CS/HB 879

1	A bill to be entitled
2	An act relating to nursing specialties; amending s.
3	464.003, F.S.; defining the terms "clinical nurse
4	specialist practice" and "clinical nurse specialist";
5	creating s. 464.0115, F.S.; providing requirements for
6	certification as a clinical nurse specialist; providing
7	fees; authorizing the Board of Nursing to adopt rules;
8	amending s. 464.012, F.S.; conforming a cross-reference;
9	amending s. 464.015, F.S.; restricting the use of
10	professional titles and abbreviations relating to practice
11	by clinical nurse specialists, certified registered nurse
12	anesthetists, and certified nurse midwives; providing
13	penalties; amending s. 464.016, F.S.; prohibiting the use
14	of any name or title stating or implying that a person is
15	a clinical nurse specialist, certified registered nurse
16	anesthetist, or certified nurse midwife unless the person
17	is licensed or certified; providing penalties; reenacting
18	s. 921.0022(3)(g), F.S., relating to the offense severity
19	ranking chart of the Criminal Punishment Code, to
20	incorporate the amendment to s. 464.016, F.S., in a
21	reference thereto; amending ss. 458.348 and 459.025, F.S.;
22	conforming cross-references; providing an effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1.  Section 464.003, Florida Statutes, is amended
27	to read:
28	464.003  Definitions.--As used in this part, the term:
29	(1)  "Department" means the Department of Health.
30	(2)  "Board" means the Board of Nursing.
31	(3)(a)  "Practice of professional nursing" means the
32	performance of those acts requiring substantial specialized
33	knowledge, judgment, and nursing skill based upon applied
34	principles of psychological, biological, physical, and social
35	sciences which shall include, but not be limited to:
36	1.  The observation, assessment, nursing diagnosis,
37	planning, intervention, and evaluation of care; health teaching
38	and counseling of the ill, injured, or infirm; and the promotion
39	of wellness, maintenance of health, and prevention of illness of
40	others.
41	2.  The administration of medications and treatments as
42	prescribed or authorized by a duly licensed practitioner
43	authorized by the laws of this state to prescribe such
44	medications and treatments.
45	3.  The supervision and teaching of other personnel in the
46	theory and performance of any of the above acts.
47	(b)  "Practice of practical nursing" means the performance
48	of selected acts, including the administration of treatments and
49	medications, in the care of the ill, injured, or infirm and the
50	promotion of wellness, maintenance of health, and prevention of
51	illness of others under the direction of a registered nurse, a
52	licensed physician, a licensed osteopathic physician, a licensed
53	podiatric physician, or a licensed dentist.
54
55	The professional nurse and the practical nurse shall be
56	responsible and accountable for making decisions that are based
57	upon the individual's educational preparation and experience in
58	nursing.
59	(c)  "Clinical nurse specialist practice" means the
60	delivery and management of advanced practice nursing care to
61	individuals or groups, including the ability to:
62	1.  Assess the health status of individuals and families
63	using methods appropriate to the population and area of
64	practice.
65	2.  Diagnose human responses to actual or potential health
66	problems.
67	3.  Plan for health promotion, disease prevention, and
68	therapeutic intervention in collaboration with the patient or
69	client.
70	4.  Implement therapeutic interventions based on the
71	clinical nurse specialist's area of expertise, within the scope
72	of advanced nursing practice, including, but not limited to,
73	direct nursing care, counseling, teaching, and collaboration
74	with other licensed health care providers.
75	5.  Coordinate health care as necessary and appropriate and
76	evaluate with the patient or client the effectiveness of care.
