Shown verbatim: the complete text as captured from the official page posted by the Alaska State Legislature, fetched 2026-08-28. Where this bill amends existing law, language marked for deletion in the official page appears here in brackets. This is the enrolled version. The official bill page.
Enrolled HB 195 Changing the term "physician assistant" to "physician associate"; relating to physician associates; relating to collaborative practice agreements for pharmacists; relating to the prescription of opioid overdose drugs; relating to the prescription and administration of drugs and devices by pharmacists; relating to reciprocity for pharmacists; amending the definition of "practitioner"; and providing for an effective date. _______________ * Section 1. AS 08.02.130(e) is amended to read: (e) A physician, podiatrist, osteopath, or physician associate [ASSISTANT] licensed under AS 08.64 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 - 11.71.190 if the physician, podiatrist, osteopath, or physician associate [ASSISTANT] complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance. * Sec. 2. AS 08.02.130(j)(1) is amended to read: (1) "health care provider" means (A) an audiologist or speech-language pathologist licensed under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor licensed under AS 08.20; a professional or associate counselor licensed under AS 08.29; a dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a dietitian or nutritionist licensed under AS 08.38; a naturopath licensed under AS 08.45; a marital and family therapist licensed under AS 08.63; a physician licensed under AS 08.64; a podiatrist, osteopath, or physician associate [ASSISTANT] licensed under AS 08.64; a direct-entry midwife certified under AS 08.65; a nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or occupational therapist licensed under AS 08.84; a psychologist or psychological associate licensed under AS 08.86; or a social worker licensed under AS 08.95; (B) a physician licensed in another state; or (C) a member of a multidisciplinary care team who is licensed in another state; * Sec. 3. AS 08.02.130(j)(4) is amended to read: (4) "member of a multidisciplinary care team" means an audiologist, speech-language pathologist, behavior analyst, professional counselor, dietitian, nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician associate [ASSISTANT], nurse, pharmacist, physical therapist, occupational therapist, psychologist or psychological associate, advanced nurse practitioner, or social worker who is a member of a team coordinated by a physician licensed in another state who meets the requirements of (b)(3) of this section; * Sec. 4. AS 08.02 is amended by adding a new section to article 3 to read: Sec. 08.02.150. Regulation of collaborative practice agreements. (a) The department or a board may not (1) require a pharmacist to pay a fee to enter into, or provide patient care services under, a collaborative practice agreement; (2) require department or board approval of a collaborative practice agreement; (3) define the nature and scope of patient care services a pharmacist provides under a collaborative practice agreement; or (4) otherwise regulate collaborative practice agreements. (b) In this section, (1) "collaborative practice agreement" means a collaborative practice agreement authorized under AS 08.80.337(a); and (2) "patient care services" has the meaning given in AS 08.80.337(d). * Sec. 5. AS 08.36.355(c) is amended by adding a new paragraph to read: (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). * Sec. 6. AS 08.36.355 is amended by adding a new subsection to read: (d) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply; (2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more; (3) the patient is concurrently prescribed a benzodiazepine; or (4) the patient has a history of overdose or substance use disorder. * Sec. 7. AS 08.64.010 is amended to read: Sec. 08.64.010. Creation and membership of State Medical Board. The governor shall appoint a board of medical examiners, to be known as the State Medical Board, consisting of five physicians licensed in the state and residing in as many separate geographical areas of the state as possible, one physician associate [ASSISTANT] licensed under AS 08.64.107, and two persons with no direct financial interest in the health care industry. * Sec. 8. AS 08.64.101(a) is amended to read: (a) The board shall (1) except as provided in regulations adopted by the board under (b) of this section, examine and issue licenses to applicants; (2) develop written guidelines to ensure that licensing requirements are not unreasonably burdensome and the issuance of licenses is not unreasonably withheld or delayed; (3) after a hearing, impose disciplinary sanctions on persons who violate this chapter or the regulations or orders of the board; (4) adopt regulations ensuring that renewal of licenses is contingent on proof of continued competency on the part of the licensee; (5) under regulations adopted by the board, contract with private professional organizations to establish an impaired medical professionals program to identify, confront, evaluate, and treat persons licensed under this chapter who abuse alcohol, other drugs, or other substances or are mentally ill or cognitively impaired; (6) adopt regulations that establish guidelines for a physician or physician associate [ASSISTANT] who is rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.64.364; the guidelines must include a nationally recognized model policy for standards of care of a patient who is at a different location than the physician or physician associate [ASSISTANT]; (7) require that a licensee who has a federal Drug Enforcement Administration registration number register with the controlled substance prescription database under AS 17.30.200(n). * Sec. 9. AS 08.64.106 is amended to read: Sec. 08.64.106. Delegation of routine medical duties. The board shall adopt regulations authorizing a physician, podiatrist, osteopath, or physician associate [ASSISTANT] licensed under this chapter to delegate routine medical duties to an agent of the physician, podiatrist, osteopath, or physician associate [ASSISTANT]. The regulations must (1) require that an agent who is not licensed under this chapter may perform duties delegated under this section only if the agent meets applicable standards established by the board; (2) require that a physician, podiatrist, osteopath, or physician associate [ASSISTANT] may not delegate duties related to pain management and opioid use and addiction; and (3) define the phrase "routine medical duties." * Sec. 10. AS 08.64.107 is amended to read: Sec. 08.64.107. Regulation of physician associates [ASSISTANTS]. The board shall adopt regulations regarding the licensure of physician associates [ASSISTANTS] and the medical services that they may perform, including the (1) educational and other qualifications, including education in pain management and opioid use and addiction; (2) application and licensing procedures; (3) scope of activities authorized; and (4) responsibilities of the supervising or training physician. * Sec. 11. AS 08.64.170(a) is amended to read: (a) A person may not practice medicine, podiatry, or osteopathy in the state unless the person is licensed under this chapter, except that (1) a physician associate [ASSISTANT] may examine, diagnose, or treat persons under the supervision, control, and responsibility of either a physician licensed under this chapter or a physician exempted from licensing under AS 08.64.370; (2) a person who is licensed or authorized under another law of the state may engage in a practice that is authorized under that law; and (3) a person may perform routine medical duties delegated under AS 08.64.106. * Sec. 12. AS 08.64.360 is amended to read: Sec. 08.64.360. Penalty for practicing without a license or in violation of law. Except for a physician associate [ASSISTANT] or a person licensed or authorized under another law of the state who engages in practices for which that person is licensed or authorized under that law, a person practicing medicine or osteopathy in the state without a valid license or permit is guilty of a class A misdemeanor. Each day of illegal practice is a separate offense. * Sec. 13. AS 08.64.363(c) is amended by adding a new paragraph to read: (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). * Sec. 14. AS 08.64.363 is amended by adding a new subsection to read: (d) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply; (2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more; (3) the patient is concurrently prescribed a benzodiazepine; or (4) the patient has a history of overdose or substance use disorder. * Sec. 15. AS 08.64.364(a) is amended to read: (a) The board may not impose disciplinary sanctions on a physician or physician associate [ASSISTANT] for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if (1) the physician, physician associate [ASSISTANT], or another licensed health care provider in the medical practice is available to provide follow-up care; and (2) the physician or physician associate [ASSISTANT] requests that the person consent to sending a copy of all records of the encounter to the person's primary care provider if the prescribing physician or physician associate [ASSISTANT] is not the person's primary care provider and, if the person consents, the physician or physician associate [ASSISTANT] sends the records to the person's primary care provider. * Sec. 16. AS 08.64.364(b) is amended to read: (b) The board may not impose disciplinary sanctions on a physician or physician associate [ASSISTANT] for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and AS 08.64.363 are met. * Sec. 17. AS 08.64.364(c) is amended to read: (c) Notwithstanding (a) and (b) of this section, (1) a physician may not prescribe, dispense, or administer an abortion- inducing drug under (a) of this section unless the physician complies with AS 18.16.010; and (2) a physician or physician associate [ASSISTANT] may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the physician or physician associate [ASSISTANT] does not have a prior physician-patient relationship. * Sec. 18. AS 08.64.369(d) is amended to read: (d) In this section, "health care professional" includes an emergency medical technician certified under AS 18.08, health aide, physician, nurse, mobile intensive care paramedic licensed under AS 18.08, and physician associate [ASSISTANT], but does not include a practitioner of religious healing. * Sec. 19. AS 08.65.140 is amended to read: Sec. 08.65.140. Required practices. The board shall adopt regulations regarding the practice of direct-entry midwifery. At a minimum, the regulations must require that a certified direct-entry midwife (1) recommend, before care or delivery of a client, that the client undergo a physical examination performed by a physician, physician associate [ASSISTANT], or advanced practice registered nurse who is licensed in this state; (2) obtain informed consent from a client before onset of labor; (3) comply with AS 18.15.150 regarding taking of blood samples, AS 18.15.200 regarding screening of phenylketonuria (PKU), AS 18.50.160 regarding birth registration, AS 18.50.230 regarding registration of deaths, AS 18.50.240 regarding fetal death registration, and regulations adopted by the Department of Health concerning prophylactic treatment of the eyes of newborn infants; (4) not knowingly deliver a woman with certain types of health conditions, prior history, or complications as specified by the board. * Sec. 20. AS 08.68.265 is amended to read: Sec. 08.68.265. Supervision of practical nurses. A practical nurse shall work under the supervision of a licensed registered or advanced practice registered nurse, a licensed physician, a licensed physician associate [ASSISTANT], or a licensed dentist. * Sec. 21. AS 08.68.700(a) is amended to read: (a) A registered nurse licensed under this chapter may make a determination and pronouncement of death of a person under the following circumstances: (1) an attending physician, an attending advanced practice registered nurse, or an attending physician associate [ASSISTANT] has documented in the person's medical or clinical record that the person's death is anticipated due to illness, infirmity, or disease; this prognosis is valid for purposes of this section for not more than 120 days from the date of the documentation; (2) at the time of documentation under (1) of this subsection, the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] authorized in writing a specific registered nurse or nurses to make a determination and pronouncement of the person's death; however, if the person is in a health care facility and the health care facility has complied with (d) of this section, the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] may authorize all nurses employed by the facility to make a determination and pronouncement of the person's death. * Sec. 22. AS 08.68.700(b) is amended to read: (b) A registered nurse who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement in the person's medical or clinical record and notify the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] who determined that the prognosis for the patient was for an anticipated death. The registered nurse shall sign the death certificate, which must include the (1) name of the deceased; (2) presence of a contagious disease, if known; and (3) date and time of death. * Sec. 23. AS 08.68.700(c) is amended to read: (c) Except as otherwise provided under AS 18.50.230, a physician or physician associate [ASSISTANT] licensed under AS 08.64 or an advanced practice registered nurse licensed under this chapter shall certify a death determined under (b) of this section within 24 hours after the pronouncement by the registered nurse. * Sec. 24. AS 08.68.700(d) is amended to read: (d) In a health care facility in which a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] chooses to proceed under (a) of this section, written policies and procedures shall be adopted that provide for the determination and pronouncement of death by a registered nurse authorized by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] under this section. A registered nurse employed by a health care facility and authorized by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] to make a determination and pronouncement of death under this section may not make the determination or pronouncement unless the facility has written policies and procedures implementing and ensuring compliance with this section. * Sec. 25. AS 08.68.705(d) is amended by adding a new paragraph to read: (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). * Sec. 26. AS 08.68.705 is amended by adding a new subsection to read: (e) An advanced practice registered nurse who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply; (2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more; (3) the patient is concurrently prescribed a benzodiazepine; or (4) the patient has a history of overdose or substance use disorder. * Sec. 27. AS 08.72.276 is amended by adding new subsections to read: (c) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply; (2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more; (3) the patient is concurrently prescribed a benzodiazepine; or (4) the patient has a history of overdose or substance use disorder. (d) In this section, "opioid overdose drug" has the meaning given in AS 17.20.085(g). * Sec. 28. AS 08.80.030(b) is amended to read: (b) In order to fulfill its responsibilities, the board has the powers necessary for implementation and enforcement of this chapter, including the power to (1) elect a president and secretary from its membership and adopt rules for the conduct of its business; (2) license by examination or by license transfer the applicants who are qualified to engage in the practice of pharmacy; (3) assist the department in inspections and investigations for violations of this chapter, or of any other state or federal statute relating to the practice of pharmacy; (4) adopt regulations to carry out the purposes of this chapter; (5) establish and enforce compliance with professional standards and rules of conduct for pharmacists engaged in the practice of pharmacy; (6) determine standards for recognition and approval of degree programs of schools and colleges of pharmacy whose graduates shall be eligible for licensure in this state, including the specification and enforcement of requirements for practical training, including internships; (7) establish for pharmacists and pharmacies minimum specifications for the physical facilities, technical equipment, personnel, and procedures for the storage, compounding, and dispensing of drugs or related devices, and for the monitoring of drug therapy, including independent monitoring of drug therapy; (8) enforce the provisions of this chapter relating to the conduct or competence of pharmacists practicing in the state, and the suspension, revocation, or restriction of licenses to engage in the practice of pharmacy; (9) license and regulate the training, qualifications, and employment of pharmacy interns and pharmacy technicians; (10) license and regulate the qualifications of entities and individuals engaged in the manufacture or distribution of drugs and related devices; (11) establish and maintain a controlled substance prescription database as provided in AS 17.30.200; (12) establish standards for the independent prescribing and administration of vaccines and related emergency medications under AS 08.80.168, including the completion of an immunization training program approved by the board and an epinephrine auto-injector training program under AS 17.22.020(b); (13) establish standards for the independent prescribing and dispensing by a pharmacist of an opioid overdose drug under AS 17.20.085, including the completion of an opioid overdose training program approved by the board; (14) require that a licensed pharmacist who prescribes, administers, or dispenses a schedule II, III, or IV controlled substance under federal law to a person in the state register with the controlled substance prescription database under AS 17.30.200(n); (15) establish the qualifications and duties of the executive administrator and delegate authority to the executive administrator that is necessary to conduct board business; (16) license and inspect the facilities of pharmacies, manufacturers, wholesale drug distributors, third-party logistics providers, and outsourcing facilities located outside the state under AS 08.80.159; (17) license Internet-based pharmacies providing services to residents in the state; (18) adopt regulations pertaining to retired pharmacist status. * Sec. 29. AS 08.80.110 is amended to read: Sec. 08.80.110. Qualifications for licensure by examination. An applicant for licensure as a pharmacist shall (1) be fluent in the reading, writing, and speaking of the English language; (2) be a graduate of a college in a degree program approved by the board; (3) pass an examination or examinations given by the board or acceptable to the board under the score transfer process administered by the National Association of Boards of Pharmacy; (4) have completed internship training or another