00 CS FOR HOUSE BILL NO. 195(FIN) 01 "An Act changing the term 'physician assistant' to 'physician associate'; relating to 02 physician associates; relating to collaborative practice agreements for pharmacists; 03 relating to the prescription of opioid overdose drugs; relating to the prescription and 04 administration of drugs and devices by pharmacists; relating to reciprocity for 05 pharmacists; amending the definition of 'practitioner'; and providing for an effective 06 date." 07 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 08  * Section 1. AS 08.02.130(e) is amended to read: 09 (e) A physician, podiatrist, osteopath, or physician associate [ASSISTANT] 10 licensed under AS 08.64 may prescribe, dispense, or administer through telehealth 11 under this section a prescription for a controlled substance listed in AS 11.71.140 - 12 11.71.190 if the physician, podiatrist, osteopath, or physician associate [ASSISTANT] 13 complies with state and federal law governing the prescription, dispensing, or 01 administering of a controlled substance. 02  * Sec. 2. AS 08.02.130(j)(1) is amended to read: 03 (1) "health care provider" means 04 (A) an audiologist or speech-language pathologist licensed 05 under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor 06 licensed under AS 08.20; a professional or associate counselor licensed under 07 AS 08.29; a dental hygienist licensed under AS 08.32; a dentist licensed under 08 AS 08.36; a dietitian or nutritionist licensed under AS 08.38; a naturopath 09 licensed under AS 08.45; a marital and family therapist licensed under 10 AS 08.63; a physician licensed under AS 08.64; a podiatrist, osteopath, or 11 physician associate [ASSISTANT] licensed under AS 08.64; a direct-entry 12 midwife certified under AS 08.65; a nurse licensed under AS 08.68; a 13 dispensing optician licensed under AS 08.71; an optometrist licensed under 14 AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or 15 occupational therapist licensed under AS 08.84; a psychologist or 16 psychological associate licensed under AS 08.86; or a social worker licensed 17 under AS 08.95; 18 (B) a physician licensed in another state; or 19 (C) a member of a multidisciplinary care team who is licensed 20 in another state; 21  * Sec. 3. AS 08.02.130(j)(4) is amended to read: 22 (4) "member of a multidisciplinary care team" means an audiologist, 23 speech-language pathologist, behavior analyst, professional counselor, dietitian, 24 nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician 25 associate [ASSISTANT], nurse, pharmacist, physical therapist, occupational therapist, 26 psychologist or psychological associate, advanced nurse practitioner, or social worker 27 who is a member of a team coordinated by a physician licensed in another state who 28 meets the requirements of (b)(3) of this section; 29  * Sec. 4. AS 08.02 is amended by adding a new section to article 3 to read: 30 Sec. 08.02.150. Regulation of collaborative practice agreements. (a) The 31 department or a board may not 01 (1) require a pharmacist to pay a fee to enter into, or provide patient 02 care services under, a collaborative practice agreement; 03 (2) require department or board approval of a collaborative practice 04 agreement; 05 (3) define the nature and scope of patient care services a pharmacist 06 provides under a collaborative practice agreement; or 07 (4) otherwise regulate collaborative practice agreements. 08 (b) In this section, 09 (1) "collaborative practice agreement" means a collaborative practice 10 agreement authorized under AS 08.80.337(a); and 11 (2) "patient care services" has the meaning given in AS 08.80.337(d). 12  * Sec. 5. AS 08.36.355(c) is amended by adding a new paragraph to read: 13 (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). 14  * Sec. 6. AS 08.36.355 is amended by adding a new subsection to read: 15 (d) A licensee who issues a prescription for an opioid to a patient shall offer 16 the patient a prescription for an opioid overdose drug if 17 (1) the prescription is for an opioid that exceeds a three-day supply; 18 (2) the prescription is for a total daily opioid dosage representing a 19 morphine milligram equivalent of 50 milligrams or more; 20 (3) the patient is concurrently prescribed a benzodiazepine; or 21 (4) the patient has a history of overdose or substance use disorder. 22  * Sec. 7. AS 08.64.010 is amended to read: 23 Sec. 08.64.010. Creation and membership of State Medical Board. The 24 governor shall appoint a board of medical examiners, to be known as the State 25 Medical Board, consisting of five physicians licensed in the state and residing in as 26 many separate geographical areas of the state as possible, one physician associate 27 [ASSISTANT] licensed under AS 08.64.107, and two persons with no direct financial 28 interest in the health care industry. 29  * Sec. 8. AS 08.64.101(a) is amended to read: 30 (a) The board shall 31 (1) except as provided in regulations adopted by the board under (b) of 01 this section, examine and issue licenses to applicants; 02 (2) develop written guidelines to ensure that licensing requirements are 03 not unreasonably burdensome and the issuance of licenses is not unreasonably 04 withheld or delayed; 05 (3) after a hearing, impose disciplinary sanctions on persons who 06 violate this chapter or the regulations or orders of the board; 07 (4) adopt regulations ensuring that renewal of licenses is contingent on 08 proof of continued competency on the part of the licensee; 09 (5) under regulations adopted by the board, contract with private 10 professional organizations to establish an impaired medical professionals program to 11 identify, confront, evaluate, and treat persons licensed under this chapter who abuse 12 alcohol, other drugs, or other substances or are mentally ill or cognitively impaired; 13 (6) adopt regulations that establish guidelines for a physician or 14 physician associate [ASSISTANT] who is rendering a diagnosis, providing treatment, 15 or prescribing, dispensing, or administering a prescription drug to a person without 16 conducting a physical examination under AS 08.64.364; the guidelines must include a 17 nationally recognized model policy for standards of care of a patient who is at a 18 different location than the physician or physician associate [ASSISTANT]; 19 (7) require that a licensee who has a federal Drug Enforcement 20 Administration registration number register with the controlled substance prescription 21 database under AS 17.30.200(n). 22  * Sec. 9. AS 08.64.106 is amended to read: 23 Sec. 08.64.106. Delegation of routine medical duties. The board shall adopt 24 regulations authorizing a physician, podiatrist, osteopath, or physician associate 25 [ASSISTANT] licensed under this chapter to delegate routine medical duties to an 26 agent of the physician, podiatrist, osteopath, or physician associate [ASSISTANT]. 27 The regulations must 28 (1) require that an agent who is not licensed under this chapter may 29 perform duties delegated under this section only if the agent meets applicable 30 standards established by the board; 31 (2) require that a physician, podiatrist, osteopath, or physician 01 associate [ASSISTANT] may not delegate duties related to pain management and 02 opioid use and addiction; and 03 (3) define the phrase "routine medical duties." 04  * Sec. 10. AS 08.64.107 is amended to read: 05 Sec. 08.64.107. Regulation of physician associates [ASSISTANTS]. The 06 board shall adopt regulations regarding the licensure of physician associates 07 [ASSISTANTS] and the medical services that they may perform, including the 08 (1) educational and other qualifications, including education in pain 09 management and opioid use and addiction; 10 (2) application and licensing procedures; 11 (3) scope of activities authorized; and 12 (4) responsibilities of the supervising or training physician. 13  * Sec. 11. AS 08.64.170(a) is amended to read: 14 (a) A person may not practice medicine, podiatry, or osteopathy in the state 15 unless the person is licensed under this chapter, except that 16 (1) a physician associate [ASSISTANT] may examine, diagnose, or 17 treat persons under the supervision, control, and responsibility of either a physician 18 licensed under this chapter or a physician exempted from licensing under 19 AS 08.64.370; 20 (2) a person who is licensed or authorized under another law of the 21 state may engage in a practice that is authorized under that law; and 22 (3) a person may perform routine medical duties delegated under 23 AS 08.64.106. 24  * Sec. 12. AS 08.64.360 is amended to read: 25 Sec. 08.64.360. Penalty for practicing without a license or in violation of  26 law. Except for a physician associate [ASSISTANT] or a person licensed or 27 authorized under another law of the state who engages in practices for which that 28 person is licensed or authorized under that law, a person practicing medicine or 29 osteopathy in the state without a valid license or permit is guilty of a class A 30 misdemeanor. Each day of illegal practice is a separate offense. 31  * Sec. 13. AS 08.64.363(c) is amended by adding a new paragraph to read: 01 (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). 02  * Sec. 14. AS 08.64.363 is amended by adding a new subsection to read: 03 (d) A licensee who issues a prescription for an opioid to a patient shall offer 04 the patient a prescription for an opioid overdose drug if 05 (1) the prescription is for an opioid that exceeds a three-day supply; 06 (2) the prescription is for a total daily opioid dosage representing a 07 morphine milligram equivalent of 50 milligrams or more; 08 (3) the patient is concurrently prescribed a benzodiazepine; or 09 (4) the patient has a history of overdose or substance use disorder. 10  * Sec. 15. AS 08.64.364(a) is amended to read: 11 (a) The board may not impose disciplinary sanctions on a physician or 12 physician associate [ASSISTANT] for rendering a diagnosis, providing treatment, or 13 prescribing, dispensing, or administering a prescription drug that is not a controlled 14 substance to a person without conducting a physical examination if 15 (1) the physician, physician associate [ASSISTANT], or another 16 licensed health care provider in the medical practice is available to provide follow-up 17 care; and 18 (2) the physician or physician associate [ASSISTANT] requests that 19 the person consent to sending a copy of all records of the encounter to the person's 20 primary care provider if the prescribing physician or physician associate 21 [ASSISTANT] is not the person's primary care provider and, if the person consents, 22 the physician or physician associate [ASSISTANT] sends the records to the person's 23 primary care provider. 