77	(d)(c)  "Advanced or specialized nursing practice" means,
78	in addition to the practice of professional nursing, the
79	performance of advanced-level nursing acts approved by the board
80	which, by virtue of postbasic specialized education, training,
81	and experience, are proper to be performed by an advanced
82	registered nurse practitioner.  Within the context of advanced
83	or specialized nursing practice, the advanced registered nurse
84	practitioner may perform acts of nursing diagnosis and nursing
85	treatment of alterations of the health status.  The advanced
86	registered nurse practitioner may also perform acts of medical
87	diagnosis and treatment, prescription, and operation which are
88	identified and approved by a joint committee composed of three
89	members appointed by the Board of Nursing, two of whom shall be
90	advanced registered nurse practitioners; three members appointed
91	by the Board of Medicine, two of whom shall have had work
92	experience with advanced registered nurse practitioners; and the
93	secretary of the department or the secretary's designee. Each
94	committee member appointed by a board shall be appointed to a
95	term of 4 years unless a shorter term is required to establish
96	or maintain staggered terms. The Board of Nursing shall adopt
97	rules authorizing the performance of any such acts approved by
98	the joint committee. Unless otherwise specified by the joint
99	committee, such acts shall be performed under the general
100	supervision of a practitioner licensed under chapter 458,
101	chapter 459, or chapter 466 within the framework of standing
102	protocols which identify the medical acts to be performed and
103	the conditions for their performance.  The department may, by
104	rule, require that a copy of the protocol be filed with the
105	department along with the notice required by s. 458.348.
106	(e)(d)  "Nursing diagnosis" means the observation and
107	evaluation of physical or mental conditions, behaviors, signs
108	and symptoms of illness, and reactions to treatment and the
109	determination as to whether such conditions, signs, symptoms,
110	and reactions represent a deviation from normal.
111	(f)(e)  "Nursing treatment" means the establishment and
112	implementation of a nursing regimen for the care and comfort of
113	individuals, the prevention of illness, and the education,
114	restoration, and maintenance of health.
115	(4)  "Registered nurse" means any person licensed in this
116	state to practice professional nursing.
117	(5)  "Licensed practical nurse" means any person licensed
118	in this state to practice practical nursing.
119	(6)  "Clinical nurse specialist" means any person licensed
120	in this state to practice professional nursing and certified in
121	clinical nurse specialist practice.
122	(7)(6)  "Advanced registered nurse practitioner" means any
123	person licensed in this state to practice professional nursing
124	and certified in advanced or specialized nursing practice,
125	including certified registered nurse anesthetists, certified
126	nurse midwives, and nurse practitioners.
127	(8)(7)  "Approved program" means a nursing program
128	conducted in a school, college, or university which is approved
129	by the board pursuant to s. 464.019 for the education of nurses.
130	Section 2.  Section 464.0115, Florida Statutes, is created
131	to read:
132	464.0115  Certification of clinical nurse specialists.--
133	(1)  Any nurse desiring to be certified as a clinical nurse
134	specialist must apply to the department and submit proof that he
135	or she holds a current license to practice professional nursing,
136	a master's degree in a clinical nursing specialty, and current
137	certification in a specialty area as a clinical nurse specialist
138	from a nationally recognized certifying body as determined by
139	the board.
140	(2)  The board shall certify, and the department shall
141	issue a certificate to, any nurse who fulfills the
142	qualifications in this section. The board shall establish an
143	application fee not to exceed $75 and a biennial renewal fee not
144	to exceed $75.
145	(3)  The board may adopt rules necessary to administer this
146	section pursuant to ss. 120.536(1) and 120.54.
147	Section 3.  Subsection (3) of section 464.012, Florida
148	Statutes, is amended to read:
149	464.012  Certification of advanced registered nurse
150	practitioners; fees.--
151	(3)  An advanced registered nurse practitioner shall
152	perform those functions authorized in this section within the
153	framework of an established protocol that is filed with the
154	board upon biennial license renewal and within 30 days after
155	entering into a supervisory relationship with a physician or
156	changes to the protocol. The board shall review the protocol to
157	ensure compliance with applicable regulatory standards for
158	protocols. The board shall refer to the department licensees
159	submitting protocols that are not compliant with the regulatory
160	standards for protocols. A practitioner currently licensed under
161	chapter 458, chapter 459, or chapter 466 shall maintain
162	supervision for directing the specific course of medical
163	treatment. Within the established framework, an advanced
164	registered nurse practitioner may:
165	(a)  Monitor and alter drug therapies.
166	(b)  Initiate appropriate therapies for certain conditions.