program that has been approved by the board or demonstrated to the board's satisfaction that the applicant has experience in the practice of pharmacy that meets or exceeds the minimum internship requirements of the board; and (5) receive education in pain management and opioid use and addiction, unless the applicant has demonstrated to the satisfaction of the board that the applicant does not currently hold a valid federal Drug Enforcement Administration registration number; an applicant may include past professional experience or professional education as proof of professional competence. * Sec. 30. AS 08.80.145 is amended to read: Sec. 08.80.145. Reciprocity; license transfer. If another jurisdiction allows licensure in that jurisdiction of a pharmacist licensed in this state under conditions similar to those in this section, the board may license as a pharmacist in this state a person licensed as a pharmacist in the other jurisdiction if the person (1) submits a written application to the board on a form required by the board; (2) is at least 18 years of age; (3) possesses at the time of the request for licensure as a pharmacist in this state the qualifications necessary to be eligible for licensure in this state; (4) has engaged in the practice of pharmacy for at least one year immediately before applying for a license under this section; (5) presents proof satisfactory to the board that the person is currently licensed as a pharmacist in the other jurisdiction and does not currently have a pharmacist license suspended, revoked, or otherwise restricted except for failure to apply for renewal or failure to obtain the required continuing education credits; (6) has passed an examination approved by the board that tests the person's knowledge of Alaska laws relating to pharmacies and pharmacists and the regulations adopted under those laws; [AND] (7) meets the requirements of AS 08.80.110(5); and (8) pays all required fees. * Sec. 31. AS 08.80.157(j) is amended to read: (j) This section does not apply to the offices of physicians, osteopaths, podiatrists, physician associates [ASSISTANTS], advanced nurse practitioners, dentists, veterinarians, dispensing opticians, or optometrists. * Sec. 32. AS 08.80.165 is amended to read: Sec. 08.80.165. Continuing education requirements. The board shall establish requirements for continuing education in pharmacy that must be satisfied before a license issued under this chapter may be renewed. The continuing education requirements must include at least two hours of education in pain management and opioid use and addiction during the concluding licensing period. The board may exempt a licensee from the requirement to receive at least two hours of education in pain management and opioid use and addiction if the licensee demonstrates to the satisfaction of the board that (1) the licensee's practice does not include pain management and opioid prescription or administration; or (2) the licensee does not currently hold a valid federal Drug Enforcement Administration registration number. * Sec. 33. AS 08.80.337(a) is amended to read: (a) A pharmacist may, under a collaborative practice agreement with a written protocol approved by a practitioner who is not a pharmacist, provide patient care services. The collaborative practice agreement must define the nature and scope of patient care services the pharmacist may provide under the agreement. * Sec. 34. AS 08.80.337(b) is amended to read: (b) A pharmacist may independently provide patient care services for (1) general health and wellness; (2) disease prevention; or (3) a condition that (A) is minor and generally self limiting; (B) does not require a new diagnosis; (C) requires a new diagnosis only if (i) the pharmacist uses [(B) HAS] a test [THAT IS USED] to guide the pharmacist's diagnosis or clinical decision- making; and (ii) the test is waived under 42 U.S.C. 263a (Clinical Laboratory Improvement Amendments of 1988); or (D) [(C)] falls under a statewide standing order from the chief medical officer in the Department of Health. * Sec. 35. AS 08.80.337(d) is amended to read: (d) In this section, "patient care services" (1) means medical care services, including the prescription or administration of a drug or device to a patient, that are given in exchange for compensation and intended to achieve outcomes related to the cure or prevention of a disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a disease process; (2) does not include the prescription or administration of the following drugs unless the drug is being used for the treatment of an opioid use disorder in a clinic: (A) a schedule IA or IIA controlled substance under state law or a schedule II controlled substance under federal law; (B) a drug that may only be prescribed or administered after completing a certified education program required by (i) the manufacturer; or (ii) the United States Food and Drug Administration, including by a risk evaluation and mitigation strategy; or (C) a drug that is not generally available at pharmacies and may only be dispensed at a pharmacy that (i) is authorized by the manufacturer to dispense the drug; or (ii) meets a requirement to dispense the drug under federal law. * Sec. 36. AS 08.80.337 is amended by adding a new subsection to read: (e) A pharmacist prescribing or administering a drug or device under this section shall recognize the limits of the pharmacist's education, training, and experience and consult with and refer to other practitioners as appropriate. * Sec. 37. AS 08.80.400 is amended to read: Sec. 08.80.400. Other licensees not affected. This chapter does not affect the practice of medicine by a licensed medical doctor and does not limit a licensed medical doctor, osteopath, podiatrist, physician associate [ASSISTANT], advanced practice registered nurse, dentist, veterinarian, dispensing optician, or optometrist in supplying a patient with any medicinal preparation or article within the scope of the person's license. * Sec. 38. AS 08.80.480(30) is amended to read: (30) "practice of pharmacy" means the interpretation, evaluation, and dispensing of prescription drug orders in the patient's best interest; participation in drug and device selection, drug administration, drug regimen reviews, and drug or drug-related research; provision of patient counseling and the provision of those acts or services necessary to provide pharmaceutical care; the independent prescribing, dispensing, and administration of drugs in accordance with AS 08.80.168; providing patient care services in accordance with AS 08.80.337; the responsibility for compounding and labeling of drugs and devices except labeling by a manufacturer, repackager, or distributor of nonprescription drugs and commercially packaged legend drugs and devices; proper and safe storage of drugs and devices; and maintenance of proper records for them; * Sec. 39. AS 08.80.480 is amended by adding a new paragraph to read: (40) "opioid" includes the opium and opiate substances and opium and opiate derivatives listed in AS 11.71.140 and 11.71.160. * Sec. 40. AS 09.55.560(2) is amended to read: (2) "health care provider" means an acupuncturist licensed under AS 08.06; an audiologist or speech-language pathologist licensed under AS 08.11; a chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or occupational therapist licensed under AS 08.84; a physician or physician associate [ASSISTANT] licensed under AS 08.64; a podiatrist; a psychologist and a psychological associate licensed under AS 08.86; a hospital as defined in AS 47.32.900, including a governmentally owned or operated hospital; an employee of a health care provider acting within the course and scope of employment; an ambulatory surgical facility and other organizations whose primary purpose is the delivery of health care, including a health maintenance organization, individual practice association, integrated delivery system, preferred provider organization or arrangement, and a physical hospital organization; * Sec. 41. AS 09.65.300(c)(1) is amended to read: (1) "health care provider" means a physician, physician associate [ASSISTANT], dentist, dental hygienist, osteopath, optometrist, chiropractor, registered nurse, practical nurse, advanced practice registered nurse, naturopath, physical therapist, occupational therapist, marital and family therapist, psychologist, psychological associate, behavior analyst, assistant behavior analyst, licensed clinical social worker, athletic trainer, certified direct-entry midwife, licensed professional counselor, or licensed associate counselor; * Sec. 42. AS 09.65.340(d)(1) is amended to read: (1) "health care provider" means a licensed physician, osteopath, dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village health aide, or pharmacist operating within the scope of the health care provider's authority; * Sec. 43. AS 09.68.120 is amended to read: Sec. 09.68.120. Definition of death. An individual is considered dead if, in the opinion of a physician licensed or exempt from licensing under AS 08.64 or a registered nurse authorized to pronounce death under AS 08.68.700, based on acceptable medical standards, or in the opinion of a mobile intensive care paramedic, physician associate [ASSISTANT], or emergency medical technician authorized to pronounce death based on the medical standards in AS 18.08.089, the individual has sustained irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem. Death may be pronounced in this circumstance before artificial means of maintaining respiratory and cardiac function are terminated. * Sec. 44. AS 11.41.470(1) is amended to read: (1) "health care worker" includes a