24  * Sec. 16. AS 08.64.364(b) is amended to read: 25 (b) The board may not impose disciplinary sanctions on a physician or 26 physician associate [ASSISTANT] for prescribing, dispensing, or administering a 27 prescription drug that is a controlled substance if the requirements under (a) of this 28 section and AS 08.64.363 are met. 29  * Sec. 17. AS 08.64.364(c) is amended to read: 30 (c) Notwithstanding (a) and (b) of this section, 31 (1) a physician may not prescribe, dispense, or administer an abortion- 01 inducing drug under (a) of this section unless the physician complies with 02 AS 18.16.010; and 03 (2) a physician or physician associate [ASSISTANT] may not 04 prescribe, dispense, or administer a prescription drug in response to an Internet 05 questionnaire or electronic mail message to a person with whom the physician or 06 physician associate [ASSISTANT] does not have a prior physician-patient 07 relationship. 08  * Sec. 18. AS 08.64.369(d) is amended to read: 09 (d) In this section, "health care professional" includes an emergency medical 10 technician certified under AS 18.08, health aide, physician, nurse, mobile intensive 11 care paramedic licensed under AS 18.08, and physician associate [ASSISTANT], but 12 does not include a practitioner of religious healing. 13  * Sec. 19. AS 08.65.140 is amended to read: 14 Sec. 08.65.140. Required practices. The board shall adopt regulations 15 regarding the practice of direct-entry midwifery. At a minimum, the regulations must 16 require that a certified direct-entry midwife 17 (1) recommend, before care or delivery of a client, that the client 18 undergo a physical examination performed by a physician, physician associate 19 [ASSISTANT], or advanced practice registered nurse who is licensed in this state; 20 (2) obtain informed consent from a client before onset of labor; 21 (3) comply with AS 18.15.150 regarding taking of blood samples, 22 AS 18.15.200 regarding screening of phenylketonuria (PKU), AS 18.50.160 regarding 23 birth registration, AS 18.50.230 regarding registration of deaths, AS 18.50.240 24 regarding fetal death registration, and regulations adopted by the Department of 25 Health concerning prophylactic treatment of the eyes of newborn infants; 26 (4) not knowingly deliver a woman with certain types of health 27 conditions, prior history, or complications as specified by the board. 28  * Sec. 20. AS 08.68.265 is amended to read: 29 Sec. 08.68.265. Supervision of practical nurses. A practical nurse shall work 30 under the supervision of a licensed registered or advanced practice registered nurse, a 31 licensed physician, a licensed physician associate [ASSISTANT], or a licensed 01 dentist. 02  * Sec. 21. AS 08.68.700(a) is amended to read: 03 (a) A registered nurse licensed under this chapter may make a determination 04 and pronouncement of death of a person under the following circumstances: 05 (1) an attending physician, an attending advanced practice registered 06 nurse, or an attending physician associate [ASSISTANT] has documented in the 07 person's medical or clinical record that the person's death is anticipated due to illness, 08 infirmity, or disease; this prognosis is valid for purposes of this section for not more 09 than 120 days from the date of the documentation; 10 (2) at the time of documentation under (1) of this subsection, the 11 physician, the advanced practice registered nurse, or the physician associate 12 [ASSISTANT] authorized in writing a specific registered nurse or nurses to make a 13 determination and pronouncement of the person's death; however, if the person is in a 14 health care facility and the health care facility has complied with (d) of this section, 15 the physician, the advanced practice registered nurse, or the physician associate 16 [ASSISTANT] may authorize all nurses employed by the facility to make a 17 determination and pronouncement of the person's death. 18  * Sec. 22. AS 08.68.700(b) is amended to read: 19 (b) A registered nurse who has determined and pronounced death under this 20 section shall document the clinical criteria for the determination and pronouncement in 21 the person's medical or clinical record and notify the physician, the advanced practice 22 registered nurse, or the physician associate [ASSISTANT] who determined that the 23 prognosis for the patient was for an anticipated death. The registered nurse shall sign 24 the death certificate, which must include the 25 (1) name of the deceased; 26 (2) presence of a contagious disease, if known; and 27 (3) date and time of death. 28  * Sec. 23. AS 08.68.700(c) is amended to read: 29 (c) Except as otherwise provided under AS 18.50.230, a physician or 30 physician associate [ASSISTANT] licensed under AS 08.64 or an advanced practice 31 registered nurse licensed under this chapter shall certify a death determined under (b) 01 of this section within 24 hours after the pronouncement by the registered nurse. 02  * Sec. 24. AS 08.68.700(d) is amended to read: 03 (d) In a health care facility in which a physician, an advanced practice 04 registered nurse, or a physician associate [ASSISTANT] chooses to proceed under (a) 05 of this section, written policies and procedures shall be adopted that provide for the 06 determination and pronouncement of death by a registered nurse authorized by a 07 physician, an advanced practice registered nurse, or a physician associate 08 [ASSISTANT] under this section. A registered nurse employed by a health care 09 facility and authorized by a physician, an advanced practice registered nurse, or a 10 physician associate [ASSISTANT] to make a determination and pronouncement of 11 death under this section may not make the determination or pronouncement unless the 12 facility has written policies and procedures implementing and ensuring compliance 13 with this section. 14  * Sec. 25. AS 08.68.705(d) is amended by adding a new paragraph to read: 15 (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g). 16  * Sec. 26. AS 08.68.705 is amended by adding a new subsection to read: 17 (e) An advanced practice registered nurse who issues a prescription for an 18 opioid to a patient shall offer the patient a prescription for an opioid overdose drug if 19 (1) the prescription is for an opioid that exceeds a three-day supply; 20 (2) the prescription is for a total daily opioid dosage representing a 21 morphine milligram equivalent of 50 milligrams or more; 22 (3) the patient is concurrently prescribed a benzodiazepine; or 23 (4) the patient has a history of overdose or substance use disorder. 24  * Sec. 27. AS 08.72.276 is amended by adding new subsections to read: 25 (c) A licensee who issues a prescription for an opioid to a patient shall offer 26 the patient a prescription for an opioid overdose drug if 27 (1) the prescription is for an opioid that exceeds a three-day supply; 28 (2) the prescription is for a total daily opioid dosage representing a 29 morphine milligram equivalent of 50 milligrams or more; 30 (3) the patient is concurrently prescribed a benzodiazepine; or 31 (4) the patient has a history of overdose or substance use disorder. 01 (d) In this section, "opioid overdose drug" has the meaning given in 02 AS 17.20.085(g). 03  * Sec. 28. AS 08.80.030(b) is amended to read: 04 (b) In order to fulfill its responsibilities, the board has the powers necessary 05 for implementation and enforcement of this chapter, including the power to 06 (1) elect a president and secretary from its membership and adopt rules 07 for the conduct of its business; 08 (2) license by examination or by license transfer the applicants who are 09 qualified to engage in the practice of pharmacy; 10 (3) assist the department in inspections and investigations for 11 violations of this chapter, or of any other state or federal statute relating to the practice 12 of pharmacy; 13 (4) adopt regulations to carry out the purposes of this chapter; 14 (5) establish and enforce compliance with professional standards and 15 rules of conduct for pharmacists engaged in the practice of pharmacy; 16 (6) determine standards for recognition and approval of degree 17 programs of schools and colleges of pharmacy whose graduates shall be eligible for 18 licensure in this state, including the specification and enforcement of requirements for 19 practical training, including internships; 20 (7) establish for pharmacists and pharmacies minimum specifications 21 for the physical facilities, technical equipment, personnel, and procedures for the 22 storage, compounding, and dispensing of drugs or related devices, and for the 23 monitoring of drug therapy, including independent monitoring of drug therapy; 24 (8) enforce the provisions of this chapter relating to the conduct or 25 competence of pharmacists practicing in the state, and the suspension, revocation, or 26 restriction of licenses to engage in the practice of pharmacy; 27 (9) license and regulate the training, qualifications, and employment of 28 pharmacy interns and pharmacy technicians; 29 (10) license and regulate the qualifications of entities and individuals 30 engaged in the manufacture or distribution of drugs and related devices; 31 (11) establish and maintain a controlled substance prescription 01 database as provided in AS 17.30.200; 02 (12) establish standards for the independent prescribing and 03 administration of vaccines and related emergency medications under AS 08.80.168, 04 including the completion of an immunization training program approved by the board 05 and an epinephrine auto-injector training program under AS 17.22.020(b); 06 (13) establish standards for the independent prescribing and dispensing 07 by a pharmacist of an opioid overdose drug under AS 17.20.085, including the 08 completion of an opioid overdose training program approved by the board; 09 (14) require that a licensed pharmacist who prescribes, administers,  10 or dispenses a schedule II, III, or IV controlled substance under federal law to a 11 person in the state register with the controlled substance prescription database under 12 AS 17.30.200(n); 13 (15) establish the qualifications and duties of the executive 14 administrator and delegate authority to the executive administrator that is necessary to 15 conduct board business; 16 (16) license and inspect the facilities of pharmacies, manufacturers, 17 wholesale drug distributors, third-party logistics providers, and outsourcing facilities 18 located outside the state under AS 08.80.159; 19 (17) license Internet-based pharmacies providing services to residents 20 in the state; 21 (18) adopt regulations pertaining to retired pharmacist status.  