To repeal sections 334.031, 334.100 and 334.715, RSMo 1994, and sections 334.040, 334.046 and 334.735, RSMo Supp. 1996, relating to the licensing, registration and disciplinary procedures of physicians and surgeons, athletic trainers and physician attendants and to enact in lieu thereof six new sections relating to the same subject.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI, AS FOLLOWS:

     Section A. Sections 334.031, 334.100 and 334.715, RSMo 1994, and sections 334.040, 334.046 and 334.735, RSMo Supp. 1996, are repealed and six new sections enacted in lieu thereof, to be known as sections 334.031, 334.040, 334.046, 334.100, 334.715 and 334.735, to read as follows:

     334.031. 1. Candidates for licenses as physicians and surgeons shall furnish satisfactory evidence of their good moral character, and their preliminary qualifications, to wit: A certificate of graduation from an accredited high school or its equivalent, and satisfactory evidence of completion of pre-professional education consisting of a minimum of sixty semester hours of college credits in acceptable subjects leading towards the degree of Bachelor of Arts or Bachelor of Science from an accredited college or university. They shall also furnish satisfactory evidence of having attended throughout at least four terms of thirty-two weeks of actual instructions in each term and of having received a diploma from some reputable medical college or osteopathic college that enforces requirements of four terms of thirty-two weeks for actual instruction in each term, including, in addition to class work, such experience in operative and hospital work during the last two years of instruction as is required by the American Medical Association and the American Osteopathic Association before the college is approved and accredited as reputable. Any medical college approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education and any osteopathic college approved and accredited as reputable by the American Osteopathic Association is deemed to have complied with the requirements of this subsection.

     2. In determining the qualifications necessary for licensure as a qualified physician and surgeon, the board, by rule and regulation, may accept the certificate of the National Board of Medical Examiners of the United States, chartered under the laws of the District of Columbia, of the National Board of Examiners for Osteopathic Physicians and Surgeons chartered under the laws of the state of Indiana, or the licentiate of the Medical Counsel of Canada, in lieu of and as equivalent to its own professional examination. Every applicant for a license on the basis of such certificate, upon making application showing necessary qualifications as above set out, shall be required to pay the same fee required of applicants to take the examination before the board.

     3. If the board chooses to accept an applicant's licentiate of the Medical Counsel of Canada in lieu of and as equivalent to its own professional examination, such applicant shall receive a temporary administrative license for the first year of medical practice in the state of Missouri.

     4. The board may refuse to issue any certificate of registration or authority, permit or license required pursuant to this chapter for any one or any combination of causes stated in subsection 3 of section 334.100. The board shall notify the applicant in writing of the refusal and the reason for the refusal. The board shall also advise the applicant of the right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo.

     334.040. 1. Except as provided in section 334.260, all persons desiring to practice as physicians and surgeons in this state shall be examined as to their fitness to engage in such practice by the board. All persons applying for examination shall file a completed application with the board at least eighty days before the date set for examination upon blanks furnished by the board.

     2. The examination shall be sufficient to test the applicant's fitness to practice as a physician and surgeon. The examination shall be conducted in such a manner as to conceal the identity of the applicant until all examinations have been scored. In all such examinations an average score of not less than seventy-five percent is required to pass; provided, however, that the board may require applicants to take the Federation Licensing Examination, also known as FLEX, or the United States Medical Licensing Examination (USMLE). If the FLEX examination is required, a weighted average score of no less than seventy-five percent is required to pass. The passing score of the United States Medical Licensing Examination shall be determined by the board through rule and regulation. The board shall not issue a permanent license as a physician and surgeon or allow the Missouri state board examination to be administered to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States [or], the District of Columbia or Canada. The steps one, two and three of the United States Medical Licensing Examination must be taken within a seven-year period with no more than three attempts on any step of the examination. The board may waive the provisions of this section if the applicant is American Board-certified, licensed to practice as a physician and surgeon in another state of the United States [or], the District of Columbia or Canada and the applicant has achieved a passing score on a licensing examination administered in a state or territory of the United States [or], the District of Columbia or Canada. Prior to waiving the provisions of this section, the board may require the applicant to achieve a passing score on one of the following:

     (1) The American Specialty Board's certifying examination in the physician's field of specialization;

     (2) Part II of the FLEX; or

     (3) The Federation portion of the State Medical Board's Special Purpose Examination (SPEX).