person who is or purports to be an acupuncturist, advanced practice registered nurse, anesthesiologist, certified direct- entry midwife, chiropractor, dentist, health aide, hypnotist, massage therapist, mental health counselor, midwife, nurse, occupational therapist, occupational therapy assistant, osteopath, naturopath, physical therapist, physical therapist assistant, physician, physician associate [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist, religious healing practitioner, surgeon, x-ray technician, or a substantially similar position; * Sec. 45. AS 11.71.900(20) is amended to read: (20) "practitioner" means (A) a physician, dentist, advanced practice registered nurse, optometrist, veterinarian, scientific investigator, or other person licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer or use in teaching or chemical analysis a controlled substance in the course of professional practice or research in the state; (B) a pharmacist prescribing or administering a controlled substance in the course of professional practice in the state; or (C) [(B)] a pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a controlled substance in the course of professional practice or research in the state; * Sec. 46. AS 12.55.135(k)(3) is amended to read: (3) "medical professional" means a person who is an advanced practice registered nurse, anesthesiologist, chiropractor, dental hygienist, dentist, health aide, nurse, nurse aide, mental health counselor, osteopath, physician, physician associate [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist, surgeon, or x-ray technician, or who holds a substantially similar position. * Sec. 47. AS 13.52.065(a) is amended to read: (a) A physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] may issue a do not resuscitate order for a patient of the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] with the consent of the patient or the parent or guardian of the patient if the patient is under 18 years of age. The physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] shall document the grounds for the order in the patient's medical file. * Sec. 48. AS 13.52.065(c) is amended to read: (c) The department shall develop standardized designs and symbols for do not resuscitate identification cards, forms, necklaces, and bracelets that signify, when carried or worn, that the carrier or wearer is an individual for whom a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] has issued a do not resuscitate order. * Sec. 49. AS 13.52.065(d) is amended to read: (d) A health care provider other than a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] shall comply with the protocol adopted under (b) of this section for do not resuscitate orders when the health care provider is presented with a do not resuscitate identification, an oral do not resuscitate order issued directly by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] if the applicable hospital allows oral do not resuscitate orders, or a written do not resuscitate order entered on and as required by a form prescribed by the department. * Sec. 50. AS 13.52.065(f) is amended to read: (f) A do not resuscitate order may not be made ineffective unless a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] revokes the do not resuscitate order, a patient for whom the order is written and who has capacity requests that the do not resuscitate order be revoked, or the patient for whom the order is written is under 18 years of age and the parent or guardian of the patient requests that the do not resuscitate order be revoked. Any physician, advanced practice registered nurse, or physician associate [ASSISTANT] of a patient for whom a do not resuscitate order is written may revoke the do not resuscitate order if the person for whom the order is written requests that the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] revoke the do not resuscitate order. * Sec. 51. AS 13.52.080(a) is amended to read: (a) A health care provider or health care institution that acts in good faith and in accordance with generally accepted health care standards applicable to the health care provider or institution is not subject to civil or criminal liability or to discipline for unprofessional conduct for (1) providing health care information in good faith under AS 13.52.070; (2) complying with a health care decision of a person based on a good faith belief that the person has authority to make a health care decision for a patient, including a decision to withhold or withdraw health care; (3) declining to comply with a health care decision of a person based on a good faith belief that the person then lacked authority; (4) complying with an advance health care directive and assuming in good faith that the directive was valid when made and has not been revoked or terminated; (5) participating in the withholding or withdrawal of cardiopulmonary resuscitation under the direction or with the authorization of a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] or upon discovery of do not resuscitate identification on [UPON] an individual; (6) causing or participating in providing cardiopulmonary resuscitation or other life-sustaining procedures (A) under AS 13.52.065(e) when an individual has made an anatomical gift; (B) because an individual has made a do not resuscitate order ineffective under AS 13.52.065(f) or another provision of this chapter; or (C) because the patient is a woman of childbearing age and AS 13.52.055 applies; or (7) acting in good faith under the terms of this chapter or the law of another state relating to anatomical gifts. * Sec. 52. AS 13.52.100(c) is amended to read: (c) An individual who is a qualified patient, including an individual for whom a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] has issued a do not resuscitate order, has the right to make a decision regarding the use of cardiopulmonary resuscitation and other life-sustaining procedures as long as the individual is able to make the decision. If an individual who is a qualified patient, including an individual for whom a physician, advanced practice registered nurse, or physician associate [ASSISTANT] has issued a do not resuscitate order, is not able to make the decision, the protocol adopted under AS 13.52.065 for do not resuscitate orders governs a decision regarding the use of cardiopulmonary resuscitation and other life-sustaining procedures. * Sec. 53. AS 13.52.300 is amended to read: Sec. 13.52.300. Optional form. The following sample form may be used to create an advance health care directive. The other sections of this chapter govern the effect of this or any other writing used to create an advance health care directive. This form may be duplicated. This form may be modified to suit the needs of the person, or a different form that complies with this chapter may be used, including the mandatory witnessing requirements: ADVANCE HEALTH CARE DIRECTIVE Explanation You have the right to give instructions about your own health care to the extent allowed by law. You also have the right to name someone else to make health care decisions for you to the extent allowed by law. This form lets you do either or both of these things. It also lets you express your wishes regarding the designation of your health care provider. If you use this form, you may complete or modify all or any part of it. You are free to use a different form if the form complies with the requirements of AS 13.52. Part 1 of this form is a durable power of attorney for health care. A "durable power of attorney for health care" means the designation of an agent to make health care decisions for you. Part 1 lets you name another individual as an agent to make health care decisions for you if you do not have the capacity to make your own decisions or if you want someone else to make those decisions for you now even though you still have the capacity to make those decisions. You may name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner, operator, or employee of a health care institution where you are receiving care. Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you that you could legally make for yourself. This form has a place for you to limit the authority of your agent. You do not have to limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right, to the extent allowed by law, to (a) consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition, including the administration or discontinuation of psychotropic medication; (b) select or discharge health care providers and institutions; (c) approve or disapprove proposed diagnostic tests, surgical procedures, and programs of medication; (d) direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care; and (e) make an anatomical gift following your death. Part 2 of this form lets you give specific instructions for any aspect of your health care to the extent allowed by law, except you may not authorize mercy killing, assisted suicide, or euthanasia. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, including the provision of artificial nutrition and hydration, as well as the provision of pain relief medication. Space is provided for you to add to the choices you have made or for you to write out any additional wishes. Part 3 of this form lets you express an intention to make an anatomical gift following your death. Part 4 of this form lets you make decisions in advance about certain types of mental health treatment. Part 5 of this form lets you designate a physician to have primary responsibility for your health care. After completing this form, sign and date the form at the end and have the form witnessed by one of the two alternative methods listed below. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as your agent to make sure that the person understands your wishes and is willing to take the responsibility. You have the right to revoke this advance health care directive or replace this form at any time, except that you may not revoke this declaration when you are determined not to be competent by a court, by two physicians, at least one of whom shall be a psychiatrist, or by both a physician and a professional mental health clinician. In this advance health care directive, "competent" means that you have the capacity (1) to assimilate relevant facts and to appreciate and understand your situation with regard to those facts; and (2) to participate in treatment decisions by means of a rational thought process. PART 1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS (1) DESIGNATION OF AGENT. I designate the following individual as my agent to make health care decisions for me: _________________________________________________________ (name of individual you choose as agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) OPTIONAL: If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alternate agent _________________________________________________________ (name of individual you choose as first alternate agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent _________________________________________________________ (name of individual you choose as second alternate agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) (2) AGENT'S AUTHORITY. My agent is authorized and directed to follow my individual instructions and my other wishes to the extent known to the agent in making all health care decisions for me. If these are not known, my agent is authorized to make these decisions in accordance with my best interest, including decisions to provide, withhold, or withdraw artificial hydration and nutrition and other forms of health care to keep me alive, except as I state here: _________________________________________________________ _________________________________________________________ _________________________________________________________ (Add additional sheets if needed.) Under this authority, "best interest" means that the benefits to you resulting from a treatment outweigh the burdens to you resulting from that treatment after assessing (A) the effect of the treatment on your physical, emotional, and cognitive functions; (B) the degree of physical pain or discomfort caused to you by the treatment or the withholding or withdrawal of the treatment; (C) the degree to which your medical condition, the treatment, or the withholding or withdrawal of treatment, results in a severe and continuing impairment; (D) the effect of the treatment on your life expectancy; (E) your prognosis for recovery, with and without the treatment; (F) the risks, side effects, and benefits of the treatment or the withholding of treatment; and (G) your religious beliefs and basic values, to the extent that these may assist in determining benefits and burdens. (3) WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE. Except in the case of mental illness, my agent's authority becomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box. In the case of mental illness, unless I mark the following box, my agent's authority becomes effective when a court determines I am unable to make my own decisions, or, in an emergency, if my primary physician or another health care provider determines I am unable to make my own decisions. If I mark this box [ ], my agent's authority to make health care decisions for me takes effect immediately. (4) AGENT'S OBLIGATION. My agent shall make health care decisions for me in accordance with this durable power of attorney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent. (5) NOMINATION OF GUARDIAN. If a guardian of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not willing, able, or reasonably available to act as guardian, I nominate the alternate agents whom I have named under (1) above, in the order designated. PART 2 INSTRUCTIONS FOR HEALTH CARE If you are satisfied to allow your agent to determine what is best for you in making health care decisions, you do not need to fill out this part of the form. If you do fill out this part of the form, you may strike any wording you do not want. There is a state protocol that governs the use of do not resuscitate orders by physicians, advanced practice registered nurses, physician associates [ASSISTANTS], and other health care providers. You may obtain a copy of the protocol from the Alaska Department of Health. A "do not resuscitate order" means a directive from a licensed physician, advanced practice registered nurse, or physician associate [ASSISTANT] that emergency cardiopulmonary resuscitation should not be administered to you. (6) END-OF-LIFE DECISIONS. Except to the extent prohibited by law, I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (Check only one box.) [ ] (A) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards; OR [ ] (B) Choice Not To Prolong Life I want comfort care only and I do not want my life to be prolonged with medical treatment if, in the judgment of my physician, I have (check all choices that represent your wishes) [ ] (i) a condition of permanent unconsciousness: a condition that, to a high degree of medical certainty, will last permanently without improvement; in which, to a high degree of medical certainty, thought, sensation, purposeful action, social interaction, and awareness of myself and the environment are absent; and for which, to a high degree of medical certainty, initiating or continuing life- sustaining procedures for me, in light of my medical outcome, will provide only minimal medical benefit for me; or [ ] (ii) a terminal condition: an incurable or irreversible illness or injury that without the administration of life-sustaining procedures will result in my death in a short period of time, for which there is no reasonable prospect of cure or recovery, that imposes severe pain or otherwise imposes an inhumane burden on me, and for which, in light of my medical condition, initiating or continuing life-sustaining procedures will provide only minimal medical benefit; [ ] Additional instructions: ________________ ___________________________________________________ (C) Artificial Nutrition and Hydration. If I am unable to safely take nutrition, fluids, or nutrition and fluids (check your choices or write your instructions), [ ] I wish to receive artificial nutrition and hydration indefinitely; [ ] I wish to receive artificial nutrition and hydration indefinitely, unless it clearly increases my suffering and is no longer in my best interest; [ ] I wish to receive artificial nutrition and hydration on a limited trial basis to see if I can improve; [ ] In accordance with my choices in (6)(B) above, I do not wish to receive artificial nutrition and hydration. [ ] Other instructions:_____________________ ___________________________________________________ (D) Relief from Pain. [ ] I direct that adequate treatment be provided at all times for the sole purpose of the alleviation of pain or discomfort; or [ ] I give these instructions: _____________________________________________ _____________________________________________ (E) Should I become unconscious and I am pregnant, I direct that ________________________ _____________________________________________ _____________________________________________ (7) OTHER WISHES. (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that _________________________________________________________ _________________________________________________________ Conditions or limitations: ______________________________ _________________________________________________________. (Add additional sheets if needed.) PART 3 ANATOMICAL GIFT AT DEATH (OPTIONAL) If you are satisfied to allow your agent to determine whether to make an anatomical gift at your death, you do not need to fill out this part of the form. (8) Upon my death: (mark applicable box) [ ] (A) I give any needed organs, tissues, or other body parts, OR [ ] (B) I give the following organs, tissues, or other body parts only ________________________________ __________________________________________________ [ ] (C) My gift is for the following purposes (mark any of the following you want): [ ] (i) transplant; [ ] (ii) therapy; [ ] (iii) research; [ ] (iv) education. [ ] (D) I refuse to make an anatomical gift. PART 4 MENTAL HEALTH TREATMENT This part of the declaration allows you to make decisions in advance about mental health treatment. The instructions that you include in this declaration will be followed only if a court, two physicians that include a psychiatrist, or a physician and a professional mental health clinician believe that you are not competent and cannot make treatment decisions. Otherwise, you will be considered to be competent and to have the capacity to give or withhold consent for the treatments. If you are satisfied to allow your agent to determine what is best for you in making these mental health decisions, you do not need to fill out this part of the form. If you do fill out this part of the form, you may strike any wording you do not want. (9) PSYCHOTROPIC MEDICATIONS. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding psychotropic medications are as follows: ________ I consent to the administration of the following medications: ______________________________________________ ________ I do not consent to the administration of the following medications: ______________________________________ Conditions or limitations:_______________________________ _________________________________________________________. (10) ELECTROCONVULSIVE TREATMENT. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding electroconvulsive treatment are as follows: ________ I consent to the administration of electroconvulsive treatment. ________ I do not consent to the administration of electroconvulsive treatment. Conditions or limitations: ______________________________ _________________________________________________________. (11) ADMISSION TO AND RETENTION IN FACILITY. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding admission to and retention in a mental health facility for mental health treatment are as follows: ________ I consent to being admitted to a mental health facility for mental health treatment for up to ________ days. (The number of days not to exceed 17.) ________ I do not consent to being admitted to a mental health facility for mental health treatment. Conditions or limitations: ______________________________ _________________________________________________________. OTHER WISHES OR INSTRUCTIONS _________________________________________________________ _________________________________________________________ _________________________________________________________ Conditions or limitations: ______________________________ _________________________________________________________. PART 5 PRIMARY PHYSICIAN (OPTIONAL) (12) I designate the following physician as my primary physician: _________________________________________________________ (name of physician) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (telephone) OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician: _________________________________________________________ (name of physician) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (telephone) (13) EFFECT OF COPY. A copy of this form has the same effect as the original. (14) SIGNATURES. Sign and date the form here: _________________________________________________________ (date) (sign your name) _________________________________________________________ (print your name) _________________________________________________________ (address) (city) (state) (zip code) (15) WITNESSES. This advance care health directive will not be valid for making health care decisions unless it is (A) signed by two qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature; the witnesses may not be a health care provider employed at the health care institution or health care facility where you are receiving health care, an employee of the health care provider who is providing health care to you, an employee of the health care institution or health care facility where you are receiving health care, or the person appointed as your agent by this document; at least one of the two witnesses may not be related to you by blood, marriage, or adoption or entitled to a portion of your estate upon your death under your will or codicil; or (B) acknowledged before a notary public in the state. ALTERNATIVE NO. 1 Witness Who is Not Related to or a Devisee of the Principal I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence, and that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care; (2) an employee of the health care provider providing health care to the principal; (3) an employee of the health care institution or health care facility where the principal is receiving health care; (4) the person appointed as agent by this document; (5) related to the principal by blood, marriage, or adoption; or (6) entitled to a portion of the principal's estate upon the principal's death under a will or codicil. ________________________________________________________ (date) (signature of witness) ________________________________________________________ (printed name of witness) ________________________________________________________ (address) (city) (state) (zip code) Witness Who May be Related to or a Devisee of the Principal I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence, and that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care; (2) an employee of the health care provider who is providing health care to the principal; (3) an employee of the health care institution or health care facility where the principal is receiving health care; or (4) the person appointed as agent by this document. _______________________________________________________ (date) (signature of witness) _______________________________________________________ (printed name of witness) _______________________________________________________ (address) (city) (state) (zip code) ALTERNATIVE NO. 2 State of Alaska ________________ Judicial District On this ____ day of ___________________, in the year ______________, before me, _______________________________ (insert name of notary public) appeared _______________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that the person executed it. Notary Seal ___________________________ (signature of notary public) * Sec. 54. AS 13.52.390(13) is amended to read: (13) "do not resuscitate order" means a directive from a licensed physician, advanced practice registered nurse, or physician associate [ASSISTANT] that emergency cardiopulmonary resuscitation should not be administered to a qualified patient; * Sec. 55. AS 13.52.390(24) is amended to read: (24) "life-sustaining procedures" means any medical treatment, procedure, or intervention that, in the judgment of the primary physician, advanced practice registered nurse, or physician associate [ASSISTANT], when applied to a patient with a qualifying condition, would not be effective to remove the qualifying condition, would serve only to prolong the dying process, or, when administered to a patient with a condition of permanent unconsciousness, may keep the patient alive but is not expected to restore consciousness; in this paragraph, "medical treatment, procedure, or intervention" includes assisted ventilation, renal dialysis, surgical procedures, blood transfusions, and the administration of drugs, including antibiotics, or artificial nutrition and hydration; * Sec. 56. AS 13.52.390(31) is amended to read: (31) "physician associate [ASSISTANT]" means an individual licensed under AS 08.64.107; * Sec. 57. AS 14.30.141(e) is amended to read: (e) In this section, "health care provider" means a licensed physician, advanced practice registered nurse, physician associate [ASSISTANT], village health aide, or pharmacist operating within the scope of the health care provider's authority. * Sec. 58. AS 17.20.085(g)(1) is amended to read: (1) "health care provider" means a licensed physician, osteopath, dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village health aide, or pharmacist operating within the scope of the health care provider's authority; * Sec. 59. AS 18.08.087 is amended to read: Sec. 18.08.087. Disclosure of medical records. When requested for the purpose of evaluating the performance of an emergency medical technician, mobile intensive care paramedic, or physician who provided emergency medical care or other assistance to a sick or injured person, a licensed physician, advanced practice registered nurse, or physician associate [ASSISTANT] may disclose to an emergency medical technician, a mobile intensive care paramedic, or physician the medical or hospital records of a sick or injured person to whom the paramedic, technician, or physician is providing or has rendered emergency medical care or assistance. However, the disclosing physician, advanced practice registered nurse, or physician associate [ASSISTANT] shall limit disclosure under this section to the records that are considered necessary by the discloser for evaluation of the paramedic's, technician's, or physician's performance in providing the emergency medical care or assistance. A mobile intensive care paramedic, emergency medical care technician, or physician to whom confidential records are disclosed under this section may not further disclose the information to a person not entitled to receive that information under this section or another law. * Sec. 60. AS 18.08.089(a) is amended to read: (a) A mobile intensive care paramedic licensed under this chapter, a physician associate [ASSISTANT] registered or licensed under AS 08.64.107, or an emergency medical technician certified under this chapter may make a determination and pronouncement of death of a person under the following circumstances: (1) the mobile intensive care paramedic or emergency medical technician is an active member of an emergency medical service certified under this chapter; (2) neither a physician licensed under AS 08.64 nor a physician exempt from licensure under AS 08.64 is immediately available for consultation by radio or telephone communications; (3) the mobile intensive care paramedic, physician associate [ASSISTANT], or emergency medical technician has determined, based on acceptable medical standards, that the person has sustained irreversible cessation of circulatory and respiratory functions. * Sec. 61. AS 18.08.089(b) is amended to read: (b) A mobile intensive care paramedic, physician associate [ASSISTANT], or emergency medical technician who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement on the person's emergency medical service report form and notify the appropriate medical director or collaborative physician as soon as communication can be established. The paramedic, physician associate [ASSISTANT], or emergency medical technician shall provide to the person who signs the death certificate the (1) name of the deceased; (2) presence of a contagious disease, if known; and (3) date and time of death. * Sec. 62. AS 18.08.089(c) is