influence violations or has been subject to an administrative finding for driving under the influence in the past 24 months;

(13) Whether the applicant has been the subject of any investigation or disciplinary proceeding or been reported to the National Practitioners Data Bank (NPDB) during the past 24 months;

(14) Whether the applicant has lost or been denied any hospital privileges or had such privileges restricted in any way during the past 24 months;

(15) Whether any malpractice claims have been made against the applicant during the past 24 months;

(16) If the applicant has answered in the affirmative to any inquiries under (7) - (14), a written explanation of the circumstances which caused the applicant to respond in the affirmative;

(17) Whether the applicant has an ownership interest in an entity which provides diagnostic or therapeutic services. Pursuant to RSA 125:25-c, the applicant shall list all diagnostic and therapeutic services provided by any entity in which the applicant has an ownership interest;

(18) The last 4 digits of the applicant’s social security number on the line provided below the following preprinted statement: "The board will deny licensure if you refuse to submit the last 4 digits of your social security number (SSN). Your professional license will not display your SSN. Your SSN will not be made available to the public. The board is required to obtain your social security number for the purpose of child support enforcement and in compliance with RSA 161-B:11. This collection of your social security number is mandatory."; and

(19) The applicant's signature and the date of the applicant's signature, certifying the accuracy of his or her responses under the penalty for unsworn falsification pursuant to RSA 641:3.

(c) An application for renewal which is not completed in its entirety or which does not include payment of the renewal fee shall be returned to the licensee unprocessed with a letter stating the reason(s) for the return.

(d) Pursuant to RSA 126-A:5, XVIII-a(a) and RSA 330-A:10-a, licensees shall complete, as part of their renewal application, the New Hampshire division of public health service’s health professions survey issued by the state office of rural health and primary care, department of health and human services.

(e) The board shall provide licensees with the opportunity to opt out of the survey. Written notice of the opt-out opportunity shall be provided with the renewal application. The opt out form shall be available on the NH state office of rural health and primary care website and the board’s website.

(f) Licensees choosing to opt-out of the survey shall submit a completed opt out form described in He-C 801.04, to the state office of rural health and primary care, department of health and human services, via one of the following:

(1) Mail;

(2) Email; or

(3) Fax.

(g) Information contained in the opt-out forms shall be kept confidential in the same accord with the survey form results, pursuant to RSA 126-A:5, XVIII-a(c).

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97; amd by #7949, eff 9-6-03; amd by #8096, eff 6-5-04; amd by #8429, eff 9-13-05; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (paragraphs (a), (b)(2)-(6), (14) and (15), now (15) and (17), and (c)); ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); amd by #10876, eff 7-8-15; amd by #11048, eff 3-2-16; ss by #12972, eff 1-10-20

Med 401.04 Late Renewal and Reinstatement of License.

(a) Any licensee who allows his or her license to lapse by reason of error, omission, nonpayment of the biennial renewal fee, or failure to submit proof of completion of continuing education may request late renewal within 90 days following the expiration of the license by providing a written request for late renewal which demonstrates:

(1) An inadvertent failure to renew the license; and

(2) A statement that the licensee has not continued to practice during the period of expiration.

(b) If a license expires or lapses as a result of a licensee being ordered to active duty with the armed services or the National Guard, the licensee shall have one year from the date of discharge or release from the armed service to apply for renewal and all late fees shall be waived.

(c) Any licensee whose license has expired by reason of error, omission, or neglect to pay the biennial renewal fee beyond 90 days after expiration of the license, whose license has been included on the inactive list pursuant to RSA 329:16-h, or whose license has been suspended or revoked by the board shall be eligible to apply for reinstatement barring any order or agreement to the contrary, at the time of their original disciplinary action, by filing the application specified in (d) below.

(d) Applicants for reinstatement shall provide, pursuant to (b) above, or cause to be provided, on a “Physician Reinstatement Application,” revised 11/2019:

(1) The same information required in Med 301.03 (a) (1-27) excluding Med 301.03 (a) (4-8) and Med 301.03 (a) (24); and

(2) Proof of completion of continuing education which meets the requirements of Med 402.01.

(e) Applicants for reinstatement shall pay the reinstatement fee specified in Med 306.01 Table 3.6.1.

(f) Applicants for reinstatement of a suspended or revoked license shall have the burden of persuading the board that the actions which were the basis for the original disciplinary action have been satisfactorily remediated, that no additional charges of misconduct are pending, and that the applicant meets all the character and competency requirements of an applicant for initial licensure.

Source. #4970, eff 11-8-90; amd by #5223, eff 9-12-91; ss by #6517, eff 5-30-97; ss by #7949, eff 9-6-03; ss by #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss and renumbered by #11048, eff 3-2-16 (formerly Med 401.03); ss by #12972, eff 1-10-20

Med 401.05 Denial of Renewal.

(a) Renewal of a license shall be denied if, after notice and an opportunity for hearing, there is evidence to establish that:

(1) Continuing medical education has not been fulfilled pursuant to Med 402;

(2) The applicant has failed to provide complete or accurate information on the renewal application;

(3) The applicant has committed any unethical act for which discipline could be imposed under RSA 329:17, VI;

(4) If the applicant has previously surrendered a license under Med 412.03(a) and has failed to comply with any necessary requirements of Med 412.02;

(5) Reasons for which an initial application could be denied under RSA 329:14, II; or

(6) The applicant failed to register for the Controlled Drug Prescription Health and Safety Program pursuant to RSA 318-B:33, II and Ph 1503.01 (a).

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; amd by #10876, eff 7-8-15; paras. (a)(1)-(3) EXPIRED: 7-18-15; amd by #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; amd by #11048, eff 3-2-16

PART Med 402 CONTINUING MEDICAL EDUCATION

Med 402.01 Continuing Medical Education.

(a) All licensed physicians shall complete 100 hours of approved continuing medical education (CME) requirements every 2 years, 40 hours of which shall be in Category I, and no more than 60 credit hours of which shall be in Category II.

(b) Category I courses shall be those courses or activities which satisfy the current requirements of the American Medical Association's Physician's Recognition Award program (PRA), as set forth in the AMA's current PRA bulletin, or which are fully equivalent to these requirements and satisfy the CME requirements of the New Hampshire Osteopathic Association. Such courses shall be considered approved for purposes of Med 402.

(c) Licensees shall acquaint themselves with the requirements of the PRA program or the New Hampshire Osteopathic Association, and may obtain a copy of the AMA's PRA bulletin by contacting the:

American Medical Association

AMA Plaza

330 N Wabash Avenue, Suite 39300

Chicago, Illinois 60611-5885

Telephone Number (312) 464-4677.

(d) Licensees who were previously licensed in another state may continue to take continuing medical education courses in accordance with a previously established PRA renewal cycle.

(e) Each year of full-time training in a residency accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), each accredited fellowship taken in the United States shall be awarded 50 Category I CME credit hours.

(f) Completion of a degree in a medically-related field shall be awarded 25 Category I credit hours as stated on official documentation.

(g) Passage of an American Specialty Board examination, whether for initial eligibility or for recertification, shall be accepted as the equivalent of 100 category I CME credit hours.

(h) Annual Certificates of Competency/Recertification exams shall be awarded credits as stated on official documentation from the relevant board certifying agency.

(i) Licensees who show proof of being up to date on a program of maintenance of certification by the physician’s specialty organization, deemed adequate by the board, shall be considered to have completed their continuing medical education requirement for the preceding 2 years.

(j) Category II credit hours shall be awarded on the basis of actual time spent on the educational aspects of the course or activity.

(k) Category II CME courses shall include the following courses and activities:

(1) CME lectures and seminars not designated as Category I;

(2) Time spent teaching medical courses to practicing physicians, residents, physician assistants, physician assistant students, preceptees, medical students, or allied health professionals;

(3) Presentation or publication of a scientific paper to a medical audience or in a medical journal;

(4) Unsupervised learning activities of the type described in Med 402.01(l); and

(5) Meritorious learning experiences which provide a unique educational benefit to a licensee and meet the requirements of Med 402.01(m).

(l) Allowable non-supervised Category II CME activities shall include:

(1) Self-instruction, including journal reading and the use of television and other audiovisual materials;

(2) The education a physician received from a consultant;

(3) Participation in programs concerned with review and evaluation of patient care; and

(4) Time spent in a self-assessment examination, not including examinations and quizzes published in journals.

(m) Meritorious learning experiences for which Category II CME credit hours shall be awarded shall be documented by a narrative report demonstrating the presence of the following features:

(1) The educational need served by the activity;

(2) A description of the activity, including the educational content and the manner in which the learning occurred;

(3) The time spent on the project, itemized to show the total time spent and the time spent on the direct educational aspects of the project for which CME credit is claimed; and

(4) The number of credit hours claimed, which number shall not exceed the number of full hours actually spent on the direct educational aspects of the project and shall exclude transportation to and other preliminary time expended.

(n) A licensee may claim 10 Category II CME credit hours for the presentation or publication of a scientific paper as of the date of the publication or presentation, and one CME credit hour for each full hour of actual participation in courses or activities recognized in Med 402.01(k)(1), (2) or (4), upon successful completion of the course or activity.

(o) Pursuant to RSA 318-B:40, all licensees required to register with the controlled drug prescription health and safety program shall complete 3 credit hours of approved online continuing education or pass an online examination in the area of pain management or addiction disorders.

(p) Licensees may satisfy the requirements in (o) above by taking CMEs that:

(1) Are AMA PRA Category 1 credits or AACME accredited; and

(2) Reference opioid prescribing for the management or treatment of pain or opioid use disorders in the course abstract and learning objectives.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400) ; ss by #12972, eff 1-10-20

Med 402.02 Reporting Requirements.

(a) Licensees shall submit a biennial CME report using a form which shall be provided to him or her prior to December 31st of the final year of their cycle. This form provided by the board, or an independent contractor designated by the board, shall be completed and returned on or before February 28^th of the physician’s renewal year. Failure of any licensees to receive this form shall not relieve them of the obligation to comply with these rules. This form shall be a necessary part of the licensee's biennial license renewal application.