22  * Sec. 29. AS 08.80.110 is amended to read: 23 Sec. 08.80.110. Qualifications for licensure by examination. An applicant 24 for licensure as a pharmacist shall  25 (1) be fluent in the reading, writing, and speaking of the English 26 language; 27 (2) be a graduate of a college in a degree program approved by the 28 board; 29 (3) pass an examination or examinations given by the board or 30 acceptable to the board under the score transfer process administered by the National 31 Association of Boards of Pharmacy; 01 (4) have completed internship training or another program that has 02 been approved by the board or demonstrated to the board's satisfaction that the 03 applicant has experience in the practice of pharmacy that meets or exceeds the 04 minimum internship requirements of the board; and  05 (5) receive education in pain management and opioid use and  06 addiction, unless the applicant has demonstrated to the satisfaction of the board  07 that the applicant does not currently hold a valid federal Drug Enforcement  08 Administration registration number; an applicant may include past professional  09 experience or professional education as proof of professional competence. 10  * Sec. 30. AS 08.80.145 is amended to read: 11 Sec. 08.80.145. Reciprocity; license transfer. If another jurisdiction allows 12 licensure in that jurisdiction of a pharmacist licensed in this state under conditions 13 similar to those in this section, the board may license as a pharmacist in this state a 14 person licensed as a pharmacist in the other jurisdiction if the person  15 (1) submits a written application to the board on a form required by the 16 board; 17 (2) is at least 18 years of age; 18 (3) possesses at the time of the request for licensure as a pharmacist in 19 this state the qualifications necessary to be eligible for licensure in this state; 20 (4) has engaged in the practice of pharmacy for at least one year 21 immediately before applying for a license under this section; 22 (5) presents proof satisfactory to the board that the person is currently 23 licensed as a pharmacist in the other jurisdiction and does not currently have a 24 pharmacist license suspended, revoked, or otherwise restricted except for failure to 25 apply for renewal or failure to obtain the required continuing education credits; 26 (6) has passed an examination approved by the board that tests the 27 person's knowledge of Alaska laws relating to pharmacies and pharmacists and the 28 regulations adopted under those laws; [AND] 29 (7) meets the requirements of AS 08.80.110(5); and  30 (8) pays all required fees. 31  * Sec. 31. AS 08.80.157(j) is amended to read: 01 (j) This section does not apply to the offices of physicians, osteopaths, 02 podiatrists, physician associates [ASSISTANTS], advanced nurse practitioners, 03 dentists, veterinarians, dispensing opticians, or optometrists. 04  * Sec. 32. AS 08.80.165 is amended to read: 05 Sec. 08.80.165. Continuing education requirements. The board shall 06 establish requirements for continuing education in pharmacy that must be satisfied 07 before a license issued under this chapter may be renewed. The continuing education  08 requirements must include at least two hours of education in pain management  09 and opioid use and addiction during the concluding licensing period. The board  10 may exempt a licensee from the requirement to receive at least two hours of  11 education in pain management and opioid use and addiction if the licensee  12 demonstrates to the satisfaction of the board that  13 (1) the licensee's practice does not include pain management and  14 opioid prescription or administration; or  15 (2) the licensee does not currently hold a valid federal Drug  16 Enforcement Administration registration number.  17  * Sec. 33. AS 08.80.337(a) is amended to read: 18 (a) A pharmacist may, under a collaborative practice agreement with a written 19 protocol approved by a practitioner who is not a pharmacist, provide patient care 20 services. The collaborative practice agreement must define the nature and scope  21 of patient care services the pharmacist may provide under the agreement.  22  * Sec. 34. AS 08.80.337(b) is amended to read: 23 (b) A pharmacist may independently provide patient care services for 24 (1) general health and wellness; 25 (2) disease prevention; or 26 (3) a condition that 27 (A) is minor and generally self limiting;  28 (B) does not require a new diagnosis;  29 (C) requires a new diagnosis only if  30 (i) the pharmacist uses [(B) HAS] a test [THAT IS 31 USED] to guide the pharmacist's diagnosis or clinical decision- 01 making; and 02 (ii) the test is waived under 42 U.S.C. 263a (Clinical 03 Laboratory Improvement Amendments of 1988); or 04 (D) [(C)] falls under a statewide standing order from the chief 05 medical officer in the Department of Health.  06  * Sec. 35. AS 08.80.337(d) is amended to read: 07 (d) In this section, "patient care services" 08 (1) means medical care services, including the prescription or  09 administration of a drug or device to a patient, that are given in exchange for 10 compensation and intended to achieve outcomes related to the cure or prevention of a 11 disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a 12 disease process;  13 (2) does not include the prescription or administration of the  14 following drugs unless the drug is being used for the treatment of an opioid use  15 disorder in a clinic:  16 (A) a schedule IA or IIA controlled substance under state  17 law or a schedule II controlled substance under federal law; 18 (B) a drug that may only be prescribed or administered  19 after completing a certified education program required by  20 (i) the manufacturer; or  21 (ii) the United States Food and Drug  22 Administration, including by a risk evaluation and mitigation  23 strategy; or  24 (C) a drug that is not generally available at pharmacies and  25 may only be dispensed at a pharmacy that  26 (i) is authorized by the manufacturer to dispense the  27 drug; or  28 (ii) meets a requirement to dispense the drug under  29 federal law. 30  * Sec. 36. AS 08.80.337 is amended by adding a new subsection to read: 31 (e) A pharmacist prescribing or administering a drug or device under this 01 section shall recognize the limits of the pharmacist's education, training, and 02 experience and consult with and refer to other practitioners as appropriate. 03  * Sec. 37. AS 08.80.400 is amended to read: 04 Sec. 08.80.400. Other licensees not affected. This chapter does not affect the 05 practice of medicine by a licensed medical doctor and does not limit a licensed 06 medical doctor, osteopath, podiatrist, physician associate [ASSISTANT], advanced 07 practice registered nurse, dentist, veterinarian, dispensing optician, or optometrist in 08 supplying a patient with any medicinal preparation or article within the scope of the 09 person's license. 10  * Sec. 38. AS 08.80.480(30) is amended to read: 11 (30) "practice of pharmacy" means the interpretation, evaluation, and 12 dispensing of prescription drug orders in the patient's best interest; participation in 13 drug and device selection, drug administration, drug regimen reviews, and drug or 14 drug-related research; provision of patient counseling and the provision of those acts 15 or services necessary to provide pharmaceutical care; the independent prescribing, 16 dispensing, and administration of drugs in accordance with AS 08.80.168; providing  17 patient care services in accordance with AS 08.80.337; the responsibility for 18 compounding and labeling of drugs and devices except labeling by a manufacturer, 19 repackager, or distributor of nonprescription drugs and commercially packaged legend 20 drugs and devices; proper and safe storage of drugs and devices; and maintenance of 21 proper records for them; 22  * Sec. 39. AS 08.80.480 is amended by adding a new paragraph to read: 23 (40) "opioid" includes the opium and opiate substances and opium and 24 opiate derivatives listed in AS 11.71.140 and 11.71.160. 25  * Sec. 40. AS 09.55.560(2) is amended to read: 26 (2) "health care provider" means an acupuncturist licensed under 27 AS 08.06; an audiologist or speech-language pathologist licensed under AS 08.11; a 28 chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a 29 dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing 30 optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an 31 optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a 01 physical therapist or occupational therapist licensed under AS 08.84; a physician or 02 physician associate [ASSISTANT] licensed under AS 08.64; a podiatrist; a 03 psychologist and a psychological associate licensed under AS 08.86; a hospital as 04 defined in AS 47.32.900, including a governmentally owned or operated hospital; an 05 employee of a health care provider acting within the course and scope of employment; 06 an ambulatory surgical facility and other organizations whose primary purpose is the 07 delivery of health care, including a health maintenance organization, individual 08 practice association, integrated delivery system, preferred provider organization or 09 arrangement, and a physical hospital organization; 10  * Sec. 41. AS 09.65.300(c)(1) is amended to read: 11 (1) "health care provider" means a physician, physician associate 12 [ASSISTANT], dentist, dental hygienist, osteopath, optometrist, chiropractor, 13 registered nurse, practical nurse, advanced practice registered nurse, naturopath, 14 physical therapist, occupational therapist, marital and family therapist, psychologist, 15 psychological associate, behavior analyst, assistant behavior analyst, licensed clinical 16 social worker, athletic trainer, certified direct-entry midwife, licensed professional 17 counselor, or licensed associate counselor; 18  * Sec. 42. AS 09.65.340(d)(1) is amended to read: 19 (1) "health care provider" means a licensed physician, osteopath, 20 dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village 21 health aide, or pharmacist operating within the scope of the health care provider's 22 authority; 23  * Sec. 43. AS 09.68.120 is amended to read: 24 Sec. 09.68.120. Definition of death. An individual is considered dead if, in the 25 opinion of a physician licensed or exempt from licensing under AS 08.64 or a 26 registered nurse authorized to pronounce death under AS 08.68.700, based on 27 acceptable medical standards, or in the opinion of a mobile intensive care paramedic, 28 physician associate [ASSISTANT], or emergency medical technician authorized to 29 pronounce death based on the medical standards in AS 18.08.089, the individual has 30 sustained irreversible cessation of circulatory and respiratory functions, or irreversible 31 cessation of all functions of the entire brain, including the brain stem. Death may be 01 pronounced in this circumstance before artificial means of maintaining respiratory and 02 cardiac function are terminated. 