amended to read: (c) Except as otherwise provided under AS 18.50.230, a physician licensed under AS 08.64 shall certify a death determined under (b) of this section within 24 hours after the pronouncement by the mobile intensive care paramedic, physician associate [ASSISTANT], or emergency medical technician. * Sec. 63. AS 18.15.310(a) is amended to read: (a) The withdrawal of blood for a test under AS 18.15.300 - 18.15.320 shall be performed in a medically approved manner. Only a physician or physician associate [ASSISTANT] licensed under AS 08.64, registered or advanced practice registered nurse, licensed practical nurse, or certified emergency medical technician may withdraw blood specimens for the purposes of AS 18.15.300 - 18.15.320. * Sec. 64. AS 18.15.395(11) is amended to read: (11) "health care practitioner" means a physician, advanced practice registered nurse, or physician associate [ASSISTANT] licensed or otherwise authorized to practice their respective professions in this state; * Sec. 65. AS 18.15.395(12) is amended to read: (12) "health care provider" means any person that provides health care services; "health care provider" includes a hospital, medical clinic or office, special care facility, medical laboratory, physician, pharmacist, dentist, physician associate [ASSISTANT], nurse, paramedic, emergency medical or laboratory technician, community health worker, and ambulance and emergency medical worker; * Sec. 66. AS 18.20.095(e)(2) is amended to read: (2) "licensed staff member" means a person who is employed by the hospital to provide direct patient care and who is licensed or certified in the state as a physician or physician associate [ASSISTANT] under AS 08.64, direct-entry midwife under AS 08.65, nurse or nurse aide under AS 08.68, or physical therapist or occupational therapist under AS 08.84; * Sec. 67. AS 18.29.190(9) is amended to read: (9) "tier II health care professional" means a person who spends not less than 50 percent of the person's time on direct patient health care services and who is licensed or exempt from licensure in the state as a dental hygienist, advanced practice registered nurse, registered nurse, physician associate [ASSISTANT], physical therapist, professional counselor, associate counselor, board certified behavior analyst, marital and family therapist, clinical social worker, or other health care professional as determined by the commissioner; * Sec. 68. AS 18.50.230(c) is amended to read: (c) The medical certification shall be completed and signed within 24 hours after death by the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] in charge of the patient's care for the illness or condition that resulted in death except when an official inquiry or inquest is required and except as provided by regulation in special problem cases. * Sec. 69. AS 18.65.310(m) is amended to read: (m) The department shall provide a method for a person to designate voluntarily on an identification card that the person has a disability, including a cognitive, mental, neurological, or physical disability, or a combination of those disabilities. The department shall create a discreet symbol to place on the identification card of a person requesting the designation. The method must provide a means by which the person may cancel the designation. The department may not charge a fee solely for the designation. To receive the designation, the person shall provide proof of the disability from a person licensed as a physician or physician associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45, as an advanced practice registered nurse under AS 08.68, or as a licensed psychologist under AS 08.86. Notwithstanding (a) of this section, the department may charge a fee of $5 for replacement of a valid identification card with a new identification card with a disability designation and may charge a fee of $5 for replacement of an identification card with a disability designation with a new identification card without a disability designation. * Sec. 70. AS 18.67.020(a) is amended to read: (a) The Violent Crimes Compensation Board is composed of three members to be appointed by the governor. One of the members shall be designated as chair by the governor. At least one member must be a medical or osteopathic physician, a physician associate [ASSISTANT], or an advanced nurse practitioner licensed to practice in this state or retired from practice in this state, and one member must be an attorney licensed to practice in this state or retired from practice in this state. * Sec. 71. AS 21.36.090(d) is amended to read: (d) Except to the extent necessary to comply with AS 21.42.365 and AS 21.56, a person may not practice or permit unfair discrimination against a person who provides a service covered under a group health insurance policy that extends coverage on an expense incurred basis, or under a group service or indemnity type contract issued by a health maintenance organization or a nonprofit corporation, if the service is within the scope of the provider's occupational license. In this subsection, "provider" means a state licensed physician, physician associate [ASSISTANT], dentist, osteopath, optometrist, chiropractor, advanced practice registered nurse, pharmacist, naturopath, physical therapist, occupational therapist, marital and family therapist, psychologist, psychological associate, licensed clinical social worker, licensed professional counselor, licensed associate counselor, certified direct-entry midwife, or dental hygienist holding an advanced practice permit. * Sec. 72. AS 21.42.351(b)(2) is amended to read: (2) "health care professional" means a health aide, physician, nurse, and physician associate [ASSISTANT], but does not include a practitioner of religious healing; * Sec. 73. AS 23.30.395(3) is amended to read: (3) "attending physician" means one of the following designated by the employee under AS 23.30.095(a) or (b): (A) a licensed medical doctor; (B) a licensed doctor of osteopathy; (C) a licensed dentist or dental surgeon; (D) a licensed physician associate [ASSISTANT] acting under supervision of a licensed medical doctor or doctor of osteopathy; (E) a licensed advanced practice registered nurse; or (F) a licensed chiropractor; * Sec. 74. AS 28.10.181(d) is amended to read: (d) Vehicles owned by veterans with disabilities, including persons disabled in the line of duty while serving in the Alaska Territorial Guard, or other persons with disabilities. Upon the request of a person with a disability that limits or impairs the ability to walk, as defined in 23 C.F.R. 1235.2, the department shall (1) register one motor vehicle in the name of the person without charge; and (2) issue a specially designed registration plate that displays (A) recognition of the disabled veteran if the applicant's disability originated from the applicant's service with the Alaska Territorial Guard or the armed forces of the United States; (B) the international symbol of accessibility (the wheelchair logo); and (C) if the applicant is a veteran, the Alaska and United States flags and red, white, and blue colors. A person who is not otherwise qualified under this subsection, but who meets the qualifications of a disabled veteran under AS 29.45.030(i), may register one motor vehicle without charge, and the department shall issue a specially designed registration plate that displays recognition of the disabled veteran that does not display the international symbol of accessibility and does not carry with it special parking privileges. A disabled veteran who otherwise qualifies for a registration plate under this subsection may elect to receive a plate under (p) or (q) of this section for which the person is otherwise qualified that does not display the international symbol of accessibility and does not carry with it special parking privileges. A disabled person who otherwise qualifies for a registration plate under (2)(B) of this subsection may elect to receive a plate under another provision of this section for which the person is otherwise qualified that does not display the international symbol of accessibility and does not carry with it special parking privileges. For purposes of this subsection, proof of disability may be provided by a person licensed as a speech-language pathologist under AS 08.11, as a chiropractor under AS 08.20, as a physician or physician associate [ASSISTANT] under AS 08.64, as an advanced practice registered nurse under AS 08.68, or as a physical therapist or occupational therapist under AS 08.84. * Sec. 75. AS 28.15.111(d) is amended to read: (d) The department shall provide a method, at the time that a driver's license is issued, by which the owner of a license may voluntarily designate on the license that the owner has a disability, including a cognitive, mental, neurological, or physical disability, or a combination of those disabilities. The department shall create a discreet symbol to place on the driver's license of a person requesting the designation. The method must provide a means by which the owner may cancel the designation. The department may not charge a fee solely for the designation. To receive the designation, the person shall provide proof of the disability from a person licensed as a physician or physician associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45, as an advanced practice nurse under AS 08.68, or as a licensed psychologist under AS 08.86. The department may charge a fee of $5 for replacement of a valid driver's license with a new driver's license with a disability designation and may charge a fee of $5 for replacement of a driver's license with a disability