(b) The New Hampshire Medical Society (NHMS) shall audit and investigate the annual continuing education reports of each licensed physician, and shall prepare a written report which records the credits awarded to each licensee during the 2 year period applicable to each licensee. NHMS shall report to the board the failure of any licensee to fulfill the CME requirements. Unless excused by the board for good cause shown, including accident, illness, hardship, or other circumstances beyond the control of the licensee, the board shall issue a late fee if CMEs are not completed by December 31 of the final year of their cycle.

(1) The applicant's name;

(2) The applicant's business address and telephone number;

(3) Copies of documents which establish that the requirements of Med 402.01 have been met;

(4) In the case of all Category I courses for which CME credit is claimed, copies of documents which establish that the course satisfies the requirements of Med 402.01(b) and include the following information:

a. The name and headquarters address of the sponsor and any co-sponsor;

b. The course title and the fields of medicine involved;

c. A description of the type of course and the learning activities involved;

d. The inclusive dates of attendance; and

e. The number of credit hours certified for the activity;

(5) In the case of Category II CME activities, copies of documents which establish the following information:

a. The full name of the organizational sponsor or co-sponsor;

b. The sponsor or co-sponsor's headquarters office address and telephone number;

c. The program title and a description of the program's content; and

d. The inclusive dates of the licensee's attendance.;

(6) In the case of claimed medical teaching activities, copies of documents which establish the following information:

a. The type of educational program which was conducted and a description of the exact role the licensee played in that program;

b. The name, business address, and telephone number of the institution or organization sponsoring the education program;

c. The subject covered by the education program;

d. The type and educational level of students attending the educational program; and

e. The inclusive dates of the licensee's participation in the educational program;

(7) In the case of claimed publications or presentations, copies of documents which establish the following information:

a. The title of the paper or article presented or published;

b. The name, sponsor, and location of the conference or the name, business address, and telephone number of the medical journal involved; and

c. The date of the presentation or publication; and

(8) In the case of claimed non-supervised CME activities, copies of documents which establish the following information:

a. The type of material or activity involved;

b. The title and a thorough description of the type of activity involved;

c. The sponsor of the activity involved; and

d. The inclusive dates of the licensee's participation in the activity involved.

Source. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #12972, eff 1-10-20

Med 402.03 Waiver of CME Deadlines.

(a) The board shall consider petitions for waiver of CME deadlines which meet the requirements of Med 212.01, if:

(1) Such petitions are filed before the expiration of the 2 year CME period in question;

(2) Late filing is justified by a showing of good cause and not merely neglect; and

(3) A specific timetable is proposed for completing specific courses which will meet the petitioner's CME's deficiency.

(b) Good cause under (a)(2) above shall include, but not be limited to, illness, death of a family member, or other reason beyond the control of the petitioner.

(c) If the petition for waiver of CME deadline is approved by the board, the board shall allow up to a 6-month extension to complete the CME requirements.

Source. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); ); ss by #12972, eff 1-10-20

PART Med 403 ONGOING REQUIREMENTS

Med 403.01 Severance of Connection. All licensees shall notify the board in writing within 30 days after they sever connection with any commitment to practice medicine for any reason, either personal, professional, or disciplinary.

Source. #4970, eff 11-8-90; amd by #5223, eff 9-12-91; amd by #5402, eff 5-22-92; ss by #6517, eff 5-30-97, EXPIRED:5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss by #10331, eff 5-8-13; ss by #13628, eff 7-2-23

Med 403.02 Change of Address.

(a) All licensees and applicants for licensure shall notify the board of any change in home or business address, including any change in e-mail address, in writing within 30 days of such change.

(b) A licensee whose mail is returned to the board by the post office due to a wrong address shall be issued a letter of concern pursuant to RSA 329:17, VII-a.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96

New. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: l 12-13-06

New. #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); ss by #10125-B, eff 5-9-12, EXPIRED: 5-9-22

New. #13628, eff 7-2-23

Med 403.03 Notice of Action. All licensees and applicants for licensure shall notify the board of any notice of complaint, legal action, or asserted claim for medical injury, or disciplinary action received from this or any other jurisdiction or from any health care facility licensed by the State of New Hampshire within 30 days of receipt by the licensee. Licensees shall also notify the board of any misdemeanor or felony criminal convictions within 30 days of the trial court disposition of the case.

Source. #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #12972, eff 1-10-20

Med 403.04 Noncompliance. Failure to complete continuing medical education requirements or to submit documentation of such completion in a timely fashion, shall result in denial of license renewal.

Source. #6517, eff 5-30-97, EXPIRED: 5-30-05

New. #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06

New. #8945, eff 7-18-07; ss and renumbered by #9900, eff 4-12-11 (from Med 403.03) (see Revision Note #1 at chapter heading for Med 400); ss by #12972, eff 1-10-20

Med 403.05 Letters of Good Standing. Licensees who wish to request a license verification or a letter of good standing from the board shall complete and submit a “Letter of Good Standing Request Form”, revised 11/2019, to the board along with the $20.00 fee.

Source. #12972, eff 1-10-20

PART Med 404 DISCIPLINARY SANCTIONS - EXPIRED

REVISION NOTE:

Although Document #6517, effective 5-30-97, had included a repeal of Parts Med 404 through Med 406, these rules had already expired on 11-8-96. Parts Med 404 through Med 406 had been last filed in Document #4970, effective 11-8-90, and no repeal was necessary.

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96 (See Revision Note at part heading for Med 404)

PART Med 405 LICENSE SURRENDER WHEN DISCIPLINARY ALLEGATIONS ARE PENDING - EXPIRED

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96 (See Revision Note #1 at part heading for Med 404)

PART Med 406 UNETHICAL CONDUCT - EXPIRED

Source. #4970, eff 11-8-90, EXPIRED: 11-8-96 (See Revision Note #1 at part heading for Med 404)

PART Med 407 PROFESSIONALS’ HEALTH PROGRAM

Med 407.01 Definitions.

(a) "Contract" means a contract voluntarily entered into between a licensee and a program that has been approved pursuant to Med 407.02, which contains requirements designed to protect the public from harm.

(b) “Director” means a person designated by a program to oversee the program of a licensee under the terms of the contract or to provide physical or mental care to said licensee.

(d) "Program" means an organization approved by the board to design and provide dependable oversight programs for licensees impaired or potentially impaired by physical or mental illness including addiction to alcohol and other drugs.

(e) "Therapy" means a patient-therapist relationship prescribed by the contract for the purpose of treatment.

(f) "Treatment standards" means the current standards of practice established by medical specialties recognized by the American Board of Medical Specialties.

Source. #5402, eff 5-22-92; ss by #5690, eff 8-26-93; rpld by #6517, eff 5-30-97; ss by #7150, eff 12-7-99; ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); ss by #12972, eff 1-10-20

Med 407.02 Approved Professionals’ Health Program.

(a) Only programs which have been approved by the board shall be recognized as an acceptable vehicle for monitoring the treatment, rehabilitation, or improvement of a licensee, or for the protection of the public.

(b) Only programs which meet the minimum standards of Med 407.03 shall be approved by the board, which shall maintain a listing of approved programs.

(c) A program may obtain general approval from the board by filing a petition with the board requesting approval and demonstrating that the program complies with the standards of Med 407.03.

(d) General approval of a program shall not constitute approval of the appropriateness of the program in the case of any given licensee.

(e) A licensee's participation in a program shall not be disclosed to the board unless the licensee violates the terms of his or her contract or requests such consideration by motion or signed authorization.

(f) Individual programs, and motions requesting approval of such programs, shall be kept confidential except to the extent they are incorporated into public settlement agreements or disciplinary actions, or become evidence in disciplinary hearings in situations where a violation of the terms of the contract is relevant to the misconduct or disciplinary action at issue.

(g) Individual licensees who have been accepted into an approved program shall not be relieved of their obligation to provide relevant information regarding their treatment for physical or mental disability, disease, disorder, or condition or substance abuse on their annual license renewal applications.

Med 407.03 Standards for Approved Programs.

(a) Monitors, directors, and therapists involved in an approved program shall:

(1) Be licensed or certified health care practitioners;

(2) Fully disclose in writing any disciplinary action, including reprimand or restriction, taken against them by any licensing, certifying, or credentialing agency or professional society; and

(3) Be readily accessible to the licensee.

(b) An approved program shall not assign a monitor, director, or therapist to a licensee's case if there is any question of that person's objectivity, dependability, or commitment.

(c) Disciplinary action shall disqualify a person from serving as a monitor, director, or therapist if the discipline involved conduct similar in nature to the issues being monitored and the discipline occurred within 5 years of the date he or she would provide services to the licensee under the auspices of the program.

(d) An approved program shall require, to the maximum extent possible, that participating licensees make full disclosure of all relevant facts to the monitor, and provide the monitor with continuing, unrestricted access to the licensee's medical records and any other records of the licensee, except for patient records, relevant to the condition or conduct being addressed by the program.

(e) An approved program shall employ written contracts which contain specific and objectively determinable requirements to be met by the participating licensees. The contract and any amendments or modifications thereto shall be signed by the licensee and the director.

(f) An approved program which addresses a treatable or modifiable condition of a participating licensee shall employ a written contract which includes a detailed treatment or corrective action plan which:

(1) Identifies the licensing requirements of treatment providers;

(2) Specifies the frequency of treatment;

(3) Requires reports to the board administrator from director(s) regarding relapse or other contract violations; and

(4) Describes in detail if required urine screening or other physical monitoring is included in the plan, such monitoring provisions and the licensee's obligations thereunder.

(g) An approved program shall employ written contract with participating licensees which requires the program to keep detailed records of the licensee's participation in all aspects of the program.

(h) An approved program shall employ a written contract with participating licensees which require the program to inform the board immediately when he or she verifies that the licensee has not met any of the program requirements contained in his or her contract.

(i) An approved program shall employ a written contract with participating licensees which authorizes the monitor to keep records concerning the licensee's participation in the program confidential unless they are released by the licensee, except in cases where the licensee has been reported to the board pursuant Med 407.03(h) for violating a requirement of the contract. In such cases, the monitor's records shall be made available to the board upon request and the monitor shall cooperate with the board in any disciplinary action undertaken by the board which relates to the condition or conduct addressed by the licensee's contract.