03  * Sec. 44. AS 11.41.470(1) is amended to read: 04 (1) "health care worker" includes a person who is or purports to be an 05 acupuncturist, advanced practice registered nurse, anesthesiologist, certified direct- 06 entry midwife, chiropractor, dentist, health aide, hypnotist, massage therapist, mental 07 health counselor, midwife, nurse, occupational therapist, occupational therapy 08 assistant, osteopath, naturopath, physical therapist, physical therapist assistant, 09 physician, physician associate [ASSISTANT], psychiatrist, psychological associate, 10 psychologist, radiologist, religious healing practitioner, surgeon, x-ray technician, or a 11 substantially similar position; 12  * Sec. 45. AS 11.71.900(20) is amended to read: 13 (20) "practitioner" means 14 (A) a physician, dentist, advanced practice registered nurse, 15 optometrist, veterinarian, scientific investigator, or other person licensed, 16 registered, or otherwise permitted to distribute, dispense, conduct research with 17 respect to, or to administer or use in teaching or chemical analysis a controlled 18 substance in the course of professional practice or research in the state; 19 (B) a pharmacist prescribing or administering a controlled  20 substance in the course of professional practice in the state; or  21 (C) [(B)] a pharmacy, hospital, or other institution licensed, 22 registered, or otherwise permitted to distribute, dispense, conduct research with 23 respect to, or to administer a controlled substance in the course of professional 24 practice or research in the state; 25  * Sec. 46. AS 12.55.135(k)(3) is amended to read: 26 (3) "medical professional" means a person who is an advanced practice 27 registered nurse, anesthesiologist, chiropractor, dental hygienist, dentist, health aide, 28 nurse, nurse aide, mental health counselor, osteopath, physician, physician associate 29 [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist, 30 surgeon, or x-ray technician, or who holds a substantially similar position. 31  * Sec. 47. AS 13.52.065(a) is amended to read: 01 (a) A physician, an advanced practice registered nurse, or a physician 02 associate [ASSISTANT] may issue a do not resuscitate order for a patient of the 03 physician, the advanced practice registered nurse, or the physician associate 04 [ASSISTANT] with the consent of the patient or the parent or guardian of the patient 05 if the patient is under 18 years of age. The physician, the advanced practice registered 06 nurse, or the physician associate [ASSISTANT] shall document the grounds for the 07 order in the patient's medical file. 08  * Sec. 48. AS 13.52.065(c) is amended to read: 09 (c) The department shall develop standardized designs and symbols for do not 10 resuscitate identification cards, forms, necklaces, and bracelets that signify, when 11 carried or worn, that the carrier or wearer is an individual for whom a physician, an 12 advanced practice registered nurse, or a physician associate [ASSISTANT] has issued 13 a do not resuscitate order. 14  * Sec. 49. AS 13.52.065(d) is amended to read: 15 (d) A health care provider other than a physician, an advanced practice 16 registered nurse, or a physician associate [ASSISTANT] shall comply with the 17 protocol adopted under (b) of this section for do not resuscitate orders when the health 18 care provider is presented with a do not resuscitate identification, an oral do not 19 resuscitate order issued directly by a physician, an advanced practice registered nurse, 20 or a physician associate [ASSISTANT] if the applicable hospital allows oral do not 21 resuscitate orders, or a written do not resuscitate order entered on and as required by a 22 form prescribed by the department. 23  * Sec. 50. AS 13.52.065(f) is amended to read: 24 (f) A do not resuscitate order may not be made ineffective unless a physician, 25 an advanced practice registered nurse, or a physician associate [ASSISTANT] revokes 26 the do not resuscitate order, a patient for whom the order is written and who has 27 capacity requests that the do not resuscitate order be revoked, or the patient for whom 28 the order is written is under 18 years of age and the parent or guardian of the patient 29 requests that the do not resuscitate order be revoked. Any physician, advanced practice 30 registered nurse, or physician associate [ASSISTANT] of a patient for whom a do not 31 resuscitate order is written may revoke the do not resuscitate order if the person for 01 whom the order is written requests that the physician, the advanced practice registered 02 nurse, or the physician associate [ASSISTANT] revoke the do not resuscitate order. 03  * Sec. 51. AS 13.52.080(a) is amended to read: 04 (a) A health care provider or health care institution that acts in good faith and 05 in accordance with generally accepted health care standards applicable to the health 06 care provider or institution is not subject to civil or criminal liability or to discipline 07 for unprofessional conduct for 08 (1) providing health care information in good faith under 09 AS 13.52.070; 10 (2) complying with a health care decision of a person based on a good 11 faith belief that the person has authority to make a health care decision for a patient, 12 including a decision to withhold or withdraw health care; 13 (3) declining to comply with a health care decision of a person based 14 on a good faith belief that the person then lacked authority; 15 (4) complying with an advance health care directive and assuming in 16 good faith that the directive was valid when made and has not been revoked or 17 terminated; 18 (5) participating in the withholding or withdrawal of cardiopulmonary 19 resuscitation under the direction or with the authorization of a physician, an advanced 20 practice registered nurse, or a physician associate [ASSISTANT] or upon discovery of 21 do not resuscitate identification on [UPON] an individual; 22 (6) causing or participating in providing cardiopulmonary resuscitation 23 or other life-sustaining procedures 24 (A) under AS 13.52.065(e) when an individual has made an 25 anatomical gift; 26 (B) because an individual has made a do not resuscitate order 27 ineffective under AS 13.52.065(f) or another provision of this chapter; or 28 (C) because the patient is a woman of childbearing age and 29 AS 13.52.055 applies; or 30 (7) acting in good faith under the terms of this chapter or the law of 31 another state relating to anatomical gifts. 01  * Sec. 52. AS 13.52.100(c) is amended to read: 02 (c) An individual who is a qualified patient, including an individual for whom 03 a physician, an advanced practice registered nurse, or a physician associate 04 [ASSISTANT] has issued a do not resuscitate order, has the right to make a decision 05 regarding the use of cardiopulmonary resuscitation and other life-sustaining 06 procedures as long as the individual is able to make the decision. If an individual who 07 is a qualified patient, including an individual for whom a physician, advanced practice 08 registered nurse, or physician associate [ASSISTANT] has issued a do not resuscitate 09 order, is not able to make the decision, the protocol adopted under AS 13.52.065 for 10 do not resuscitate orders governs a decision regarding the use of cardiopulmonary 11 resuscitation and other life-sustaining procedures. 12  * Sec. 53. AS 13.52.300 is amended to read: 13 Sec. 13.52.300. Optional form. The following sample form may be used to 14 create an advance health care directive. The other sections of this chapter govern the 15 effect of this or any other writing used to create an advance health care directive. This 16 form may be duplicated. This form may be modified to suit the needs of the person, or 17 a different form that complies with this chapter may be used, including the mandatory 18 witnessing requirements:  19 ADVANCE HEALTH CARE DIRECTIVE 20 Explanation 21 You have the right to give instructions about your own health 22 care to the extent allowed by law. You also have the right to name 23 someone else to make health care decisions for you to the extent 24 allowed by law. This form lets you do either or both of these things. It 25 also lets you express your wishes regarding the designation of your 26 health care provider. If you use this form, you may complete or modify 27 all or any part of it. You are free to use a different form if the form 28 complies with the requirements of AS 13.52. 29 Part 1 of this form is a durable power of attorney for health 30 care. A "durable power of attorney for health care" means the 31 designation of an agent to make health care decisions for you. Part 1 01 lets you name another individual as an agent to make health care 02 decisions for you if you do not have the capacity to make your own 03 decisions or if you want someone else to make those decisions for you 04 now even though you still have the capacity to make those decisions. 05 You may name an alternate agent to act for you if your first choice is 06 not willing, able, or reasonably available to make decisions for you. 07 Unless related to you, your agent may not be an owner, operator, or 08 employee of a health care institution where you are receiving care. 09 Unless the form you sign limits the authority of your agent, 10 your agent may make all health care decisions for you that you could 11 legally make for yourself. This form has a place for you to limit the 12 authority of your agent. You do not have to limit the authority of your 13 agent if you wish to rely on your agent for all health care decisions that 14 may have to be made. If you choose not to limit the authority of your 15 agent, your agent will have the right, to the extent allowed by law, to 16 (a) consent or refuse consent to any care, treatment, service, or 17 procedure to maintain, diagnose, or otherwise affect a physical or 18 mental condition, including the administration or discontinuation of 19 psychotropic medication; 20 (b) select or discharge health care providers and institutions; 21 (c) approve or disapprove proposed diagnostic tests, surgical 22 procedures, and programs of medication; 23 (d) direct the provision, withholding, or withdrawal of artificial 24 nutrition and hydration and all other forms of health care; and 25 (e) make an anatomical gift following your death. 26 Part 2 of this form lets you give specific instructions for any 27 aspect of your health care to the extent allowed by law, except you may 28 not authorize mercy killing, assisted suicide, or euthanasia. Choices are 29 provided for you to express your wishes regarding the provision, 30 withholding, or withdrawal of treatment to keep you alive, including 31 the provision of artificial nutrition and hydration, as well as the 01 provision of pain relief medication. Space is provided for you to add to 02 the choices you have made or for you to write out any additional 03 wishes. 04 Part 3 of this form lets you express an intention to make an 05 anatomical gift following your death. 06 Part 4 of this form lets you make decisions in advance about 07 certain types of mental health treatment. 