     3. If the board waives the provisions of this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty. Scores from one test administration shall not be combined or averaged with scores from other test administrations to achieve a passing score. The board shall not be permitted to favor any particular school or system of healing.

     4. If the board chooses to accept an applicant's licentiate of the Medical Counsel of Canada in lieu of and as equivalent to its own professional examination, such applicant shall receive a temporary administrative license for the first year of medical practice in the state of Missouri. The applicant shall make a written request asking that the temporary one-year administrative license be reclassified into permanent licensure status during the tenth month of practice in Missouri. The board shall have forty-five days to respond to this request.

     5. The board may refuse to issue any certificate of registration or authority, permit or license required pursuant to this chapter for any one or any combination of causes stated in subsection 3 of section 334.100. The board shall notify the applicant in writing of the refusal and the reason for the refusal. The board shall also advise the applicant of the right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo.

     334.046. 1. Notwithstanding any other provisions of law to the contrary, the board may grant a temporary license to any otherwise qualified physician to teach or lecture in a program sponsored by an accredited medical school in the state of Missouri or any accredited [teaching] hospital. The temporary license shall not extend beyond twelve months from the date of its issuance and shall terminate automatically. To be granted a temporary license under this section, a physician must meet all requirements for permanent licensure in the state of Missouri, including those imposed by rule and regulation; except that, the board may recognize and take into account the credentials of a physician licensed in other states or in foreign countries. Nothing contained in this section shall be construed so as to permit the issuance of a temporary license for locum tenens or other itinerant practices of the healing arts.

     2. Within guidelines established by rule and regulation, the board may authorize an intern or a resident who is otherwise properly enrolled and duly licensed to participate in a program of graduate medical or osteopathic education in an accredited program in a contiguous state, to act as an intern or resident in this state; provided, that such activity is a recognized part of the educational experience offered by that program.

     3. Notwithstanding any other provision of law to the contrary, the board may waive the provisions of sections 334.035 and 334.040, but not section 334.031, and grant a permanent license to practice as a physician and surgeon to the holder of a temporary license issued pursuant to this section. The board shall not grant a waiver pursuant to this section unless and until the applicant has held a temporary license for a minimum of twelve months preceding the date of application and complies with all requirements the board may impose by rule or regulation. An applicant for a permanent license pursuant to this section shall present evidence to the board that the applicant holds a certificate of licensure in any state or territory of the United States, of the District of Columbia or in a foreign country, authorizing the applicant to practice in the same manner and to the same extent as physicians and surgeons are authorized to practice by this chapter.

     4. Before granting a waiver pursuant to this section, the board may require the applicant to achieve a passing score on the federation portion of the state medical board's special purpose examination (SPEX).

     5. If the board grants a waiver pursuant to this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty.

     6. The board may not grant a waiver pursuant to this section to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States, the District of Columbia or in any foreign country.

     7. Any waiver granted by the board pursuant to this section, or pursuant to section 334.040, shall be granted in the sole discretion of the board. A refusal by the board to grant such a waiver shall not be appealable to the administrative hearing commission or circuit court.

     334.100. 1. The board may refuse to issue or renew any certificate of registration or authority, permit or license required pursuant to this chapter for one or any combination of causes stated in subsection [2] 3 of this section. The board shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of his right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo.