167	(c)  Perform additional functions as may be determined by
168	rule in accordance with s. 464.003(3)(d) s. 464.003(3)(c).
169	(d)  Order diagnostic tests and physical and occupational
170	therapy.
171	Section 4.  Section 464.015, Florida Statutes, is amended
172	to read:
173	464.015  Titles and abbreviations; restrictions; penalty.--
174	(1)  Only persons who hold licenses to practice
175	professional nursing in this state or who are performing nursing
176	services pursuant to the exception set forth in s. 464.022(8)
177	shall have the right to use the title "Registered Nurse" and the
178	abbreviation "R.N."
179	(2)  Only persons who hold licenses to practice as licensed
180	practical nurses in this state or who are performing practical
181	nursing services pursuant to the exception set forth in s.
182	464.022(8) shall have the right to use the title "Licensed
183	Practical Nurse" and the abbreviation "L.P.N."
184	(3)  Only persons who are graduates of approved programs or
185	the equivalent may use the term "Graduate Nurse" and the
186	abbreviation "G.N.," pending the results of the first licensure
187	examination for which they are eligible.
188	(4)  Only persons who are graduates of approved programs or
189	the equivalent may use the term "Graduate Practical Nurse" and
190	the abbreviation "G.P.N.," pending the results of the first
191	licensure examination for which they are eligible.
192	(5)  Only persons who hold valid certificates to practice
193	as clinical nurse specialists in this state may use the title
194	"Clinical Nurse Specialist" and the abbreviation "C.N.S."
195	(6)  Only persons who hold valid certificates to practice
196	as certified registered nurse anesthetists in this state may use
197	the title "Certified Registered Nurse Anesthetist" and the
198	abbreviations "C.R.N.A." or "nurse anesthetist."
199	(7)  Only persons who hold valid certificates to practice
200	as certified nurse midwives in this state may use the title
201	"Certified Nurse Midwife" and the abbreviations "C.N.M." or
202	"nurse midwife."
203	(8)(5)  Only persons who hold valid certificates to
204	practice as advanced registered nurse practitioners in this
205	state may shall have the right to use the title "Advanced
206	Registered Nurse Practitioner" and the abbreviation "A.R.N.P."
207	(9)(6)  A No person may not shall practice or advertise as,
208	or assume the title of, registered nurse, licensed practical
209	nurse, clinical nurse specialist, certified registered nurse
210	anesthetist, certified nurse midwife, or advanced registered
211	nurse practitioner or use the abbreviation "R.N.," "L.P.N.,"
212	"C.N.S.," "C.R.N.A.," "C.N.M.," or "A.R.N.P." or take any other
213	action that would lead the public to believe that person was
214	certified as such or is performing nursing services pursuant to
215	the exception set forth in s. 464.022(8), unless that person is
216	licensed or certified to practice as such.
217	(10)(7)  A violation of this section is a misdemeanor of
218	the first degree, punishable as provided in s. 775.082 or s.
219	775.083.
220	Section 5.  Section 464.016, Florida Statutes, is amended
221	to read:
222	464.016  Violations and penalties.--
223	(1)  Each of the following acts constitutes a felony of the
224	third degree, punishable as provided in s. 775.082, s. 775.083,
225	or s. 775.084:
226	(a)  Practicing advanced or specialized, professional, or
227	practical nursing, as defined in this part, unless holding an
228	active license or certificate to do so.
229	(b)  Using or attempting to use a license or certificate
230	which has been suspended or revoked.
231	(c)  Knowingly employing unlicensed persons in the practice
232	of nursing.
233	(d)  Obtaining or attempting to obtain a license or
234	certificate under this part by misleading statements or knowing
235	misrepresentation.
236	(2)  Each of the following acts constitutes a misdemeanor
237	of the first degree, punishable as provided in s. 775.082 or s.
238	775.083:
239	(a)  Using the name or title "Nurse," "Registered Nurse,"
240	"Licensed Practical Nurse," "Clinical Nurse Specialist,"
241	"Certified Registered Nurse Anesthetist," "Certified Nurse
242	Midwife," "Advanced Registered Nurse Practitioner," or any other
243	name or title which implies that a person was licensed or
244	certified as same, unless such person is duly licensed or
245	certified.
