What the statutes mean

These are excerpts of the rules that govern the medical profession. They are published without commentary. The rules have been included because chiropractors now have a broad range of working relationships with medical doctors and may be interested in the regulations that control different portions of a medical doctor’s practice. Questions about the working relationships between chiropractors and medical doctors may be directed to the WCA. Questions about the practice of medicine or specific applications of the rules should be directed to the Department of Regulation & Licensing.

Statute excerpts

Ed 1.015 Definitions
Ed 1.03 Translation of documents
Ed 1.04 Application deadline
Ed 1.06 Panel review of applications; examinations required
Ed 1.07 Conduct of examination
Ed 1.08 Failure and reexamination
Ed 1.09 Examination review by applicant
Ed 1.10 Board review of examination error claim
Ed 8.01 Physician assistants
Ed 8.05 Application
Ed 8.05(2) Examinations, panel review of applications
Ed 8.05(3) Examination failure
Ed 8.05(4) Licensure; renewal
Ed 8.053 Examination review by applicant
Ed 8.056 Board review of examination error claim
Ed 8.07(1) Scope and limitations
Ed 8.07(2) Medical care
Ed 8.08 Prescribing limitations
Ed 8.09 Employee status
Ed 8.10 Employment requirements; supervising physician responsibilities
Ed 10.02 Definitions
Ed 15.02 Tattooing and body piercing
Ed 17.04 Labeling
Ed 17.05 Recordkeeping
Ed 17.05(1) Prescription drugs
Ed 17.05(2) Controlled substances
Ed 18.03 Communication of alternate modes of treatment
Ed 18.04 Exceptions to communication of alternate modes of treatment
Ed 19.02 Definitions
Ed 19.03(1) Applications and credentials
Ed 19.04 Examinations, panel review of applications
Ed 19.05 Examination review by applicant
Ed 19.08 Screening
Ed 19.08(2) Referral
Ed 19.08(3) Evaluation
Ed 19.08(4) Program planning
Ed 19.08(5) Program implementation
Ed 19.08(6) Discontinuation of services
Ed 21 Patient health care records

Chapter Ed 1 License to Practice Medicine and Surgery
Ed 1.01 Authority and purpose. The rules in this chapter are adopted by the medical examining board pursuant to the authority delegated by ss. 15.08 (5), 227.11, and 448.40, Stats., and govern application and examination for license to practice medicine and surgery under s. 448.04 (1) (a) Stats., (hereinafter “regular license”).

Ed 1.015 Definitions. As used in this chapter,

Ed 1.015(1) “FLEX” means the federated licensing examination.

Ed 1.015(2) “NBME” means the national board of medical examiners examination.

Ed 1.015(3) “USMLE” means the United States medical licensing examination.

Ed 1.02 Applications and credentials. Every person applying for regular license to practice medicine and surgery shall make application therefor on forms provided for this purpose by the board and shall submit to the board the following:

Ed 1.02(1) A completed and verified application form.

Ed 1.02(2) Verified documentary evidence of graduation from a medical or osteopathic school approved by the board and a verified photographic copy of the diploma conferring the degree of doctor of medicine or doctor of osteopathy granted to the applicant by such school. The board recognizes as approved those medical or osteopathic schools recognized and approved at the time of the applicant’s graduation therefrom by the council on medical education and hospitals of the American medical association, or the American osteopathic association, or the liaison committee on medical education,

or successors. If an applicant is not a graduate of a medical school approved by the board, but is a graduate of a medical school recognized and listed as such by the world health organization of the united nations, such applicant shall submit verified documentary evidence of graduation from such school and a verified photographic copy of the diploma conferring the degree of doctor of medicine or equivalent degree as determined by the board granted to the applicant by such school and also verified documentary evidence of having passed the examinations conducted by the educational council for foreign medical graduates or successors, and shall also present for the board’s inspection the originals thereof, and if such medical school requires either social service or internship or both of its graduates, and if the applicant has not completed either such required social service or internship or both, such applicant shall also submit verified documentary evidence of having completed a 12 month supervised clinical training program under the direction of a medical school approved by the board.

Ed 1.02(3) A verified certificate showing satisfactory completion by the applicant of 12 months’ postgraduate training in a facility approved by the board. The board recognizes as approved those facilities and training programs recognized as approved at the time of the applicant’s service therein by the council on medical education of the American medical association, or the American osteopathic association, or the liaison committee on graduate medical education, or the national joint committee on approval of pre-registration physician training programs of Canada, or successors. If an applicant is a graduate of a foreign medical school not approved by the board and if such applicant has not completed 12 months’ postgraduate training in a facility approved by the board, but such applicant has had other professional experience which the applicant believes has given that applicant education and training substantially equivalent, such applicant may submit to the board documentary evidence thereof. The board will review such documentary evidence and may make such further inquiry including a personal interview of the applicant as the board deems necessary to determine that such substantial equivalence in fact exists. The burden of proof of such equivalence shall lie upon the applicant. If the board finds such equivalence, the board may accept this in lieu of requiring that applicant to have completed 12 months’ postgraduate training in a program approved by the board.

Ed 1.02(4) An unmounted photograph, approximately 8 by 12 cm., of the applicant taken not more than 60 days prior to the date of application and bearing on the reverse side the statement of a notary public that such photograph is a true likeness of the applicant.

Ed 1.02(5) A verified statement that the applicant is familiar with the state health laws and the rules of the department of health and family services as related to communicable diseases.

Ed 1.02(6) The required fees made payable to the Wisconsin department of regulation and licensing.

Ed 1.03 Translation of documents. If any of the documents required under this chapter are in a language other than English, the applicant shall also submit a verified English translation thereof, and the cost of such translation shall be borne by the applicant.

Ed 1.04 Application deadline. The fully completed application and all required documents must be received by the board at its office not less than 3 weeks prior to the date of examination.

Ed 1.05 The required fees must accompany the application, and all remittances must be made payable to the Wisconsin medical examining board.

Panel review of applications; examinations required.

Ed 1.06(1)(a) All applicants shall complete the written examination under sub. (3), and an open book examination on statutes and rules governing the practice of medicine and surgery in Wisconsin. In addition, an applicant may be required to complete an oral examination if the applicant:

Ed 1.06(1)(a)1. Has a medical condition which in any way impairs or limits the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

Ed 1.06(1)(a)2. Uses chemical substances so as to impair in any way the applicant’s ability to practice medicine and surgery with reasonable skill and safety.

Ed 1.06(1)(a)3. Has been disciplined or had licensure denied by a licensing or regulatory authority in Wisconsin or another jurisdiction.

Ed 1.06(1)(a)4. Has been found to have been negligent in the practice of medicine or has been a party in a lawsuit in which it was alleged that the applicant had been negligent in the practice of medicine.

Ed 1.06(1)(a)5. Has been convicted of a crime the circumstances of which substantially relate to the practice of medicine.

Ed 1.06(1)(a)6. Has lost, had reduced or had suspended his or her hospital staff privileges, or has failed to continuously maintain hospital privileges during the applicant’s period of licensure following post-graduate training.

Ed 1.06(1)(a)7. Has been graduated from a medical school not approved by the board.

Ed 1.06(1)(a)8. Has been diagnosed as suffering from pedophilia, exhibitionism or voyeurism.

Ed 1.06(1)(a)9. Has within the past 2 years engaged in the illegal use of controlled substances.

Ed 1.06(1)(a)10. Has been subject to adverse formal action during the course of medical education, postgraduate training, hospital practice, or other medical employment.

Ed 1.06(1)(a)11. Has not practiced medicine and surgery for a period of 3 years prior to application, unless the applicant has been graduated from a school of medicine within that period.