     2. As an alternate to the board's refusal to issue or renew any certificate of registration or authority, permit or license, the board may, at its discretion, issue a certificate of registration or authority, permit or license which is subject to probation, restriction or limitation to an applicant for licensure for any one or any combination of causes stated in subsection 3 of this section. The board's order of probation, restriction or limitation shall contain a statement of the discipline imposed, the basis thereof, the date such action shall become effective and a statement that the applicant shall have thirty days to request, in writing, a hearing before the administrative hearing commission as provided in chapter 621, RSMo. If no written request for a hearing is received by the administrative review commission within the thirty-day period, the applicant shall have waived the right to seek review of the board's decision.

     [2.] 3. The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621, RSMo, against any holder of any certificate of registration or authority, permit or license required by this chapter, any certificate of registration authority, permit or license subject to probation, restriction or limitation or any person who has failed to renew or has surrendered his certificate of registration or authority, permit or license for any one or any combination of the following causes:

     (1) Use of any controlled substance, as defined in chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by this chapter;

     (2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated under this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed;

     (3) Use of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given or required pursuant to this chapter;

     (4) Misconduct, fraud, misrepresentation, dishonesty, unethical conduct or unprofessional conduct in the performance of the functions or duties of any profession licensed or regulated by this chapter, including, but not limited to, the following:

     (a) Obtaining or attempting to obtain any fee, charge, tuition or other compensation by fraud, deception or misrepresentation; willfully and continually overcharging or overtreating patients; or charging for visits to the physician's office which did not occur unless the services were contracted for in advance, or for services which were not rendered or documented in the patient's records;

     (b) Attempting, directly or indirectly, by way of intimidation, coercion or deception, to obtain or retain a patient or discourage the use of a second opinion or consultation;

     (c) Willfully and continually performing inappropriate or unnecessary treatment, diagnostic tests or medical or surgical services;

     (d) Delegating professional responsibilities to a person who is not qualified by training, skill, competency, age, experience or licensure to perform them;

     (e) Misrepresenting that any disease, ailment or infirmity can be cured by a method, procedure, treatment, medicine or device;

     (f) Performing or prescribing medical services which have been declared by board rule to be of no medical or osteopathic value;

     (g) Final disciplinary action by any professional medical or osteopathic association or society or licensed hospital or medical staff of such hospital in this or any other state or territory, whether agreed to voluntarily or not, and including, but not limited to, any removal, suspension, limitation, or restriction of his license or staff or hospital privileges, failure to renew such privileges or license for cause, or other final disciplinary action, if the action was in any way related to unprofessional conduct, professional incompetence, malpractice or any other violation of any provision of this chapter;

     (h) Signing a blank prescription form; or dispensing, prescribing, administering or otherwise distributing any drug, controlled substance or other treatment without sufficient examination, or for other than medically accepted therapeutic or experimental or investigative purposes duly authorized by a state or federal agency, or not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, except as authorized in section 334.104;

     (i) Exercising influence within a physician-patient relationship for purposes of engaging a patient in sexual activity;

     (j) Terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient;

     (k) Failing to furnish details of a patient's medical records to other treating physicians or hospitals upon proper request; or failing to comply with any other law relating to medical records;

     (l) Failure of any applicant or licensee, other than the licensee subject to the investigation, to cooperate with the board during any investigation;

     (m) Failure to comply with any subpoena or subpoena duces tecum from the board or an order of the board;

     (n) Failure to timely pay license renewal fees specified in this chapter;

     (o) Violating a probation agreement with this board or any other licensing agency;

     (p) Failing to inform the board of the physician's current residence and business address;

     (q) Advertising by an applicant or licensee which is false or misleading, or which violates any rule of the board, or which claims without substantiation the positive cure of any disease, or professional superiority to or greater skill than that possessed by any other physician. An applicant or licensee shall also be in violation of this provision if he has a financial interest in any organization, corporation or association which issues or conducts such advertising;