246	(b)  Knowingly concealing information relating to
247	violations of this part.
248	Section 6.  For the purpose of incorporating the amendment
249	to section 464.016, Florida Statutes, in a reference thereto,
250	paragraph (g) of subsection (3) of section 921.0022, Florida
251	Statutes, is reenacted to read:
252	921.0022  Criminal Punishment Code; offense severity
253	ranking chart.--
254	(3)  OFFENSE SEVERITY RANKING CHART
	FloridaStatute FelonyDegree Description
255
	(g)  LEVEL 7
256
	316.027(1)(b) 1st Accident involving death, failure to stop; leaving scene.
257
	316.193(3)(c)2. 3rd DUI resulting in serious bodily injury.
258
	316.1935(3)(b) 1st Causing serious bodily injury or death to another person; driving at high speed or with wanton disregard for safety while fleeing or attempting to elude law enforcement officer who is in a patrol vehicle with siren and lights activated.
259
	327.35(3)(c)2. 3rd Vessel BUI resulting in serious bodily injury.
260
	402.319(2) 2nd Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.
261
	409.920(2) 3rd Medicaid provider fraud.
262
	456.065(2) 3rd Practicing a health care profession without a license.
263
	456.065(2) 2nd Practicing a health care profession without a license which results in serious bodily injury.
264
	458.327(1) 3rd Practicing medicine without a license.
265
	459.013(1) 3rd Practicing osteopathic medicine without a license.
266
	460.411(1) 3rd Practicing chiropractic medicine without a license.
267
	461.012(1) 3rd Practicing podiatric medicine without a license.
268
	462.17 3rd Practicing naturopathy without a license.
269
	463.015(1) 3rd Practicing optometry without a license.
270
	464.016(1) 3rd Practicing nursing without a license.
271
	465.015(2) 3rd Practicing pharmacy without a license.
272
	466.026(1) 3rd Practicing dentistry or dental hygiene without a license.
273
	467.201 3rd Practicing midwifery without a license.
274
	468.366 3rd Delivering respiratory care services without a license.
275
	483.828(1) 3rd Practicing as clinical laboratory personnel without a license.
276
	483.901(9) 3rd Practicing medical physics without a license.
277
	484.013(1)(c) 3rd Preparing or dispensing optical devices without a prescription.
278
	484.053 3rd Dispensing hearing aids without a license.
279
	494.0018(2) 1st Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.
280
	560.123(8)(b)1. 3rd Failure to report currency or payment instruments exceeding $300 but less than $20,000 by money transmitter.
281
	560.125(5)(a) 3rd Money transmitter business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.
282
	655.50(10)(b)1. 3rd Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.
283
	775.21(10)(a) 3rd Sexual predator; failure to register; failure to renew driver's license or identification card; other registration violations.
284
	775.21(10)(b) 3rd Sexual predator working where children regularly congregate.
285
	775.21(10)(g) 3rd Failure to report or providing false information about a sexual predator; harbor or conceal a sexual predator.
286
	782.051(3) 2nd Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.
287
	782.07(1) 2nd Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).
288
	782.071 2nd Killing of human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).
289
	782.072 2nd Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).
290
	784.045(1)(a)1. 2nd Aggravated battery; intentionally causing great bodily harm or disfigurement.
291
	784.045(1)(a)2. 2nd Aggravated battery; using deadly weapon.
292
	784.045(1)(b) 2nd Aggravated battery; perpetrator aware victim pregnant.
293
	784.048(4) 3rd Aggravated stalking; violation of injunction or court order.
294
	784.048(7) 3rd Aggravated stalking; violation of court order.
295
	784.07(2)(d) 1st Aggravated battery on law enforcement officer.
296
	784.074(1)(a) 1st Aggravated battery on sexually violent predators facility staff.
297
	784.08(2)(a) 1st Aggravated battery on a person 65 years of age or older.
298
	784.081(1) 1st Aggravated battery on specified official or employee.