08 Part 5 of this form lets you designate a physician to have 09 primary responsibility for your health care. 10 After completing this form, sign and date the form at the end 11 and have the form witnessed by one of the two alternative methods 12 listed below. Give a copy of the signed and completed form to your 13 physician, to any other health care providers you may have, to any 14 health care institution at which you are receiving care, and to any health 15 care agents you have named. You should talk to the person you have 16 named as your agent to make sure that the person understands your 17 wishes and is willing to take the responsibility. 18 You have the right to revoke this advance health care directive 19 or replace this form at any time, except that you may not revoke this 20 declaration when you are determined not to be competent by a court, by 21 two physicians, at least one of whom shall be a psychiatrist, or by both 22 a physician and a professional mental health clinician. In this advance 23 health care directive, "competent" means that you have the capacity 24 (1) to assimilate relevant facts and to appreciate and 25 understand your situation with regard to those facts; and 26 (2) to participate in treatment decisions by means of a 27 rational thought process. 28 PART 1 29 DURABLE POWER OF ATTORNEY FOR 30 HEALTH CARE DECISIONS 31 (1) DESIGNATION OF AGENT. I designate the 01 following individual as my agent to make health care decisions for me: 02 _________________________________________________________ 03 (name of individual you choose as agent) 04 _________________________________________________________ 05 (address) (city) (state) (zip code) 06 _________________________________________________________ 07 (home telephone) (work telephone) 08 OPTIONAL: If I revoke my agent's authority or if my agent is 09 not willing, able, or reasonably available to make a health care decision 10 for me, I designate as my first alternate agent 11 _________________________________________________________ 12 (name of individual you choose as first alternate agent) 13 _________________________________________________________ 14 (address) (city) (state) (zip code) 15 _________________________________________________________ 16 (home telephone) (work telephone) 17 OPTIONAL: If I revoke the authority of my agent and first 18 alternate agent or if neither is willing, able, or reasonably available to 19 make a health care decision for me, I designate as my second alternate 20 agent 21 _________________________________________________________ 22 (name of individual you choose as second alternate agent) 23 _________________________________________________________ 24 (address) (city) (state) (zip code) 25 _________________________________________________________ 26 (home telephone) (work telephone) 27 (2) AGENT'S AUTHORITY. My agent is authorized 28 and directed to follow my individual instructions and my other wishes 29 to the extent known to the agent in making all health care decisions for 30 me. If these are not known, my agent is authorized to make these 31 decisions in accordance with my best interest, including decisions to 01 provide, withhold, or withdraw artificial hydration and nutrition and 02 other forms of health care to keep me alive, except as I state here: 03 _________________________________________________________ 04 _________________________________________________________ 05 _________________________________________________________ 06 (Add additional sheets if needed.) 07 Under this authority, "best interest" means that the benefits to you 08 resulting from a treatment outweigh the burdens to you resulting from 09 that treatment after assessing 10 (A) the effect of the treatment on your physical, 11 emotional, and cognitive functions; 12 (B) the degree of physical pain or discomfort 13 caused to you by the treatment or the withholding or withdrawal 14 of the treatment; 15 (C) the degree to which your medical condition, 16 the treatment, or the withholding or withdrawal of treatment, 17 results in a severe and continuing impairment; 18 (D) the effect of the treatment on your life 19 expectancy; 20 (E) your prognosis for recovery, with and 21 without the treatment; 22 (F) the risks, side effects, and benefits of the 23 treatment or the withholding of treatment; and 24 (G) your religious beliefs and basic values, to 25 the extent that these may assist in determining benefits and 26 burdens. 27 (3) WHEN AGENT'S AUTHORITY BECOMES 28 EFFECTIVE. Except in the case of mental illness, my agent's authority 29 becomes effective when my primary physician determines that I am 30 unable to make my own health care decisions unless I mark the 31 following box. In the case of mental illness, unless I mark the 01 following box, my agent's authority becomes effective when a court 02 determines I am unable to make my own decisions, or, in an 03 emergency, if my primary physician or another health care provider 04 determines I am unable to make my own decisions. If I mark this box [ 05 ], my agent's authority to make health care decisions for me takes effect 06 immediately. 07 (4) AGENT'S OBLIGATION. My agent shall make 08 health care decisions for me in accordance with this durable power of 09 attorney for health care, any instructions I give in Part 2 of this form, 10 and my other wishes to the extent known to my agent. To the extent 11 my wishes are unknown, my agent shall make health care decisions for 12 me in accordance with what my agent determines to be in my best 13 interest. In determining my best interest, my agent shall consider my 14 personal values to the extent known to my agent. 15 (5) NOMINATION OF GUARDIAN. If a guardian of 16 my person needs to be appointed for me by a court, I nominate the 17 agent designated in this form. If that agent is not willing, able, or 18 reasonably available to act as guardian, I nominate the alternate agents 19 whom I have named under (1) above, in the order designated. 20 PART 2 21 INSTRUCTIONS FOR HEALTH CARE 22 If you are satisfied to allow your agent to determine what is best 23 for you in making health care decisions, you do not need to fill out this 24 part of the form. If you do fill out this part of the form, you may strike 25 any wording you do not want. There is a state protocol that governs the 26 use of do not resuscitate orders by physicians, advanced practice 27 registered nurses, physician associates [ASSISTANTS], and other 28 health care providers. You may obtain a copy of the protocol from the 29 Alaska Department of Health. A "do not resuscitate order" means a 30 directive from a licensed physician, advanced practice registered nurse, 31 or physician associate [ASSISTANT] that emergency cardiopulmonary 01 resuscitation should not be administered to you. 02 (6) END-OF-LIFE DECISIONS. Except to the extent 03 prohibited by law, I direct that my health care providers and others 04 involved in my care provide, withhold, or withdraw treatment in 05 accordance with the choice I have marked below: (Check only one 06 box.) 07 [ ] (A) Choice To Prolong Life 08 I want my life to be prolonged as long as 09 possible within the limits of generally accepted health care 10 standards; OR 11 [ ] (B) Choice Not To Prolong Life 12 I want comfort care only and I do not want my 13 life to be prolonged with medical treatment if, in the judgment 14 of my physician, I have (check all choices that represent your 15 wishes) 16 [ ] (i) a condition of permanent 17 unconsciousness: a condition that, to a high degree of 18 medical certainty, will last permanently without 19 improvement; in which, to a high degree of medical 20 certainty, thought, sensation, purposeful action, social 21 interaction, and awareness of myself and the 22 environment are absent; and for which, to a high degree 23 of medical certainty, initiating or continuing life- 24 sustaining procedures for me, in light of my medical 25 outcome, will provide only minimal medical benefit for 26 me; or 27 [ ] (ii) a terminal condition: an 28 incurable or irreversible illness or injury that without the 29 administration of life-sustaining procedures will result in 30 my death in a short period of time, for which there is no 31 reasonable prospect of cure or recovery, that imposes 01 severe pain or otherwise imposes an inhumane burden 02 on me, and for which, in light of my medical condition, 03 initiating or continuing life-sustaining procedures will 04 provide only minimal medical benefit; 05 [ ] Additional instructions: ________________ 06 ___________________________________________________ 07 (C) Artificial Nutrition and Hydration. If I am 08 unable to safely take nutrition, fluids, or nutrition and fluids 09 (check your choices or write your instructions), 10 [ ] I wish to receive artificial nutrition and 11 hydration indefinitely; 12 [ ] I wish to receive artificial nutrition and 13 hydration indefinitely, unless it clearly increases my suffering 14 and is no longer in my best interest; 15 [ ] I wish to receive artificial nutrition and 16 hydration on a limited trial basis to see if I can improve; 17 [ ] In accordance with my choices in (6)(B) 18 above, I do not wish to receive artificial nutrition and hydration. 19 [ ] Other instructions:_____________________ 20 ___________________________________________________ 21 (D) Relief from Pain. 22 [ ] I direct that adequate treatment be 23 provided at all times for the sole purpose of the 24 alleviation of pain or discomfort; or 25 [ ] I give these instructions: 26 _____________________________________________ 27 _____________________________________________ 28 (E) Should I become unconscious and I 29 am pregnant, I direct that ________________________ 30 _____________________________________________ 31 _____________________________________________ 01 (7) OTHER WISHES. (If you do not agree with any of 02 the optional choices above and wish to write your own, or if you wish 03 to add to the instructions you have given above, you may do so here.) I 04 direct that 05 _________________________________________________________ 06 _________________________________________________________ 07 Conditions or limitations: ______________________________ 08 _________________________________________________________. 09 (Add additional sheets if needed.) 10 PART 3 11 ANATOMICAL GIFT AT DEATH 12 (OPTIONAL) 13 If you are satisfied to allow your agent to determine whether to 14 make an anatomical gift at your death, you do not need to fill out this 15 part of the form. 16 (8) Upon my death: (mark applicable box) 17 [ ] (A) I give any needed organs, tissues, or 18 other body parts, OR 19 [ ] (B) I give the following organs, tissues, or 20 other body parts only ________________________________ 21 __________________________________________________ 22 [ ] (C) My gift is for the following purposes 23 (mark any of the following you want): 24 [ ] (i) transplant; 25 [ ] (ii) therapy; 26 [ ] (iii) research; 27 [ ] (iv) education. 