Ed 1.06(1)(b) An application filed under s. Ed 1.02 shall be reviewed by an application review panel of at least 2 board members designated by the chairperson of the board. The panel shall determine whether the applicant is eligible for a regular license without completing an oral examination.

Ed 1.06(1)(c) All examinations shall be conducted in the English language.

Ed 1.06(1)(d) Where both written and oral examinations are required they shall be scored separately and the applicant shall achieve a passing grade on all examinations to qualify for a license.

Ed 1.06(2) The board will notify each applicant found eligible for examination of the time and place scheduled for that applicant’s examinations. Failure of an applicant to appear for examinations as scheduled will void that applicant’s application and require the applicant to reapply for licensure, unless prior scheduling arrangements have been made with the board by the applicant.

Ed 1.06(3)(a) The board accepts the FLEX examination administered on or before December 31, 1993, as its written examination and requires a score of not less than 75.0 on each component of the 2-component FLEX examination administered on or after January 1, 1985. Every applicant shall take the complete 2-component examination the first time the applicant is admitted to the FLEX examination. If the applicant fails to achieve a passing grade on one of the 2 components, the applicant may apply for and be reexamined on only the component failed according to the reexamination provisions of s. Ed 1.08 (1).

Ed 1.06(3)(b) Commencing January 1, 1994, the board accepts the 3-step USMLE sequence as its written examination and administers step 3 of the sequence. Minimum standard passing scores for each step shall be not less than 75.0. Applicants shall complete all 3 steps of the examination sequence within 7 years from the date upon which the applicant first passes a step, either step 1 or step 2. Applicants who have passed a step may not repeat the step unless required to do so in order to comply with the 7-year time limit. If the applicant fails to achieve a passing grade on any step, the applicant may apply for and be reexamined on only the step failed according to the reexamination provisions of s. Ed 1.08 (1).

Ed 1.06(3)(c) Prior to the January 1, 2000, the board shall waive completion of steps 1 and 2 of the USMLE sequence for applicants who have passed FLEX component 1; and shall waive step 3 of the USMLE sequence for applicants who have passed FLEX component 2. Prior to January 1, 2000, the board shall waive any step of the USMLE sequence for applicants who have passed the corresponding part of the NBME examination.

Ed 1.06(3)(d) The board may waive the requirement for written examinations required in this section for any applicant who has achieved a weighted average score of no less than 75.0 on all 3 components of the FLEX examination taken prior to January 1, 1985 in a single session in another licensing jurisdiction in the United States or Canada, in no more than 3 attempts. If the applicant had been examined 4 or more times before achieving a weighted average score of no less than 75.0 on all 3 components, the applicant shall meet requirements specified in s. Ed 1.08 (2).

Ed 1.06(3)(e) The board may waive the requirement for written examinations required in this section for any applicant who has achieved a score of no less than 75.0 on each of the 2 components of the FLEX examination administered on or after January 1, 1985 in another licensing jurisdiction in the United States or Canada, if the applicant achieved a score of no less than 75.0 on each of the 2 components in no more than 3 attempts. If the applicant had been examined 4 or more times before achieving a score of 75.0 on either or both components of the FLEX examination, the applicant shall meet requirements specified in s. Ed 1.08 (2).

Ed 1.06(3)(f) An applicant who has passed all 3 components of the examinations of the following boards and councils may submit to the board verified documentary evidence thereof, and the board will accept this in lieu of requiring further written examination of the applicant:

Ed 1.06(3)(f)1. National board of medical examiners;

Ed 1.06(3)(f)2. National board of examiners of osteopathic physicians and surgeons; or

Ed 1.06(3)(f)3. Medical council of Canada, if the examination is taken on or after January 1, 1978.

Ed 1.06(3)(g) An applicant who has received passing grades in written examinations for a license to practice medicine and surgery conducted by another licensing jurisdiction of the United States or Canada may submit to the board verified documentary evidence thereof. The board will review such documentary evidence to determine whether the scope and passing grades of such examinations are substantially equivalent to those of this state at the time of the applicant’s examination, and if the board finds such equivalence, the board will accept this in lieu of requiring further written examination of the candidate. The burden of proof of such equivalence shall lie upon the applicant.

Ed 1.06(4) Oral examinations of each applicant are conducted by one or more physician members of the board. The purpose of the oral exams is to test the applicant’s knowledge of the practical application of medical principles and techniques of diagnosis and treatment, judgment and professional character and are scored pass or fail. Any applicant who fails the initial oral examination shall be examined by the board which shall then make the final decision as to pass or fail.

Ed 1.06(5) Any applicant who is a graduate of a medical school in which English is not the primary language of communication may be examined by the board on his or her proficiency in the English language.

Conduct of examinations.

Ed 1.07(1) At the opening of the examinations each applicant shall be assigned a number which shall be used by the applicant on all examination papers, and neither the name of the applicant nor any other identifying marks shall appear on any such papers.

Ed 1.07(2) At the beginning of the examinations a proctor shall read and distribute to the applicants the rules of conduct to be followed during the examinations and the consequences of violation of the rules. If an applicant violates the rules of conduct, the board may withhold or invalidate the applicant’s examination scores, disqualify the applicant from the practice of medicine or impose other appropriate discipline.

Failure and reexamination.

Ed 1.08(1) An applicant who fails to achieve a passing grade in the examinations required under this chapter may apply for reexamination on forms provided by the board and pay the appropriate fee for each reexamination as required in s. 440.05, Stats. An applicant who fails to achieve a passing grade may be reexamined twice at not less than 4-month intervals. If the applicant fails to achieve a passing grade on the second reexamination, the applicant may not be admitted to any further examination until the applicant reapplies for licensure and presents evidence satisfactory to the board of further professional training or education as the board may prescribe following its evaluation of the applicant’s specific case.

Ed 1.08(2) If an applicant has been examined 4 or more times in another licensing jurisdiction in the United States or Canada before achieving a passing grade in written examinations also required under this chapter, the board may require the applicant to submit evidence satisfactory to the board of further professional training or education in examination areas in which the applicant had previously demonstrated deficiencies. If the evidence provided by the applicant is not satisfactory to the board, the board may require the applicant to obtain further professional training or education as the board deems necessary to establish the applicant’s fitness to practice medicine and surgery in this state. In order to determine any further professional training or education requirement, the board shall consider any information available relating to the quality of the applicant’s previous practice, including the results of the applicant’s performance on the oral examination required under s. 448.05 (6), Stats., and s. Ed 1.06.

Examination review by applicant.

Ed 1.09(1) An applicant who fails the oral-practical or statutes and rules examination may request a review of that examination by filing a written request and required fee with the board within 30 days of the date on which examination results were mailed.

Ed 1.09(2) Examination reviews are by appointment only.

Ed 1.09(3) An applicant may review the statutes and rules examination for not more than one hour.

Ed 1.09(4) An applicant may review the oral-practical examination for not more than 2 hours.

Ed 1.09(5) The applicant may not be accompanied during the review by any person other than the proctor.

Ed 1.09(6) At the beginning of the review, the applicant shall be provided with a copy of the questions, a copy of the applicant’s answer sheet or oral-practical tape and a copy of the master answer sheet.

Ed 1.09(7) The applicant may review the examination in the presence of a proctor. The applicant shall be provided with a form on which to write comments, questions or claims of error regarding any items in the examination. Bound reference books shall be permitted. Applicants shall not remove any notes from the area. Notes shall be retained by the proctor and made available to the applicant for use at a hearing, if desired. The proctor shall not defend the examination nor attempt to refute claims of error during the review.