299
	784.082(1) 1st Aggravated battery by detained person on visitor or other detainee.
300
	784.083(1) 1st Aggravated battery on code inspector.
301
	790.07(4) 1st Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).
302
	790.16(1) 1st Discharge of a machine gun under specified circumstances.
303
	790.165(2) 2nd Manufacture, sell, possess, or deliver hoax bomb.
304
	790.165(3) 2nd Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.
305
	790.166(3) 2nd Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.
306
	790.166(4) 2nd Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.
307
	796.03 2nd Procuring any person under 16 years for prostitution.
308
	800.04(5)(c)1. 2nd Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.
309
	800.04(5)(c)2. 2nd Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.
310
	806.01(2) 2nd Maliciously damage structure by fire or explosive.
311
	810.02(3)(a) 2nd Burglary of occupied dwelling; unarmed; no assault or battery.
312
	810.02(3)(b) 2nd Burglary of unoccupied dwelling; unarmed; no assault or battery.
313
	810.02(3)(d) 2nd Burglary of occupied conveyance; unarmed; no assault or battery.
314
	812.014(2)(a)1. 1st Property stolen, valued at $100,000 or more or a semitrailer deployed by a law enforcement officer; property stolen while causing other property damage; 1st degree grand theft.
315
	812.014(2)(b)2. 2nd Property stolen, cargo valued at less than $50,000, grand theft in 2nd degree.
316
	812.014(2)(b)3. 2nd Property stolen, emergency medical equipment; 2nd degree grand theft.
317
	812.0145(2)(a) 1st Theft from person 65 years of age or older; $50,000 or more.
318
	812.019(2) 1st Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.
319
	812.131(2)(a) 2nd Robbery by sudden snatching.
320
	812.133(2)(b) 1st Carjacking; no firearm, deadly weapon, or other weapon.
321
	817.234(8)(a) 2nd Solicitation of motor vehicle accident victims with intent to defraud.
322
	817.234(9) 2nd Organizing, planning, or participating in an intentional motor vehicle collision.
323
	817.234(11)(c) 1st Insurance fraud; property value $100,000 or more.
324
	817.2341(2)(b) & (3)(b) 1st Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.
325
	825.102(3)(b) 2nd Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.
326
	825.103(2)(b) 2nd Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.
327
	827.03(3)(b) 2nd Neglect of a child causing great bodily harm, disability, or disfigurement.
328
	827.04(3) 3rd Impregnation of a child under 16 years of age by person 21 years of age or older.
329
	837.05(2) 3rd Giving false information about alleged capital felony to a law enforcement officer.
330
	838.015 2nd Bribery.
331
	838.016 2nd Unlawful compensation or reward for official behavior.
332
	838.021(3)(a) 2nd Unlawful harm to a public servant.
333
	838.22 2nd Bid tampering.
334
	847.0135(3) 3rd Solicitation of a child, via a computer service, to commit an unlawful sex act.
335
	872.06 2nd Abuse of a dead human body.
336
	893.13(1)(c)1. 1st Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.
337
	893.13(1)(e)1. 1st Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.
338
	893.13(4)(a) 1st Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).
339
	893.135(1)(a)1. 1st Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.
340
	893.135(1)(b)1.a. 1st Trafficking in cocaine, more than 28 grams, less than 200 grams.
341
	893.135(1)(c)1.a. 1st Trafficking in illegal drugs, more than 4 grams, less than 14 grams.
342
	893.135(1)(d)1. 1st Trafficking in phencyclidine, more than 28 grams, less than 200 grams.
343
	893.135(1)(e)1. 1st Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.
344
	893.135(1)(f)1. 1st Trafficking in amphetamine, more than 14 grams, less than 28 grams.
345
	893.135(1)(g)1.a. 1st Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.
346
	893.135(1)(h)1.a. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.
347
	893.135(1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.
348
	893.135(1)(k)2.a. 1st Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.
349
	896.101(5)(a) 3rd Money laundering, financial transactions exceeding $300 but less than $20,000.
350
	896.104(4)(a)1. 3rd Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.
351
	943.0435(4)(c) 2nd Sexual offender vacating permanent residence; failure to comply with reporting requirements.