     (5) Any conduct or practice which is or might be harmful or dangerous to the mental or physical health of a patient or the public; or incompetency, gross negligence or repeated negligence in the performance of the functions or duties of any profession licensed or regulated by this chapter. For the purposes of this subdivision, "repeated negligence" means the failure, on more than one occasion, to use that degree of skill and learning ordinarily used under the same or similar circumstances by the member of the applicant's or licensee's profession;

     (6) Violation of, or attempting to violate, directly or indirectly, or assisting or enabling any person to violate, any provision of this chapter, or of any lawful rule or regulation adopted pursuant to this chapter;

     (7) Impersonation of any person holding a certificate of registration or authority, permit or license or allowing any person to use his or her certificate of registration or authority, permit, license or diploma from any school;

     (8) Revocation, suspension, restriction, modification, limitation, reprimand, warning, censure, probation or other final disciplinary action against the holder of or applicant for a license or other right to practice any profession regulated by this chapter by another state, territory, federal agency or country, whether or not voluntarily agreed to by the licensee or applicant, including, but not limited to, the denial of licensure, surrender of the license, allowing the license to expire or lapse, or discontinuing or limiting the practice of medicine while subject to an investigation or while actually under investigation by any licensing authority, medical facility, branch of the armed forces of the United States of America, insurance company, court, agency of the state or federal government, or employer;

     (9) A person is finally adjudged incapacitated or disabled by a court of competent jurisdiction;

     (10) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by this chapter who is not registered and currently eligible to practice under this chapter; or knowingly performing any act which in any way aids, assists, procures, advises, or encourages any person to practice medicine who is not registered and currently eligible to practice under this chapter. A physician who works in accordance with standing orders or protocols or in accordance with the provisions of section 334.104 shall not be in violation of this subdivision;

     (11) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;

     (12) Failure to display a valid certificate or license if so required by this chapter or any rule promulgated under this chapter;

     (13) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;

     (14) Knowingly making, or causing to be made, or aiding, or abetting in the making of, a false statement in any birth, death or other certificate or document executed in connection with the practice of his profession;

     (15) Soliciting patronage in person or by agents or representatives, or by any other means or manner, under his own name or under the name of another person or concern, actual or pretended, in such a manner as to confuse, deceive, or mislead the public as to the need or necessity for or appropriateness of health care services for all patients, or the qualifications of an individual person or persons to diagnose, render, or perform health care services;

     (16) Using, or permitting the use of, his name under the designation of "Doctor", "Dr.", "M.D.", or "D.O.", or any similar designation with reference to the commercial exploitation of any goods, wares or merchandise;

     (17) Knowingly making or causing to be made a false statement or misrepresentation of a material fact, with intent to defraud, for payment under the provisions of chapter 208, RSMo, or chapter 630, RSMo, or for payment from Title XVIII or Title XIX of the federal medicare program;

     (18) Failure or refusal to properly guard against contagious, infectious or communicable diseases or the spread thereof; maintaining an unsanitary office or performing professional services under unsanitary conditions; or failure to report the existence of an unsanitary condition in the office of a physician or in any health care facility to the board, in writing, within thirty days after the discovery thereof;

     (19) Any candidate for licensure or person licensed to practice as a physical therapist, paying or offering to pay a referral fee or practicing or offering to practice professional physical therapy independent of the prescription and direction of a person licensed and registered as a physician and surgeon under this chapter, as a dentist under chapter 332, RSMo, or as a podiatrist under chapter 330, RSMo, whose license is in good standing;

     (20) Any candidate for licensure or person licensed to practice as a physical therapist, treating or attempting to treat ailments or other health conditions of human beings other than by professional physical therapy and as authorized by sections 334.500 to 334.620;