28 [ ] (D) I refuse to make an anatomical gift. 29 PART 4 30 MENTAL HEALTH TREATMENT 31 This part of the declaration allows you to make decisions in 01 advance about mental health treatment. The instructions that you 02 include in this declaration will be followed only if a court, two 03 physicians that include a psychiatrist, or a physician and a professional 04 mental health clinician believe that you are not competent and cannot 05 make treatment decisions. Otherwise, you will be considered to be 06 competent and to have the capacity to give or withhold consent for the 07 treatments. 08 If you are satisfied to allow your agent to determine what is best 09 for you in making these mental health decisions, you do not need to fill 10 out this part of the form. If you do fill out this part of the form, you 11 may strike any wording you do not want. 12 (9) PSYCHOTROPIC MEDICATIONS. If I do not 13 have the capacity to give or withhold informed consent for mental 14 health treatment, my wishes regarding psychotropic medications are as 15 follows: 16 ________ I consent to the administration of the following 17 medications: ______________________________________________ 18 ________ I do not consent to the administration of the 19 following medications: ______________________________________ 20 Conditions or limitations:_______________________________ 21 _________________________________________________________. 22 (10) ELECTROCONVULSIVE TREATMENT. If I do 23 not have the capacity to give or withhold informed consent for mental 24 health treatment, my wishes regarding electroconvulsive treatment are 25 as follows: 26 ________ I consent to the administration of electroconvulsive 27 treatment. 28 ________ I do not consent to the administration of 29 electroconvulsive treatment. 30 Conditions or limitations: ______________________________ 31 _________________________________________________________. 01 (11) ADMISSION TO AND RETENTION IN 02 FACILITY. If I do not have the capacity to give or withhold informed 03 consent for mental health treatment, my wishes regarding admission to 04 and retention in a mental health facility for mental health treatment are 05 as follows: 06 ________ I consent to being admitted to a mental health facility 07 for mental health treatment for up to ________ days. (The number of 08 days not to exceed 17.) 09 ________ I do not consent to being admitted to a mental health 10 facility for mental health treatment. 11 Conditions or limitations: ______________________________ 12 _________________________________________________________. 13 OTHER WISHES OR INSTRUCTIONS 14 _________________________________________________________ 15 _________________________________________________________ 16 _________________________________________________________ 17 Conditions or limitations: ______________________________ 18 _________________________________________________________. 19 PART 5 20 PRIMARY PHYSICIAN 21 (OPTIONAL) 22 (12) I designate the following physician as my primary 23 physician: 24 _________________________________________________________ 25 (name of physician) 26 _________________________________________________________ 27 (address) (city) (state) (zip code) 28 _________________________________________________________ 29 (telephone) 30 OPTIONAL: If the physician I have designated above is 31 not willing, able, or reasonably available to act as my primary 01 physician, I designate the following physician as my primary physician: 02 _________________________________________________________ 03 (name of physician) 04 _________________________________________________________ 05 (address) (city) (state) (zip code) 06 _________________________________________________________ 07 (telephone) 08 (13) EFFECT OF COPY. A copy of this form has the 09 same effect as the original. 10 (14) SIGNATURES. Sign and date the form here: 11 _________________________________________________________ 12 (date) (sign your name) 13 _________________________________________________________ 14 (print your name) 15 _________________________________________________________ 16 (address) (city) (state) (zip code) 17 (15) WITNESSES. This advance care health directive 18 will not be valid for making health care decisions unless it is 19 (A) signed by two qualified adult witnesses who 20 are personally known to you and who are present when you sign 21 or acknowledge your signature; the witnesses may not be a 22 health care provider employed at the health care institution or 23 health care facility where you are receiving health care, an 24 employee of the health care provider who is providing health 25 care to you, an employee of the health care institution or health 26 care facility where you are receiving health care, or the person 27 appointed as your agent by this document; at least one of the 28 two witnesses may not be related to you by blood, marriage, or 29 adoption or entitled to a portion of your estate upon your death 30 under your will or codicil; or 31 (B) acknowledged before a notary public in the 01 state. 02 ALTERNATIVE NO. 1 03 Witness Who is Not Related to or a Devisee of the Principal 04 I swear under penalty of perjury under AS 11.56.200 05 that the principal is personally known to me, that the principal signed or 06 acknowledged this durable power of attorney for health care in my 07 presence, that the principal appears to be of sound mind and under no 08 duress, fraud, or undue influence, and that I am not 09 (1) a health care provider employed at the health care 10 institution or health care facility where the principal is receiving health 11 care; 12 (2) an employee of the health care provider providing 13 health care to the principal; 14 (3) an employee of the health care institution or health 15 care facility where the principal is receiving health care; 16 (4) the person appointed as agent by this document; 17 (5) related to the principal by blood, marriage, or 18 adoption; or 19 (6) entitled to a portion of the principal's estate upon the 20 principal's death under a will or codicil. 21 ________________________________________________________ 22 (date) (signature of witness) 23 ________________________________________________________ 24 (printed name of witness) 25 ________________________________________________________ 26 (address) (city) (state) (zip code) 27 Witness Who May be Related to or a Devisee of the Principal 28 I swear under penalty of perjury under AS 11.56.200 29 that the principal is personally known to me, that the principal signed or 30 acknowledged this durable power of attorney for health care in my 31 presence, that the principal appears to be of sound mind and under no 01 duress, fraud, or undue influence, and that I am not 02 (1) a health care provider employed at the health care 03 institution or health care facility where the principal is receiving health 04 care; 05 (2) an employee of the health care provider who is 06 providing health care to the principal; 07 (3) an employee of the health care institution or health 08 care facility where the principal is receiving health care; or 09 (4) the person appointed as agent by this document. 10 _______________________________________________________ 11 (date) (signature of witness) 12 _______________________________________________________ 13 (printed name of witness) 14 _______________________________________________________ 15 (address) (city) (state) (zip code) 16 ALTERNATIVE NO. 2 17 State of Alaska 18 ________________ Judicial District 19 On this ____ day of ___________________, in the year 20 ______________, before me, _______________________________ 21 (insert name of notary public) appeared 22 _______________________________, personally known to me (or 23 proved to me on the basis of satisfactory evidence) to be the person 24 whose name is subscribed to this instrument, and acknowledged that 25 the person executed it. 26 Notary Seal 27 ___________________________ 28 (signature of notary public) 29  * Sec. 54. AS 13.52.390(13) is amended to read: 30 (13) "do not resuscitate order" means a directive from a licensed 31 physician, advanced practice registered nurse, or physician associate [ASSISTANT] 01 that emergency cardiopulmonary resuscitation should not be administered to a 02 qualified patient; 03  * Sec. 55. AS 13.52.390(24) is amended to read: 04 (24) "life-sustaining procedures" means any medical treatment, 05 procedure, or intervention that, in the judgment of the primary physician, advanced 06 practice registered nurse, or physician associate [ASSISTANT], when applied to a 07 patient with a qualifying condition, would not be effective to remove the qualifying 08 condition, would serve only to prolong the dying process, or, when administered to a 09 patient with a condition of permanent unconsciousness, may keep the patient alive but 10 is not expected to restore consciousness; in this paragraph, "medical treatment, 11 procedure, or intervention" includes assisted ventilation, renal dialysis, surgical 12 procedures, blood transfusions, and the administration of drugs, including antibiotics, 13 or artificial nutrition and hydration; 14  * Sec. 56. AS 13.52.390(31) is amended to read: 15 (31) "physician associate [ASSISTANT]" means an individual 16 licensed under AS 08.64.107. 17  * Sec. 57. AS 14.30.141(e) is amended to read: 18 (e) In this section, "health care provider" means a licensed physician, 19 advanced practice registered nurse, physician associate [ASSISTANT], village health 20 aide, or pharmacist operating within the scope of the health care provider's authority. 21  * Sec. 58. AS 17.20.085(g)(1) is amended to read: 22 (1) "health care provider" means a licensed physician, osteopath, 23 dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village 24 health aide, or pharmacist operating within the scope of the health care provider's 25 authority; 26  * Sec. 59. AS 18.08.087 is amended to read: 27 Sec. 18.08.087. Disclosure of medical records. When requested for the 28 purpose of evaluating the performance of an emergency medical technician, mobile 29 intensive care paramedic, or physician who provided emergency medical care or other 30 assistance to a sick or injured person, a licensed physician, advanced practice 31 registered nurse, or physician associate [ASSISTANT] may disclose to an emergency 01 medical technician, a mobile intensive care paramedic, or physician the medical or 02 hospital records of a sick or injured person to whom the paramedic, technician, or 03 physician is providing or has rendered emergency medical care or assistance. 