(j) An approved program shall include no language in any contract with a licensee or make representations to any person which indicates:

(1) The monitor is an agent of the board or is performing functions of the board;

(2) Participation in the approved program will determine whether disciplinary action is taken by the board or the severity of such discipline; or

(3) The board is financially or otherwise responsible for any aspect of the licensee's participation in the program.

(k) An approved program may advertise its approved status and the fact that it is an appropriate vehicle for licensees who:

(1) Have been directed to participate in such a program by a board disciplinary order or agreement; or

(2) Wish to propose to the board that their participation in a monitoring program be considered by the board in disposing of pending or potential disciplinary allegations.

Source. #5402, eff 5-22-92; ss by #5690, eff 8-26-93; amd by #5838, eff 6-17-94; rpld by #6517, eff 5-30-97; ss by #7150, eff 12-7-99; ss by #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); ss by #12972, eff 1-10-20

PART Med 408 DISCIPLINARY MATTERS

Med 408.01 Disciplinary Sanctions.

(a) Other than immediate license suspensions authorized by RSA 329:18-b, the board shall impose disciplinary sanctions only:

(1) After prior notice and an opportunity to be heard; or

(2) Pursuant to a mutually agreed upon settlement or consent decree.

(b) After finding that misconduct has occurred, the board shall impose any disciplinary sanction authorized by RSA 329:17, VI, if, after considering the factors in (c) below, the board determines that disciplinary sanctions are warranted.

(1) The seriousness of the offense;

(2) The licensee's prior disciplinary record;

(3) The licensee's state of mind at the time of the offense;

(4) The licensee's acknowledgment of his or her wrongdoing;

(5) The licensee's willingness to cooperate with the board's investigation;

(6) The purpose of the rule or statute violated;

(7) The potential harm to public health and safety;

(8) The deterrent effect upon other practitioners; and

(9) The nature and extent of the enforcement activities required of the board as a result of the offense.

(d) Copies of board orders imposing disciplinary sanctions, including all settlement agreements or consent decrees, shall be sent to the licensing body of each state in which the licensee is licensed and to such other entities, organizations, associations, or boards as are required to be notified under applicable state or federal law. The board administrator shall also issue a press release to news organizations providing a summary of any and all disciplinary actions taken.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 400); ss by #12972, eff 1-10-20; renumbered by #14021-B (formerly Med 408.03)

PART Med 409 IMMEDIATE LICENSE SUSPENSION IN SPECIAL CIRCUMSTANCES

Med 409.01 Suspension Pending Completion of Disciplinary Proceedings.

(a) When the board receives information indicating that a licensee has engaged in or is likely to engage in professional conduct which poses an immediate danger to life or health, the board shall issue an order pursuant to RSA 329:18-b which sets forth the alleged misconduct and immediately suspends the license for up to 120 days pending completion of an adjudicatory proceeding on the specified issues, which hearing shall be commenced within 10 days.

(b) No hearing date established in a disciplinary proceeding commenced under Med 409.01(a) shall be postponed at the request of the licensee unless the licensee also agrees to continue the suspension period pending issuance of the board's final decision.

(c) To effectuate (b) above, the licensee may sign a preliminary agreement not to practice as proposed by hearing counsel which shall include the following stipulations:

(1) The licensee recognizes that professional misconduct allegations are now pending against the licensee before the board; and

(2) The licensee agrees that during the pendency of the investigation and until the board issues a further order, the licensee will not:

a. practice medicine;

b. treat or see patients; or

c. write prescriptions.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #12972, eff 1-10-20

PART Med 410 DISCIPLINARY ACTION TAKEN IN OTHER JURISDICTIONS

Med 410.01 Reciprocal Discipline.

(a) When the board receives notice that a licensee has been subjected to disciplinary action related to professional conduct by the licensing authority of another jurisdiction, the board shall issue an order directing the licensee to demonstrate why reciprocal discipline should not be imposed in New Hampshire.

(b) The board shall impose any disciplinary sanction authorized by RSA 329:17, VI or RSA 329:17-c in a disciplinary proceeding brought under this rule, but shall provide notice to the licensee if, in considering the factors on Med 408.03, it intends to consider sanctions which exceed those imposed by other jurisdictions.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #12972, eff 1-10-20

PART Med 411 ADMINISTRATIVE FINES

Med 411.01 Liability For Fines.

(a) Adjudicative procedures seeking the assessment of an administrative fine shall be commenced against any person subject to such fines or penalties under any provision of RSA 329:9, XV, when the board possesses evidence indicating that a violation has occurred.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 411.02 Criteria For Setting Fines.

(a) Administrative fines shall be assessed and compromised in accordance with the factors stated in Med 408.03(c) and the following additional considerations:

(1) The cost of any investigation or hearing conducted by the board; and

(2) The licensee's ability to pay a fine assessed by the board.

(b) Administrative fines imposed by the board shall not exceed $3,000 per offense or, in the case of continuing violations, $300 for each day that the violation continues to a maximum fine of $100,000, whichever is greater.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16; ss by #13083, eff 8-7-20

Med 411.03 Procedures for Assessing and Collecting Fines.

(a) Payment of a fine shall be included among the options available for settling disciplinary allegations,

and shall be included among the types of disciplinary sanctions imposed after notice and hearing.

(b) In cases where the board initially intends to limit disciplinary sanctions against a licensee to an administrative fine, or in cases involving nonlicensees, the board shall issue a "notice of apparent liability" describing the alleged offense, stating the amount of the assessed fine, and notifying the alleged offender that her or she must pay or compromise the fine by a date certain or request that an administrative hearing be held. If a hearing is requested, the notice of apparent liability shall be withdrawn and a notice of hearing shall be issued. In such hearings, the board's disciplinary options shall not be limited to the assessment of an administrative fine.

(c) Nonpayment of a fine by a licensee in contravention of an order, agreement or promise to pay, shall be a separate ground for discipline by the board or a basis for denying a subsequent license application.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

PART Med 412 VOLUNTARY SURRENDER OF A LICENSE

Med 412.01 Procedure for Surrendering A License. License surrender may be requested by a licensee at any time by filing a petition or motion with the board.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 412.02 Effect of Voluntary License Surrender.

(a) A licensee who voluntarily surrenders a license shall retain no right or privilege in a New Hampshire license except as specifically set forth in a board order or settlement agreement authorizing the voluntary surrender.

(b) A licensee who reapplies for licensure in New Hampshire after a voluntary surrender shall have the burden of proving compliance with all of the requirements then in effect for new applicants, including professional character requirements.

(c) Surrender or non-renewal of a license shall not preclude the board from investigating or completing a disciplinary proceeding based upon the licensee's professional conduct while the license was still in effect. Such investigations and proceedings shall be handled in the same manner as other disciplinary investigations and proceedings.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07, EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 412.03 Terms of Voluntary Surrender.

(a) A licensee who wishes to surrender his or her license as part of a settlement of a misconduct allegation, or allegations, shall reach a written settlement agreement with hearing counsel, who, in turn, shall offer it to the board.

(b) Any license surrender offered to the board under (a), above, that occurs after information is provided to the board under RSA 329:17, I, II, III, IV, or V, shall include the following information:

(1) That the board has commenced an investigation against the licensee pursuant to RSA 329:18;

(2) That the license surrender has occurred in settlement of pending allegations;

(3) Whether the board has issued a notice of hearing;

(4) That the license surrender shall be reported as discipline;

(5) A general statement of the allegations by hearing counsel;

(6) A statement that the disposition of the disciplinary allegations shall be resolved before any future application is submitted by the licensee in New Hampshire; and

(7) A waiver by the licensee that any issues of speedy hearing or spoliation of the evidence shall be waived should the licensee later apply for a license from the board.

(c) The board shall decline to accept a license surrender under (a), above, if the board determines the licensee has declined to disclose material information concerning the alleged misconduct.

(d) The statement of allegations by hearing counsel concerning the alleged misconduct under Med 412.03(b)(5) shall be exempt from public disclosure provisions of RSA 91-A if provided on a separate document and if subject to a recognized exception of RSA 91-A.

(e) The board shall not disclose information acquired in an investigation except:

(1) With the permission of the licensee and if such disclosure would include patient information, with the permission of such patients;

(2) To law enforcement:

a. When specifically required by statute;

b. If the information relates to a potential violation of a criminal law; or

c. In response to a subpoena or other court order; or

(3) To health licensing agencies in this state or any other jurisdiction when the licensee holds, has held, or has applied for a license with that agency.

(f) When considering whether to accept a license surrender under (a), above, the board shall consider a written representation by the licensee that he or she will not again seek licensure in New Hampshire.

(g) License surrender under (a), above, shall constitute disciplinary action. The fact of license surrender and the terms of any settlement agreement pertaining thereto shall be distributed to all relevant licensing authorities and professional societies in the same manner as a final decision containing a specific finding of professional misconduct.

(h) License surrender under (a), above, shall not apply to non-disciplinary remedial proceedings or allegations against any person licensed by the board alleging only an affliction of a physical or mental disability, disease, disorder, or condition deemed dangerous to the public health.

Source. (See Revision Note #1 at chapter heading for Med 500) #8945, eff 7-18-07; ss by #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #10097, eff 3-9-12; ss by #13482, eff 11-19-22

PART Med 413 Settlement Agreements and Consent Orders

Med 413.01 Negotiating a Settlement Agreement. A licensee may engage in settlement negotiations with hearing counsel at any time until the board issues a final order in accordance with Med 208.01(a).

Source. #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #12972, eff 1-10-20

Med 413.02 Reviewing a Settlement Agreement.

(a) Hearing counsel may present a proposed settlement agreement to the board by petition, as outlined in Med 205.03(l), at any time until the board issues a final order in accordance with Med 208.01(a).

(b) Upon receipt of a signed, negotiated proposed settlement agreement, the board shall place the matter on its agenda for its next regularly scheduled board meeting.

(d) After deliberation, the board shall:

(1) Accept the proposed settlement agreement;

(2) Reject the proposed settlement agreement as too lenient;

(3) Reject the proposed settlement agreement as too stringent; or

(4) Reject the proposed settlement agreement and provide hearing counsel with general provisions of guidance. However, the board shall not engage in settlement negotiations with the parties.