     (21) Any person licensed to practice as a physician or surgeon, requiring, as a condition of the physician-patient relationship, that the patient receive prescribed drugs, devices or other professional services directly from facilities of that physician's office or other entities under that physician's ownership or control. A physician shall provide the patient with a prescription which may be taken to the facility selected by the patient and a physician knowingly failing to disclose to a patient on a form approved by the advisory commission for professional physical therapists as established by section 334.625 which is dated and signed by a patient or guardian acknowledging that the patient or guardian has read and understands that the physician has a pecuniary interest in a physical therapy or rehabilitation service providing prescribed treatment and that the prescribed treatment is available on a competitive basis. This subdivision does not apply to a referral by one physician to another physician within a group of physicians practicing together;

     (22) A pattern of personal use or consumption of any controlled substance unless it is prescribed, dispensed or administered by another physician who is authorized by law to do so;

     (23) Revocation, suspension, limitation or restriction of any kind whatsoever of any controlled substance authority, whether agreed to voluntarily or not;

     (24) For a physician to operate, conduct, manage, or establish an abortion facility, or for a physician to perform an abortion in an abortion facility, if such facility comes under the definition of an ambulatory surgical center pursuant to sections 197.200 to 197.240, RSMo, and such facility has failed to obtain or renew a license as an ambulatory surgical center;

     (25) Being unable to practice as a physician and surgeon or with a specialty with reasonable skill and safety to patients by reasons of medical or osteopathic incompetency, or because of illness, drunkenness, excessive use of drugs, narcotics, chemicals, or as a result of any mental or physical condition.

     (a) In enforcing this subdivision the board shall, after a hearing by the board, upon a finding of probable cause, require a physician to submit to a reexamination for the purpose of establishing his or her competency to practice as a physician or surgeon or with a specialty conducted in accordance with rules adopted for this purpose by the board, including rules to allow the examination of the pattern and practice of said physician's or surgeon's professional conduct, or to submit to a mental or physical examination or combination thereof by at least three physicians, one selected by the physician compelled to take the examination, one selected by the board, and one selected by the two physicians so selected who are graduates of a professional school approved and accredited as reputable by the association which has approved and accredited as reputable the professional school from which the licentiate graduated. However, if the physician is a graduate of a medical school not accredited by the American Medical Association or American Osteopathic Association, then each party shall choose any physician who is a graduate of a medical school accredited by the American Medical Association or the American Osteopathic Association.

     (b) For the purpose of this subdivision, every physician licensed under this chapter is deemed to have consented to submit to a mental or physical examination when directed in writing by the board and further to have waived all objections to the admissibility of the examining physician's testimony or examination reports on the ground that same is privileged.

     (c) In addition to ordering a physical or mental examination to determine competency, the board may, notwithstanding any other law limiting access to medical or other health data, obtain medical data and health records relating to a physician or applicant without the physician's or applicant's consent.

     (d) Written notice of the reexamination or the physical or mental examination shall be sent to the physician, by registered mail, addressed to the physician at his last known address. Failure of a physician to designate an examining physician to the board or failure to submit to the examination when directed shall constitute an admission of the allegations against him, in which case the board may enter a final order without the presentation of evidence, unless the failure was due to circumstances beyond his control. A physician whose right to practice has been affected under this subdivision shall, at reasonable intervals, be afforded an opportunity to demonstrate that he can resume the competent practice as a physician and surgeon with reasonable skill and safety to patients.

     (e) In any proceeding under this subdivision neither the record of proceedings nor the orders entered by the board shall be used against a physician in any other proceeding. Proceedings under this subdivision shall be conducted by the board without the filing of a complaint with the administrative hearing commission.

     (f) When the board finds any person unqualified because of any of the grounds set forth in this subdivision, it may enter an order imposing one or more of the disciplinary measures set forth in subsection [4] 5 of this section.

     [3.] 4. Collaborative practice arrangements, protocols and standing orders shall be in writing and signed and dated by a physician prior to their implementation.