04 However, the disclosing physician, advanced practice registered nurse, or physician 05 associate [ASSISTANT] shall limit disclosure under this section to the records that 06 are considered necessary by the discloser for evaluation of the paramedic's, 07 technician's, or physician's performance in providing the emergency medical care or 08 assistance. A mobile intensive care paramedic, emergency medical care technician, or 09 physician to whom confidential records are disclosed under this section may not 10 further disclose the information to a person not entitled to receive that information 11 under this section or another law. 12  * Sec. 60. AS 18.08.089(a) is amended to read: 13 (a) A mobile intensive care paramedic licensed under this chapter, a physician 14 associate [ASSISTANT] registered or licensed under AS 08.64.107, or an emergency 15 medical technician certified under this chapter may make a determination and 16 pronouncement of death of a person under the following circumstances: 17 (1) the mobile intensive care paramedic or emergency medical 18 technician is an active member of an emergency medical service certified under this 19 chapter; 20 (2) neither a physician licensed under AS 08.64 nor a physician 21 exempt from licensure under AS 08.64 is immediately available for consultation by 22 radio or telephone communications; 23 (3) the mobile intensive care paramedic, physician associate 24 [ASSISTANT], or emergency medical technician has determined, based on acceptable 25 medical standards, that the person has sustained irreversible cessation of circulatory 26 and respiratory functions. 27  * Sec. 61. AS 18.08.089(b) is amended to read: 28 (b) A mobile intensive care paramedic, physician associate [ASSISTANT], or 29 emergency medical technician who has determined and pronounced death under this 30 section shall document the clinical criteria for the determination and pronouncement 31 on the person's emergency medical service report form and notify the appropriate 01 medical director or collaborative physician as soon as communication can be 02 established. The paramedic, physician associate [ASSISTANT], or emergency 03 medical technician shall provide to the person who signs the death certificate the 04 (1) name of the deceased; 05 (2) presence of a contagious disease, if known; and 06 (3) date and time of death. 07  * Sec. 62. AS 18.08.089(c) is amended to read: 08 (c) Except as otherwise provided under AS 18.50.230, a physician licensed 09 under AS 08.64 shall certify a death determined under (b) of this section within 24 10 hours after the pronouncement by the mobile intensive care paramedic, physician 11 associate [ASSISTANT], or emergency medical technician. 12  * Sec. 63. AS 18.15.310(a) is amended to read: 13 (a) The withdrawal of blood for a test under AS 18.15.300 - 18.15.320 shall be 14 performed in a medically approved manner. Only a physician or physician associate 15 [ASSISTANT] licensed under AS 08.64, registered or advanced practice registered 16 nurse, licensed practical nurse, or certified emergency medical technician may 17 withdraw blood specimens for the purposes of AS 18.15.300 - 18.15.320. 18  * Sec. 64. AS 18.15.395(11) is amended to read: 19 (11) "health care practitioner" means a physician, advanced practice 20 registered nurse, or physician associate [ASSISTANT] licensed or otherwise 21 authorized to practice their respective professions in this state; 22  * Sec. 65. AS 18.15.395(12) is amended to read: 23 (12) "health care provider" means any person that provides health care 24 services; "health care provider" includes a hospital, medical clinic or office, special 25 care facility, medical laboratory, physician, pharmacist, dentist, physician associate 26 [ASSISTANT], nurse, paramedic, emergency medical or laboratory technician, 27 community health worker, and ambulance and emergency medical worker; 28  * Sec. 66. AS 18.20.095(e)(2) is amended to read: 29 (2) "licensed staff member" means a person who is employed by the 30 hospital to provide direct patient care and who is licensed or certified in the state as a 31 physician or physician associate [ASSISTANT] under AS 08.64, direct-entry midwife 01 under AS 08.65, nurse or nurse aide under AS 08.68, or physical therapist or 02 occupational therapist under AS 08.84; 03  * Sec. 67. AS 18.29.190(9) is amended to read: 04 (9) "tier II health care professional" means a person who spends not 05 less than 50 percent of the person's time on direct patient health care services and who 06 is licensed or exempt from licensure in the state as a dental hygienist, advanced 07 practice registered nurse, registered nurse, physician associate [ASSISTANT], 08 physical therapist, professional counselor, associate counselor, board certified 09 behavior analyst, marital and family therapist, clinical social worker, or other health 10 care professional as determined by the commissioner; 11  * Sec. 68. AS 18.50.230(c) is amended to read: 12 (c) The medical certification shall be completed and signed within 24 hours 13 after death by the physician, the advanced practice registered nurse, or the physician 14 associate [ASSISTANT] in charge of the patient's care for the illness or condition that 15 resulted in death except when an official inquiry or inquest is required and except as 16 provided by regulation in special problem cases. 17  * Sec. 69. AS 18.65.310(m) is amended to read: 18 (m) The department shall provide a method for a person to designate 19 voluntarily on an identification card that the person has a disability, including a 20 cognitive, mental, neurological, or physical disability, or a combination of those 21 disabilities. The department shall create a discreet symbol to place on the 22 identification card of a person requesting the designation. The method must provide a 23 means by which the person may cancel the designation. The department may not 24 charge a fee solely for the designation. To receive the designation, the person shall 25 provide proof of the disability from a person licensed as a physician or physician 26 associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45, as an 27 advanced practice registered nurse under AS 08.68, or as a licensed psychologist 28 under AS 08.86. Notwithstanding (a) of this section, the department may charge a fee 29 of $5 for replacement of a valid identification card with a new identification card with 30 a disability designation and may charge a fee of $5 for replacement of an identification 31 card with a disability designation with a new identification card without a disability 01 designation. 02  * Sec. 70. AS 18.67.020(a) is amended to read: 03 (a) The Violent Crimes Compensation Board is composed of three members to 04 be appointed by the governor. One of the members shall be designated as chair by the 05 governor. At least one member must be a medical or osteopathic physician, a 06 physician associate [ASSISTANT], or an advanced nurse practitioner licensed to 07 practice in this state or retired from practice in this state, and one member must be an 08 attorney licensed to practice in this state or retired from practice in this state. 09  * Sec. 71. AS 21.36.090(d) is amended to read: 10 (d) Except to the extent necessary to comply with AS 21.42.365 and 11 AS 21.56, a person may not practice or permit unfair discrimination against a person 12 who provides a service covered under a group health insurance policy that extends 13 coverage on an expense incurred basis, or under a group service or indemnity type 14 contract issued by a health maintenance organization or a nonprofit corporation, if the 15 service is within the scope of the provider's occupational license. In this subsection, 16 "provider" means a state licensed physician, physician associate [ASSISTANT], 17 dentist, osteopath, optometrist, chiropractor, advanced practice registered nurse, 18 pharmacist, naturopath, physical therapist, occupational therapist, marital and family 19 therapist, psychologist, psychological associate, licensed clinical social worker, 20 licensed professional counselor, licensed associate counselor, certified direct-entry 21 midwife, or dental hygienist holding an advanced practice permit. 22  * Sec. 72. AS 21.42.351(b)(2) is amended to read: 23 (2) "health care professional" means a health aide, physician, nurse, 24 and physician associate [ASSISTANT], but does not include a practitioner of 25 religious healing; 26  * Sec. 73. AS 23.30.395(3) is amended to read: 27 (3) "attending physician" means one of the following designated by the 28 employee under AS 23.30.095(a) or (b): 29 (A) a licensed medical doctor; 30 (B) a licensed doctor of osteopathy; 31 (C) a licensed dentist or dental surgeon; 01 (D) a licensed physician associate [ASSISTANT] acting under 02 supervision of a licensed medical doctor or doctor of osteopathy; 03 (E) a licensed advanced practice registered nurse; or 04 (F) a licensed chiropractor; 05  * Sec. 74. AS 28.10.181(d) is amended to read: 06 (d) Vehicles owned by veterans with disabilities, including persons disabled in 07 the line of duty while serving in the Alaska Territorial Guard, or other persons with 08 disabilities. Upon the request of a person with a disability that limits or impairs the 09 ability to walk, as defined in 23 C.F.R. 1235.2, the department shall (1) register one 10 motor vehicle in the name of the person without charge; and (2) issue a specially 11 designed registration plate that displays (A) recognition of the disabled veteran if the 12 applicant's disability originated from the applicant's service with the Alaska Territorial 13 Guard or the armed forces of the United States; (B) the international symbol of 14 accessibility (the wheelchair logo); and (C) if the applicant is a veteran, the Alaska and 15 United States flags and red, white, and blue colors. A person who is not otherwise 16 qualified under this subsection, but who meets the qualifications of a disabled veteran 17 under AS 29.45.030(i), may register one motor vehicle without charge, and the 18 department shall issue a specially designed registration plate that displays recognition 19 of the disabled veteran that does not display the international symbol of accessibility 20 and does not carry with it special parking privileges. A disabled veteran who 21 otherwise qualifies for a registration plate under this subsection may elect to receive a 22 plate under (p) or (q) of this section for which the person is otherwise qualified that 23 does not display the international symbol of accessibility and does not carry with it 24 special parking privileges. A disabled person who otherwise qualifies for a registration 25 plate under (2)(B) of this subsection may elect to receive a plate under another 26 provision of this section for which the person is otherwise qualified that does not 27 display the international symbol of accessibility and does not carry with it special 28 parking privileges. For purposes of this subsection, proof of disability may be 29 provided by a person licensed as a speech-language pathologist under AS 08.11, as a 30 chiropractor under AS 08.20, as a physician or physician associate [ASSISTANT] 31 under AS 08.64, as an advanced practice registered nurse under AS 08.68, or as a 01 physical therapist or occupational therapist under AS 08.84. 