Ed 1.09(8) An applicant may not review the examination more than once.

Board review of examination error claim.

Ed 1.10(1) An applicant claiming examination error shall file a written request for board review in the board office within 30 days of the date the examination was reviewed. The request shall include all of the following:

Ed 1.10(1)(a) The applicant’s name and address.

Ed 1.10(1)(b) The type of license for which the applicant applied.

Ed 1.10(1)(c) A description of the mistakes the applicant believes were made in the examination content, procedures, or scoring, including the specific questions or procedures claimed to be in error.

Ed 1.10(1)(d) The facts which the applicant intends to prove, including reference text citations or other supporting evidence for the applicant’s claim.

Ed 1.10(2) The board shall review the claim, make a determination of the validity of the objections and notify the applicant in writing of the board’s decision and any resulting grade changes.

Ed 1.10(3) If the decision does not result in the applicant passing the examination, a notice of denial of license shall be issued. If the board issues a notice of denial following its review, the applicant may request a hearing under s. RL 1.05.

PHYSICIAN ASSISTANTS

Ed 8.01 Authority and purpose. The rules in this chapter are adopted by the medical examining board pursuant to authority in ss. 15.08 (5), 227.11, 448.04 (1) (f) and 448.40, Stats., and govern the licensure and regulation of physician assistants.

Definitions.

Ed 8.02(1) “Board” means the medical examining board.

Ed 8.02(2) “Council” means the council on physician assistants.

Ed 8.02(3m) “DEA” means the United States drug enforcement administration.

Ed 8.02(4) “Educational program” means a program for educating and preparing physician assistants which is approved by the board.

Ed 8.02(5) “Individual” means a natural person, and does not include the terms firm, corporation, association, partnership, institution, public body, joint stock association, or any other group of individuals.

Ed 8.02(5m) “License” means documentary evidence issued by the board to applicants for licensure as a physician assistant who meet all of the requirements of the board.

Ed 8.02(6) “Supervision” means to coordinate, direct, and inspect the accomplishments of another, or to oversee with powers of direction and decision the implementation of one’s own or another’s intentions.

Ed 8.03 Council. As specified in s. 15.407 (1) and (2), Stats., the council shall advise the board on the formulation of rules on the education, examination, licensure and practice of a physician assistant.

Ed 8.04 Educational program approval. The board shall approve only educational programs accredited and approved by the committee on allied health education and accreditation of the American medical association, the commission for accreditation of allied health education programs, or its successor agency.

Ed 8.05 Panel review of applications; examinations required. The board may use a written examination prepared, administered and scored by the national commission on certification of physician assistants or its successor agency, or a written examination from other professional testing services as approved by the board.

Ed 8.05(1) APPLICATION. An applicant for examination for licensure as a physician assistant shall submit to the board:

Ed 8.05(1)(a) An application on a form prescribed by the board.

Ed 8.05(1)(b) After July 1, 1993, proof of successful completion of an educational program, as defined in ss. Ed 8.02 (4) and 8.04.

Ed 8.05(1)(c) Proof of successful completion of the national certifying examination.

Ed 8.05(1)(cm) Proof that the applicant is currently certified by the national commission on certification of physician assistants or its successor agency.

Ed 8.05(1)(d) The fee specified in s. 440.05 (1), Stats.

Ed 8.05(1)(e) An unmounted photograph, approximately 8 by 12 cm., of the applicant taken no more than 60 days prior to the date of application which has on the reverse side a statement of a notary public that the photograph is a true likeness of the applicant.

EXAMINATIONS, PANEL REVIEW OF APPLICATIONS.

Ed 8.05(2)(a) All applicants shall complete the written examination under this section, and an open book examination on statutes and rules governing the practice of physician assistants in Wisconsin.

Ed 8.05(2)(b) An applicant may be required to complete an oral examination if the applicant:

Ed 8.05(2)(b)1. Has a medical condition which in any way impairs or limits the applicant’s ability to practice as a physician assistant with reasonable skill and safety.

Ed 8.05(2)(b)2. Uses chemical substances so as to impair in any way the applicant’s ability to practice as a physician assistant with reasonable skill and safety.

Ed 8.05(2)(b)3. Has been disciplined or had certification denied by a licensing or regulatory authority in Wisconsin or another jurisdiction.

Ed 8.05(2)(b)4. Has been convicted of a crime, the circumstances of which substantially relate to the practice of physician assistants.

Ed 8.05(2)(b)5. Has not practiced as a physician assistant for a period of 3 years prior to application, unless the applicant has been graduated from an approved educational program for physician assistants within that period.

Ed 8.05(2)(b)6. Has been found to have been negligent in the practice as a physician assistant or has been a party in a lawsuit in which it was alleged that the applicant has been negligent in the practice of medicine.

Ed 8.05(2)(b)7. Has been diagnosed as suffering from pedophilia, exhibitionism or voyeurism.

Ed 8.05(2)(b)8. Has within the past 2 years engaged in the illegal use of controlled substances.

Ed 8.05(2)(b)9. Has been subject to adverse formal action during the course of physician assistant education, postgraduate training, hospital practice, or other physician assistant employment.

Ed 8.05(2)(c) An application filed under this chapter shall be reviewed by an application review panel of at least 2 council members designated by the chairperson of the board to determine whether an applicant is required to complete an oral examination under par. (a). If the application review panel is not able to reach unanimous agreement on whether an applicant is eligible for licensure without completing an oral examination, the application shall be referred to the board for a final determination.

Ed 8.05(2)(d) Where both written and oral examinations are required they shall be scored separately and the applicant shall achieve a passing grade on both examinations to qualify for a license.

Ed 8.05(3) EXAMINATION FAILURE. An applicant who fails to receive a passing score on an examination may reapply by payment of the fee specified in sub. (1) (d). An applicant may reapply twice at not less than 4-month intervals. If an applicant fails the examination 3 times, he or she may not be admitted to an examination unless the applicant submits proof of having completed further professional training or education as the board may prescribe.

Ed 8.05(4) LICENSURE; RENEWAL. At the time of licensure and each biennial registration of licensure thereafter, a physician assistant shall list with the board the name and address of the supervising physician and shall notify the board within 20 days of any change of a supervising physician.

Examination review by applicant.

Ed 8.053(1) An applicant who fails the oral or statutes and rules examination may request a review of that examination by filing a written request and required fee with the board within 30 days of the date on which examination results were mailed.

Ed 8.053(2) Examination reviews are by appointment only.

Ed 8.053(3) An applicant may review the statutes and rules examination for not more than one hour.

Ed 8.053(4) An applicant may review the oral examination for not more than 2 hours.

Ed 8.053(5) The applicant may not be accompanied during the review by any person other than the proctor.

Ed 8.053(6) At the beginning of the review, the applicant shall be provided with a copy of the questions, a copy of the applicant’s answer sheer or oral tape and a copy of the master answer sheet.

Ed 8.053(7) The applicant may review the examination in the presence of a proctor. The applicant shall be provided with a form on which to write comments, questions or claims of error regarding any items in the examination. Bound reference books shall be permitted. Applicants shall not remove any notes from the area. Notes shall be retained by the proctor and made available to the applicant for use at a hearing, if desired. The proctor shall not defend the examination nor attempt to refute claims of error during the review.

Ed 8.053(8) An applicant may not review the examination more than once.

Board review of examination error claim.

Ed 8.056(1) An applicant claiming examination error shall file a written request for board review in the board office within 30 days of the date the examination was reviewed. The request shall include all of the following:

Ed 8.056(1)(a) The applicant’s name and address.

Ed 8.056(1)(b) The type of license for which the applicant applied.