352
	943.0435(8) 2nd Sexual offender; remains in state after indicating intent to leave; failure to comply with reporting requirements.
353
	943.0435(9)(a) 3rd Sexual offender; failure to comply with reporting requirements.
354
	943.0435(13) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
355
	943.0435(14) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
356
	944.607(9) 3rd Sexual offender; failure to comply with reporting requirements.
357
	944.607(10)(a) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
358
	944.607(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
359
	944.607(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
360
361	Section 7.  Paragraph (a) of subsection (1) and subsection
362	(2) of section 458.348, Florida Statutes, are amended to read:
363	458.348  Formal supervisory relationships, standing orders,
364	and established protocols; notice; standards.--
365	(1)  NOTICE.--
366	(a)  When a physician enters into a formal supervisory
367	relationship or standing orders with an emergency medical
368	technician or paramedic licensed pursuant to s. 401.27, which
369	relationship or orders contemplate the performance of medical
370	acts, or when a physician enters into an established protocol
371	with an advanced registered nurse practitioner, which protocol
372	contemplates the performance of medical acts identified and
373	approved by the joint committee pursuant to s. 464.003(3)(d) s.
374	464.003(3)(c) or acts set forth in s. 464.012(3) and (4), the
375	physician shall submit notice to the board. The notice shall
376	contain a statement in substantially the following form:
377
378	I,   (name and professional license number of physician)  ,
379	of   (address of physician)   have hereby entered into a formal
380	supervisory relationship, standing orders, or an established
381	protocol with   (number of persons)   emergency medical
382	technician(s),   (number of persons)   paramedic(s), or
383	(number of persons)   advanced registered nurse practitioner(s).
384	(2)  ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The
385	joint committee created by s. 464.003(3)(d) s. 464.003(3)(c)
386	shall determine minimum standards for the content of established
387	protocols pursuant to which an advanced registered nurse
388	practitioner may perform medical acts identified and approved by
389	the joint committee pursuant to s. 464.003(3)(d) s.
390	464.003(3)(c) or acts set forth in s. 464.012(3) and (4) and
391	shall determine minimum standards for supervision of such acts
392	by the physician, unless the joint committee determines that any
393	act set forth in s. 464.012(3) or (4) is not a medical act. Such
394	standards shall be based on risk to the patient and acceptable
395	standards of medical care and shall take into account the
396	special problems of medically underserved areas. The standards
397	developed by the joint committee shall be adopted as rules by
398	the Board of Nursing and the Board of Medicine for purposes of
399	carrying out their responsibilities pursuant to part I of
400	chapter 464 and this chapter, respectively, but neither board
401	shall have disciplinary powers over the licensees of the other
402	board.
403	Section 8.  Paragraph (a) of subsection (1) of section
404	459.025, Florida Statutes, is amended to read:
405	459.025  Formal supervisory relationships, standing orders,
406	and established protocols; notice; standards.--
407	(1)  NOTICE.--
408	(a)  When an osteopathic physician enters into a formal
409	supervisory relationship or standing orders with an emergency
410	medical technician or paramedic licensed pursuant to s. 401.27,
411	which relationship or orders contemplate the performance of
412	medical acts, or when an osteopathic physician enters into an
413	established protocol with an advanced registered nurse
414	practitioner, which protocol contemplates the performance of
415	medical acts identified and approved by the joint committee
416	pursuant to s. 464.003(3)(d) s. 464.003(3)(c) or acts set forth
417	in s. 464.012(3) and (4), the osteopathic physician shall submit
418	notice to the board. The notice must contain a statement in
419	substantially the following form:
420	I,   (name and professional license number of osteopathic
421	physician)  , of   (address of osteopathic physician)   have
422	hereby entered into a formal supervisory relationship, standing
423	orders, or an established protocol with   (number of persons)
424	emergency medical technician(s),   (number of persons)
425	paramedic(s), or   (number of persons)   advanced registered
426	nurse practitioner(s).
427	Section 9.  This act shall take effect July 1, 2007.

CODING: Words stricken are deletions; words underlined are additions.