(e) The board shall consider the factors listed in Med 408.03(c) when making a determination under (d) above.

(f) The board shall decline to accept a settlement agreement under (d) above, if the board determines the licensee has declined to disclose material information concerning the alleged misconduct.

(g) The statement of allegations by hearing counsel concerning the alleged misconduct under Med 412.03(b)(5) shall be exempt from public disclosure provisions of RSA 91-A if provided on a separate document and if subject to a recognized exception of the right to know law.

(h) The board shall not disclose information acquired in an investigation except:

(1) With the permission of the licensee and if such disclosure would include patient information, with the permission of such patients;

(2) To law enforcement:

a. When specifically required by statute;

b. If the information relates to a potential violation of a criminal law; or

c. In response to a subpoena or other court order; or

(3) To health licensing agencies in this state or any other jurisdiction when the licensee holds, has held, or has applied for a license with that agency.

(i) Accepted settlement agreements shall constitute disciplinary action. Distribution shall be in accordance with Med 408.03(d).

Source. #9900, eff 4-12-11 (see Revision Note at chapter heading for Med 400); ss by #10097, eff 3-9-12; ss by #13482, eff 11-19-22

CHAPTER Med 500 ETHICAL STANDARDS

REVISION NOTE #1:

Document #8945, effective 7-18-07, readopted with amendments and renumbered the former Parts Med 502 through Med 506 as Med 408 through Med 412, as follows:

Med 502 Disciplinary Matters, renumbered as Med 408.

Med 503 Immediate License Suspension in Certain Circumstances, renumbered as Med 409.

Med 504 DISCIPLINARY ACTION TAKEN IN OTHER JURISDICTIONS, renumbered as Med 410.

Med 505 ADMINISTRATIVE FINES, renumbered as Med 411.

Med 506 VOLUNTARY SURRENDER OF A LICENSE, renumbered as Med 412.

Document #8945 superseded all prior filings for the former Med 502 through Med 506. See Med 408 through Med 412 for subsequent filings in these areas. The filings affecting the former Med 502 through Med 506 include the following documents:

For Med 502:

#1136, eff 3-27-78

#2199, eff 12-2-82

#2910, eff 11-21-84

#4970, eff 11-8-90

#5223, eff 9-12-91

#5782, eff 2-3-94

#5838, eff 6-17-94

#5908, eff 10-7-94

#6517, eff 5-30-97, EXPIRED 5-30-05

#8662, INTERIM, eff 6-16-06, EXPIRED 12-13-06

For Med 503 through Med 506:

#6517, eff 5-30-97, EXPIRED 5-30-05

#8662, INTERIM, eff 6-16-06, EXPIRED 12-13-06

REVISION NOTE #2:

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 500, Document #9900 readopted with amendments Med 501.02.

PART Med 501 ETHICAL STANDARDS

Med 501.01 Obligation to Obey.

(a) The ethical standards set forth in this part shall bind all licensees, and violation of any such standard shall constitute unprofessional conduct within the meaning of RSA 329:17, VI(d).

(b) Conduct proscribed by these ethical standards, when performed by an unlicensed person or during a prior period of licensure, shall also be a basis for denying an application for licensure or issuing a restricted license.

Source. #1136, eff 3-27-78; as amd by #1203, eff 7-16-78; ss by #2199, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4970, eff 11-8-90; ss by #5782, eff 2-3-94; ss by #6517, eff 5-30-97; amd by #7150, eff 12-7-99; amd by #8068, eff 4-10-04; amd by #8662, INTERIM, eff 6-16-06, EXPIRED: 12-13-06 (para (b)); ss by #8945, eff 7-18-07 (see Revision Note #1 at chapter heading for Med 500); EXPIRED: 7-18-15

New. #10925, INTERIM, eff 9-4-15, EXPIRES: 3-2-16; ss by #11048, eff 3-2-16

Med 501.02 Standards of Conduct.

(a) A licensee shall inform the board of a principal address to which all official board communications shall be directed, and also of all addresses where he or she is practicing. The establishment of a business address or the change or abandonment of a business address shall be reported to the board within 30 days.

(b) A licensee shall submit only complete, truthful, and correct information in any application or other document filed with or statement made to the board.

(c) A licensee shall cooperate with investigations and requests for information from the board and from other licensing or credentialing organizations.

(d) A licensee shall maintain a complete and accurate medical record of all patient encounters.

(e) Records shall be entirely legible and include but not be limited to:

(1) A history, an exam, a diagnosis, and a plan appropriate for the licensee’s specialty; and

(2) Documentation of all drug prescriptions including name and dose.

(f) The responsible party shall promptly honor all requests made by a patient or an authorized agent of a patient, for complete copies of the patient’s medical record in accordance with the following standards:

(1) The patient shall have the right to have his or her request for medical records by either themselves or an authorized agent of the patient promptly honored. The responsible party or entity that controls the medical records shall have the ultimate responsibility to comply with the request. In the case of a practice owned and controlled by a licensee, the responsible party shall be the licensee and the licensee shall be ultimately responsible for transferring copies of medical records regardless of whether the licensee had delegated this task to another person or organization. In the case of an employed licensee, the responsible party shall be the employer or organization and the ultimate responsibility for transferring copies of the medical records shall fall upon the employer or organization, pursuant to these rules and RSA 151:21, X;

(2) Upon the patient’s request, the responsible party shall provide copies of the medical records, either a specified portion or the entire contents depending on the patient’s request, regardless of whether the licensee created the records or the records were provided to the licensee by another health care provider;

(3) The responsible party may charge the actual cost of duplication for x-rays or other color photographs;

(4) Upon receipt of a written release, the requested transfer of medical records shall:

a. Not be delayed, including for non-payment of services or non-payment of copying costs and of costs for transmitting of medical records; and

b. Be accomplished in any case within 30 days from receipt of the signed release, unless the nature of the medical treatment requires an immediate response from the licensee;

(5) In the case of patients who are minors or are legally incapacitated, the responsible party shall release medical records to a third party who is legally responsible for authorizing medical treatment for the patient;

(6) Medical records shall be released to that third party on the same basis that they would

otherwise be for the patient if the licensee possesses written documentation establishing the legal guardianship in question;

(7) The responsible party may require written authorization for release of medical records, but, in no instance, shall the responsible party require the personal appearance of the patient prior to accepting a release;

(8) The licensee shall retain a complete copy of all patient medical records for at least 7 years from the date of the patient’s last contact with the licensee, unless, before that date, the patient has requested that the file be transferred to another health provider;

(9) If a licensee retires, moves from the area or decides to stop treating a patient or group of patients, the licensee shall:

a. Provide notice to those active patients which explains that the licensee is no longer available to them;

b. Ensure that their records can be transferred to another health care provider as requested by the patient; and

c. Whenever possible, notice shall be provided at least 30 days prior to cessation of treatment; and

(10) After transfer of the licensee’s medical records which meets the requirements of (9) above, the licensee shall be relieved of further responsibility for complying with requests for copies of records.

(g) A licensee shall know and have available in his or her office information regarding where patients may go to file complaints regarding their treatment or billing. Such information shall be furnished immediately upon request of the patient.

(h) A licensee shall adhere to the Code of Medical Ethics: Current Opinions With Annotations (June 2016 Edition) as adopted by the American Medical Association, as cited in Appendix II. In the Code of Medical Ethics – Current Opinions With Annotations Opinion 8.19, “immediate family member” shall include cohabiting significant others or other cohabiting individuals. A licensee shall adhere to the ethical rules incorporated by reference at the time of the conduct at issue.

(i) Deviation from these treatment standards shall constitute unprofessional conduct within the meaning of RSA 329:17, VI,(c) and a violation of Med 501.01(a).

(j) Licensees shall register for the Controlled Drug Prescription Health and Safety Program pursuant to the requirements of RSA 318-B:33, II and Ph 1503.01(a). Failure to register shall constitute unprofessional conduct within the meaning of RSA 329:17, VI (d) pursuant to RSA 318-B:36, IV and Ph 1503.01 (a) and (g).

(k) Applicants shall have 90 days from the date of issuance of a license to register with the Controlled Drug Prescription Health and Safety Program. Failure to register within 90 days shall constitute unprofessional conduct within the meaning of RSA 329:17, VI (d) pursuant to Ph 1503.01 (a).

(l) The knowing disclosure of Controlled Drug Prescription Health and Safety Program information shall constitute unprofessional conduct within the meaning of RSA 329:17, VI (d) pursuant to RSA 318-B:36, IV.

(m) The unauthorized use of the Controlled Drug Prescription Health and Safety Program information shall constitute unprofessional conduct within the meaning of RSA 329:17, VI (d) and shall be grounds disciplinary action pursuant to RSA 318-B:36, V.

(n) A licensee shall not engage in the prescribing or dispensing of controlled substances in schedules II-IV without having registered with the Controlled Drug Prescription Health and Safety Program pursuant to RSA 318-B:36, III. The prescribing or dispensing of a controlled substance in schedules II-IV by a licensee who has not registered shall constitute unprofessional conduct within the meaning of RSA 329:17, VI (d) pursuant to RSA 318-B:36, III.

Source. #1203, eff 7-l6-78; ss by #2199, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4970, eff 11-8-90; amd by #5223, eff 9-12-91; ss by #5782, eff 2-3-94; ss by #6517, eff 5-30-97; ss by #7150, eff 12-7-99; amd by #7868, eff 4-4-03; amd by #8429, eff 9-13-05; ss by #8945, eff 7-18-07 (see Revision Note #1 at chapter heading for Med 500); ss by #9900, eff 4-12-11 (see Revision Note #2 at chapter heading for Med 500); ss by #10331, eff 5-8-13; amd by #10876, eff 7-8-15; amd in (i) by #10969, EMERGENCY RULE, eff 11-6-15, EXPIRES: 5-4-16; amd in (i) by #11089, REPEAL OF EMERGENCY RULE, eff 5-3-16; ss by #12972, eff 1-10-20

PART Med 502 OPIOID PRESCRIBING

Med 502.01 Applicability. This part shall apply to the prescribing of opioids for the management or treatment of non-cancer and non-terminal pain, and shall not apply to the supervised administration of opioids in a health care setting.