Ed 8.056(1)(c) A description of the mistakes the applicant believes were made in the examination content, procedures, or scoring, including the specific questions or procedures claimed to be in error.

Ed 8.056(1)(d) The facts which the applicant intends to prove, including reference text citations or other supporting evidence for the applicant’s claim.

Ed 8.056(2) The board shall review the claim, make a determination of the validity of the objections and notify the applicant in writing of the board’s decision and any resulting grade changes.

Ed 8.056(3) If the decision does not result in the applicant passing the examination, a notice of denial of license shall be issued. If the board issues a notice of denial following its review, the applicant may request a hearing under s. RL 1.05.

Practice.

Ed 8.07(1) SCOPE AND LIMITATIONS. In providing medical care, the entire practice of any physician assistant shall be under the supervision of a licensed physician. The scope of practice is limited to providing medical care specified in sub. (2). A physician assistant’s practice may not exceed his or her educational training or experience and may not exceed the scope of practice of the supervising physician. A medical care task assigned by the supervising physician to a physician assistant may not be delegated by the physician assistant to another person.

Ed 8.07(2) MEDICAL CARE. Medical care a physician assistant may provide include:

Ed 8.07(2)(a) Attending initially a patient of any age in any setting to obtain a personal medical history, perform an appropriate physical examination, and record and present pertinent data concerning the patient in a manner meaningful to the supervising physician.

Ed 8.07(2)(b) Performing, or assisting in performing, routine diagnostic studies as appropriate for a specific practice setting.

Ed 8.07(2)(c) Performing routine therapeutic procedures, including, but not limited to, injections, immunizations, and the suturing and care of wounds.

Ed 8.07(2)(d) Instructing and counseling a patient on physical and mental health, including diet, disease, treatment and normal growth and development.

Ed 8.07(2)(e) Assisting the supervising physician in a hospital or facility, as defined in s. 50.01 (1m), Stats., by assisting in surgery, making patient rounds, recording patient progress notes, compiling and recording detailed narrative case summaries and accurately writing or executing orders under the supervision of a licensed physician.

Ed 8.07(2)(f) Assisting in the delivery of medical care to a patient by reviewing and monitoring treatment and therapy plans.

Ed 8.07(2)(g) Performing independently evaluative and treatment procedures necessary to provide an appropriate response to life-threatening emergency situations.

Ed 8.07(2)(h) Facilitating referral of patients to other appropriate community health-care facilities, agencies and resources.

Ed 8.07(2)(i) Issuing written prescription orders for drugs under the supervision of a licensed physician and in accordance with procedures specified in s. Ed 8.08 (2).

Prescribing limitations.

Ed 8.08(1) A physician assistant may not prescribe or dispense any drug independently.

Ed 8.08(2) A physician assistant may issue a prescription order only if all the following conditions apply:

Ed 8.08(2)(a) The physician assistant issues the prescription order only in patient situations specified and described in established written guidelines. The guidelines shall be reviewed at least annually by the physician assistant and his or her supervising physician.

Ed 8.08(2)(b) The supervising physician and physician assistant determine by mutual agreement that the physician assistant is qualified through training and experience to issue a prescription order as specified in the established written guidelines.

Ed 8.08(2)(c) The supervising physician is available for consultation as specified in s. Ed 8.10 (3).

Ed 8.08(2)(d) The prescription orders prepared under procedures in this section contain all information required under s. 450.11 (1), Stats.

Ed 8.08(2)(e) The supervising physician either:

Ed 8.08(2)(e)1. Reviews and countersigns the prescription order prepared by the physician assistant, or

Ed 8.08(2)(e)2. Reviews and countersigns within 72 hours the patient record prepared by the physician assistant practicing in the office of the supervising physician or at a facility or a hospital in which the supervising physician has staff privileges, or

Ed 8.08(2)(e)3. Reviews by telephone or other means, as soon as practicable but within a 72-hour period, and countersigns within one week, the patient record prepared by the physician assistant who practices in an office facility other than the supervising physician’s main office of a facility or hospital in which the supervising physician has staff privileges.

Ed 8.09 Employee status. No physician assistant may be self-employed. If the employer of a physician assistant is other than a licensed physician, the employer shall provide for, and may not interfere with, the supervisory responsibilities of the physician, as defined in s. Ed 8.02 (6) and required in ss. Ed 8.07 (1) and 8.10.

Employment requirements; supervising physician responsibilities.

Ed 8.10(1) No physician may concurrently supervise more than 2 physician assistants unless the physician submits a written plan for the supervision of more than 2 physician assistants and the board approves the plan. A physician assistant may be supervised by more than one physician.

Ed 8.10(2) Another licensed physician may be designated by the supervising physician to supervise a physician assistant for a period not to exceed 8 weeks per year. Except in an emergency, the designation shall be made in writing to the substitute supervising physician and the physician assistant. The supervising physician shall file with the board a copy of the substitution agreement before the beginning date of the period of his or her absence.

Ed 8.10(3) The supervising physician or substitute supervising physician shall be available to the physician assistant at all times for consultation either in person or within 15 minutes of contact by telephone or by 2-way radio or television communication.

Ed 8.10(4) A supervising physician shall visit and conduct an on-site review of facilities attended by the physician assistants at least once a month. Any patient in a location other than the location of the supervising physician’s main office shall be attended personally by the physician consistent with his or her medical needs.

Chapter Ed 10 Unprofessional Conduct

Ed 10.01 Authority and purpose. The definitions of this chapter are adopted by the medical examining board pursuant to the authority delegated by ss. 15.08 (5) 227.11, and 448.40, Stats., for the purposes of ch. 448, Stats.

Ed 10.02 Definitions.

(1) For the purposes of these rules:

Ed 10.02(1)(a) “Board” means the medical examining board.

Ed 10.02(1)(b) “License” means any license, permit, certificate, or registration issued by the board.

Ed 10.02(2) The term “unprofessional conduct” is defined to mean and include but not be limited to the following, or aiding or abetting the same:

Ed 10.02(2)(a) Violating or attempting to violate any provision or term of ch. 448, Stats., or of any valid rule of the board.

Ed 10.02(2)(b) Violating or attempting to violate any term, provision, or condition of any order of the board.

Ed 10.02(2)(c) Knowingly making or presenting or causing to be made or presented any false, fraudulent, or forged statement, writing, certificate, diploma, or other thing in connection with any application for license.

Ed 10.02(2)(d) Practicing fraud, forgery, deception, collusion, or conspiracy in connection with any examination for license.

Ed 10.02(2)(e) Giving, selling, buying, bartering, or attempting to give, sell, buy, or barter any license.

Ed 10.02(2)(f) Engaging or attempting to engage in practice under any license under any given name or surname other than that under which originally licensed or registered to practice in this or any other state. This subsection does not apply to change of name resulting from marriage, divorce, or order by a court of record.

Ed 10.02(2)(g) Engaging or attempting to engage in the unlawful practice of medicine and surgery or treating the sick.

Ed 10.02(2)(h) Any practice or conduct which tends to constitute a danger to the health, welfare, or safety of patient or public.

Ed 10.02(2)(i) Practicing or attempting to practice under any license when unable to do so with reasonable skill and safety to patients.

Ed 10.02(2)(j) Practicing or attempting to practice under any license beyond the scope of that license.

Ed 10.02(2)(k) Offering, undertaking, or agreeing to treat or cure a disease or condition by a secret means, method, device, or instrumentality; or refusing to divulge to the board upon demand the means, method, device, or instrumentality used in the treatment of a disease or condition.

Ed 10.02(2)(L) Representing that a manifestly incurable disease or condition can be or will be permanently cured; or that a curable disease or condition can be cured within a stated time, if such is not the fact.