     [4.] 5. After the filing of such complaint before the administrative hearing commission, the proceedings shall be conducted in accordance with the provisions of chapter 621, RSMo. Upon a finding by the administrative hearing commission that the grounds, provided in subsection [2] 3 of this section, for disciplinary action are met, the board may, singly or in combination, warn, censure or place the person named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed ten years, or may suspend his license, certificate or permit for a period not to exceed three years, or restrict or limit his license, certificate or permit for an indefinite period of time, or revoke his license, certificate, or permit, or administer a public or private reprimand, or deny his application for a license, or permanently withhold issuance of a license or require him to submit to the care, counseling or treatment of physicians designated by the board at the expense of the individual to be examined, or require him to attend such continuing educational courses and pass such examinations as the board may direct.

      [5.] 6. In any order of revocation, the board may provide that the person may not apply for reinstatement of his license for a period of time ranging from two to seven years following the date of the order of revocation. All stay orders shall toll this time period.

      [6.] 7. Before restoring to good standing a license, certificate or permit issued under this chapter which has been in a revoked, suspended or inactive state for any cause for more than two years, the board may require the applicant to attend such continuing medical education courses and pass such examinations as the board may direct.

      [7.] 8. In any investigation, hearing or other proceeding to determine a licensee's or applicant's fitness to practice, any record relating to any patient of the licensee or applicant shall be discoverable by the board and admissible into evidence, regardless of any statutory or common law privilege which such licensee, applicant, record custodian or patient might otherwise invoke. In addition, no such licensee, applicant, or record custodian may withhold records or testimony bearing upon a licensee's or applicant's fitness to practice on the ground of privilege between such licensee, applicant or record custodian and a patient.

     334.715. 1. The board may refuse to register any applicant or may suspend, revoke, or refuse to renew the registration of any registrant for any one or any combination of the causes stated in subsection 3 of section 334.100 or if [it finds that] the applicant or registrant has:

     (1) Secured or attempted to secure registration by fraud or deceit; or

     (2) Violated or conspired to violate any provision of sections 334.700 to 334.725 or any provision of any rule promulgated pursuant to sections 334.700 to 334.725; or

     (3) Been convicted of a felony or misdemeanor in connection with the practice of the profession; or

     (4) Has been found guilty of unethical conduct as defined in the ethical standards of the National Athletic Trainers Association as adopted and published by the committee and the board and filed with the secretary of state.

     2. Upon receipt of a written application made in the form and manner prescribed by the board, the board may reinstate any registration which has expired, been suspended or been revoked or may issue any registration which has been denied; provided, that no application for reinstatement or issuance of registration shall be considered until at least six months have elapsed from the date of denial, expiration, suspension, or revocation when the registration to be reinstated or issued was denied issuance or renewal or was suspended or revoked for one of the causes listed in subsection 1 of this section.

     334.735. As used in sections 334.735 to 334.748, the following terms mean:

     (1) "Applicant", any individual who seeks to become a registered health care professional in one of the following health care professions: occupational therapist or physician assistant;

     (2) "Certificate of registration", a document issued to an applicant by the department acknowledging that the applicant has been entered on the register of individuals successfully completing the requirements of a certifying entity, and is entitled to practice in the health care profession for which the certificate applies;

     (3) "Certification" or "registration", a process by a certifying entity that grants recognition to applicants meeting predetermined qualifications specified by that certifying entity;

     (4) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;

     (5) "Department", the department of economic development or a designated agency thereof;

     (6) "Occupational therapist", one engaged in the use of purposeful activity with individuals who are limited in their ability to function by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and cultural differences or the aging process in order to maximize independence, prevent disability and maintain health. The practice encompasses evaluation, treatment and consultation. Specific occupational therapy services include: teaching daily living skills; developing perceptual motor skills and sensory integrative functioning; developing vocational and prevocational capacities; designing, fabricating, or applying selected orthotic and prosthetic devices or selective adaptive equipment; specifically designed manual, creative, prevocational activities and exercises to enhance functional performance; administering and interpreting tests such as manual muscle and range of motion; and adaptive environments for the handicapped. The services may be provided individually, in groups, or through social systems;