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17

Med 502.02 Noncompliance with Standards as Unprofessional Conduct. Noncompliance with the standards set forth in this part may constitute unprofessional conduct as used in NH RSA 329:17, VI(d).

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17

Med 502.03 Definitions. Except where the context makes another meaning manifest, the following words have the meanings indicated when used in this chapter:

(a) “Acute pain” means the normal, predicted physiological response to a noxious chemical, thermal, or mechanical stimulus and typically is associated with invasive procedures, trauma, and disease. It can be time-limited, often less than 3 months in duration;

(b) “Administer” means an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a person for immediate consumption or use;

(c) “Addiction” means a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include impaired control over drug use, craving, compulsive use, or continued use despite harm. The term does not include physical dependence and tolerance, which are normal physiological consequences of extended opioid therapy for pain;

(d) “Chronic pain” means a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that might or might not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. It also includes intermittent episodic pain that might require periodic treatment. For the purposes of these rules, chronic pain does not include pain from cancer or pain from terminal disease. “Chronic pain” includes but is not limited to pain commonly referred to as "chronic," "intractable," "high impact," "chronic episodic," and "chronic relapsing."

(e) “Clinical coverage” means specified and prearranged coverage that is available 24 hours a day, 7 days a week, to assist in the management of patients with chronic pain;

(f) “Dose unit” means one pill, one capsule, one patch, or one liquid dose;

(g) “Medication-assisted treatment” means any treatment of opioid addiction that includes a medication, such as methadone, buprenorphine, or naltrexone, that is approved by the FDA for opioid detoxification or maintenance treatment;

(h) “Morphine milligram equivalent (MEE)” means a conversion of various opioids to a morphine equivalent dose by the use of board-approved conversion tables;

(i) “Prescription” means a verbal, or written, or facsimile, or electronically transmitted order for medications, for self-administration by an individual patient.

(j) “Risk assessment” means a process for predicting a patient’s likelihood of misusing or abusing opioids in order to develop and document a level of monitoring for that patient;

(k) “Treatment agreement” means a written agreement that outlines the joint responsibilities of licensee and patient; and

(l) “Treatment plan” means a written plan that reflects the particular benefits and risks of opioid use for each individual patient and establishes goals, expectations, methods, and time course for treatment.

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17 (from Med 502.02); ss by #13248, eff 8-6-21

Med 502.04 Acute Pain. If opioids are indicated and clinically appropriate for prescription for acute pain, prescribing licensees shall:

(a) Conduct and document a physical examination and history;

(b) Consider the patient’s risk for opioid misuse, abuse, or diversion and prescribe for the lowest effective dose for a limited duration;

(d) Ensure that the patient has been provided information that contains the following:

(1) Risk of side effects, including addiction and overdose resulting in death;

(2) Risks of keeping unused medication;

(3) Options for safely securing and disposing of unused medication; and

(4) Danger in operating motor vehicle or heavy machinery;

(e) Comply with all federal and state controlled substances laws, rules, and regulations;

(f) Complete a board-approved risk assessment tool, such as the evidence-based screening tool Screener and Opioid Assessment for Patients with Pain (SOAPP);

(g) Document an appropriate pain treatment plan and consideration of non-pharmacological modalities and non-opioid therapy;

(h) Utilize a written informed consent that explains the following risks associated with opioids:

(1) Addiction;

(2) Overdose and death;

(3) Physical dependence;

(4) Physical side effects;

(5) Hyperalgesia;

(6) Tolerance; and

(7) Crime victimization;

(i) In an emergency department, urgent care setting, or walk-in clinic:

(1) Not prescribe more than the minimum amount of opioids medically necessary to treat the patient’s medical condition. In most cases, an opioid prescription of 3 or fewer days is sufficient, but a licensee shall not prescribe for more than 7 days; and

(2) If prescribing an opioid for acute pain that exceeds a board-approved limit, document the medical condition and appropriate clinical rationale in the patient’s medical record.

(j) Prescribers shall not be obligated to prescribe opioids for more than 30 days, but if opioids are indicated and appropriate for persistent, unresolved acute pain that extends beyond a period of 30 days, the licensee shall conduct an in-office follow-up with the patient prior to issuing a new opioid prescription.

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17 (from Med 502.03)

Med 502.05 Chronic Pain.

(a) This section shall only apply to the treatment of “chronic pain” as defined in Med 502.03(d) and shall not apply to the treatment of pain from cancer or pain from terminal disease.

(b) If opioids are indicated and prescribed for chronic pain, prescribing licensees shall:

(1) Conduct and document a history and physical examination;

(2) Conduct and document a risk assessment, including, but not be limited to, the use of an evidence-based screening tool such as the Screener and Opioid Assessment for Patients with Pain (SOAPP);

(3) Document the prescription and rationale for all opioids according to Med 501.02(d) and (e);

(4) Prescribe opioid analgesics in a measured and monitored manner and administered in the lowest amount necessary to control pain.

(5) Comply with all federal and state controlled substances laws, rules, and regulations;

(6) Utilize a written informed consent that explains the following risks associated with opioids:

a. Addiction;

b. Overdose and death;

c. Physical dependence;

d. Physical side effects;

e. Hyperalgesia;

f. Tolerance; and

g. Crime victimization;

(7) Create and discuss a treatment plan with the patient. This shall include, but not be limited to the goals of treatment, in terms of pain management, restoration of function, safety, time course for treatment, and consideration of non-pharmacological modalities and non-opioid therapy. Informed consent documents and treatment agreements may be part of one document for the sake of convenience;

(8) Utilize a written treatment agreement that is included in the medical record, and specifies conduct that triggers the titration, discontinuation, or tapering of opioids based on ongoing, objective evaluation of the patient’s injury or illness as required for ongoing successful treatment of chronic pain;

(9) The treatment agreement shall also address, at a minimum, the following:

a. The requirement of safe medication use and storage;

b. The requirement of obtaining opioids from only one prescriber or practice;

c. The consent to periodic and random drug testing; and

d. The prescriber’s responsibility to be available or to have clinical coverage available;

(10) Document the consideration of a consultation with an appropriate specialist in the following circumstances:

a. When a patient is at high risk for abuse or addiction; or

b. When a patient has a co-morbid psychiatric disorder;

(11) Reevaluate treatment plan and use of opioids at least twice a year;

(12) Require random and periodic urine drug testing at least annually for all patients using opioids for longer than 90 days. Unanticipated findings shall be addressed in a manner that supports the health of the patient;

(13) Have clinical coverage available for 24 hours per day, 7 days per week, to assist in the management of patients;

(14) The prescriber may forego the requirements for a written treatment agreement and for periodic drug testing for patients:

a. Who are residents in a long-term, non-rehabilitative nursing home facility where medications are administered by licensed staff; or

b. Who are being treated for episodic intermittent pain and receiving no more than 50 dose units of opioids in a 3 month period; and

(15) Be allowed to continue prescribing opioid treatment, when there is no indication of misuse or diversion, for patients:

a. Who experience chronic illness or injury which results in chronic pain; and

b. Who are on a managed and monitored regimen of opioid analgesic treatment which has resulted in an increase in functionality and quality of life.

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17 (from Med 502.04); ss by #13248, eff 8-6-21

Med 502.06 Prescription Drug Monitoring Program.

(a) Prescribers required to register with the program under RSA 318-B:31-40, or their delegate, shall query the prescription drug monitoring program to obtain a history of schedule II-IV controlled substances dispensed to a patient, prior to prescribing an initial schedule II, III, and IV opioids for the management or treatment of this patient’s pain and then periodically and at least twice per year, except when:

(1) Controlled medications are to be administered to patients in a health care setting;

(2) The program is inaccessible or not functioning properly, due to an internal or external electronic issue; or

(3) An emergency department is experiencing a higher than normal patient volume such that querying the program database would materially delay care.

(b) A licensee shall document the exceptions described in (a)(2) and (3) above in the patient’s medical record.

Source. #11090, eff 5-3-16; ss by #12038, eff 1-1-17 (from Med 502.05)

Med 502.07 Medication Assisted Treatment.

(a) Licensees who prescribe medication assisted treatment shall adhere to the principles outlined in the American Society of Addiction Medicine’s National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015) found at http://www.asam.org/quality-practice/guidelines-and-consensus-documents/npg/complete-guideline as cited in Appendix II.

Source. #12038, eff 1-1-17 (from Med 502.06)

CHAPTER Med 600 PHYSICIAN ASSISTANT

Statutory Authority: RSA 328-D:10, I

REVISION NOTE #1:

Document #9900, effective 4-12-11, adopted, amended, readopted with amendments, or repealed many rules in Chapters Med 100 through Med 600. In Chapter Med 600, Document #9900 readopted with amendments Med 602.01, 602.02, 604.01, 608.01, 609.02, and 611.01. Document #9900 also repealed Med 601.06 defining “Physician Assistant Advisory Committee (PAAC)”, which necessitated the renumbering, but not readoption, of Med 601.07, 601.08, and 601.09 as, respectively, Med 601.06, 601.07, and 601.08. The source notes for Med 601.06, 601.07, and 601.08 indicate the former rule numbers, and the document numbers and effective dates apply to the rules under the former number. The prior filings affecting the former Med 601.06 include the following documents:

#1497, effective 11-29-79

#2197, effective 12-2-82

#2199, effective 12-2-82

#2910, effective 11-21-84

#4745, effective 1-25-90, EXPIRED 1-25-96

#6472, effective 3-25-97, EXPIRED 3-25-05

#8678, effective 7-11-06

REVISION NOTE #2:

Document #13803, effective 12-31-23, readopted with amendment or repealed various rules in Chapter Med 600. Med 601.06 defining “registered supervisory physician (RSP)” and Med 601.07 defining “supervision” were readopted with amendment as defining “participating physician” and “collaboration”, respectively. These actions necessitated the renumbering of these and other existing rules in Part Med 601 titled “Chapter Definitions”, as indicated in the source notes, as editorial changes during the process pursuant to RSA 541-A:15, I of preparing the rules in Document #13803 for certification.