Ed 10.02(2)(m) Knowingly making any false statement, written or oral, in practicing under any license, with fraudulent intent; or obtaining or attempting to obtain any professional fee or compensation of any form by fraud or deceit.

Ed 10.02(2)(n) Willfully divulging a privileged communication or confidence entrusted by a patient or deficiencies in the character of patients observed in the course of professional attendance, unless lawfully required to do so.

Ed 10.02(2)(o) Engaging in uninvited, in-person solicitation of actual or potential patients who, because of their particular circumstances, are vulnerable to undue influence; or engaging in false, misleading or deceptive advertising.

Ed 10.02(2)(p) Administering, dispensing, prescribing, supplying, or obtaining controlled substances as defined in s. 961.01 (4), Stats., otherwise than in the course of legitimate professional practice, or as otherwise prohibited by law.

Ed 10.02(2)(q) Having a license, certificate, permit, registration, or other practice credential granted by another state or by any agency of the federal government to practice medicine and surgery or treat the sick, which becomes limited, restricted, suspended, or revoked, or having been subject to other adverse action by the state licensing authority or by any agency of the federal government, including but not limited to the denial or limitation of an original credential, or the surrender of a credential, whether or not accompanied by findings of negligence or unprofessional conduct.

Ed 10.02(2)(r) Conviction of any crime which may relate to practice under any license, or of violation of any federal or state law regulating the possession, distribution, or use of controlled substances as defined in s. 961.01 (4), Stats. A certified copy of a judgment of a court of record showing such conviction, within this state or without, shall be presumptive evidence thereof.

Ed 10.02(2)(s) Prescribing, ordering, dispensing, administering, supplying, selling, or giving any amphetamine, sympathomimetic amine drug or compound designated as a schedule II controlled substance pursuant to the provisions of s. 961.16 (5), Stats., to or for any person except for any of the following:

Ed 10.02(2)(s)1. Use as an adjunct to opioid analgesic compounds for treatment of cancer-related pain,

Ed 10.02(2)(s)2.Treatment of narcolepsy,

Ed 10.02(2)(s)3. Treatment of hyperkinesis,

Ed 10.02(2)(s)4. Treatment of drug induced brain dysfunction,

Ed 10.02(2)(s)5. Treatment of epilepsy,

Ed 10.02(2)(s)6. Differential diagnostic psychiatric evaluation of depression,

Ed 10.02(2)(s)7. Treatment of depression shown to be refractory to other therapeutic modalities,

Ed 10.02(2)(s)8. Clinical investigation of the effects of such drugs or compounds in which case an investigative protocol therefore shall have been submitted to and reviewed and approved by the board before such investigation has been begun.

Ed 10.02(2)(t) Aiding or abetting the unlicensed practice of medicine or representing that unlicensed persons practicing under supervision, including unlicensed M.D.’s and D.O’s, are licensed, by failing to identify the individuals clearly as unlicensed physicians or delegates.

Ed 10.02(2)(u) Failure to inform a patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments, including the benefits and risks associated with the use of extended wear contact lenses.

Ed 10.02(2)(w) Use in advertising of the term “board certified” or a similar phrase of like meaning unless in fact so certified and unless disclosure is made of the complete name of the specialty board which conferred the certification.

Ed 10.02(2)(x) Prescribing, ordering, dispensing, administering, supplying, selling or giving any anabolic steroid for the purposes of enhancing athletic performance or for other nonmedical purposes.

Ed 10.02(2)(z) Violating or aiding and abetting the violation of any law or administrative rule or regulation the circumstances of which substantially relate to the circumstances of the practice of medicine.

Ed 10.02(2)(za) Failure by a physician or physician assistant to maintain patient health care records consistent with the requirements of ch. Ed 21.

Ed 10.02(2)(zb) Prescribing, ordering, dispensing, administering, supplying, selling or giving any anorectic drug designated as a schedule II, III, IV or V controlled substance for the purpose of weight reduction or control in the treatment of obesity unless each of the following conditions is met:

Ed 10.02(2)(zb)1. The patient’s body mass index, weight in kilograms divided by height in meters squared, is greater than 25.

Ed 10.02(2)(zb)2. A comprehensive history, physical examination, and interpreted electrocardiogram are performed and recorded at the time of initiation of treatment for obesity by the prescribing physician.

Ed 10.02(2)(zb)3. A diet and exercise program for weight loss is prescribed and recorded.

Ed 10.02(2)(zb)4. The patient is weighed at least once a month, at which time a recording is made of blood pressure, pulse, and any other tests as may be necessary for monitoring potential adverse effects of drug therapy.

Ed 10.02(2)(zb)5. No more than a 30-day supply of drugs is prescribed or dispensed at any one time.

Ed 10.02(2)(zb)6. No drugs are prescribed or dispensed for more than 90 days unless all of the following occur:

Ed 10.02(2)(zb)6.a The patient has a recorded weight loss of at least 12 pounds in the first 90 days of therapy.

Ed 10.02(2)(zb)6.b. The patient has continued progress toward achieving or maintaining a target weight.

Ed 10.02(2)(zb)6.c. The patient has no significant adverse effects from the prescribed program.

Ed 10.02(2)(zb)7. Any variance from the foregoing requirements is justified by documentation in the patient’s record.

Chapter Ed 15
Practice of Medicine and Surgery Defined: Exclusion of Tattooing and Body Piercing

Ed 15.01 Authority and purpose. The rules in this chapter are adopted by the medical examining board pursuant to the authority delegated by ss. 15.08 (5), 227.11 and 448.40, Stats., and further define the practice of medicine and surgery.

Ed 15.02 Tattooing and body piercing. The practice of medicine and surgery is further defined not to include tattooing and body piercing when done for purposes of bodily adornment.

Chapter Ed 17 Standards for Dispensing and Prescribing Drugs

Authority and purpose.

Ed 17.01(1) The rules in this chapter are adopted pursuant to authority in ss. 15.08 (5) (b), 227.11 and ch. 448, Stats.

Ed 17.01(2) The rules in this chapter are adopted to specify standards practitioners shall follow in dispensing prescription drugs for the protection of the public.

Definitions.

Ed 17.02(1) “Controlled substance” has the meaning under s. 961.01 (4), Stats.

Ed 17.02(2) “Practitioner” means a person holding a license to practice medicine and surgery.

Ed 17.02(3) “Prescription drug” has the meaning under s. 450.01 (20), Stats.

Ed 17.03 Packaging. A prescription drug dispensed by a practitioner shall be dispensed in a child-resistant container if it is a substance requiring special packaging under 16 CFR 1700.14 (1982) of the federal poison prevention packaging act.

Labeling.

Ed 17.04(1) A prescription drug dispensed by a practitioner shall contain a legible label affixed to the immediate container disclosing:

Ed 17.04(1)(a) The name and address of the facility from which the prescribed drug is dispensed;

Ed 17.04(1)(b) The date on which the prescription is dispensed;

Ed 17.04(1)(c) The name of the practitioner who prescribed the drug or device;

Ed 17.04(1)(d) The full name of the patient;

Ed 17.04(1)(e) The generic name and strength of the prescription drug dispensed unless the prescribing practitioner requests omission of the name and strength of the drug dispensed; and,

Ed 17.04(1)(f) Directions for use of the prescribed drug and cautionary statements, if any, contained in the prescription or required by law.

Ed 17.04(2) NONAPPLICATION OF LABELING REQUIREMENTS. The labeling requirement specified in sub. (1) does not apply to complimentary samples dispensed by a practitioner in original containers or packaging supplied to the practitioner by a pharmaceutical manufacturer or distributor.