designation with a new driver's license without a disability designation. * Sec. 76. AS 33.30.901(10) is amended to read: (10) "health care provider" means (A) a physician associate [ASSISTANT] licensed to practice in the state and working under the direct supervision of a licensed physician or psychiatrist; (B) a mental health professional as defined in AS 47.30.915; or (C) an advanced practice registered nurse as defined in AS 08.68.850; * Sec. 77. AS 47.17.290(14) is amended to read: (14) "practitioner of the healing arts" includes athletic trainers, chiropractors, mental health counselors, social workers, dental hygienists, dentists, health aides, nurses, nurse practitioners, certified nurse aides, occupational therapists, occupational therapy assistants, optometrists, osteopaths, naturopaths, physical therapists, physical therapist assistants, physicians, physician associates [ASSISTANTS], psychiatrists, psychologists, psychological associates, audiologists and speech-language pathologists licensed under AS 08.11, hearing aid dealers licensed under AS 08.55, marital and family therapists licensed under AS 08.63, behavior analysts, assistant behavior analysts, religious healing practitioners, acupuncturists, and surgeons; * Sec. 78. AS 47.30.705(a) is amended to read: (a) A peace officer, health officer, mental health professional, or physician associate [ASSISTANT] licensed by the State Medical Board to practice in this state who has probable cause to believe that a person is gravely disabled or is suffering from mental illness and is likely to cause serious harm to self or others of such immediate nature that considerations of safety do not allow initiation of involuntary commitment procedures set out in AS 47.30.700, may cause the person to be taken into custody by a peace officer or health officer and delivered to the nearest crisis stabilization center, crisis residential center, evaluation facility, or treatment facility. A person taken into custody for emergency evaluation may not be placed in a jail or other correctional facility except for protective custody purposes and only while awaiting transportation to a crisis stabilization center, crisis residential center, evaluation facility, or treatment facility. However, protective custody under this section may not include placement of a minor in a jail or secure facility. The peace officer, health officer, mental health professional, or physician associate [ASSISTANT] shall complete an application for examination of the person in custody and be interviewed by a mental health professional at the crisis stabilization center, crisis residential center, evaluation facility, or treatment facility. * Sec. 79. AS 47.30.838(a) is amended to read: (a) Except as provided in (c) and (d) of this section, an evaluation facility or designated treatment facility may administer psychotropic medication to a patient without the patient's informed consent, regardless of whether the patient is capable of giving informed consent, only if (1) there is a crisis situation, or an impending crisis situation, that requires immediate use of the medication to preserve the life of, or prevent significant physical harm to, the patient or another person, as determined by a physician, physician associate [ASSISTANT], or advanced practice registered nurse; the behavior or condition of the patient giving rise to a crisis under this paragraph and the staff's response to the behavior or condition must be documented in the patient's medical record; the documentation must include an explanation of alternative responses to the crisis that were considered or attempted by the staff and why those responses were not sufficient; and (2) the medication is ordered by a physician, physician associate [ASSISTANT], or advanced practice registered nurse; the order (A) may be written or oral and may be received by telephone, facsimile machine, or in person; (B) may include an initial dosage and may authorize additional, as needed, doses; if additional, as needed, doses are authorized, the order must specify the medication, the quantity of each authorized dose, the method of administering the medication, the maximum frequency of administration, the specific conditions under which the medication may be given, and the maximum amount of medication that may be administered to the patient in a 24-hour period; (C) is valid for only 24 hours and may be renewed by a physician, physician associate [ASSISTANT], or advanced practice registered nurse for a total of 72 hours, including the initial 24 hours, only after a personal assessment of the patient's status and a determination that there is still a crisis situation as described in (1) of this subsection; upon renewal of an order under this subparagraph, the facts supporting the renewal shall be written into the patient's medical record. * Sec. 80. AS 47.37.180(b) is amended to read: (b) The certifying physician, physician associate [ASSISTANT], advanced practice registered nurse, spouse, guardian, or relative of the person to be committed, or any other responsible person, may make a written application for commitment under this section, directed to the administrator of the approved public treatment facility. The application must state facts to support the need for emergency treatment and be accompanied by a physician's, physician associate's [ASSISTANT'S], or advanced practice registered nurse's certificate supporting the need for emergency treatment and stating that the physician, physician associate [ASSISTANT], or advanced practice registered nurse has examined the person sought to be committed within two days before the certificate's date. * Sec. 81. AS 47.37.180(f) is amended to read: (f) A copy of the written application for commitment and of the physician's, physician associate's [ASSISTANT'S], or advanced practice registered nurse's certificate, and a written explanation of the person's right to legal counsel, shall be given to the person within 24 hours after commitment by the administrator, who shall provide a reasonable opportunity for the person to consult with legal counsel. * Sec. 82. AS 47.37.190(a) is amended to read: (a) A spouse or guardian, a relative, the certifying physician, physician associate, or [ASSISTANT,] advanced practice registered nurse, or the administrator in charge of an approved public treatment facility may petition the court for a 30-day involuntary commitment order. The petition must allege that the person is an alcoholic or drug abuser who (1) has threatened, attempted to inflict, or inflicted physical harm on another and that unless committed is likely to inflict physical harm on another; or (2) is incapacitated by alcohol or drugs. A refusal to undergo treatment does not constitute evidence of lack of judgment as to the need for treatment. The petition must be accompanied by a certificate of a licensed physician, physician associate [ASSISTANT], or advanced practice registered nurse who has examined the person within two days before submission of the petition, unless the person whose commitment is sought has refused to submit to a medical examination, in which case the fact of refusal must be alleged in the petition. The certificate must set out the physician's, physician associate's [ASSISTANT'S], or advanced practice registered nurse's findings of the examination in support of the allegations of the petition. * Sec. 83. AS 47.37.200(a) is amended to read: (a) At the hearing for a 30-day commitment required under AS 47.37.190(b), the court shall hear all relevant testimony, including, if possible, the testimony of at least one person who has examined the person whose commitment is sought under AS 47.37.180(b) or 47.37.190(a). The person whose commitment is sought shall be present unless the court believes that being present is likely to be injurious to the person, in which case the court may conduct the hearing telephonically. The court may examine the person in open court, or, if advisable, examine the person out of court. If the person has refused to be examined under AS 47.37.180(b) or 47.37.190(a), the person shall be given an opportunity to request examination by a court-appointed licensed physician, physician associate [ASSISTANT], or advanced practice registered nurse. If the person fails to request a medical examination and there is sufficient evidence to believe that the allegations of the petition are true, or, if the court believes that more medical evidence is necessary, the court may issue a temporary order committing the person to a private or public facility for a period of not more than five days for purposes of a diagnostic examination. * Sec. 84. AS 08.80.337(c) is repealed. * Sec. 85. The uncodified law of the State of Alaska is amended by adding a new section to read: REVISOR'S INSTRUCTION. If SB 89, as passed by the Thirty-Fourth Alaska State Legislature, is enacted into law, the revisor of statutes shall replace all occurrences of "physician assistant" in SB 89 with "physician associate," except for occurrences of "physician assistant" when used in "Accreditation Review Commission on Education for the Physician Assistant" and "National Commission on Certification of Physician Assistants." * Sec. 86. The uncodified law of the State of Alaska is amended by adding a new section to read: CONDITIONAL EFFECT. Sections 7, 10, 12, 56, 60, 73, and 76 of this Act take effect only if SB 89, as passed by the Thirty-Fourth Alaska State Legislature, is not enacted into law. * Sec. 87. Sections 4 - 6, 13, 14, 25 - 30, 32 - 36, 38, 39, 45, and 84 of this Act take effect January 1, 2027.
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