The rules repealed were Med 602.02 titled “Number of Physician Assistants Supervised” and Med 602.04 titled “Change of Supervisory Relationship”. Med 602.03 titled “Practice Agreement” was readopted with amendment and retitled “Collaboration Agreement”. The repeals necessitated the renumbering of Med 602.03 as Med 602.02, as indicated in the source note, as an editorial change during the process pursuant to RSA 541-A:15, I of preparing the rules in Document #13803 for certification.

The prior filings affecting the repealed Med 602.02 included the following documents:

#1497, eff 11-29-79

#2199, eff 12-2-82

#2197, eff 12-2-82

#2910, eff 11-21-84

#4745, eff 1-25-90, EXPIRED 1-25-96

#6472, eff 3-25-97, EXPIRED: 3-25-05

#8678, eff 7-11-06

#9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600)

#12972, eff 1-10-20

#13249, eff 8-6-21

The prior filings affecting the repealed Med 602.04 included the following documents:

#6472, eff 3-25-97, EXPIRED: 3-25-05

#8678, eff 7-11-06, EXPIRED: 7-11-14

#10926, INTERIM, eff 9-4-15

#11049, eff 3-2-16

#13249, eff 8-6-21

PART Med 601 CHAPTER DEFINITIONS

Med 601.01 "Applicant" means “applicant” as defined in RSA 328-D:1, I namely “a physician assistant who has submitted an application for licensure.”

Source. #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15, ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.02)

Med 601.02 “Approved program” means a program for the education and training of physician associates that is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its successor.

Source. #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.03); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 601.03 “Collaboration” means “collaboration” as defined in RSA 328-D:1, II-a, namely “a physician assistant’s consultation with or referral to a physician or to the appropriate member of the health care team as indicated based on the patient’s condition, the physician assistant’s education, training, and experience, and the applicable standards of care.”

Source. #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06; renumbered by #9900 (from Med 601.08) (see Revision Note #1 at chapter heading for Med 600); EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #11049, eff 3-2-16 (formerly Med 601.08); ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (formerly Med 601.07) (see Revision Note #2 at chapter heading for Med 600); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.03); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 601.04 "National certification" means to hold a current physician assistant certificate issued by the National Commission on Certification of Physician Assistants (NCCPA).

Source. #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.04); (formerly Med 601.03) (see Revision Note #2 at chapter heading for Med 600)

Med 601.05 “Participating physician” means “participating physician” as defined in RSA 328-D:1, II-c, namely, “a physician practicing as a sole practitioner, a physician designated by a group of physicians to represent their physician group, or a physician designated by a health care facility to represent that facility, who collaborates with a physician associate or who enters into a collaboration agreement with a physician associate in accordance with this chapter.”

Source. #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06; renumbered by #9900 (from Med 601.07) (see Revision Note at chapter heading for Med 600); EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16 (formerly Med 601.07); ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (formerly Med 601.06) (see Revision Note #2 at chapter heading for Med 600); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 601.06 “Physician associate (PA)” means “physician associate or P.A.” as defined in RSA 328-D:1, III, namely “a person qualified both by academic and practical training to provide patient services and licensed under this chapter.”

Source. #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.05); (formerly Med 601.04) (see Revision Note #2 at chapter heading for Med 600); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 601.07 "Prescription" means “prescription” as defined in RSA 318:1, XVI, namely “a verbal, or written, or facsimile or electronically transmitted order for drugs, medicines and devices by a practitioner licensed in the United States, to be compounded and dispensed by licensed pharmacists in a duly registered pharmacy, and to be kept on file for a period of 4 years. A written order shall include an electronic transmission prescription received and retained in a form complying with rules adopted pursuant to RSA 318:5-a, XV. Prescriptions may also apply to the finished products dispensed or administered by the licensed pharmacist in the registered pharmacy, on order of a licensed practitioner as defined in this section.”

Source. #1497, eff 11-29-79; ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21 (formerly Med 601.06); (formerly Med 601.05) (see Revision Note #2 at chapter heading for Med 600)

PART Med 602 PHYSICIAN ASSOCIATE RESPONSIBILITIES; COLLABORATION AGREEMENTS

Med 602.01 Responsibility of the Physician Assistant.

(a) As stated in RSA 328-D:12, “A physician associate is responsible for his or her own medical decision making. A participating physician included in a collaboration agreement with a physician associate shall not, by the existence of the collaboration agreement alone, be legally liable for the actions or inactions of the physician associate; provided, however, that this shall not otherwise limit the liability of the participating physician.”

(b) As required by RSA 328-D:18, each physician associate shall have current valid professional liability coverage while actively engaged in providing medical care.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600); ss by #12972, eff 1-10-20; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 602.02 Collaboration Agreement for PAs Having Fewer Than 8,000 Hours of Post-Graduate Clinical Practice Hours.

(a) Except as provided in RSA 328-D:15, III and RSA 328-D:16, II, a physician associate with fewer than 8,000 hours of post-graduate clinical practice hours who is practicing in a group, practice, or health system that does not have at least one licensed New Hampshire physician shall engage in practice as a physician associate in this state only if the physician associate has entered into a written collaboration agreement with a licensed physician who practices in a similar area of medicine.

(b) A collaboration agreement shall include all of the following:

(1) Processes for collaboration and consultation with the appropriate physician and other health care professional as indicated based on the patient’s condition and the physician associate’s education, training, and experience, and the applicable standards of care;

(2) An acknowledgment that the physician associate’s scope of practice shall be limited to medical care that is within the physician associate’s education, training, and experience as outlined in RSA 328-D:3-b, VII-XIII;

(3) A statement that although collaboration occurs between the physician associate and physicians and other health care professionals, a physician shall be accessible for consultation in person, by telephone, or electronic means at all times when a physician associate is practicing; and

(4) The signatures of the physician associate and the participating physician. No other signatures shall be required.

(d) In the event of the unanticipated unavailability of a participating physician practicing as a sole practitioner due to serious illness or death, a physician associate shall not practice for more than 30 days without entering into a new collaboration agreement with another participating physician.

(e) The collaboration agreement shall be kept on file at the practice and made available to the board upon request.

Source. #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (formerly Med 602.03) (see Revision Note #2 at chapter heading for Med 600); ss by #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

Med 602.03 Waiver of Collaboration Agreement Available for PAs Having More Than 8,000 Hours of Post-Graduate Clinical Practice Hours.

(a) Until January 1, 2027, a New Hampshire licensed physician associate with more than 8,000 post-graduate clinical practice hours who intends to practice in a setting that does not have at least one licensed New Hampshire physician in the group, practice, or health system may request the board of medicine to waive the collaboration agreement requirement.

(b) The physician associate shall complete and submit the board’s “Waiver Form”, along with the following:

(1) The information specified in (c), below;

(2) The documentation specified in (d), below; and

(3) The signature of the physician associate who is requesting the waiver attesting they will "continue to practice according to their training and hours accumulated".

(1) The physician associate’s name, preferred e-mail address, and license number;

(2) The name of the group, practice, or health system, that the physician associate is employed by, and their physical location, mailing address, and telephone number;

(3) The physician associate’s primary area of medical practice; and

(4) Confirmation that that there is not a New Hampshire licensed physician on staff at this listed group, practice, or health system location by marking the checkbox on the form.

(d) The documentation required by (b)(2), above, shall be:

(1) Proof of malpractice insurance, in the form of a copy of the malpractice insurance declaration page that includes the premium amount and coverage limits; and

(2) Proof of the required post-graduate clinical practice hours, in the form of either:

a. A letter signed by the manager of the physician associate’s medical office, hospital administration, department chair, or collaborating physician that the physician associate has accrued the requisite hours; or

b. A notarized affidavit affirming, under penalty of law, that the physician associate has accrued the requisite hours and that shows the hours earned by practice name, dates of service, employment status, and total clinical hours earned.

(e) The physician associate may include information regarding additional training and qualifications or other relevant evidence to support the waiver request.

(f) Upon receipt of a waiver request, the board’s administrator shall:

(1) Review the requestor’s file to determine whether the requestor is in good standing and whether the requestor is the subject of a pending active investigation or disciplinary action; and

(2) Provide the information to the board.

(g) The board shall review a waiver request at the first board meeting that is at least 10 business days following receiving notification from the office of professional licensure and certification (OPLC):

(1) Confirming that the application is complete; and

(2) Determining that the applicant’s license is in good standing and is not the subject of a pending investigation or disciplinary action.

(h) The board shall approve the request and grant the waiver request if the requestor:

(1) Has submitted a complete request that demonstrates the requestor’s qualifications;

(2) Is in good standing; and

(3) Is not the subject of a pending investigation or disciplinary action.

(i) If the board is unable to determine that the criteria for approval in (g), above, are met, the board shall request further information from the requestor.

(j) The board shall notify the requestor of its decision. If the requested waiver is denied, the notification shall:

(1) Identify each reason why the request was denied; and

(2) Inform the requestor that a rehearing request shall be filed within 30 days in accordance with Plc 206.31.

(k) A physician associate whose waiver request is denied may re-apply for a waiver after the reason(s) for the denial have been addressed.

(l) Waivers shall expire on a date specified by the board that is not later than December 31, 2026.

Source. #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

PART Med 603 SCOPE OF PRACTICE OF PHYSICIAN ASSISTANT

Med 603.01 Scope of Practice.

(a) Physician assistants may provide any legal medical service for which they have been prepared by their education, training, and experience and are competent to perform.

(b) Medical and surgical services provided by physician assistants include, but are not limited to:

(1) Obtaining and performing comprehensive health histories and physical examinations;

(2) Evaluating, diagnosing, managing, and providing medical treatment;

(3) Ordering, performing, and interpreting diagnostic studies and therapeutic procedures;

(4) Educating patients on health promotion and disease prevention;

(5) Providing consultation upon request; and

(6) Writing medical orders.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 8-3-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)

PART Med 604 APPLICATION FOR LICENSURE

Med 604.01 Application Form and Supporting Documents.

(a) Applicants for licensure as a physician assistant shall complete and submit:

(1) The information described in Plc 304.03 on the “Universal Application for Initial Licensure”; and

(2) The following information specific to the board of medicine:

a. Place of birth;

b. A statement that the applicant has arranged for the direct submission of one letter of reference from a physician and one letter of reference from either a physician or physician assistant, who have served in an advisory capacity to the applicant;

c. A list of all names the applicant has ever been known by; and

d. A 2 x 2 passport photograph of the applicant taken within 6 months of submission of the application.