Recordkeeping.

Ed 17.05(1) PRESCRIPTION DRUGS.

Ed 17.05(1)(a) A practitioner shall maintain complete and accurate records of each prescription drug received, dispensed or disposed of in any other manner.

Ed 17.05(1)(b) All prescription drugs dispensed by a practitioner shall be recorded in the patient record.

Ed 17.05(2) CONTROLLED SUBSTANCES.

Ed 17.05(2)(a) Records required by the federal controlled substances act and ch. 961, Stats., shall be maintained at the location where the drug is received, distributed or dispensed and be available for inspection by authorized persons for at least 5 years from the date of such record.

Ed 17.05(2)(b) Controlled substances dispensed by a practitioner shall be recorded as follows:

Ed 17.05(2)(b)1 As provided in this section; and

Ed 17.05(2)(b)2. On a separate log, in a separate bound log book in which each schedule of controlled substances dispensed is recorded separately and in chronological order with the following information:

Ed 17.05(2)(b)2.a. The name of the substance.

Ed 17.05(2)(b)2.b. Dosage form and strength of the substance.

Ed 17.05(2)(b)2.c. Name and address of the person for whom dispensed.

Ed 17.05(2)(b)2.d. Date of dispensing.

Ed 17.05(2)(b)2.e. Quantity dispensed.

Ed 17.05(2)(b)2.f. Name or initials of practitioner who dispensed the substance.

Ed 17.06 Prescription orders by nurses and ancillary health care personnel. Prescription orders prepared by professional nurses and ancillary health care personnel, as delegated and supervised by a practitioner under s. 448.03 (2) (e), Stats., shall contain in addition to other information required by this chapter, the name, address and telephone number of the delegating practitioner and the name, address and signature of the person preparing the prescription order.
Chapter Ed 18 Alternate Modes of Treatment

Authority, purpose and scope.

Ed 18.01(1) AUTHORITY. The rules in this chapter are adopted pursuant to authority in ss. 15.08 (5) (b), 227.11,and 448.40, Stats.

Ed 18.01(2) PURPOSE. The purpose of the rules is to define the obligation of a physician to communicate alternate modes of treatment to a patient.

Ed 18.01(3) SCOPE. The scope of the rules pertain to medical and surgical procedures which may be prescribed and performed only by a physician, as defined in s. 448.01 (5), Stats.

Ed 18.02 Definitions.

Ed 18.02(1) “Emergency” means a circumstance in which there is an immediate risk to a patient’s life, body part or function which demands prompt action by a physician.

Ed 18.02(2) “Experimental treatment” means a mode of treatment which has not been generally adopted by the medical profession.

Ed 18.02(3) “Viable” as used in s. 448.30, Stats., to modify the term, “medical modes of treatment” means modes of treatment generally considered by the medical profession to be within the scope of current, acceptable standards of care.

Communication of alternate modes of treatment.

Ed 18.03(1) It is the obligation of a physician to communicate alternate viable modes of treatment to a patient. The communication shall include the nature of the recommended treatment, alternate viable treatments, and risks or complications of the proposed treatment, sufficient to allow the patient to make a prudent decision. In the communication with a patient, a physician shall take into consideration:

Ed 18.03(1)(a) A patient’s ability to understand the information;

Ed 18.03(1)(b) The emotional state of a patient; and,

Ed 18.03(1)(c) The physical state of a patient.

Ed 18.03(2) Nothing in sub. (1) shall be construed as preventing or limiting a physician in recommending a mode of treatment which is in his or her judgment the best treatment for a patient.

Exceptions to communication of alternate modes of treatment.

Ed 18.04(1) A physician is not required to explain each procedural or prescriptive alternative inherent to a particular mode of treatment.

Ed 18.04(2) In an emergency, a physician is not required to communicate alternate modes of treatment to a patient if failure to provide immediate treatment would be more harmful to a patient than immediate treatment.

Ed 18.04(3) A physician is not required to communicate any mode of treatment which is not viable or which is experimental.

Ed 18.04(4) A physician may not be held responsible for failure to inform a patient of a possible complication or benefit not generally known to reasonably well qualified physicians in a similar medical classification.

Ed 18.04(5) A physician may simplify or omit communication of viable modes of treatment if the communication would unduly confuse or frighten a patient or if a patient refuses to receive the communication.

Ed 18.05 Recordkeeping. A physician shall indicate on a patient’s medical record he or she has communicated to the patient alternate viable modes of treatment.

Chapter Ed 19 Occupational Therapy

Ed 19.01 Authority and purpose. The rules in this chapter are adopted by the medical examining board under the authority of ss. 15.08 (5), 227.11 (2) and 448.05, Stats., to govern the certification and regulation of occupational therapists and occupational therapy assistants.

Ed 19.02 Definitions. As used in this chapter,

Ed 19.02(1) “Assessment” means the process of determining the need for, nature of, and estimated time of treatment at different intervals during the treatment, determining needed coordination with or referrals to other disciplines, and documenting these activities.

Ed 19.02(2) “Consultation” means a work-centered, problem-solving helping relationship in which knowledge, experience, abilities and skills are shared with other professionals in the process of helping to rehabilitate through the use of occupational therapy.

Ed 19.02(3) “Entry-level” means the person has no demonstrated experience in a specific position, such as a new graduate, a person new to the position, or a person in a new setting with no previous experience in that area of practice.

Ed 19.02(4) “Evaluation” means documented reporting of the results of the use of structured or standardized evaluative tools and professional observations to determine an individual’s functional abilities and deficits.

Ed 19.02(5) “Experienced” means demonstrated competence in the performance of duties in a given area of practice.

Ed 19.02(6) “Habilitation” means the education, training or support services provided to individuals to assist them in acquiring skills not yet gained or learned. This enables them to learn, practice and refine skills needed for independent living, productive employment and community participation.

Ed 19.02(7) “Level I fieldwork” is an integral part of didactic courses and includes varied learning experiences. Students are supervised in observation and assistance with clients during short term contacts.

Ed 19.02(8) “Level II fieldwork” is extended fieldwork which emphasizes the application and integration of academically acquired knowledge and skills in the supervised delivery of occupational therapy services to clients.

Ed 19.02(9) “Occupational performance areas” means the activities that occupational therapy addresses when determining functional abilities which include activities of daily living, work and productive activities, and play or leisure activities.

Ed 19.02(10) “Occupational performance components” means the skills and abilities that an individual uses to engage in performance areas including sensorimotor, cognitive, psychosocial and psychological components.

Ed 19.02(10m) “Occupational performance contexts” means situations or factors that influence an individual’s engagement in desired or required occupational performance areas including temporal aspects and environmental aspects.

Ed 19.02(11)”Occupational therapist training program” means an educational program and supervised internship in occupational therapy recognized by the medical examining board and accredited by the accreditation council for occupational therapy education of the American occupational therapy association or a program approved by the world federation of occupational therapy.

Ed 19.02(12) ”Occupational therapy assistant training program” means an educational program and supervised internship in occupational therapy recognized by the medical examining board and accredited by the accreditation council for occupational therapy education of the American occupational therapy association or a program approved by the world federation of occupational therapy.

Ed 19.02(13) “Prevention” means the fostering of normal development, sustaining and protecting existing functions and abilities, preventing disability or supporting levels of restoration or change to enable individuals to maintain maximum independence.

Ed 19.02(14) “Referral” means the practice of requesting occupational therapy services and delegating the responsibility for evaluation and treatment to an occupational therapist.

Ed 19.02(15) “Rehabilitation” means the process of treatment and education to restore a person’s ability to live and work as normally as possible after a disabling injury or illness.