02  * Sec. 75. AS 28.15.111(d) is amended to read: 03 (d) The department shall provide a method, at the time that a driver's license is 04 issued, by which the owner of a license may voluntarily designate on the license that 05 the owner has a disability, including a cognitive, mental, neurological, or physical 06 disability, or a combination of those disabilities. The department shall create a discreet 07 symbol to place on the driver's license of a person requesting the designation. The 08 method must provide a means by which the owner may cancel the designation. The 09 department may not charge a fee solely for the designation. To receive the designation, 10 the person shall provide proof of the disability from a person licensed as a physician or 11 physician associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45, 12 as an advanced practice nurse under AS 08.68, or as a licensed psychologist under 13 AS 08.86. The department may charge a fee of $5 for replacement of a valid driver's 14 license with a new driver's license with a disability designation and may charge a fee 15 of $5 for replacement of a driver's license with a disability designation with a new 16 driver's license without a disability designation. 17  * Sec. 76. AS 33.30.901(10) is amended to read: 18 (10) "health care provider" means 19 (A) a physician associate [ASSISTANT] licensed to practice in 20 the state and working under the direct supervision of a licensed physician or 21 psychiatrist; 22 (B) a mental health professional as defined in AS 47.30.915; or 23 (C) an advanced practice registered nurse as defined in 24 AS 08.68.850; 25  * Sec. 77. AS 47.17.290(14) is amended to read: 26 (14) "practitioner of the healing arts" includes athletic trainers, 27 chiropractors, mental health counselors, social workers, dental hygienists, dentists, 28 health aides, nurses, nurse practitioners, certified nurse aides, occupational therapists, 29 occupational therapy assistants, optometrists, osteopaths, naturopaths, physical 30 therapists, physical therapist assistants, physicians, physician associates 31 [ASSISTANTS], psychiatrists, psychologists, psychological associates, audiologists 01 and speech-language pathologists licensed under AS 08.11, hearing aid dealers 02 licensed under AS 08.55, marital and family therapists licensed under AS 08.63, 03 behavior analysts, assistant behavior analysts, religious healing practitioners, 04 acupuncturists, and surgeons; 05  * Sec. 78. AS 47.30.705(a) is amended to read: 06 (a) A peace officer, health officer, mental health professional, or physician 07 associate [ASSISTANT] licensed by the State Medical Board to practice in this state 08 who has probable cause to believe that a person is gravely disabled or is suffering 09 from mental illness and is likely to cause serious harm to self or others of such 10 immediate nature that considerations of safety do not allow initiation of involuntary 11 commitment procedures set out in AS 47.30.700, may cause the person to be taken 12 into custody by a peace officer or health officer and delivered to the nearest crisis 13 stabilization center, crisis residential center, evaluation facility, or treatment facility. A 14 person taken into custody for emergency evaluation may not be placed in a jail or 15 other correctional facility except for protective custody purposes and only while 16 awaiting transportation to a crisis stabilization center, crisis residential center, 17 evaluation facility, or treatment facility. However, protective custody under this 18 section may not include placement of a minor in a jail or secure facility. The peace 19 officer, health officer, mental health professional, or physician associate 20 [ASSISTANT] shall complete an application for examination of the person in custody 21 and be interviewed by a mental health professional at the crisis stabilization center, 22 crisis residential center, evaluation facility, or treatment facility. 23  * Sec. 79. AS 47.30.838(a) is amended to read: 24 (a) Except as provided in (c) and (d) of this section, an evaluation facility or 25 designated treatment facility may administer psychotropic medication to a patient 26 without the patient's informed consent, regardless of whether the patient is capable of 27 giving informed consent, only if 28 (1) there is a crisis situation, or an impending crisis situation, that 29 requires immediate use of the medication to preserve the life of, or prevent significant 30 physical harm to, the patient or another person, as determined by a physician, 31 physician associate [ASSISTANT], or advanced practice registered nurse; the 01 behavior or condition of the patient giving rise to a crisis under this paragraph and the 02 staff's response to the behavior or condition must be documented in the patient's 03 medical record; the documentation must include an explanation of alternative 04 responses to the crisis that were considered or attempted by the staff and why those 05 responses were not sufficient; and 06 (2) the medication is ordered by a physician, physician associate 07 [ASSISTANT], or advanced practice registered nurse; the order 08 (A) may be written or oral and may be received by telephone, 09 facsimile machine, or in person; 10 (B) may include an initial dosage and may authorize additional, 11 as needed, doses; if additional, as needed, doses are authorized, the order must 12 specify the medication, the quantity of each authorized dose, the method of 13 administering the medication, the maximum frequency of administration, the 14 specific conditions under which the medication may be given, and the 15 maximum amount of medication that may be administered to the patient in a 16 24-hour period; 17 (C) is valid for only 24 hours and may be renewed by a 18 physician, physician associate [ASSISTANT], or advanced practice registered 19 nurse for a total of 72 hours, including the initial 24 hours, only after a 20 personal assessment of the patient's status and a determination that there is still 21 a crisis situation as described in (1) of this subsection; upon renewal of an 22 order under this subparagraph, the facts supporting the renewal shall be written 23 into the patient's medical record. 24  * Sec. 80. AS 47.37.180(b) is amended to read: 25 (b) The certifying physician, physician associate [ASSISTANT], advanced 26 practice registered nurse, spouse, guardian, or relative of the person to be committed, 27 or any other responsible person, may make a written application for commitment 28 under this section, directed to the administrator of the approved public treatment 29 facility. The application must state facts to support the need for emergency treatment 30 and be accompanied by a physician's, physician associate's [ASSISTANT'S], or 31 advanced practice registered nurse's certificate supporting the need for emergency 01 treatment and stating that the physician, physician associate [ASSISTANT], or 02 advanced practice registered nurse has examined the person sought to be committed 03 within two days before the certificate's date. 04  * Sec. 81. AS 47.37.180(f) is amended to read: 05 (f) A copy of the written application for commitment and of the physician's, 06 physician associate's [ASSISTANT'S], or advanced practice registered nurse's 07 certificate, and a written explanation of the person's right to legal counsel, shall be 08 given to the person within 24 hours after commitment by the administrator, who shall 09 provide a reasonable opportunity for the person to consult with legal counsel. 10  * Sec. 82. AS 47.37.190(a) is amended to read: 11 (a) A spouse or guardian, a relative, the certifying physician, physician 12 associate [ASSISTANT], advanced practice registered nurse, or the administrator in 13 charge of an approved public treatment facility may petition the court for a 30-day 14 involuntary commitment order. The petition must allege that the person is an alcoholic 15 or drug abuser who (1) has threatened, attempted to inflict, or inflicted physical harm 16 on another and that unless committed is likely to inflict physical harm on another; or 17 (2) is incapacitated by alcohol or drugs. A refusal to undergo treatment does not 18 constitute evidence of lack of judgment as to the need for treatment. The petition must 19 be accompanied by a certificate of a licensed physician, physician associate 20 [ASSISTANT], or advanced practice registered nurse who has examined the person 21 within two days before submission of the petition, unless the person whose 22 commitment is sought has refused to submit to a medical examination, in which case 23 the fact of refusal must be alleged in the petition. The certificate must set out the 24 physician's, physician associate's [ASSISTANT'S], or advanced practice registered 25 nurse's findings of the examination in support of the allegations of the petition. 26  * Sec. 83. AS 47.37.200(a) is amended to read: 27 (a) At the hearing for a 30-day commitment required under AS 47.37.190(b), 28 the court shall hear all relevant testimony, including, if possible, the testimony of at 29 least one person who has examined the person whose commitment is sought under 30 AS 47.37.180(b) or 47.37.190(a). The person whose commitment is sought shall be 31 present unless the court believes that being present is likely to be injurious to the 01 person, in which case the court may conduct the hearing telephonically. The court may 02 examine the person in open court, or, if advisable, examine the person out of court. If 03 the person has refused to be examined under AS 47.37.180(b) or 47.37.190(a), the 04 person shall be given an opportunity to request examination by a court-appointed 05 licensed physician, physician associate [ASSISTANT], or advanced practice 06 registered nurse. If the person fails to request a medical examination and there is 07 sufficient evidence to believe that the allegations of the petition are true, or, if the 08 court believes that more medical evidence is necessary, the court may issue a 09 temporary order committing the person to a private or public facility for a period of 10 not more than five days for purposes of a diagnostic examination. 11  * Sec. 84. AS 08.80.337(c) is repealed.  12  * Sec. 85. The uncodified law of the State of Alaska is amended by adding a new section to 13 read: 14 REVISOR'S INSTRUCTION. If SB 89, as passed by the Thirty-Fourth Alaska State 15 Legislature, is enacted into law, the revisor of statutes shall replace all occurrences of 16 "physician assistant" in SB 89 with "physician associate," except for occurrences of 17 "physician assistant" when used in "Accreditation Review Commission on Education for the 18 Physician Assistant" and "National Commission on Certification of Physician Assistants." 19  * Sec. 86. The uncodified law of the State of Alaska is amended by adding a new section to 20 read: 21 CONDITIONAL EFFECT. Sections 7, 10, 12, 56, 60, 73, and 76 of this Act take 22 effect only if SB 89, as passed by the Thirty-Fourth Alaska State Legislature, is not enacted 23 into law. 24  * Sec. 87. Sections 4 - 6, 13, 14, 25 - 30, 32 - 36, 38, 39, 45, and 84 of this Act take effect 25 January 1, 2027.