     (7) "Physician assistant", a person who has graduated from a physician assistant program accredited by the American Medical Association's Committee on Allied Health Education and Accreditation or by its successor agency, who has passed the certifying examination administered by the national commission on certification of physician assistants and has active certification by the National Commission on Certification of Physician Assistants who provides health care services delegated by a licensed physician. A person who has been employed as a physician assistant for three years prior to August 28, 1989, who has passed the National Commission on Certification of Physician Assistants examination, and who has an active certification by the National Commission on Certification of Physician Assistants shall be eligible for registration;

     (a) The scope of practice of a physician assistant shall consist only of the following services and procedures:

     a. Taking patient histories;

     b. Performing physical examinations of a patient;

     c. Performing or assisting in the performance of routine office laboratory and patient screening procedures;

     d. Performing routine therapeutic procedures;

     e. Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures;

     f. Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a licensed physician;

     g. Assisting the supervising physician in institutional settings, including reviewing of treatment plans, ordering of tests and diagnostic laboratory and radiological services, and ordering of therapies, using procedures reviewed and approved by a licensed physician;

     h. Assisting in surgery;

     i. Performing such other tasks not prohibited by law under the supervision of a licensed physician as the physician's assistant has been trained and is proficient to perform;

     (b) Physician assistants shall not prescribe nor dispense any drug, medicine, device or therapy independent of consultation with the supervising physician, nor prescribe lenses, prisms or contact lenses for the aid, relief or correction of vision or the measurement of visual power or visual efficiency of the human eye, nor administer or monitor general or regional block anesthesia during diagnostic tests, surgery or obstetric procedures;

     (c) A physician assistant shall clearly identify himself or herself as a physician assistant and shall not use or permit to be used in the physician assistant's behalf the terms "doctor", "Dr." or "doc" nor hold himself or herself out in any way to be a physician or surgeon. No physician assistant shall practice or attempt to practice without physician supervision or in any location where the supervising physician is not immediately available for consultation, assistance and intervention, except in an emergency situation, nor shall any physician assistant bill a patient independently or directly for any services or procedure by the physician assistant;

     (d) The physician assistant shall be a person who is a graduate of a physician assistant program accredited by the [Commission for the Accreditation of Allied Health Education Programs] American Medical Association's Committee on Allied Health Education and Accreditation or its successor or is certified by a national nongovernmental agency or association, who has passed the National Commission on Certification of Physician Assistants Examination, and has [been certified] an active certification by the National Commission on Certification of Physician Assistants or its successor. A person who has been employed as a physician assistant for three years prior to August 28, 1989, and has passed the National Commission on Certification of Physician Assistants Examination shall be deemed to have met the academic requirements necessary for registration or certification;

     (e) For purposes of this section, the registration of physician assistants shall take place within processes established by the state board of registration for the healing arts through rule and regulation. The board of healing arts is authorized to establish rules and regulations establishing registration and renewal procedures, fees, and addressing such other matters as are necessary to protect the public and discipline the profession. An application for registration may be denied or the registration of a physician assistant may be suspended or revoked by the board in the same manner and for violation of the standards as set forth by section 334.100, or such other standards of conduct set by the board by rule or regulation. Persons licensed pursuant to the provisions of chapter 335, RSMo, shall not be required to register as physicians assistants;

     (8) "Recognition", the formal process of becoming a certifying entity as required by the provisions of sections 334.735 to 334.743;

     (9) "Supervision", control exercised over a physician assistant working within the same office facility of the supervising physician except a physician assistant may make follow-up patient examinations in hospitals, nursing homes and correctional facilities, each such examination being reviewed, approved and signed by the supervising physician. The board shall develop rules for the proximity of practice between the physician assistant and the supervising physician and documentation of joint review of the physician assistant activity by the supervising physician and the physician assistant.