Illinois General Assembly - Full Text of HB0421
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Full Text of HB0421  99th General Assembly

HB0421ham002 99TH GENERAL ASSEMBLY

Rep. Sara Feigenholtz

Filed: 4/20/2015

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 421

2    AMENDMENT NO. ______. Amend House Bill 421, AS AMENDED,
3with reference to page and line numbers of House Amendment No.
41, by replacing line 9 on page 47 through line 8 on page 59 with
5the following:
 
6    "Section 33. The Medical Practice Act of 1987 is amended by
7changing Section 54.5 as follows:
 
8    (225 ILCS 60/54.5)
9    (Section scheduled to be repealed on December 31, 2015)
10    Sec. 54.5. Physician delegation of authority to physician
11assistants, advanced practice nurses, and prescribing
12psychologists.
13    (a) Physicians licensed to practice medicine in all its
14branches may delegate care and treatment responsibilities to a
15physician assistant under guidelines in accordance with the
16requirements of the Physician Assistant Practice Act of 1987. A

 

 

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1physician licensed to practice medicine in all its branches may
2enter into supervising physician agreements with no more than 5
3physician assistants as set forth in subsection (a) of Section
47 of the Physician Assistant Practice Act of 1987.
5    (b) A physician licensed to practice medicine in all its
6branches in active clinical practice may collaborate with an
7advanced practice nurse in accordance with the requirements of
8the Nurse Practice Act. Collaboration is for the purpose of
9providing medical consultation, and no employment relationship
10is required. A written collaborative agreement shall conform to
11the requirements of Section 65-35 of the Nurse Practice Act.
12The written collaborative agreement shall be for services in
13the same area of practice or specialty as the collaborating
14physician generally provides or may provide in his or her
15clinical medical practice. A written collaborative agreement
16shall be adequate with respect to collaboration with advanced
17practice nurses if all of the following apply:
18        (1) The agreement is written to promote the exercise of
19    professional judgment by the advanced practice nurse
20    commensurate with his or her education and experience. The
21    agreement need not describe the exact steps that an
22    advanced practice nurse must take with respect to each
23    specific condition, disease, or symptom, but must specify
24    those procedures that require a physician's presence as the
25    procedures are being performed.
26        (2) Practice guidelines and orders are developed and

 

 

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1    approved jointly by the advanced practice nurse and
2    collaborating physician, as needed, based on the practice
3    of the practitioners. Such guidelines and orders and the
4    patient services provided thereunder are periodically
5    reviewed by the collaborating physician.
6        (2) (3) The advance practice nurse provides services
7    based upon a written collaborative agreement with the
8    collaborating physician generally provides or may provide
9    in his or her clinical medical practice, except as set
10    forth in subsection (b-5) of this Section. With respect to
11    labor and delivery, the collaborating physician must
12    provide delivery services in order to participate with a
13    certified nurse midwife.
14        (4) The collaborating physician and advanced practice
15    nurse consult at least once a month to provide
16    collaboration and consultation.
17        (3) (5) Methods of communication are available with the
18    collaborating physician in person or through
19    telecommunications for consultation, collaboration, and
20    referral as needed to address patient care needs.
21        (6) The agreement contains provisions detailing notice
22    for termination or change of status involving a written
23    collaborative agreement, except when such notice is given
24    for just cause.
25    (b-5) An anesthesiologist or physician licensed to
26practice medicine in all its branches may collaborate with a

 

 

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1certified registered nurse anesthetist in accordance with
2Section 65-35 of the Nurse Practice Act for the provision of
3anesthesia services. With respect to the provision of
4anesthesia services, the collaborating anesthesiologist or
5physician shall have training and experience in the delivery of
6anesthesia services consistent with Department rules.
7Collaboration shall be adequate if:
8        (1) an anesthesiologist or a physician participates in
9    the joint formulation and joint approval of orders or
10    guidelines and periodically reviews such orders and the
11    services provided patients under such orders; and
12        (2) for anesthesia services, the anesthesiologist or
13    physician participates through discussion of and agreement
14    with the anesthesia plan and is physically present and
15    available on the premises during the delivery of anesthesia
16    services for diagnosis, consultation, and treatment of
17    emergency medical conditions. Anesthesia services in a
18    hospital shall be conducted in accordance with Section 10.7
19    of the Hospital Licensing Act and in an ambulatory surgical
20    treatment center in accordance with Section 6.5 of the
21    Ambulatory Surgical Treatment Center Act.
22    (b-10) The anesthesiologist or operating physician must
23agree with the anesthesia plan prior to the delivery of
24services.
25    (c) The supervising physician shall have access to the
26medical records of all patients attended by a physician

 

 

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1assistant. The collaborating physician shall have access to the
2medical records of all patients attended to by an advanced
3practice nurse.
4    (d) (Blank).
5    (e) A physician shall not be liable for the acts or
6omissions of a prescribing psychologist, physician assistant,
7or advanced practice nurse solely on the basis of having signed
8a supervision agreement or guidelines or a collaborative
9agreement, an order, a standing medical order, a standing
10delegation order, or other order or guideline authorizing a
11prescribing psychologist, physician assistant, or advanced
12practice nurse to perform acts, unless the physician has reason
13to believe the prescribing psychologist, physician assistant,
14or advanced practice nurse lacked the competency to perform the
15act or acts or commits willful and wanton misconduct.
16    (f) A collaborating physician may, but is not required to,
17delegate prescriptive authority to an advanced practice nurse
18as part of a written collaborative agreement, and the
19delegation of prescriptive authority shall conform to the
20requirements of Section 65-40 of the Nurse Practice Act.
21    (g) A supervising physician may, but is not required to,
22delegate prescriptive authority to a physician assistant as
23part of a written supervision agreement, and the delegation of
24prescriptive authority shall conform to the requirements of
25Section 7.5 of the Physician Assistant Practice Act of 1987.
26    (h) (Blank). For the purposes of this Section, "generally

 

 

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1provides or may provide in his or her clinical medical
2practice" means categories of care or treatment, not specific
3tasks or duties, that the physician provides individually or
4through delegation to other persons so that the physician has
5the experience and ability to provide collaboration and
6consultation. This definition shall not be construed to
7prohibit an advanced practice nurse from providing primary
8health treatment or care within the scope of his or her
9training and experience, including, but not limited to, health
10screenings, patient histories, physical examinations, women's
11health examinations, or school physicals that may be provided
12as part of the routine practice of an advanced practice nurse
13or on a volunteer basis.
14    (i) A collaborating physician shall delegate prescriptive
15authority to a prescribing psychologist as part of a written
16collaborative agreement, and the delegation of prescriptive
17authority shall conform to the requirements of Section 4.3 of
18the Clinical Psychologist Licensing Act.
19(Source: P.A. 97-358, eff. 8-12-11; 97-1071, eff. 8-24-12;
2098-192, eff. 1-1-14; 98-668, eff. 6-25-14.)
 
21    Section 35. The Nurse Practice Act is amended by changing
22Sections 50-10, 65-35, and 65-45 and by adding Section 65-35.1
23as follows:
 
24    (225 ILCS 65/50-10)   (was 225 ILCS 65/5-10)

 

 

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1    (Section scheduled to be repealed on January 1, 2018)
2    Sec. 50-10. Definitions. Each of the following terms, when
3used in this Act, shall have the meaning ascribed to it in this
4Section, except where the context clearly indicates otherwise:
5    "Academic year" means the customary annual schedule of
6courses at a college, university, or approved school,
7customarily regarded as the school year as distinguished from
8the calendar year.
9    "Advanced practice nurse" or "APN" means a person who has
10met the qualifications for a (i) certified nurse midwife (CNM);
11(ii) certified nurse practitioner (CNP); (iii) certified
12registered nurse anesthetist (CRNA); or (iv) clinical nurse
13specialist (CNS) and has been licensed by the Department. All
14advanced practice nurses licensed and practicing in the State
15of Illinois shall use the title APN and may use specialty
16credentials CNM, CNP, CRNA, or CNS after their name. All
17advanced practice nurses may only practice in accordance with
18national certification and this Act.
19    "Approved program of professional nursing education" and
20"approved program of practical nursing education" are programs
21of professional or practical nursing, respectively, approved
22by the Department under the provisions of this Act.
23    "Board" means the Board of Nursing appointed by the
24Secretary.
25    "Collaboration" means a process involving 2 or more health
26care professionals working together, each contributing one's

 

 

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1respective area of expertise to provide more comprehensive
2patient care.
3    "Consultation" means the process whereby an advanced
4practice nurse seeks the advice or opinion of another health
5care professional.
6    "Credentialed" means the process of assessing and
7validating the qualifications of a health care professional.
8    "Current nursing practice update course" means a planned
9nursing education curriculum approved by the Department
10consisting of activities that have educational objectives,
11instructional methods, content or subject matter, clinical
12practice, and evaluation methods, related to basic review and
13updating content and specifically planned for those nurses
14previously licensed in the United States or its territories and
15preparing for reentry into nursing practice.
16    "Dentist" means a person licensed to practice dentistry
17under the Illinois Dental Practice Act.
18    "Department" means the Department of Financial and
19Professional Regulation.
20    "Impaired nurse" means a nurse licensed under this Act who
21is unable to practice with reasonable skill and safety because
22of a physical or mental disability as evidenced by a written
23determination or written consent based on clinical evidence,
24including loss of motor skills, abuse of drugs or alcohol, or a
25psychiatric disorder, of sufficient degree to diminish his or
26her ability to deliver competent patient care.