Ed 19.02(16) “Screening” means the review of a person’s condition to determine the need for evaluation and treatment.

Ed 19.02(17) “Supervision” of an occupational therapy assistant means a process in which an occupational therapy assistant performs duties delegated by an occupational therapist in a joint effort to promote, establish, maintain, and evaluate the occupational therapy assistant’s level of performance and service.

Applications and credentials.

Ed 19.03(1) Every applicant for initial certification as an occupational therapist or occupational therapy assistant shall submit:

Ed 19.03(1)(a) A completed application form;

Ed 19.03(1)(b) Evidence that the applicant is certified as an occupational therapist or occupational therapy assistant by the national board for certification in occupational therapy; or, that the applicant has completed an occupational therapist training program or an occupational therapy assistant training program as defined in s. Ed 19.02;

Ed 19.03(1)(c) Written verification from the national board for certification in occupational therapy that the applicant has passed the examination required by this chapter; and,

Ed 19.03(1)(d) A recent passport type photograph of the applicant.

Ed 19.03(2) Requests for verification from the national board for certification in occupational therapy shall be made by the applicant.

Ed 19.03(3) An application for certification is not complete until the board has received both a completed application form and verification of certification from the national board for certification in occupational therapy.

Ed 19.035 Biennial renewal outside of established renewal period. Certified occupational therapists and certified occupational therapy assistants may renew their certificates outside of the biennial renewal period provided in s. 448.07, Stats., by making application for renewal, paying the renewal fees specified in s. 440.05, Stats., and by furnishing evidence satisfactory to the board that the applicant has satisfactorily completed the continuing education requirements for the 2 year period prior to the date of such application.

Examinations, panel review of applications.

Ed 19.04(1) Applicants for certification as an occupational therapist or occupational therapy assistant shall pass the certification examination for occupational therapist or the certification examination for occupational therapy assistant of the national board for certification in occupational therapy, and shall complete an open book examination on statutes and rules governing the practice of occupational therapy in Wisconsin.

Ed 19.04(2) The medical examining board designates the occupational therapy examining council as its agent for conducting examinations. At the request of the council, the board shall provide a medical consultant to the council to provide assistance in evaluating applicants examined under sub. (3) (a) and (b).

Ed 19.04(3) An applicant may be required to complete an oral examination if the applicant:

Ed 19.04(3)(a) Has a medical condition which in any way impairs or limits the applicant’s ability to practice occupational therapy with reasonable skill and safety.

Ed 19.04(3)(b) Uses chemical substances so as to impair in any way the applicant’s ability to practice occupational therapy with reasonable skill and safety.

Ed 19.04(3)(c) Has been disciplined or had licensure denied by a licensing or regulatory authority in Wisconsin or another jurisdiction.

Ed 19.04(3)(d) Has been convicted of a crime the circumstances of which substantially relate to the practice of occupational therapy.

Ed 19.04(3)(e) Has not practiced occupational therapy for a period of 3 years prior to application, unless the applicant has been graduated from a school of occupational therapy within that period. Practice for the purposes of this paragraph includes direct patient treatment and education, occupational therapy instruction in an occupational therapy program recognized by the board, occupational therapy research, and service in administrative positions for health care providers or governmental bodies with responsibility relating to occupational therapy.

Ed 19.04(3)(f) Has been found negligent in the practice of occupational therapy or has been a party in a lawsuit in which it was alleged that the applicant has been negligent in the practice of occupational therapy.

Ed 19.04(3)(g) Was a resident of Wisconsin and eligible for certification as an occupational therapist or occupational therapy assistant on August 1, 1989, but did not apply for certification until after August 1, 1991.

Ed 19.04(3)(h) Has been diagnosed as suffering from pedophilia, exhibitionism or voyeurism.

Ed 19.04(3)(i) Has within the past 2 years engaged in the illegal use of controlled substances.

Ed 19.04(3)(j) Has been subject to adverse formal action during the course of occupational therapy education, postgraduate training, hospital practice, or other occupational therapy employment.

Ed 19.04(3)(k) Has been graduated from an occupational therapy school not approved by the board.

Ed 19.04(4) An application filed under s. Ed 19.03 shall be reviewed by the occupational therapy examining council to determine whether an applicant is required to complete an oral examination under sub. (3). If the application review panel is not able to reach unanimous agreement on whether an applicant is eligible for certification without completing an oral examination, the application shall be referred to the medical examining board for a final determination.

Ed 19.04(5) All examinations shall be conducted in the English language.

Ed 19.04(6) Where both written and oral examinations are required they shall be scored separately and the applicant shall achieve a passing grade on all examinations to qualify for a license.

Ed 19.04(7) If after receipt of additional information from applicants who have been treated for alcohol or drug abuse or impairment or from applicants who have been treated for an acute or chronic psychological impairment the council decides that an oral examination shall be administered, the examination shall be limited to a determination whether at the time of application the applicant’s disability appears to pose an actual risk to the health, safety or welfare of patient or public arising from the applicant’s demonstrated inability to safely carry out necessary duties and responsibilities inherent to the practice of occupational therapy.

Ed 19.05 Exemption from written examination for certain occupational therapy assistant applicants. An applicant for certification as an occupational therapy assistant who graduated from an occupational therapy assistant training program prior to 1977 is exempt from the requirements for a written certification examination for occupational therapy assistant.

Examination review by applicant.

Ed 19.053(1) An applicant who fails the oral or statutes and rules examination may request a review of that examination by filing a written request and required fee with the board within 30 days of the date on which examination results are mailed.

Ed 19.053(2) Examination reviews are by appointment only.

Ed 19.053(3) An applicant may review the statutes and rules examination for not more than one hour.

Ed 19.053(4) An applicant may review the oral examination for not more than 2 hours.

Ed 19.053(5) The applicant may not be accompanied during the review by any person other than the proctor.

Ed 19.053(6) At the beginning of the review, the applicant shall be provided with a copy of the questions, a copy of the applicant’s answer sheet or oral tape and a copy of the master answer sheet.

Ed 19.053(7) The applicant may review the examination in the presence of a proctor. The applicant shall be provided with a form on which to write comments, questions or claims of error regarding any items in the examination. Bound reference books shall be permitted. Applicants shall not remove any notes from the area. Notes shall be retained by the proctor and made available to the applicant for use at a hearing, if desired. The proctor shall not defend the examination nor attempt to refute claims of error during the review.

Ed 19.053(8) An applicant may not review the examination more than once.

Ed 19.056 Board review of examination error claim.

Ed 19.056(1) (1) An applicant claiming examination error shall file a written request for board review in the board office within 30 days of the date the examination was reviewed. The request shall include all of the following:

Ed 19.08 Standards of practice. Occupational therapists and occupational therapy assistants shall adhere to the minimum standards of practice of occupational therapy that have become established in the profession, including but not limited to the following areas:

Ed 19.08(1) SCREENING.

Ed 19.08(1)(a) An occupational therapist or occupational therapy assistant, when practicing either independently or as a member of a treatment team, shall identify individuals who present problems in occupational performance areas. The occupational therapist, when practicing either independently or as a member of a treatment team, shall identify individuals who present problems in occupational therapy performance components.

Ed 19.08(1)(b) Screening methods shall take into consideration the occupational performance contexts relevant to the individual.

Ed 19.08(1)(c) Screening methods may include interviews, observation, testing and records review.

Ed 19.08(1)(d) The occupational therapist or occupational therapy assistant shall transmit screening results and recommendations to all appropriate persons.

Ed 19.08(2) REFERRAL.

Ed 19.08(2)(a) Evaluation and rehabilitative treatment shall be based on a referral from a licensed physician, dentist, psychologist, chiropractor or podiatrist.

Ed 19.08(2)(b) An occupational therapist or occupational therapy assistant may accept a referral for the purpose of providing services which include, but are not limited to, consultation, habilitation, screening, prevention and patient education services.

Ed 19.08(2)(c) Referrals may be for an individual case or may be for an established treatment program that includes occupational therapy services. If programmatic, the individual shall meet the criteria for admission to the program and protocol for the treatment program shall be established by the treatment team members.

Ed 19.08(2)(d) Referrals shall be in writing. However, oral referrals may be accepted if they are followed by a written and signed request of the person making the referral within 14 days from the date on which the patient consults with the occupational therapist or occupational therapy assistant.

Ed 19.08(3) EVALUATION.

Ed 19.08(3)(a) An occupational therapist alone or in collaboration with the occupational therapy assistant shall prepare an occupational therapy evaluation for each individual referred for occupational therapy services.

Ed 19.08(3)(b) The evaluation shall consider the individual’s medical, vocational, social, educational, family status, and personal and family goals; and shall include an assessment of the individual’s functional abilities and deficits in occupational performance areas and occupational performance components.

Ed 19.08(3)(c) Evaluation methods may include observation, interviews, records review, and the use of structured or standardized evaluative tools or techniques.

Ed 19.08(3)(d) When standardized evaluation tools are used, the tests shall have normative data for the individual’s characteristics. If normative data are not available, the results shall be expressed in a descriptive report. Collected evaluation data shall be analyzed and summarized to indicate the individual’s current status.

Ed 19.08(3)(e) Evaluation results shall be documented in the individual’s record and shall indicate the specific evaluation tools and methods used.

Ed 19.08(3)(f) Evaluation results shall be communicated to the referral source and to the appropriate persons in the facility and community.

Ed 19.08(3)(g) If the results of the evaluation indicate areas that require intervention by other health care professionals, the individual shall be appropriately referred or an appropriate consultation shall be requested.

Ed 19.08(3)(h) Initial evaluation shall be completed and results documented within the time frames established by the applicable facility, community, regulatory, or funding body.

Ed 19.08(4) PROGRAM PLANNING.

Ed 19.08(4)(a) An occupational therapist alone or in collaboration with the occupational therapy assistant shall use the results of the evaluation to develop an individual occupational therapy program.

Ed 19.08(4)(b) The program shall be stated in measurable and reasonable terms appropriate to the individual’s needs, goals and prognosis and shall identify short and long-term goals.

Ed 19.08(4)(c) The program shall be consistent with current principles and concepts of occupational therapy theory and practice.

Ed 19.08(4)(d) In developing the program, the occupational therapist alone or in collaboration with the occupational therapy assistant shall also collaborate, as appropriate, with the individual, family, other health care professionals and community resources; shall select the media, methods, environment, and personnel needed to accomplish the goals; and shall determine the frequency and duration of occupational therapy services provided.

Ed 19.08(4)(e) The program shall be prepared and documented within the time frames established by the applicable facility, community, regulatory, or funding body.

Ed 19.08(5) PROGRAM IMPLEMENTATION.

Ed 19.08(5)(a) The occupational therapy program shall be implemented according to the program plan previously developed.

Ed 19.08(5)(b) The individual’s occupational performance areas and occupational performance components shall be periodically evaluated and documented.

Ed 19.08(5)(c) Program modifications shall be formulated and implemented consistent with the changes in the individual’s occupational performance areas, occupational performance components and occupational performance contexts.

Ed 19.08(5)(d) All aspects of the occupational therapy program shall be periodically and systematically reviewed for effectiveness and efficiency.

Ed 19.08(6) DISCONTINUATION OF SERVICES.

Ed 19.08(6)(a) Occupational therapy services shall be discontinued when the individual has achieved the program goals or has achieved maximum benefit from occupational therapy.

Ed 19.08(6)(b) A comparison of the initial and current state of functional abilities and deficits in occupational performance areas and occupational performance components shall be made and documented.

Ed 19.08(6)(c) A discharge plan shall be prepared, consistent with the services provided, the individuals goals, and the expected prognosis. Consideration shall be given to the individual’s occupational performance contexts including appropriate community resources for referral, and environmental factors or barriers that may need modification.

Ed 19.08(6)(d) Sufficient time shall be allowed for the coordination and effective implementation of the discharge plan.

Ed 19.08(6)(e) Recommendations for follow-up or reevaluation shall be documented.

Ed 19.09 Practice by occupational therapy assistants. An occupational therapy assistant may not practice without the supervision of an occupational therapist unless the occupational therapy assistant is providing screening, habilitation, prevention, patient consultation or patient education outside of rehabilitation.

Ed 19.10 Supervision of occupational therapy assistants by occupational therapists.

Ed 19.10(1) Supervision of an occupational therapy assistant by an occupational therapist shall be either close or general. The supervising occupational therapist shall have responsibility for the outcome of the performed service.

Ed 19.10(1)(a) When close supervision is required, the supervising occupational therapist shall have daily, direct contact on the premises with the occupational therapy assistant. The occupational therapist shall provide initial direction in developing the plan of treatment and shall periodically inspect the actual implementation of the plan. The occupational therapist shall counter sign all patient related documents prepared by the occupational therapy assistant.

Ed 19.10(1)(b) When general supervision is allowed, the supervising occupational therapist shall have direct contact on the premises with the occupational therapy assistant at least once each month. In the interim between direct contacts, the occupational therapist shall maintain contact with the occupational therapy assistant by telephone, written reports and group conferences. The occupational therapist shall record in writing a specific description of the supervisory activities undertaken for each occupational therapy assistant.

Ed 19.10(1)(c) Close supervision is required for all rehabilitative services provided by an entry level occupational therapy assistant. All other occupational therapy services provided by an occupational therapy assistant may be performed under general supervision, if the supervising occupational therapist determines, under the facts of the individual situation, that general supervision is appropriate using established professional guidelines.

Ed 19.10(2) In extenuating circumstances, when the supervising occupational therapist is absent from the job, the occupational therapy assistant may carry out established programs for 30 calendar days. The occupational therapist must provide up-to-date documentation prior to absence.

Ed 21 Patient health care records

Ed 21.01 Authority and purpose. The rules in this chapter are adopted by the board under the authority of ss. 15.08 (5) (b), 227.11 (2) and 448.40 (1), Stats., to govern the practice of physicians and physician assistants in the preparation and retention of patient health care records.

Ed 21.02 Definitions. As used in this chapter:

Ed 21.02(1) “Board” means the medical examining board.

Ed 21.02(2) “Patient” means a person who receives health care services from a physician or physician assistant.

Ed 21.02(3) “Patient health care record” has the meaning given in s. 146.81 (4), Stats.

Ed 21.03 Minimum standards for patient health care records.

Ed 21.03(1) A physician or physician assistant shall maintain patient health care records on every patient administered to for a period of not less than 5 years after the date of the last entry, or for such longer period as may be otherwise required by law.

Ed 21.03(2) A patient health care record prepared by a physician or physician assistant shall contain the following clinical health care information which applies to the patient’s medical condition:

Ed 21.03(2)(a) Pertinent patient history.

Ed 21.03(2)(b) Pertinent objective findings related to examination and test results.

Ed 21.03(2)(c) Assessment or diagnosis.

Ed 21.03(2)(d) Plan of treatment for the patient.

Ed 21.03(3) Each patient health care record entry shall be dated, shall identify the practitioner, and shall be sufficiently legible to allow interpretation by other practitioners for the benefit of the patient.