(b) The applicant shall sign and date the application as described in Plc 304.05.

(d) The applicant shall provide the following with the application

(1) Documentation of completion of an educational program in the form of a letter directly from the educational institution;

(2) Unless the information sought is available only on a website, an official letter of verification sent directly to the board from every state which has issued the applicant a license or other authorization to practice medicine stating:

a. Whether the license or other authorization is or was, during its period of validity, in good standing; and

b. Whether any disciplinary action was taken against the license or other authorization to practice;

(3) Documentation that the applicant has passed an initial examination administered by the NCCPA;

(4) A copy of the applicant’s curriculum vitae or resume shall accompany the application; and

(5) Two letters of reference one provided by a physician, and one provided by either a physician or physician assistant, who have served in an advisory capacity, containing the statement that the physician(s) or physician assistant(s) find the applicant to be a person of high moral character worthy of being granted a license to practice in New Hampshire. The letter shall contain the following information:

a. The physician’s or physician assistant’s name, address, and telephone number;

b. The name of the applicant;

c. The relationship between the applicant and the person providing the reference; and

d. The number of years the applicant has known the person providing the reference.

(e) The application shall be processed, and an approval or a denial issued in accordance with Plc 304.06 through Plc 304.13.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

PART Med 605 REQUIREMENTS FOR LICENSURE

Med 605.01 Educational Requirements. The applicant shall be a graduate of an approved physician assistant training program as defined in Med 601.02.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21

Med 605.02 Professional Character.

(a) The applicant shall adhere to the requirements of RSA 328-D and the rules of this chapter, and shall not have previously engaged in activities for which disciplinary sanctions might be imposed under Med 609.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16

PART Med 606 - RESERVED

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

PART Med 607 REINSTATEMENT OF LICENSE

Med 607.01 Reinstatement of Lapsed Licenses.

(a) A 90 day grace period to apply for renewal shall be allowed, subject to an additional late fee pursuant to Med 306.01. If the renewal application is not received by the grace period date, the license shall be considered lapsed.

(b) If a license expires or lapses as a result of a licensee being ordered to active duty with the armed services, the licensee shall have one year from the date of discharge or release from the armed service to apply for renewal and all late fees shall be waived.

(d) Applicants for reinstatement of a lapsed license shall pay the reinstatement fee set forth in Med 306.01, Table 3.6.1.

(e) Applicants for reinstatement shall complete and file a “Physician Assistant Reinstatement Application” form, dated 6/2021 which contains the following:

(1) The same information required in Med 604.01(a)(1-13) excluding Med 604.01(a)(3), the place of birth, and the gender of the applicant; and

(2) A chronological history of the applicant's employment since the original license was lapsed.

Source. #1497, eff 11-29-79, ss by #2199, eff 12-2-82; ss by #2197, eff 12-2-82; ss by #2910, eff 11-21-84; ss by #4745, eff 1-25-90; ss by #4902, eff 8-3-90, EXPIRED 8-3-96

New. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21

PART Med 608 LICENSE RENEWAL

Med 608.01 Renewal Application and Supporting Documents.

(a) Applications for licensure shall be renewed in accordance with Plc 308.01 and notification of renewal shall be sent to each licensee at least 2 months prior to the expiration in accordance with Plc 308.03.

(b) Applicants seeking renewal of a physician assistant license shall complete and submit:

(1) The information described in Plc 308.06 on the “Universal Application for License Renewal”; and

(2) The following information specified by the board of medicine:

a. The applicant’s US Drug Enforcement Agency (DEA) license number, the state of issuance, and the expiration date; and

b. Whether or not the applicant has registered with the Controlled Drug Health and Safety Program also known as the N.H. Prescription Drug Monitoring Program.

(d) Applicants shall include the application fee required by Plc 1002.28.

(e) The application shall be processed, and an approval or denial issued in accordance with Plc 308.09 through Plc 308.13.

Source. #4745, eff 1-25-90, EXPIRED 1-25-96

New. #6472, eff 3-25-97; ss by #6828, eff 8-11-98; ss by #8678, eff 7-11-06; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600); ss by #10331, eff 5-8-13; ss by #11049, eff 3-2-16; ss by #12972, eff 1-10-20; ss by #13249, eff 8-6-21; ss by #13444, eff 9-13-22; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)

PART Med 609 ETHICAL STANDARDS

Med 609.01 Disciplinary Action.

(a) Professional misconduct by physician assistants shall include the following:

(1) Holding oneself out as or permitting another to represent one as a licensed physician;

(2) Performing activities which are not authorized by the licensee's scope of practice pursuant to RSA 328-D:3-b;

(3) Habitual use of controlled drugs or intoxicants;

(4) Conviction of a felony under the laws of the United States or any state;

(5) Engaging in dishonest, unprofessional, or immoral conduct related to the performance of physician assistant activities;

(6) Failing to meet reasonable standards of medical care;

(7) Failing to provide the collaboration agreement upon board request;

(8) Violating the “Guidelines for Ethical Conduct for the Physician Assistant Profession” of the American Academy of Physician Assistants adopted in 2000 and reaffirmed in 2013, as specified in Appendix II;

(9) Practicing as a physician assistant while being mentally or physically impaired in a manner which precludes safe and dependable performance;

(10) Engaging in conduct inconsistent with the basic knowledge and competency expected of any physician assistant; or

(11) Intentionally injuring or exploiting any patient or person entrusted to licensee's care as a physician assistant.

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)

Med 609.02 Allegations of Professional Misconduct. Allegations of professional misconduct shall be investigated and disciplinary action shall be taken in accordance with Med 200 and Med 400, and if applicable, Jus 800 and RSA 328-D:7.

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600); ss by #12972, eff 1-10-20

Med 609.03 Change of Address. Licensees shall report any change in business or home address within 30 days of such change.

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16

PART Med 610 METHOD OF PERFORMANCE

Med 610.01 Identification. A physician assistant shall keep his or her license available for inspection at the primary place of business and shall, when engaged in his or her professional activities, wear a name tag identifying themselves as a "physician assistant".

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21

Med 610.02 Proximity. A participating physician shall be accessible for consultation in person, by telephone, or by electronic means at all times when a physician assistant is practicing, except as allowed by Med 602.03(d).

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)

PART Med 611 FEES

Med 611.01 Fees. The fees shall be as set forth in Table 3.6.1 in Med 306.01.

Source. #6472, eff 3-25-97; ss by #6828, eff 8-11-98; ss by #8678, eff 7-11-06; ss by #9900, eff 4-12-11 (see Revision Note #1 at chapter heading for Med 600); ss by #12972, eff 1-10-20

PART Med 612 PRESCRIPTIVE PRACTICE

Med 612.01 Scope of Prescriptive Practice.

(a) A physician assistant, in accordance with RSA 328-D:3-b, XIII, is authorized to prescribe, dispense, order, administer, and procure drugs and medical devices. Physician assistants may plan and initiate a therapeutic regimen that includes ordering and prescribing non pharmacological interventions, including but not limited to durable medical equipment, nutrition, blood and blood products, and diagnostic support services including but not limited to home healthcare, hospice, and physical and occupational therapy.

(b) The prescribing and dispensing of drugs by a physician assistant shall:

(1) Comply with the requirements of RSA 318:8-a, RSA 318:42, RSA 318:47-c, RSA 318:47-m, and federal and state regulations;

(2) Occur when pharmacy services are not reasonably available, or when it is in the best interests of the patient, or when it is an emergency; and

(3) Include any medications that may be dispensed by a physician.

(c) Physician assistants, in accordance with RSA 328-D:3-b, XV, are authorized to request, receive, and sign for professional samples, and distribute professional samples to patients.

Source. #6472, eff 3-25-97, EXPIRED: 3-25-05

New. #8678, eff 7-11-06, EXPIRED: 7-11-14

New. #10926, INTERIM, eff 9-4-15; ss by #11049, eff 3-2-16; ss by #13249, eff 8-6-21; ss by #13803, eff 12-31-23 (see Revision Note #2 at chapter heading for Med 600)

PART Med 613 CONTINUING MEDICAL EDUCATION

Med 613.01 Continuing Medical Education.

(a) Each physician associate shall engage in continuing medical education to maintain requisite knowledge and skills, either by:

(1) Maintaining national certification through the National Commission on Certification of Physician Assistants (NCCPA) or its successor organization; or

(2) Obtaining not less than 100 credit hours of approved continuing medical education (CME) activity, as defined in RSA 328-D:1, I-a, in each renewal period, of which 40 credit hours shall be category 1 CME, and no more than 60 credit hours of which shall be in category II CME as described in Med 402.01.

(b) Each physician associate shall demonstrate compliance with this section by submitting proof of national certification or CME credit hours with the renewal application.