 

 

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1    "License-pending advanced practice nurse" means a
2registered professional nurse who has completed all
3requirements for licensure as an advanced practice nurse except
4the certification examination and has applied to take the next
5available certification exam and received a temporary license
6from the Department.
7    "License-pending registered nurse" means a person who has
8passed the Department-approved registered nurse licensure exam
9and has applied for a license from the Department. A
10license-pending registered nurse shall use the title "RN lic
11pend" on all documentation related to nursing practice.
12    "Physician" means a person licensed to practice medicine in
13all its branches under the Medical Practice Act of 1987.
14    "Podiatric physician" means a person licensed to practice
15podiatry under the Podiatric Medical Practice Act of 1987.
16    "Practical nurse" or "licensed practical nurse" means a
17person who is licensed as a practical nurse under this Act and
18practices practical nursing as defined in this Act. Only a
19practical nurse licensed under this Act is entitled to use the
20title "licensed practical nurse" and the abbreviation
21"L.P.N.".
22    "Practical nursing" means the performance of nursing acts
23requiring the basic nursing knowledge, judgment judgement, and
24skill acquired by means of completion of an approved practical
25nursing education program. Practical nursing includes
26assisting in the nursing process as delegated by a registered

 

 

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1professional nurse or an advanced practice nurse. The practical
2nurse may work under the direction of a licensed physician,
3dentist, podiatric physician, or other health care
4professional determined by the Department.
5    "Privileged" means the authorization granted by the
6governing body of a healthcare facility, agency, or
7organization to provide specific patient care services within
8well-defined limits, based on qualifications reviewed in the
9credentialing process.
10    "Registered Nurse" or "Registered Professional Nurse"
11means a person who is licensed as a professional nurse under
12this Act and practices nursing as defined in this Act. Only a
13registered nurse licensed under this Act is entitled to use the
14titles "registered nurse" and "registered professional nurse"
15and the abbreviation, "R.N.".
16    "Registered professional nursing practice" is a scientific
17process founded on a professional body of knowledge; it is a
18learned profession based on the understanding of the human
19condition across the life span and environment and includes all
20nursing specialties and means the performance of any nursing
21act based upon professional knowledge, judgment, and skills
22acquired by means of completion of an approved professional
23nursing education program. A registered professional nurse
24provides holistic nursing care through the nursing process to
25individuals, groups, families, or communities, that includes
26but is not limited to: (1) the assessment of healthcare needs,

 

 

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1nursing diagnosis, planning, implementation, and nursing
2evaluation; (2) the promotion, maintenance, and restoration of
3health; (3) counseling, patient education, health education,
4and patient advocacy; (4) the administration of medications and
5treatments as prescribed by a physician licensed to practice
6medicine in all of its branches, a licensed dentist, a licensed
7podiatric physician, or a licensed optometrist or as prescribed
8by a physician assistant in accordance with written guidelines
9required under the Physician Assistant Practice Act of 1987 or
10by an advanced practice nurse in accordance with Article 65 of
11this Act; (5) the coordination and management of the nursing
12plan of care; (6) the delegation to and supervision of
13individuals who assist the registered professional nurse
14implementing the plan of care; and (7) teaching nursing
15students. The foregoing shall not be deemed to include those
16acts of medical diagnosis or prescription of therapeutic or
17corrective measures.
18    "Professional assistance program for nurses" means a
19professional assistance program that meets criteria
20established by the Board of Nursing and approved by the
21Secretary, which provides a non-disciplinary treatment
22approach for nurses licensed under this Act whose ability to
23practice is compromised by alcohol or chemical substance
24addiction.
25    "Secretary" means the Secretary of Financial and
26Professional Regulation.

 

 

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1    "Unencumbered license" means a license issued in good
2standing.
3    "Written collaborative agreement" means a written
4agreement between an advanced practice nurse and a
5collaborating physician, dentist, or podiatric physician
6pursuant to Section 65-35.
7(Source: P.A. 97-813, eff. 7-13-12; 98-214, eff. 8-9-13.)
 
8    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
9    (Section scheduled to be repealed on January 1, 2018)
10    Sec. 65-35. Written collaborative agreements.
11    (a) A written collaborative agreement is required for all
12advanced practice nurses engaged in clinical practice, except
13for advanced practice nurses who are authorized to practice in
14a hospital, hospital affiliate, or ambulatory surgical
15treatment center.
16    (a-5) If an advanced practice nurse engages in clinical
17practice outside of a hospital, hospital affiliate, or
18ambulatory surgical treatment center in which he or she is
19authorized to practice, the advanced practice nurse must have a
20written collaborative agreement.
21    (b) A written collaborative agreement shall describe the
22working relationship of the advanced practice nurse with the
23collaborating physician or podiatric physician and shall
24describe authorize the categories of care, treatment, or
25procedures to be provided performed by the advanced practice

 

 

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1nurse. A collaborative agreement with a dentist must be in
2accordance with subsection (c-10) of this Section.
3Collaboration does not require an employment relationship
4between the collaborating physician or podiatric physician and
5advanced practice nurse. Collaboration means the relationship
6under which an advanced practice nurse works with a
7collaborating physician or podiatric physician in an active
8clinical practice to deliver health care services in accordance
9with (i) the advanced practice nurse's training, education, and
10experience and (ii) collaboration and consultation as
11documented in a jointly developed written collaborative
12agreement.
13    The agreement shall promote the exercise of professional
14judgment by the advanced practice nurse commensurate with his
15or her education and experience. The services to be provided by
16the advanced practice nurse shall be services that the
17collaborating physician or podiatric physician is authorized
18to and generally provides or may provide in his or her clinical
19medical or podiatric practice, except as set forth in
20subsection (b-5) or (c-5) of this Section. The agreement need
21not describe the exact steps that an advanced practice nurse
22must take with respect to each specific condition, disease, or
23symptom but must specify which authorized procedures require
24the presence of the collaborating physician or podiatric
25physician as the procedures are being performed. The
26collaborative relationship under an agreement shall not be

 

 

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1construed to require the personal presence of a physician or
2podiatric physician at the place where services are rendered.
3Methods of communication shall be available for consultation
4with the collaborating physician or podiatric physician in
5person or by telecommunications or electronic communications
6in accordance with established written guidelines as set forth
7in the written agreement.
8    (b-5) Absent an employment relationship, a written
9collaborative agreement may not (1) restrict the categories of
10patients of an advanced practice nurse within the scope of the
11advanced practice nurses training and experience, (2) limit
12third party payors or government health programs, such as the
13medical assistance program or Medicare with which the advanced
14practice nurse contracts, or (3) limit the geographic area or
15practice location of the advanced practice nurse in this State.
16    (c) Collaboration and consultation under all collaboration
17agreements shall be adequate if a collaborating physician or
18podiatric physician does each of the following:
19        (1) Participates in the joint formulation and joint
20    approval of orders or guidelines with the advanced practice
21    nurse and he or she periodically reviews such orders and
22    the services provided patients under such orders in
23    accordance with accepted standards of medical practice or
24    podiatric practice and advanced practice nursing practice.
25        (2) Provides collaboration and consultation with the
26    advanced practice nurse at least once a month. In the case

 

 

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1    of anesthesia services provided by a certified registered
2    nurse anesthetist, an anesthesiologist, a physician, a
3    dentist, or a podiatric physician must participate through
4    discussion of and agreement with the anesthesia plan and
5    remain physically present and available on the premises
6    during the delivery of anesthesia services for diagnosis,
7    consultation, and treatment of emergency medical
8    conditions.
9        (3) Is available through telecommunications for
10    consultation on medical problems, complications, or
11    emergencies or patient referral. In the case of anesthesia
12    services provided by a certified registered nurse
13    anesthetist, an anesthesiologist, a physician, a dentist,
14    or a podiatric physician must participate through
15    discussion of and agreement with the anesthesia plan and
16    remain physically present and available on the premises
17    during the delivery of anesthesia services for diagnosis,
18    consultation, and treatment of emergency medical
19    conditions.
20    The agreement must contain provisions detailing notice for
21termination or change of status involving a written
22collaborative agreement, except when such notice is given for
23just cause.
24    (c-5) A certified registered nurse anesthetist, who
25provides anesthesia services outside of a hospital or
26ambulatory surgical treatment center shall enter into a written

 

 

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1collaborative agreement with an anesthesiologist or the
2physician licensed to practice medicine in all its branches or
3the podiatric physician performing the procedure. Outside of a
4hospital or ambulatory surgical treatment center, the
5certified registered nurse anesthetist may provide only those
6services that the collaborating podiatric physician is
7authorized to provide pursuant to the Podiatric Medical
8Practice Act of 1987 and rules adopted thereunder. A certified
9registered nurse anesthetist may select, order, and administer
10medication, including controlled substances, and apply
11appropriate medical devices for delivery of anesthesia
12services under the anesthesia plan agreed with by the
13anesthesiologist or the operating physician or operating
14podiatric physician.
15    (c-10) A certified registered nurse anesthetist who
16provides anesthesia services in a dental office shall enter
17into a written collaborative agreement with an
18anesthesiologist or the physician licensed to practice
19medicine in all its branches or the operating dentist
20performing the procedure. The agreement shall describe the
21working relationship of the certified registered nurse
22anesthetist and dentist and shall authorize the categories of
23care, treatment, or procedures to be performed by the certified
24registered nurse anesthetist. In a collaborating dentist's
25office, the certified registered nurse anesthetist may only
26provide those services that the operating dentist with the

 

 

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1appropriate permit is authorized to provide pursuant to the
2Illinois Dental Practice Act and rules adopted thereunder. For
3anesthesia services, an anesthesiologist, physician, or
4operating dentist shall participate through discussion of and
5agreement with the anesthesia plan and shall remain physically
6present and be available on the premises during the delivery of
7anesthesia services for diagnosis, consultation, and treatment
8of emergency medical conditions. A certified registered nurse
9anesthetist may select, order, and administer medication,
10including controlled substances, and apply appropriate medical
11devices for delivery of anesthesia services under the
12anesthesia plan agreed with by the operating dentist.
13    (d) A copy of the signed, written collaborative agreement
14must be available to the Department upon request from both the
15advanced practice nurse and the collaborating physician,
16dentist, or podiatric physician.
17    (e) Nothing in this Act shall be construed to limit the
18delegation of tasks or duties by a physician to a licensed
19practical nurse, a registered professional nurse, or other
20persons in accordance with Section 54.2 of the Medical Practice
21Act of 1987. Nothing in this Act shall be construed to limit
22the method of delegation that may be authorized by any means,
23including, but not limited to, oral, written, electronic,
24standing orders, protocols, guidelines, or verbal orders.
25Nothing in this Act shall be construed to authorize an advanced
26practice nurse to provide health care services required by law

 

 

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1or rule to be performed by a physician.
2    (f) An advanced practice nurse shall inform each
3collaborating physician, dentist, or podiatric physician of
4all collaborative agreements he or she has signed and provide a
5copy of these to any collaborating physician, dentist, or
6podiatric physician upon request.
7    (g) (Blank). For the purposes of this Act, "generally
8provides or may provide in his or her clinical medical
9practice" means categories of care or treatment, not specific
10tasks or duties, the physician provides individually or through
11delegation to other persons so that the physician has the
12experience and ability to provide collaboration and
13consultation. This definition shall not be construed to
14prohibit an advanced practice nurse from providing primary
15health treatment or care within the scope of his or her
16training and experience, including, but not limited to, health
17screenings, patient histories, physical examinations, women's
18health examinations, or school physicals that may be provided
19as part of the routine practice of an advanced practice nurse
20or on a volunteer basis.
21    For the purposes of this Act, "generally provides or may
22provide in his or her clinical podiatric practice" means
23services, not specific tasks or duties, that the podiatric
24physician routinely provides individually or through
25delegation to other persons so that the podiatric physician has
26the experience and ability to provide collaboration and

 

 

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1consultation.
2(Source: P.A. 97-358, eff. 8-12-11; 98-192, eff. 1-1-14;
398-214, eff. 8-9-13; 98-756, eff. 7-16-14.)
 
4    (225 ILCS 65/65-35.1 new)
5    Sec. 65-35.1. Written collaborative agreement; temporary
6practice. Any advanced practice nurse required to enter into a
7written collaborative agreement with a collaborating physician
8or collaborating podiatrist is authorized to continue to
9practice for up to 90 days after the termination of a
10collaborative agreement provided the advanced practice nurse
11seeks any needed collaboration at a local hospital and refers
12patients who require services beyond the training and
13experience of the advanced practice nurse to a physician or
14other health care provider.
 
15    (225 ILCS 65/65-45)   (was 225 ILCS 65/15-25)
16    (Section scheduled to be repealed on January 1, 2018)
17    Sec. 65-45. Advanced practice nursing in hospitals,
18hospital affiliates, or ambulatory surgical treatment centers.
19    (a) An advanced practice nurse may provide services in a
20hospital or a hospital affiliate as those terms are defined in
21the Hospital Licensing Act or the University of Illinois
22Hospital Act or a licensed ambulatory surgical treatment center
23without a written collaborative agreement pursuant to Section
2465-35 of this Act. An advanced practice nurse must possess

 

 

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1clinical privileges recommended by the hospital medical staff
2and granted by the hospital or the consulting medical staff
3committee and ambulatory surgical treatment center in order to
4provide services. The medical staff or consulting medical staff
5committee shall periodically review the services of advanced
6practice nurses granted clinical privileges, including any
7care provided in a hospital affiliate. Authority may also be
8granted when recommended by the hospital medical staff and
9granted by the hospital or recommended by the consulting
10medical staff committee and ambulatory surgical treatment
11center to individual advanced practice nurses to select, order,
12and administer medications, including controlled substances,
13to provide delineated care. In a hospital, hospital affiliate,
14or ambulatory surgical treatment center, the attending
15physician shall determine an advanced practice nurse's role in
16providing care for his or her patients, except as otherwise
17provided in the medical staff bylaws or consulting committee
18policies.
19    (a-2) An advanced practice nurse granted authority to order
20medications including controlled substances may complete
21discharge prescriptions provided the prescription is in the
22name of the advanced practice nurse and the attending or
23discharging physician.
24    (a-3) Advanced practice nurses practicing in a hospital or
25an ambulatory surgical treatment center are not required to
26obtain a mid-level controlled substance license to order

 

 

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1controlled substances under Section 303.05 of the Illinois
2Controlled Substances Act.
3    (a-5) For anesthesia services provided by a certified
4registered nurse anesthetist, an anesthesiologist, physician,
5dentist, or podiatric physician shall participate through
6discussion of and agreement with the anesthesia plan and shall
7remain physically present and be available on the premises
8during the delivery of anesthesia services for diagnosis,
9consultation, and treatment of emergency medical conditions,
10unless hospital policy adopted pursuant to clause (B) of
11subdivision (3) of Section 10.7 of the Hospital Licensing Act
12or ambulatory surgical treatment center policy adopted
13pursuant to clause (B) of subdivision (3) of Section 6.5 of the
14Ambulatory Surgical Treatment Center Act provides otherwise. A
15certified registered nurse anesthetist may select, order, and
16administer medication for anesthesia services under the
17anesthesia plan agreed to by the anesthesiologist or the
18physician, in accordance with hospital alternative policy or
19the medical staff consulting committee policies of a licensed
20ambulatory surgical treatment center.
21    (b) An advanced practice nurse who provides services in a
22hospital shall do so in accordance with Section 10.7 of the
23Hospital Licensing Act and, in an ambulatory surgical treatment
24center, in accordance with Section 6.5 of the Ambulatory
25Surgical Treatment Center Act.
26    (c) Advanced practice nurses certified as nurse

 

 

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1practitioners, nurse midwives, or clinical nurse specialists
2practicing in a hospital affiliate may be, but are not required
3to be, granted authority to prescribe Schedule II through V
4controlled substances when such authority is recommended by the
5appropriate physician committee of the hospital affiliate and
6granted by the hospital affiliate. This authority may, but is
7not required to, include prescription of, selection of, orders
8for, administration of, storage of, acceptance of samples of,
9and dispensing over-the-counter medications, legend drugs,
10medical gases, and controlled substances categorized as
11Schedule II through V controlled substances, as defined in
12Article II of the Illinois Controlled Substances Act, and other
13preparations, including, but not limited to, botanical and
14herbal remedies.
15    To prescribe controlled substances under this subsection
16(c), an advanced practice nurse certified as a nurse
17practitioner, nurse midwife, or clinical nurse specialist must
18obtain a mid-level practitioner controlled substance license.
19Medication orders shall be reviewed periodically by the
20appropriate hospital affiliate physicians committee or its
21physician designee.
22    The hospital affiliate shall file with the Department
23notice of a grant of prescriptive authority consistent with
24this subsection (c) and termination of such a grant of
25authority, in accordance with rules of the Department. Upon
26receipt of this notice of grant of authority to prescribe any

 

 

09900HB0421ham002- 23 -LRB099 05828 AMC 34231 a

1Schedule II through V controlled substances, the licensed
2advanced practice nurse certified as a nurse practitioner,
3nurse midwife, or clinical nurse specialist may register for a
4mid-level practitioner controlled substance license under
5Section 303.05 of the Illinois Controlled Substances Act.
6    In addition, a hospital affiliate may, but is not required
7to, grant authority to an advanced practice nurse certified as
8a nurse practitioner, nurse midwife, or clinical nurse
9specialist to prescribe any Schedule II controlled substances,
10if all of the following conditions apply:
11        (1) specific Schedule II controlled substances by oral
12    dosage or topical or transdermal application may be
13    designated, provided that the designated Schedule II
14    controlled substances are routinely prescribed by advanced
15    practice nurses in their area of certification; this grant
16    of authority must identify the specific Schedule II
17    controlled substances by either brand name or generic name;
18    authority to prescribe or dispense Schedule II controlled
19    substances to be delivered by injection or other route of
20    administration may not be granted;
21        (2) any grant of authority must be controlled
22    substances limited to the practice of the advanced practice
23    nurse;
24        (3) any prescription must be limited to no more than a
25    30-day supply;
26        (4) the advanced practice nurse must discuss the

 

 

09900HB0421ham002- 24 -LRB099 05828 AMC 34231 a

1    condition of any patients for whom a controlled substance
2    is prescribed monthly with the appropriate physician
3    committee of the hospital affiliate or its physician
4    designee; and
5        (5) the advanced practice nurse must meet the education
6    requirements of Section 303.05 of the Illinois Controlled
7    Substances Act.
8(Source: P.A. 97-358, eff. 8-12-11; 98-214, eff. 8-9-13.)"; and
 
9on page 65, immediately below line 24, by inserting the
10following:
 
11    "Section 53. The Podiatric Medical Practice Act of 1987 is
12amended by changing Section 20.5 as follows:
 
13    (225 ILCS 100/20.5)
14    (Section scheduled to be repealed on January 1, 2018)
15    Sec. 20.5. Delegation of authority to advanced practice
16nurses.
17    (a) A podiatric physician in active clinical practice may
18collaborate with an advanced practice nurse in accordance with
19the requirements of the Nurse Practice Act. Collaboration shall
20be for the purpose of providing podiatric care consultation and
21no employment relationship shall be required. A written
22collaborative agreement shall conform to the requirements of
23Section 65-35 of the Nurse Practice Act. The written

 

 

09900HB0421ham002- 25 -LRB099 05828 AMC 34231 a

1collaborative agreement shall be for services the
2collaborating podiatric physician generally provides to his or
3her patients in the normal course of clinical podiatric
4practice, except as set forth in item (3) of this subsection
5(a). A written collaborative agreement and podiatric physician
6collaboration and consultation shall be adequate with respect
7to advanced practice nurses if all of the following apply:
8        (1) The agreement is written to promote the exercise of
9    professional judgment by the advanced practice nurse
10    commensurate with his or her education and experience. The
11    agreement need not describe the exact steps that an
12    advanced practice nurse must take with respect to each
13    specific condition, disease, or symptom, but must specify
14    which procedures require a podiatric physician's presence
15    as the procedures are being performed.
16        (2) Practice guidelines and orders are developed and
17    approved jointly by the advanced practice nurse and
18    collaborating podiatric physician, as needed, based on the
19    practice of the practitioners. Such guidelines and orders
20    and the patient services provided thereunder are
21    periodically reviewed by the collaborating podiatric
22    physician.
23        (1) (3) The advance practice nurse provides services
24    that the collaborating podiatric physician generally
25    provides to his or her patients in the normal course of
26    clinical practice. With respect to the provision of

 

 

09900HB0421ham002- 26 -LRB099 05828 AMC 34231 a

1    anesthesia services by a certified registered nurse
2    anesthetist, the collaborating podiatric physician must
3    have training and experience in the delivery of anesthesia
4    consistent with Department rules.
5        (4) The collaborating podiatric physician and the
6    advanced practice nurse consult at least once a month to
7    provide collaboration and consultation.
8        (2) (5) Methods of communication are available with the
9    collaborating podiatric physician in person or through
10    telecommunications or electronic communications for
11    consultation, collaboration, and referral as needed to
12    address patient care needs.
13        (3) (6) With respect to the provision of anesthesia
14    services by a certified registered nurse anesthetist, an
15    anesthesiologist, physician, or podiatric physician shall
16    participate through discussion of and agreement with the
17    anesthesia plan and shall remain physically present and be
18    available on the premises during the delivery of anesthesia
19    services for diagnosis, consultation, and treatment of
20    emergency medical conditions. The anesthesiologist or
21    operating podiatric physician must agree with the
22    anesthesia plan prior to the delivery of services.
23        (7) The agreement contains provisions detailing notice
24    for termination or change of status involving a written
25    collaborative agreement, except when such notice is given
26    for just cause.

 

 

09900HB0421ham002- 27 -LRB099 05828 AMC 34231 a

1    (b) The collaborating podiatric physician shall have
2access to the records of all patients attended to by an
3advanced practice nurse.
4    (c) Nothing in this Section shall be construed to limit the
5delegation of tasks or duties by a podiatric physician to a
6licensed practical nurse, a registered professional nurse, or
7other appropriately trained persons.
8    (d) A podiatric physician shall not be liable for the acts
9or omissions of an advanced practice nurse solely on the basis
10of having signed guidelines or a collaborative agreement, an
11order, a standing order, a standing delegation order, or other
12order or guideline authorizing an advanced practice nurse to
13perform acts, unless the podiatric physician has reason to
14believe the advanced practice nurse lacked the competency to
15perform the act or acts or commits willful or wanton
16misconduct.
17    (e) A podiatric physician, may, but is not required to
18delegate prescriptive authority to an advanced practice nurse
19as part of a written collaborative agreement and the delegation
20of prescriptive authority shall conform to the requirements of
21Section 65-40 of the Nurse Practice Act.
22(Source: P.A. 97-358, eff. 8-12-11; 97-813, eff. 7-13-12;
2398-214, eff. 8-9-13.)"; and
 
24on page 85, immediately below line 3, by inserting the
25following:
 

 

 

09900HB0421ham002- 28 -LRB099 05828 AMC 34231 a

1    "Section 63. The Illinois Public Aid Code is amended by
2changing Section 5-8 as follows:
 
3    (305 ILCS 5/5-8)  (from Ch. 23, par. 5-8)
4    Sec. 5-8. Practitioners. In supplying medical assistance,
5the Illinois Department may provide for the legally authorized
6services of (i) persons licensed under the Medical Practice Act
7of 1987, as amended, except as hereafter in this Section
8stated, whether under a general or limited license, (ii)
9persons licensed under the Nurse Practice Act as advanced
10practice nurses, regardless of whether or not the persons have
11written collaborative agreements, (iii) persons licensed or
12registered under other laws of this State to provide dental,
13medical, pharmaceutical, optometric, podiatric, or nursing
14services, or other remedial care recognized under State law,
15and (iv) (iii) persons licensed under other laws of this State
16as a clinical social worker. The Department may not provide for
17legally authorized services of any physician who has been
18convicted of having performed an abortion procedure in a wilful
19and wanton manner on a woman who was not pregnant at the time
20such abortion procedure was performed. The utilization of the
21services of persons engaged in the treatment or care of the
22sick, which persons are not required to be licensed or
23registered under the laws of this State, is not prohibited by
24this Section.

 

 

09900HB0421ham002- 29 -LRB099 05828 AMC 34231 a

1(Source: P.A. 95-518, eff. 8-28-07.)"; and
 
2on page 140, immediately below line 5, by inserting the
3following:
 
4    "Section 120. The Illinois Controlled Substances Act is
5amended by changing Sections 102 and 303.05 as follows:
 
6    (720 ILCS 570/102)  (from Ch. 56 1/2, par. 1102)
7    Sec. 102. Definitions. As used in this Act, unless the
8context otherwise requires:
9    (a) "Addict" means any person who habitually uses any drug,
10chemical, substance or dangerous drug other than alcohol so as
11to endanger the public morals, health, safety or welfare or who
12is so far addicted to the use of a dangerous drug or controlled
13substance other than alcohol as to have lost the power of self
14control with reference to his or her addiction.
15    (b) "Administer" means the direct application of a
16controlled substance, whether by injection, inhalation,
17ingestion, or any other means, to the body of a patient,
18research subject, or animal (as defined by the Humane
19Euthanasia in Animal Shelters Act) by:
20        (1) a practitioner (or, in his or her presence, by his
21    or her authorized agent),
22        (2) the patient or research subject pursuant to an
23    order, or

 

 

09900HB0421ham002- 30 -LRB099 05828 AMC 34231 a

1        (3) a euthanasia technician as defined by the Humane
2    Euthanasia in Animal Shelters Act.
3    (c) "Agent" means an authorized person who acts on behalf
4of or at the direction of a manufacturer, distributor,
5dispenser, prescriber, or practitioner. It does not include a
6common or contract carrier, public warehouseman or employee of
7the carrier or warehouseman.
8    (c-1) "Anabolic Steroids" means any drug or hormonal
9substance, chemically and pharmacologically related to
10testosterone (other than estrogens, progestins,
11corticosteroids, and dehydroepiandrosterone), and includes:
12    (i) 3[beta],17-dihydroxy-5a-androstane, 
13    (ii) 3[alpha],17[beta]-dihydroxy-5a-androstane, 
14    (iii) 5[alpha]-androstan-3,17-dione, 
15    (iv) 1-androstenediol (3[beta], 
16        17[beta]-dihydroxy-5[alpha]-androst-1-ene), 
17    (v) 1-androstenediol (3[alpha], 
18        17[beta]-dihydroxy-5[alpha]-androst-1-ene), 
19    (vi) 4-androstenediol  
20        (3[beta],17[beta]-dihydroxy-androst-4-ene), 
21    (vii) 5-androstenediol  
22        (3[beta],17[beta]-dihydroxy-androst-5-ene), 
23    (viii) 1-androstenedione  
24        ([5alpha]-androst-1-en-3,17-dione), 
25    (ix) 4-androstenedione  
26        (androst-4-en-3,17-dione), 

 

 

09900HB0421ham002- 31 -LRB099 05828 AMC 34231 a

1    (x) 5-androstenedione  
2        (androst-5-en-3,17-dione), 
3    (xi) bolasterone (7[alpha],17a-dimethyl-17[beta]- 
4        hydroxyandrost-4-en-3-one), 
5    (xii) boldenone (17[beta]-hydroxyandrost- 
6        1,4,-diene-3-one), 
7    (xiii) boldione (androsta-1,4- 
8        diene-3,17-dione), 
9    (xiv) calusterone (7[beta],17[alpha]-dimethyl-17 
10        [beta]-hydroxyandrost-4-en-3-one), 
11    (xv) clostebol (4-chloro-17[beta]- 
12        hydroxyandrost-4-en-3-one), 
13    (xvi) dehydrochloromethyltestosterone (4-chloro- 
14        17[beta]-hydroxy-17[alpha]-methyl- 
15        androst-1,4-dien-3-one), 
16    (xvii) desoxymethyltestosterone 
17    (17[alpha]-methyl-5[alpha] 
18        -androst-2-en-17[beta]-ol)(a.k.a., madol), 
19    (xviii) [delta]1-dihydrotestosterone (a.k.a.  
20        '1-testosterone') (17[beta]-hydroxy- 
21        5[alpha]-androst-1-en-3-one), 
22    (xix) 4-dihydrotestosterone (17[beta]-hydroxy- 
23        androstan-3-one), 
24    (xx) drostanolone (17[beta]-hydroxy-2[alpha]-methyl- 
25        5[alpha]-androstan-3-one), 
26    (xxi) ethylestrenol (17[alpha]-ethyl-17[beta]- 

 

 

09900HB0421ham002- 32 -LRB099 05828 AMC 34231 a

1        hydroxyestr-4-ene), 
2    (xxii) fluoxymesterone (9-fluoro-17[alpha]-methyl- 
3        1[beta],17[beta]-dihydroxyandrost-4-en-3-one), 
4    (xxiii) formebolone (2-formyl-17[alpha]-methyl-11[alpha], 
5        17[beta]-dihydroxyandrost-1,4-dien-3-one), 
6    (xxiv) furazabol (17[alpha]-methyl-17[beta]- 
7        hydroxyandrostano[2,3-c]-furazan), 
8    (xxv) 13[beta]-ethyl-17[beta]-hydroxygon-4-en-3-one) 
9    (xxvi) 4-hydroxytestosterone (4,17[beta]-dihydroxy- 
10        androst-4-en-3-one), 
11    (xxvii) 4-hydroxy-19-nortestosterone (4,17[beta]- 
12        dihydroxy-estr-4-en-3-one), 
13    (xxviii) mestanolone (17[alpha]-methyl-17[beta]- 
14        hydroxy-5-androstan-3-one), 
15    (xxix) mesterolone (1amethyl-17[beta]-hydroxy- 
16        [5a]-androstan-3-one), 
17    (xxx) methandienone (17[alpha]-methyl-17[beta]- 
18        hydroxyandrost-1,4-dien-3-one), 
19    (xxxi) methandriol (17[alpha]-methyl-3[beta],17[beta]- 
20        dihydroxyandrost-5-ene), 
21    (xxxii) methenolone (1-methyl-17[beta]-hydroxy- 
22        5[alpha]-androst-1-en-3-one), 
23    (xxxiii) 17[alpha]-methyl-3[beta], 17[beta]- 
24        dihydroxy-5a-androstane), 
25    (xxxiv) 17[alpha]-methyl-3[alpha],17[beta]-dihydroxy 
26        -5a-androstane), 

 

 

09900HB0421ham002- 33 -LRB099 05828 AMC 34231 a

1    (xxxv) 17[alpha]-methyl-3[beta],17[beta]- 
2        dihydroxyandrost-4-ene), 
3    (xxxvi) 17[alpha]-methyl-4-hydroxynandrolone (17[alpha]- 
4        methyl-4-hydroxy-17[beta]-hydroxyestr-4-en-3-one), 
5    (xxxvii) methyldienolone (17[alpha]-methyl-17[beta]- 
6        hydroxyestra-4,9(10)-dien-3-one), 
7    (xxxviii) methyltrienolone (17[alpha]-methyl-17[beta]- 
8        hydroxyestra-4,9-11-trien-3-one), 
9    (xxxix) methyltestosterone (17[alpha]-methyl-17[beta]- 
10        hydroxyandrost-4-en-3-one), 
11    (xl) mibolerone (7[alpha],17a-dimethyl-17[beta]- 
12        hydroxyestr-4-en-3-one), 
13    (xli) 17[alpha]-methyl-[delta]1-dihydrotestosterone  
14        (17b[beta]-hydroxy-17[alpha]-methyl-5[alpha]- 
15        androst-1-en-3-one)(a.k.a. '17-[alpha]-methyl- 
16        1-testosterone'), 
17    (xlii) nandrolone (17[beta]-hydroxyestr-4-en-3-one), 
18    (xliii) 19-nor-4-androstenediol (3[beta], 17[beta]- 
19        dihydroxyestr-4-ene), 
20    (xliv) 19-nor-4-androstenediol (3[alpha], 17[beta]- 
21        dihydroxyestr-4-ene), 
22    (xlv) 19-nor-5-androstenediol (3[beta], 17[beta]- 
23        dihydroxyestr-5-ene), 
24    (xlvi) 19-nor-5-androstenediol (3[alpha], 17[beta]- 
25        dihydroxyestr-5-ene), 
26    (xlvii) 19-nor-4,9(10)-androstadienedione  

 

 

09900HB0421ham002- 34 -LRB099 05828 AMC 34231 a

1        (estra-4,9(10)-diene-3,17-dione), 
2    (xlviii) 19-nor-4-androstenedione (estr-4- 
3        en-3,17-dione), 
4    (xlix) 19-nor-5-androstenedione (estr-5- 
5        en-3,17-dione), 
6    (l) norbolethone (13[beta], 17a-diethyl-17[beta]- 
7        hydroxygon-4-en-3-one), 
8    (li) norclostebol (4-chloro-17[beta]- 
9        hydroxyestr-4-en-3-one), 
10    (lii) norethandrolone (17[alpha]-ethyl-17[beta]- 
11        hydroxyestr-4-en-3-one), 
12    (liii) normethandrolone (17[alpha]-methyl-17[beta]- 
13        hydroxyestr-4-en-3-one), 
14    (liv) oxandrolone (17[alpha]-methyl-17[beta]-hydroxy- 
15        2-oxa-5[alpha]-androstan-3-one), 
16    (lv) oxymesterone (17[alpha]-methyl-4,17[beta]- 
17        dihydroxyandrost-4-en-3-one), 
18    (lvi) oxymetholone (17[alpha]-methyl-2-hydroxymethylene- 
19        17[beta]-hydroxy-(5[alpha]-androstan-3-one), 
20    (lvii) stanozolol (17[alpha]-methyl-17[beta]-hydroxy- 
21        (5[alpha]-androst-2-eno[3,2-c]-pyrazole), 
22    (lviii) stenbolone (17[beta]-hydroxy-2-methyl- 
23        (5[alpha]-androst-1-en-3-one), 
24    (lix) testolactone (13-hydroxy-3-oxo-13,17- 
25        secoandrosta-1,4-dien-17-oic 
26        acid lactone), 

 

 

09900HB0421ham002- 35 -LRB099 05828 AMC 34231 a

1    (lx) testosterone (17[beta]-hydroxyandrost- 
2        4-en-3-one), 
3    (lxi) tetrahydrogestrinone (13[beta], 17[alpha]- 
4        diethyl-17[beta]-hydroxygon- 
5        4,9,11-trien-3-one), 
6    (lxii) trenbolone (17[beta]-hydroxyestr-4,9, 
7        11-trien-3-one). 
8    Any person who is otherwise lawfully in possession of an
9anabolic steroid, or who otherwise lawfully manufactures,
10distributes, dispenses, delivers, or possesses with intent to
11deliver an anabolic steroid, which anabolic steroid is
12expressly intended for and lawfully allowed to be administered
13through implants to livestock or other nonhuman species, and
14which is approved by the Secretary of Health and Human Services
15for such administration, and which the person intends to
16administer or have administered through such implants, shall
17not be considered to be in unauthorized possession or to
18unlawfully manufacture, distribute, dispense, deliver, or
19possess with intent to deliver such anabolic steroid for
20purposes of this Act.
21    (d) "Administration" means the Drug Enforcement
22Administration, United States Department of Justice, or its
23successor agency.
24    (d-5) "Clinical Director, Prescription Monitoring Program"
25means a Department of Human Services administrative employee
26licensed to either prescribe or dispense controlled substances

 

 

09900HB0421ham002- 36 -LRB099 05828 AMC 34231 a

1who shall run the clinical aspects of the Department of Human
2Services Prescription Monitoring Program and its Prescription
3Information Library.
4    (d-10) "Compounding" means the preparation and mixing of
5components, excluding flavorings, (1) as the result of a
6prescriber's prescription drug order or initiative based on the
7prescriber-patient-pharmacist relationship in the course of
8professional practice or (2) for the purpose of, or incident
9to, research, teaching, or chemical analysis and not for sale
10or dispensing. "Compounding" includes the preparation of drugs
11or devices in anticipation of receiving prescription drug
12orders based on routine, regularly observed dispensing
13patterns. Commercially available products may be compounded
14for dispensing to individual patients only if both of the
15following conditions are met: (i) the commercial product is not
16reasonably available from normal distribution channels in a
17timely manner to meet the patient's needs and (ii) the
18prescribing practitioner has requested that the drug be
19compounded.
20    (e) "Control" means to add a drug or other substance, or
21immediate precursor, to a Schedule whether by transfer from
22another Schedule or otherwise.
23    (f) "Controlled Substance" means (i) a drug, substance, or
24immediate precursor in the Schedules of Article II of this Act
25or (ii) a drug or other substance, or immediate precursor,
26designated as a controlled substance by the Department through

 

 

09900HB0421ham002- 37 -LRB099 05828 AMC 34231 a

1administrative rule. The term does not include distilled
2spirits, wine, malt beverages, or tobacco, as those terms are
3defined or used in the Liquor Control Act of 1934 and the
4Tobacco Products Tax Act of 1995.
5    (f-5) "Controlled substance analog" means a substance:
6        (1) the chemical structure of which is substantially
7    similar to the chemical structure of a controlled substance
8    in Schedule I or II;
9        (2) which has a stimulant, depressant, or
10    hallucinogenic effect on the central nervous system that is
11    substantially similar to or greater than the stimulant,
12    depressant, or hallucinogenic effect on the central
13    nervous system of a controlled substance in Schedule I or
14    II; or
15        (3) with respect to a particular person, which such
16    person represents or intends to have a stimulant,
17    depressant, or hallucinogenic effect on the central
18    nervous system that is substantially similar to or greater
19    than the stimulant, depressant, or hallucinogenic effect
20    on the central nervous system of a controlled substance in
21    Schedule I or II.
22    (g) "Counterfeit substance" means a controlled substance,
23which, or the container or labeling of which, without
24authorization bears the trademark, trade name, or other
25identifying mark, imprint, number or device, or any likeness
26thereof, of a manufacturer, distributor, or dispenser other

 

 

09900HB0421ham002- 38 -LRB099 05828 AMC 34231 a

1than the person who in fact manufactured, distributed, or
2dispensed the substance.
3    (h) "Deliver" or "delivery" means the actual, constructive
4or attempted transfer of possession of a controlled substance,
5with or without consideration, whether or not there is an
6agency relationship.
7    (i) "Department" means the Illinois Department of Human
8Services (as successor to the Department of Alcoholism and
9Substance Abuse) or its successor agency.
10    (j) (Blank).
11    (k) "Department of Corrections" means the Department of
12Corrections of the State of Illinois or its successor agency.
13    (l) "Department of Financial and Professional Regulation"
14means the Department of Financial and Professional Regulation
15of the State of Illinois or its successor agency.
16    (m) "Depressant" means any drug that (i) causes an overall
17depression of central nervous system functions, (ii) causes
18impaired consciousness and awareness, and (iii) can be
19habit-forming or lead to a substance abuse problem, including
20but not limited to alcohol, cannabis and its active principles
21and their analogs, benzodiazepines and their analogs,
22barbiturates and their analogs, opioids (natural and
23synthetic) and their analogs, and chloral hydrate and similar
24sedative hypnotics.
25    (n) (Blank).
26    (o) "Director" means the Director of the Illinois State

 

 

09900HB0421ham002- 39 -LRB099 05828 AMC 34231 a

1Police or his or her designated agents.
2    (p) "Dispense" means to deliver a controlled substance to
3an ultimate user or research subject by or pursuant to the
4lawful order of a prescriber, including the prescribing,
5administering, packaging, labeling, or compounding necessary
6to prepare the substance for that delivery.
7    (q) "Dispenser" means a practitioner who dispenses.
8    (r) "Distribute" means to deliver, other than by
9administering or dispensing, a controlled substance.
10    (s) "Distributor" means a person who distributes.
11    (t) "Drug" means (1) substances recognized as drugs in the
12official United States Pharmacopoeia, Official Homeopathic
13Pharmacopoeia of the United States, or official National
14Formulary, or any supplement to any of them; (2) substances
15intended for use in diagnosis, cure, mitigation, treatment, or
16prevention of disease in man or animals; (3) substances (other
17than food) intended to affect the structure of any function of
18the body of man or animals and (4) substances intended for use
19as a component of any article specified in clause (1), (2), or
20(3) of this subsection. It does not include devices or their
21components, parts, or accessories.
22    (t-5) "Euthanasia agency" means an entity certified by the
23Department of Financial and Professional Regulation for the
24purpose of animal euthanasia that holds an animal control
25facility license or animal shelter license under the Animal
26Welfare Act. A euthanasia agency is authorized to purchase,

 

 

09900HB0421ham002- 40 -LRB099 05828 AMC 34231 a

1store, possess, and utilize Schedule II nonnarcotic and
2Schedule III nonnarcotic drugs for the sole purpose of animal
3euthanasia.
4    (t-10) "Euthanasia drugs" means Schedule II or Schedule III
5substances (nonnarcotic controlled substances) that are used
6by a euthanasia agency for the purpose of animal euthanasia.
7    (u) "Good faith" means the prescribing or dispensing of a
8controlled substance by a practitioner in the regular course of
9professional treatment to or for any person who is under his or
10her treatment for a pathology or condition other than that
11individual's physical or psychological dependence upon or
12addiction to a controlled substance, except as provided herein:
13and application of the term to a pharmacist shall mean the
14dispensing of a controlled substance pursuant to the
15prescriber's order which in the professional judgment of the
16pharmacist is lawful. The pharmacist shall be guided by
17accepted professional standards including, but not limited to
18the following, in making the judgment:
19        (1) lack of consistency of prescriber-patient
20    relationship,
21        (2) frequency of prescriptions for same drug by one
22    prescriber for large numbers of patients,
23        (3) quantities beyond those normally prescribed,
24        (4) unusual dosages (recognizing that there may be
25    clinical circumstances where more or less than the usual
26    dose may be used legitimately),

 

 

09900HB0421ham002- 41 -LRB099 05828 AMC 34231 a

1        (5) unusual geographic distances between patient,
2    pharmacist and prescriber,
3        (6) consistent prescribing of habit-forming drugs.
4    (u-0.5) "Hallucinogen" means a drug that causes markedly
5altered sensory perception leading to hallucinations of any
6type.
7    (u-1) "Home infusion services" means services provided by a
8pharmacy in compounding solutions for direct administration to
9a patient in a private residence, long-term care facility, or
10hospice setting by means of parenteral, intravenous,
11intramuscular, subcutaneous, or intraspinal infusion.
12    (u-5) "Illinois State Police" means the State Police of the
13State of Illinois, or its successor agency.
14    (v) "Immediate precursor" means a substance:
15        (1) which the Department has found to be and by rule
16    designated as being a principal compound used, or produced
17    primarily for use, in the manufacture of a controlled
18    substance;
19        (2) which is an immediate chemical intermediary used or
20    likely to be used in the manufacture of such controlled
21    substance; and
22        (3) the control of which is necessary to prevent,
23    curtail or limit the manufacture of such controlled
24    substance.
25    (w) "Instructional activities" means the acts of teaching,
26educating or instructing by practitioners using controlled

 

 

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1substances within educational facilities approved by the State
2Board of Education or its successor agency.
3    (x) "Local authorities" means a duly organized State,
4County or Municipal peace unit or police force.
5    (y) "Look-alike substance" means a substance, other than a
6controlled substance which (1) by overall dosage unit
7appearance, including shape, color, size, markings or lack
8thereof, taste, consistency, or any other identifying physical
9characteristic of the substance, would lead a reasonable person
10to believe that the substance is a controlled substance, or (2)
11is expressly or impliedly represented to be a controlled
12substance or is distributed under circumstances which would
13lead a reasonable person to believe that the substance is a
14controlled substance. For the purpose of determining whether
15the representations made or the circumstances of the
16distribution would lead a reasonable person to believe the
17substance to be a controlled substance under this clause (2) of
18subsection (y), the court or other authority may consider the
19following factors in addition to any other factor that may be
20relevant:
21        (a) statements made by the owner or person in control
22    of the substance concerning its nature, use or effect;
23        (b) statements made to the buyer or recipient that the
24    substance may be resold for profit;
25        (c) whether the substance is packaged in a manner
26    normally used for the illegal distribution of controlled

 

 

09900HB0421ham002- 43 -LRB099 05828 AMC 34231 a

1    substances;
2        (d) whether the distribution or attempted distribution
3    included an exchange of or demand for money or other
4    property as consideration, and whether the amount of the
5    consideration was substantially greater than the
6    reasonable retail market value of the substance.
7    Clause (1) of this subsection (y) shall not apply to a
8noncontrolled substance in its finished dosage form that was
9initially introduced into commerce prior to the initial
10introduction into commerce of a controlled substance in its
11finished dosage form which it may substantially resemble.
12    Nothing in this subsection (y) prohibits the dispensing or
13distributing of noncontrolled substances by persons authorized
14to dispense and distribute controlled substances under this
15Act, provided that such action would be deemed to be carried
16out in good faith under subsection (u) if the substances
17involved were controlled substances.
18    Nothing in this subsection (y) or in this Act prohibits the
19manufacture, preparation, propagation, compounding,
20processing, packaging, advertising or distribution of a drug or
21drugs by any person registered pursuant to Section 510 of the
22Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360).
23    (y-1) "Mail-order pharmacy" means a pharmacy that is
24located in a state of the United States that delivers,
25dispenses or distributes, through the United States Postal
26Service or other common carrier, to Illinois residents, any

 

 

09900HB0421ham002- 44 -LRB099 05828 AMC 34231 a

1substance which requires a prescription.
2    (z) "Manufacture" means the production, preparation,
3propagation, compounding, conversion or processing of a
4controlled substance other than methamphetamine, either
5directly or indirectly, by extraction from substances of
6natural origin, or independently by means of chemical
7synthesis, or by a combination of extraction and chemical
8synthesis, and includes any packaging or repackaging of the
9substance or labeling of its container, except that this term
10does not include:
11        (1) by an ultimate user, the preparation or compounding
12    of a controlled substance for his or her own use; or
13        (2) by a practitioner, or his or her authorized agent
14    under his or her supervision, the preparation,
15    compounding, packaging, or labeling of a controlled
16    substance:
17            (a) as an incident to his or her administering or
18        dispensing of a controlled substance in the course of
19        his or her professional practice; or
20            (b) as an incident to lawful research, teaching or
21        chemical analysis and not for sale.
22    (z-1) (Blank).
23    (z-5) "Medication shopping" means the conduct prohibited
24under subsection (a) of Section 314.5 of this Act.
25    (z-10) "Mid-level practitioner" means (i) a physician
26assistant who has been delegated authority to prescribe through

 

 

09900HB0421ham002- 45 -LRB099 05828 AMC 34231 a

1a written delegation of authority by a physician licensed to
2practice medicine in all of its branches, in accordance with
3Section 7.5 of the Physician Assistant Practice Act of 1987,
4(ii) an advanced practice nurse who has been delegated
5authority to prescribe through a written delegation of
6authority by a physician licensed to practice medicine in all
7of its branches or by a podiatric physician, in accordance with
8Section 65-40 of the Nurse Practice Act, (iii) an advanced
9practice nurse certified as a nurse practitioner, nurse
10midwife, or clinical nurse specialist who has been granted
11authority to prescribe by a hospital affiliate in accordance
12with Section 65-45 of the Nurse Practice Act, (iv) an animal
13euthanasia agency, or (v) (iv) a prescribing psychologist.
14    (aa) "Narcotic drug" means any of the following, whether
15produced directly or indirectly by extraction from substances
16of vegetable origin, or independently by means of chemical
17synthesis, or by a combination of extraction and chemical
18synthesis:
19        (1) opium, opiates, derivatives of opium and opiates,
20    including their isomers, esters, ethers, salts, and salts
21    of isomers, esters, and ethers, whenever the existence of
22    such isomers, esters, ethers, and salts is possible within
23    the specific chemical designation; however the term
24    "narcotic drug" does not include the isoquinoline
25    alkaloids of opium;
26        (2) (blank);

 

 

09900HB0421ham002- 46 -LRB099 05828 AMC 34231 a

1        (3) opium poppy and poppy straw;
2        (4) coca leaves, except coca leaves and extracts of
3    coca leaves from which substantially all of the cocaine and
4    ecgonine, and their isomers, derivatives and salts, have
5    been removed;
6        (5) cocaine, its salts, optical and geometric isomers,
7    and salts of isomers;
8        (6) ecgonine, its derivatives, their salts, isomers,
9    and salts of isomers;
10        (7) any compound, mixture, or preparation which
11    contains any quantity of any of the substances referred to
12    in subparagraphs (1) through (6).
13    (bb) "Nurse" means a registered nurse licensed under the
14Nurse Practice Act.
15    (cc) (Blank).
16    (dd) "Opiate" means any substance having an addiction
17forming or addiction sustaining liability similar to morphine
18or being capable of conversion into a drug having addiction
19forming or addiction sustaining liability.
20    (ee) "Opium poppy" means the plant of the species Papaver
21somniferum L., except its seeds.
22    (ee-5) "Oral dosage" means a tablet, capsule, elixir, or
23solution or other liquid form of medication intended for
24administration by mouth, but the term does not include a form
25of medication intended for buccal, sublingual, or transmucosal
26administration.

 

 

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1    (ff) "Parole and Pardon Board" means the Parole and Pardon
2Board of the State of Illinois or its successor agency.
3    (gg) "Person" means any individual, corporation,
4mail-order pharmacy, government or governmental subdivision or
5agency, business trust, estate, trust, partnership or
6association, or any other entity.
7    (hh) "Pharmacist" means any person who holds a license or
8certificate of registration as a registered pharmacist, a local
9registered pharmacist or a registered assistant pharmacist
10under the Pharmacy Practice Act.
11    (ii) "Pharmacy" means any store, ship or other place in
12which pharmacy is authorized to be practiced under the Pharmacy
13Practice Act.
14    (ii-5) "Pharmacy shopping" means the conduct prohibited
15under subsection (b) of Section 314.5 of this Act.
16    (ii-10) "Physician" (except when the context otherwise
17requires) means a person licensed to practice medicine in all
18of its branches.
19    (jj) "Poppy straw" means all parts, except the seeds, of
20the opium poppy, after mowing.
21    (kk) "Practitioner" means a physician licensed to practice
22medicine in all its branches, dentist, optometrist, podiatric
23physician, veterinarian, scientific investigator, pharmacist,
24physician assistant, advanced practice nurse, licensed
25practical nurse, registered nurse, hospital, laboratory, or
26pharmacy, or other person licensed, registered, or otherwise

 

 

09900HB0421ham002- 48 -LRB099 05828 AMC 34231 a

1lawfully permitted by the United States or this State to
2distribute, dispense, conduct research with respect to,
3administer or use in teaching or chemical analysis, a
4controlled substance in the course of professional practice or
5research.
6    (ll) "Pre-printed prescription" means a written
7prescription upon which the designated drug has been indicated
8prior to the time of issuance; the term does not mean a written
9prescription that is individually generated by machine or
10computer in the prescriber's office.
11    (mm) "Prescriber" means a physician licensed to practice
12medicine in all its branches, dentist, optometrist,
13prescribing psychologist licensed under Section 4.2 of the
14Clinical Psychologist Licensing Act with prescriptive
15authority delegated under Section 4.3 of the Clinical
16Psychologist Licensing Act, podiatric physician, or
17veterinarian who issues a prescription, a physician assistant
18who issues a prescription for a controlled substance in
19accordance with Section 303.05, a written delegation, and a
20written supervision agreement required under Section 7.5 of the
21Physician Assistant Practice Act of 1987, or an advanced
22practice nurse with prescriptive authority delegated under
23Section 65-40 of the Nurse Practice Act and in accordance with
24Section 303.05, a written delegation, and a written
25collaborative agreement under Section 65-35 of the Nurse
26Practice Act, or an advanced practice nurse certified as a

 

 

09900HB0421ham002- 49 -LRB099 05828 AMC 34231 a

1nurse practitioner, nurse midwife, or clinical nurse
2specialist who has been granted authority to prescribe by a
3hospital affiliate in accordance with Section 65-45 of the
4Nurse Practice Act and in accordance with Section 303.05.
5    (nn) "Prescription" means a written, facsimile, or oral
6order, or an electronic order that complies with applicable
7federal requirements, of a physician licensed to practice
8medicine in all its branches, dentist, podiatric physician or
9veterinarian for any controlled substance, of an optometrist
10for a Schedule II, III, IV, or V controlled substance in
11accordance with Section 15.1 of the Illinois Optometric
12Practice Act of 1987, of a prescribing psychologist licensed
13under Section 4.2 of the Clinical Psychologist Licensing Act
14with prescriptive authority delegated under Section 4.3 of the
15Clinical Psychologist Licensing Act, of a physician assistant
16for a controlled substance in accordance with Section 303.05, a
17written delegation, and a written supervision agreement
18required under Section 7.5 of the Physician Assistant Practice
19Act of 1987, or of an advanced practice nurse with prescriptive
20authority delegated under Section 65-40 of the Nurse Practice
21Act who issues a prescription for a controlled substance in
22accordance with Section 303.05, a written delegation, and a
23written collaborative agreement under Section 65-35 of the
24Nurse Practice Act, or of an advanced practice nurse certified
25as a nurse practitioner, nurse midwife, or clinical nurse
26specialist who has been granted authority to prescribe by a

 

 

09900HB0421ham002- 50 -LRB099 05828 AMC 34231 a

1hospital affiliate in accordance with Section 65-45 of the
2Nurse Practice Act and in accordance with Section 303.05 when
3required by law.
4    (nn-5) "Prescription Information Library" (PIL) means an
5electronic library that contains reported controlled substance
6data.
7    (nn-10) "Prescription Monitoring Program" (PMP) means the
8entity that collects, tracks, and stores reported data on
9controlled substances and select drugs pursuant to Section 316.
10    (oo) "Production" or "produce" means manufacture,
11planting, cultivating, growing, or harvesting of a controlled
12substance other than methamphetamine.
13    (pp) "Registrant" means every person who is required to
14register under Section 302 of this Act.
15    (qq) "Registry number" means the number assigned to each
16person authorized to handle controlled substances under the
17laws of the United States and of this State.
18    (qq-5) "Secretary" means, as the context requires, either
19the Secretary of the Department or the Secretary of the
20Department of Financial and Professional Regulation, and the
21Secretary's designated agents.
22    (rr) "State" includes the State of Illinois and any state,
23district, commonwealth, territory, insular possession thereof,
24and any area subject to the legal authority of the United
25States of America.
26    (rr-5) "Stimulant" means any drug that (i) causes an

 

 

09900HB0421ham002- 51 -LRB099 05828 AMC 34231 a

1overall excitation of central nervous system functions, (ii)
2causes impaired consciousness and awareness, and (iii) can be
3habit-forming or lead to a substance abuse problem, including
4but not limited to amphetamines and their analogs,
5methylphenidate and its analogs, cocaine, and phencyclidine
6and its analogs.
7    (ss) "Ultimate user" means a person who lawfully possesses
8a controlled substance for his or her own use or for the use of
9a member of his or her household or for administering to an
10animal owned by him or her or by a member of his or her
11household.
12(Source: P.A. 97-334, eff. 1-1-12; 98-214, eff. 8-9-13; 98-668,
13eff. 6-25-14; 98-756, eff. 7-16-14; 98-1111, eff. 8-26-14;
14revised 10-1-14.)
 
15    (720 ILCS 570/303.05)
16    Sec. 303.05. Mid-level practitioner registration.
17    (a) The Department of Financial and Professional
18Regulation shall register licensed physician assistants,
19licensed advanced practice nurses, and prescribing
20psychologists licensed under Section 4.2 of the Clinical
21Psychologist Licensing Act to prescribe and dispense
22controlled substances under Section 303 and euthanasia
23agencies to purchase, store, or administer animal euthanasia
24drugs under the following circumstances:
25        (1) with respect to physician assistants,

 

 

09900HB0421ham002- 52 -LRB099 05828 AMC 34231 a

1            (A) the physician assistant has been delegated
2        written authority to prescribe any Schedule III
3        through V controlled substances by a physician
4        licensed to practice medicine in all its branches in
5        accordance with Section 7.5 of the Physician Assistant
6        Practice Act of 1987; and the physician assistant has
7        completed the appropriate application forms and has
8        paid the required fees as set by rule; or
9            (B) the physician assistant has been delegated
10        authority by a supervising physician licensed to
11        practice medicine in all its branches to prescribe or
12        dispense Schedule II controlled substances through a
13        written delegation of authority and under the
14        following conditions:
15                (i) Specific Schedule II controlled substances
16            by oral dosage or topical or transdermal
17            application may be delegated, provided that the
18            delegated Schedule II controlled substances are
19            routinely prescribed by the supervising physician.
20            This delegation must identify the specific
21            Schedule II controlled substances by either brand
22            name or generic name. Schedule II controlled
23            substances to be delivered by injection or other
24            route of administration may not be delegated;
25                (ii) any delegation must be of controlled
26            substances prescribed by the supervising

 

 

09900HB0421ham002- 53 -LRB099 05828 AMC 34231 a

1            physician;
2                (iii) all prescriptions must be limited to no
3            more than a 30-day supply, with any continuation
4            authorized only after prior approval of the
5            supervising physician;
6                (iv) the physician assistant must discuss the
7            condition of any patients for whom a controlled
8            substance is prescribed monthly with the
9            delegating physician;
10                (v) the physician assistant must have
11            completed the appropriate application forms and
12            paid the required fees as set by rule;
13                (vi) the physician assistant must provide
14            evidence of satisfactory completion of 45 contact
15            hours in pharmacology from any physician assistant
16            program accredited by the Accreditation Review
17            Commission on Education for the Physician
18            Assistant (ARC-PA), or its predecessor agency, for
19            any new license issued with Schedule II authority
20            after the effective date of this amendatory Act of
21            the 97th General Assembly; and
22                (vii) the physician assistant must annually
23            complete at least 5 hours of continuing education
24            in pharmacology;
25        (2) with respect to advanced practice nurses,
26            (A) the advanced practice nurse has been delegated

 

 

09900HB0421ham002- 54 -LRB099 05828 AMC 34231 a

1        authority to prescribe any Schedule III through V
2        controlled substances by a collaborating physician
3        licensed to practice medicine in all its branches or a
4        collaborating podiatric physician in accordance with
5        Section 65-40 of the Nurse Practice Act. The advanced
6        practice nurse has completed the appropriate
7        application forms and has paid the required fees as set
8        by rule; or
9            (B) the advanced practice nurse has been delegated
10        authority by a collaborating physician licensed to
11        practice medicine in all its branches or collaborating
12        podiatric physician to prescribe or dispense Schedule
13        II controlled substances through a written delegation
14        of authority and under the following conditions:
15                (i) specific Schedule II controlled substances
16            by oral dosage or topical or transdermal
17            application may be delegated, provided that the
18            delegated Schedule II controlled substances are
19            routinely prescribed by the collaborating
20            physician or podiatric physician. This delegation
21            must identify the specific Schedule II controlled
22            substances by either brand name or generic name.
23            Schedule II controlled substances to be delivered
24            by injection or other route of administration may
25            not be delegated;
26                (ii) any delegation must be of controlled

 

 

09900HB0421ham002- 55 -LRB099 05828 AMC 34231 a

1            substances prescribed by the collaborating
2            physician or podiatric physician;
3                (iii) all prescriptions must be limited to no
4            more than a 30-day supply, with any continuation
5            authorized only after prior approval of the
6            collaborating physician or podiatric physician;
7                (iv) the advanced practice nurse must discuss
8            the condition of any patients for whom a controlled
9            substance is prescribed monthly with the
10            delegating physician or podiatric physician or in
11            the course of review as required by Section 65-40
12            of the Nurse Practice Act;
13                (v) the advanced practice nurse must have
14            completed the appropriate application forms and
15            paid the required fees as set by rule;
16                (vi) the advanced practice nurse must provide
17            evidence of satisfactory completion of at least 45
18            graduate contact hours in pharmacology for any new
19            license issued with Schedule II authority after
20            the effective date of this amendatory Act of the
21            97th General Assembly; and
22                (vii) the advanced practice nurse must
23            annually complete 5 hours of continuing education
24            in pharmacology;
25        (2.5) with respect to advanced practice nurses
26    certified as nurse practitioners, nurse midwives, or

 

 

09900HB0421ham002- 56 -LRB099 05828 AMC 34231 a

1    clinical nurse specialists practicing in a hospital
2    affiliate,
3            (A) the advanced practice nurse certified as a
4        nurse practitioner, nurse midwife, or clinical nurse
5        specialist has been granted authority to prescribe any
6        Schedule II through V controlled substances by the
7        hospital affiliate upon the recommendation of the
8        appropriate physician committee of the hospital
9        affiliate in accordance with Section 65-45 of the Nurse
10        Practice Act, has completed the appropriate
11        application forms, and has paid the required fees as
12        set by rule; and
13            (B) an advanced practice nurse certified as a nurse
14        practitioner, nurse midwife, or clinical nurse
15        specialist has been granted authority to prescribe any
16        Schedule II controlled substances by the hospital
17        affiliate upon the recommendation of the appropriate
18        physician committee of the hospital affiliate, then
19        the following conditions must be met:
20                (i) specific Schedule II controlled substances
21            by oral dosage or topical or transdermal
22            application may be designated, provided that the
23            designated Schedule II controlled substances are
24            routinely prescribed by advanced practice nurses
25            in their area of certification; this grant of
26            authority must identify the specific Schedule II

 

 

09900HB0421ham002- 57 -LRB099 05828 AMC 34231 a

1            controlled substances by either brand name or
2            generic name; authority to prescribe or dispense
3            Schedule II controlled substances to be delivered
4            by injection or other route of administration may
5            not be granted;
6                (ii) any grant of authority must be controlled
7            substances limited to the practice of the advanced
8            practice nurse;
9                (iii) any prescription must be limited to no
10            more than a 30-day supply;
11                (iv) the advanced practice nurse must discuss
12            the condition of any patients for whom a controlled
13            substance is prescribed monthly with the
14            appropriate physician committee of the hospital
15            affiliate or its physician designee; and
16                (v) the advanced practice nurse must meet the
17            education requirements of this Section;
18        (3) with respect to animal euthanasia agencies, the
19    euthanasia agency has obtained a license from the
20    Department of Financial and Professional Regulation and
21    obtained a registration number from the Department; or
22        (4) with respect to prescribing psychologists, the
23    prescribing psychologist has been delegated authority to
24    prescribe any nonnarcotic Schedule III through V
25    controlled substances by a collaborating physician
26    licensed to practice medicine in all its branches in

 

 

09900HB0421ham002- 58 -LRB099 05828 AMC 34231 a

1    accordance with Section 4.3 of the Clinical Psychologist
2    Licensing Act, and the prescribing psychologist has
3    completed the appropriate application forms and has paid
4    the required fees as set by rule.
5    (b) The mid-level practitioner shall only be licensed to
6prescribe those schedules of controlled substances for which a
7licensed physician or licensed podiatric physician has
8delegated prescriptive authority, except that an animal
9euthanasia agency does not have any prescriptive authority. A
10physician assistant and an advanced practice nurse are
11prohibited from prescribing medications and controlled
12substances not set forth in the required written delegation of
13authority.
14    (c) Upon completion of all registration requirements,
15physician assistants, advanced practice nurses, and animal
16euthanasia agencies may be issued a mid-level practitioner
17controlled substances license for Illinois.
18    (d) A collaborating physician or podiatric physician may,
19but is not required to, delegate prescriptive authority to an
20advanced practice nurse as part of a written collaborative
21agreement, and the delegation of prescriptive authority shall
22conform to the requirements of Section 65-40 of the Nurse
23Practice Act.
24    (e) A supervising physician may, but is not required to,
25delegate prescriptive authority to a physician assistant as
26part of a written supervision agreement, and the delegation of

 

 

09900HB0421ham002- 59 -LRB099 05828 AMC 34231 a

1prescriptive authority shall conform to the requirements of
2Section 7.5 of the Physician Assistant Practice Act of 1987.
3    (f) Nothing in this Section shall be construed to prohibit
4generic substitution.
5(Source: P.A. 97-334, eff. 1-1-12; 97-358, eff. 8-12-11;
697-813, eff. 7-13-12; 98-214, eff. 8-9-13; 98-668, eff.
76-25-14.)".