Source. #14142, INTERIM, eff 12-5-24, EXPIRES: 6-3-25 (Remains in effect per RSA 541-A:14-a); ss by #14395, eff 10-2-25, EXPIRES: 10-2-35

APPENDIX I

RULE	STATUTE
Med 102.08	RSA 541-A:16, I(a)
Med 103.01	RSA 329:2, I; RSA 329:4
Med 103.02	RSA 329:2; RSA 329:3; RSA 329:7
Med 103.03	RSA 329:2, IV
Med 104.01	RSA 541-A:16, I(a)
Med 105.03	RSA 541-A:16, I(a)
Med 106.01	RSA 329:8, XVII
Med 107.01	RSA 329:8, XVII

Med 201.01	RSA 329:9, VI and XV

Med 201.02	RSA 541-A:16, I (b)

Med 301.01	RSA 541-A:7
Med 301.01(a)-(f)	RSA 329:9, XVI
Med 301.01(g)-(k)	RSA 329:9, I; 329:9, II; 329:12; 329:14, III
Med 301.02	RSA 329:9, I; RSA 329:12, I (b); RSA 329:14
Med 301.03	RSA 329:9, I; RSA 329:12, I (a) & (b); RSA 329:14; RSA 161-B:11, VI-a
Med 301.03 intro to (a), (a)(1), (a)(3)-(a)(27) and (b)	RSA 329:12, I(a), (c)(4), (5) and (6), 329:14, II, 161-B:11, VI-a
Med 301.03(a)(2)	RSA 329:9, I, 329:9, II and 329:12
Med 301.03(a)(28) and (29)	RSA 329:9, I; 329:14, I
Med 301.03(c) & (d)(1)-(3)	RSA 329:14, II; 329:14, III
Med 301.04	RSA 329:9, IV; 329:16-h
Med 301.04(c), (d) and (e)	RSA 329:12, I(a) and (b); 329:14, II; 329:16-e
Med 302.01	RSA 329:9, II, RSA 329:12
Med 303.01	RSA 329:9, II; 329:12, I(d)(6)
Med 303.01(a), (b), (d)	RSA 329:12, I(d)(6)
Med 301.01(c)	RSA 329:12, II
Med 303.01(a)(1), (4) and (5)	RSA 329:9, III, 329:10, 329:11, 329:12(c)(6)
Med 303.01(a)(2), (3), and (b)-(c)	RSA 329:9, II, III; 329:10; 329:12, I(c)(6)
Med 303.02	RSA 329:9, II; RSA 329:12, I (d)(6); RSA 329:14, V(a)
Med 303.02(a) and (b)	RSA 329:9, III, 329:12, (c)(6)
Med 303.02(c)(1)-(3)	RSA 329:9, II, III; 329:14, V(a)
Med 305.01	RSA 329:9, I, II; RSA 329:14, VII
Med 305.01(a) - (d)	RSA 329:9, I, II, 329:14, VII
Med 305.02	RSA 329:9, I, II, VIII; RSA 329:14, VI
Med 305.03	RSA 329:9, I, II; RSA 329:14, VIII
Med 305.04	RSA 329:9, I, II; RSA 329:14, V(a)-(c)
Med 306.01	RSA 329:9, VII; RSA 329:12, I(a); RSA 329:16-a; RSA 329:16-h

Med 401.01	RSA 329:16-e; 329:16-a
Med 401.02	RSA 329:16-a
Med 401.02(c)	RSA 329:9, II, VII; 329:16-a, 329:16-c; 329:16-g
Med 401.03	RSA 161-B:11, VI-a; RSA 329:9, I, II; RSA 329:12, I(b); RSA 329:16-a; RSA 329:16-c; RSA 329:16-f, I; RSA 329:16-g; RSA 329:16-h; RSA 329:18, VI; RSA 318-B:33, II
Med 401.03(a)	RSA 329:9, VII; 329:12, I(a); 329:16-a; 329:16-h
Med 401.03(b) intro. and (b)(1)	RSA 329:9, II, 329:16-f, I; 329:16-a; 329:18, VI
Med 401.03(b)(2)-(6), (b)(14) & (15), (c) & (d)	RSA 329:9, II, VII, 329:16-a, 329:16-c, 329:16-g
Med 401.03(b)(7) & (b)(8)-(13)	RSA 329:9, I, II & V; 329:16-a
Med 401.03(b)(17)	RSA 161-B:11; 329:9, I; 329:16-a
Med 401.03(b)(18)	RSA 329:9, I; 329:16-a
Med 401.03(b)(19)	RSA 329:9, I; 329:16-a; 318-B:33, II
Med 401.03(e)	RSA 318-B:33, II; 329:9, II; 329:16-a;
Med 401.04	RSA 329:16-e
Med 401.05	RSA 329:9, II, VII, 329:16-e, 329:16-h
Med 401.05 (a) intro, (1) – (5)	RSA 329:9, II, VII; 329:16-e; 329:16-h
Med 401.05 (a) intro., (a)(4)-(5)	RSA 329:14, II; 329:9, II
Med 401.05 (a)(6)	RSA 329:9, II; 329:16-a; 318-B:33, II
Med 402.01	RSA 329:9, II; RSA 329:16-g
Med 402.02	RSA 329:9, II; RSA 329:16-g
Med 402.03	RSA 329:9, II; RSA 329:16-g
Med 403	RSA 329:16-f, 329:16-g
Med 403.01	RSA 541-A:16, I(b)
Med 403.02	RSA 541-A:16, I(b)
Med 403.03	RSA 329:9, II, V; RSA 329:16-f; RSA 329:16-g
Med 403.04	RSA 329:9, II; RSA 329:16-g
Med 403.05	RSA 329:9, II; RSA 541-A:16, I(a)
Med 407	RSA 329:13-b
Med 407.01	RSA 329:13-b; RSA 541-A:7; RSA 541-A:16, I (b), intro.
Med 407.02	RSA 329:13-b; RSA 541-A:16, I (b), intro.
Med 407.03	RSA 329:13-b; RSA 541-A:16, I (b), intro.
Med 408.01	RSA 329:9, IV; RSA 329:17, VII; RSA 329:17-c
Med 409.01	RSA 329:9, VI, XV, XVII-XIX; RSA 329:17
Med 410.01	RSA 329:9, VI, XV, XVII-XIX; RSA 329:17
Med 411.01 – 411.03	RSA 329:9, VX; 329:17, VII (g); RSA 329:2, II(d)
Med 412.01 – 412.02	RSA 329:9, IV
Med 412.03	RSA 329:9, IV, RSA 541-A:16, I(b)
Med 413.01	RSA 329:9, VI, XV, XVII-XIX; RSA 329:17
Med 413.02	RSA 329:9, IV, RSA 541-A:16, I(b)

Med 501.02	RSA 329:9, I, II, V, XV-a; RSA 329:2, II, (a), (b), (d), RSA 329:12, I(b); RSA 329:14, II; RSA 329:17, VI(d); RSA 318-B:33, II; RSA 318-B:36, III, IV, V
Med 501.01(b)	RSA 329:14, III, 329:24
Med 501.02	RSA 329:9, V
Med 501.02(a) & (b)	RSA 329:9, I, II & V
Med 501.02(c)-(i)	RSA 329:9, V, & XV-a
Med 501.02 (k)	RSA 329:2, II (b); 329:2, II (d); RSA 329:9, V; RSA 329:17, VI (d); RSA 318-B:33, II
Med 501.02 (l)	RSA 329:2, II (d); RSA 329:9, V; RSA 329:17, VI (d); RSA 318-B:33, II; RSA 329:2, II (a); RSA 329:12, I (b); RSA 329:14, II
Med 501.02 (m)	RSA 329:2, II (b); 329:2, II (d); RSA 329:9, V; RSA 329:17 VI Cd); RSA 318-B:36, IV.
Med 501.02 (n)	RSA 329:2, II (b); RSA 329:2, II (d); RSA 329:9, V; RSA 329:17, VI (d); RSA 318-B:36,V
Med 501.02 (o)	RSA 329:2, II (b); RSA 329:2, II (d); RSA 329:9, V; RSA 329:17, VI (d); RSA 318-B:36, III
Med 502	RSA 329:9, V and XV-a
Med 502.03	RSA 329:9, V and XV-a; RSA 318-B:41, II(d)
Med 502.05	RSA 329:9, V and XV-a; RSA 318-B:41, II(d)

Med 601.01 – Med 601.07	RSA 328-D:1
Med 601.06	RSA 328-D:1
Med 601.02, Med 601.03	RSA 328-D:1
Med 601.05, Med 601.06	RSA 328-D:1
Med 602.01(a)	RSA 328-D:12
Med 602.01(b)	RSA 328-D:18
Med 602.02, Med 602.03	RSA 328-D:3-b
Med 601.07	RSA 328-D:1
Med 602.01	RSA 328-D:12
Med 602.01(a)	RSA 328-D:12
Med 602.01(b)	RSA 328-D:18
Med 602.02, Med 602.03	RSA 328-D:3-b, I
Med 603.01	RSA 328-D:10, I(a)
Med 604.01	RSA 328-D:3, RSA 328-D:10, I(b)
Med 605.01	RSA 328-D:3; RSA 328-D:10, I(e)
Med 606	Reserved
Med 607.01	RSA 328-D:5-a, I; RSA 328-D:10, I(c)
Med 608.01	RSA 328-D:5; RSA 328-D:10, I(c); RSA 318-B:33, II
Med 609.01	RSA 328-D:6; RSA 328-D:7; RSA 328-D:10, I(d) and (g)
Med 610.02	RSA 328-D:10, I(j)
Med 612.01	RSA 328-D, XIII
Med 613	RSA 328-D-10, I(m)

APPENDIX II

Med 501.02(h), Med 501.02(i)(4), Med 501.02(i)(5)

Med 501.02(h)

Code of Medical Ethics of the American Medical Association, Current Opinions with Annotations, 2012-2013 Edition. This document is available at the office of the Board of Medicine, 121 South Fruit Street, Concord, N.H. 03301 for a fee of $.25 per page.

Med 501.02(i)(4)

Federation of State Medical Boards Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain, July 2013. This document is available at the office of the Board of Medicine, 121 South Fruit Street, Concord, N.H. 03301 for a fee of $.25 per page.

Med 501.02(i)(5)

Clinical Guidelines for the Use of Buprenorphrine in the Treatment of Opioid Addiction, A Treatment Improvement Protocol by the U.S. Department of Health, and Human Services (2004), www.pcssmentor.org. This document is available at the office of the Board of Medicine, 121 South Fruit Street, Concord, N.H. 03301 for a fee of $.25 per page.

APPENDIX III INCORPORATED REFERENCES

Rule	Reference	Obtain at:
Med 501.02(h)	Code of Medical Ethics of the American Medical Association, Current Opinions with Annotations, June 2016 Edition.	Available at the office of the Board of Medicine, 121 South Fruit Street, Concord, N.H. 03301 for a fee of $.25 per page.
Med 502.06 (a)	The American Society of Addiction Medicine’s “National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use,” adopted on June 1, 2015.	No cost to download from: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline.pdf?sfvrsn=0
Med 502.07 (a)	The American Society of Addiction Medicine’s “National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use,” adopted on June 1, 2015.	No cost to download from:
Med 609.01 (a) (8)	“Guidelines for Ethical Conduct for the Physician Assistant Profession” of the American Academy of Physician Assistants, adopted in 2000 and reaffirmed in 2013	No cost to download from: https://www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf