N.Y. Comp. Codes R. & Regs. tit. 8 § 64.7

Current through Register Vol. 46, No. 25, June 18, 2024

Section 64.7 - Provision of certain medical services pursuant to non-patient specific orders and protocols

(a) Immunizations.

(1) As used in this subdivision:

(i)Immunizing agents means vaccines and immunoglobulin drugs approved by the federal Food and Drug Administration to provide immunity against diseases caused by the infectious agents described in clauses (a) through (e) of this subparagraph.

(a) In the case of adults, vaccines against the following infectious diseases: Hepatitis A, Hepatitis B, Influenza, Pneumococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, Polio, Pertussis, Human Papilloma Virus, Meningococcus, Respiratory Syncytial Virus, and Herpes Zoster;

(b) In the case of infants and children under the age of 18, vaccines against the following infectious diseases: Diphtheria, Tetanus, Pertussis, Measles, Mumps, Rubella, Varicella, Haemophilus Influenzae Type b (Hib), Polio, Hepatitis B, Hepatitis A, Influenza, Meningococcus, Pneumococcus, Rotavirus, Respiratory Syncytial Virus, and Human Papilloma Virus;

(c) immunizing agents against an infectious disease that causes an epidemic or a community wide outbreak, provided that such immunizing agents are administered as part of a public health program established by the Commissioner of the Department of Health, a County Commissioner of Health, or a County Public Health Director to immunize persons against the infectious disease during the epidemic or community outbreak of the infectious disease;

(d) additional immunizing agents approved by resolution of the Board of Regents upon recommendation by the commissioner that such additional immunization agents are safe and effective immunization agents for registered professional nurses to administer to patients, pursuant to a non-patient specific order and protocol as prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the effectiveness and safety of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. Such additional immunization agents, which are not specifically enumerated in this subparagraph, may be removed by resolution of the Board of Regents, upon recommendation of the commissioner that such immunization agents are not safe and effective immunization agents for registered professional nurses to administer to patients, pursuant to a non-patient specific order and protocol as prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the effectiveness and safety of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services; and

(e) vaccines that are fully approved or authorized for emergency use by the federal Food and Drug Administration to provide immunity against COVID-19 and administered in accordance with applicable federal Food and Drug Administration requirements and recommendations.

(ii)Entity means a State or local government, partnership, corporation or other legal entity that is authorized by the Public Health Law, Education Law or other State statute to provide professional nursing services.

(2) A registered professional nurse may administer immunizing agent(s) pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(i) The registered professional nurse shall be certified in cardio-pulmonary resuscitation or basic life support by the American Red Cross, the American Heart Association or an equivalent organization acceptable to the department which has an established record of providing programs of cardio-pulmonary resuscitation training.

(ii) The registered professional nurse shall ensure that anaphylactic agents, syringes and needles are available at the location where the immunizing agents are being administered.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name of the specific immunizing agent(s) to be administered;

(c) a protocol for administering the ordered immunizing agent(s) or a specific reference to a separate written protocol for administering the ordered immunizing agent(s), which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be immunized, including the age range of such persons;

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the immunizing agent(s); or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurse(s) execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered immunizing agent(s);

(b) the potential recipient, or when the potential recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the potential recipient, receives federally required vaccine information, such as vaccine information statements, if applicable, and instructions on addressing adverse reactions to the vaccine;

(c) informed consent for administering the ordered immunizing agent(s) has been obtained, pursuant to the criteria in the protocol, from the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient;

(d) the administration of the ordered immunizing agent(s) is documented, including the recipient's name, date of administration, address of administration, administering nurse, immunization agent(s), manufacturer(s), lot number(s), in accordance with criteria in the protocol and that documentation relating to the immunizing agent(s) is maintained in accordance with section 29.2(a)(3) of this Title;

(e) the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient, receives a certificate of immunization with the recipient's name, date of administration, address of administration, administering nurse, immunization agent(s), manufacturer(s), and lot number(s). With the consent of the recipient or a person authorized to consent for the recipient, the registered professional nurse shall communicate this information to the recipient's primary health care provider;

(f) adverse outcomes resulting from the administered immunizing agent(s) shall be reported to the United States Department of Health and Human Services, as may be required by Federal Law; and

(g) immunizing agents administered to recipients are reported to the Department of Health or the New York City Department of Health and Mental Hygiene, as may be required by law.

(b) Anaphylaxis treatment agents.

(1) Pursuant to section 6909(5) the Education Law, a registered professional nurse shall be authorized to administer anaphylaxis treatment agents, including but not limited to epinephrine, for the emergency treatment of anaphylaxis, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner, provided the order and protocol meets the requirements of paragraph (2) this subdivision.

(2) Order and protocol.

(i) The registered professional nurse shall either maintain or ensure the maintenance of a copy of the non-patient specific order and protocol prescribed by a licensed physician or a certified nurse practitioner which authorizes a registered professional nurse to administer anaphylaxis treatment agents, including but not limited to epinephrine, for the emergency treatment of anaphylaxis, in accordance with the requirements of paragraph (1) of this subdivision. The order prescribed in subparagraph (ii) of this paragraph shall incorporate a protocol that meets the requirements of subparagraph (iii) of this paragraph. Such order and protocol shall be considered a record of the patient who receives the anaphylaxis treatment agent and maintained as a record for the period of time prescribed in section 29.2(a)(3) of this Title.

(ii) The order shall authorize one or more named registered professional nurses, or registered professional nurses who are not individually named but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, to administer specified anaphylaxis treatment agents for a prescribed period of time. In instances in which the registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, such registered professional nurses shall not be authorized by such order to administer anaphylaxis treatment agents outside of such employment or contract. The order shall contain but shall not be limited to the following information:

(a) the specific anaphylaxis treatment agents that the registered professional nurse(s) is permitted to administer;

(b) the period of time that the order is effective, including the beginning and end date;

(c) the name and license number of the registered professional nurse(s) authorized to administer the anaphylaxis treatment agent(s) pursuant to the order; or the name of the entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services with whom registered professional nurses who are not individually named are employed or under contract to administer the prescribed anaphylaxis treatment agent(s) pursuant to the order;

(d) in instances in which the registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, the order shall contain a statement limiting the registered professional nurses to administering anaphylaxis treatment agents only in the course of such employment or pursuant to such contract; and

(e) the name, license number, and signature of the licensed physician or certified nurse practitioner who has issued the order.

(iii) The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:

(a) Each registered professional nurse shall ensure that a record of all persons to whom they have administered an anaphylaxis treatment agent, including but not limited to: the recipient's name, date, address of administration, administering nurse, anaphylaxis treatment agent, manufacturer, and lot number, is recorded and maintained in accordance with section 29.2(a)(3) of this Title.

(b) The registered professional nurse shall contact the local emergency medical services system following the administration of the anaphylaxis treatment agent, or shall ensure that equivalent follow-up care is provided through other arrangements.

(c) The registered professional nurse shall report to the local emergency medical system or other provider of equivalent follow-up care information concerning the administration of the anaphylaxis treatment agent, including but not limited to: when it was administered, the dosage, strength, and route of administration. The registered professional nurse shall also report such information to the patient's primary care provider if one exists, unless the patient is unable to communicate the identity of his or her primary care provider.

(c) Tuberculosis tests.

(1) As used in this subdivision, tuberculosis tests means one or more laboratory or point of care tests approved by the Federal Food and Drug Administration to detect or screen for tuberculosis infections, including, but not limited to, tuberculin skin tests (purified protein derivative [PPD] tests).

(2) A registered professional nurse may administer tuberculosis tests pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name of the specific tuberculosis tests to be administered;

(c) a protocol for administering the ordered tuberculosis tests or a specific reference to a separate written protocol for administering the ordered tuberculosis tests, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be treated; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the tuberculosis tests; or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurse(s) execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity that is legally authorized to employ or contract with registered professional to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered tuberculosis tests;

(b) informed consent for administering the ordered tuberculosis tests or disclosing the tuberculosis tests results to a third party (if applicable) has been obtained pursuant to the criteria in the protocol from the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient;

(c) any tuberculosis test results are disclosed and any recommendations for follow up care are made in accordance with the criteria in the protocol; and

(d) the administration of the ordered tuberculosis tests and the test results are documented in the recipient's medical record in accordance with the criteria in the protocol and that documentation relating to tuberculosis testing is maintained in accordance with section 29.2(a)(3) of this Title;

(e) additional requirements for tuberculin skin tests. If the non-patient specific order authorizes a tuberculin skin tests, the written protocol shall, in addition to the foregoing:

(1) require the registered professional nurse to have emergency anaphylaxis treatment agents available at the tuberculin skin testing site, except in an emergency determined by the Commissioner of Health, New York City Commissioner of the Department of Health and Mental Hygiene, a county commissioner of health, or a county public health director;

(2) require that, prior to administering the tuberculin skin tests, the potential test recipient or a person authorized pursuant to law to consent to health care for the recipient receives written information regarding the potential side effects and/or adverse reactions to the tuberculin skin tests and the appropriate course of action in the event of an adverse reaction to the test;

(3) require that, prior to administering the tuberculin skin tests, the potential test recipient or his or her authorized representative is informed of the need for a test evaluation within 48 to 72 hours after the test is administered;

(4) require that the test recipient or recipient's authorized representative receives a signed certificate of tuberculin skin testing, which shall include the results with the recipient's name, date of tests, address where the tests was administered, administering nurse, manufacturer and lot numbers for the tuberculin solution administered, as well as any recommendations for future tests; and

(5) require that the name of the manufacturer and lot number of the tuberculin solution that was administered to the recipient are documented in his or her medical record, along with the date that the tuberculin skin tests was administered and the date that the test results were evaluated.

(d) Human Immunodeficiency Virus (HIV) tests.

(1) As used in this subdivision, human immunodeficiency virus (HIV) test means HIV-related test as defined in section 63.1 of this Title.

(2) Pursuant to section 6909(5) of the Education Law, a registered professional nurse shall be authorized to execute an order to administer HIV tests, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner, provided the order and protocol meet the requirements of paragraph (3) of this subdivision. The following provisions apply to the administration of an HIV test pursuant to a non-patient specific standing order when such test is administered by a registered professional nurse.

(3) Order and protocol.

(i) The registered professional nurse shall either maintain or ensure the maintenance of a copy of the non-patient specific order and protocol prescribed by a licensed physician or a certified nurse practitioner, which authorizes a registered professional nurse to execute the order to administer an HIV test, in accordance with the requirements of paragraph (2) of this subdivision. The order prescribed in subparagraph (ii) of this paragraph shall incorporate a protocol that meets the requirements of subparagraph (iii) of this paragraph. Such order and protocol shall be considered a record of the patient who has received an HIV test and be maintained as a record for the period of time prescribed in section 29.2(a)(3) of this Title.

(ii) The order shall authorize one or more named registered professional nurses, or registered professional nurses who are not individually named but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, to execute the order to administer HIV tests for a prescribed period of time. In instances in which the registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, such registered professional nurses shall not be authorized by such order to execute the order to administer HIV tests outside of such employment or contract. The order shall contain but shall not be limited to the following information:

(a) identification of the HIV test;

(b) the period of time that the order is effective, including the beginning and ending dates;

(c) the name and license number of the registered professional nurse(s) authorized to execute the order to administer the HIV test; or the name of the entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services with whom registered professional nurses who are not individually named are employed or under contract to execute the order to administer the HIV test;

(d) in instances in which registered professional nurses are not individually named in the order, but are identified as employed or under contract with an entity that is legally authorized to employ or contract with registered professional nurses to provide nursing services, the order shall contain a statement limiting registered professional nurses to execute the order to administer HIV tests only in the course of such employment or pursuant to such contract; and

(e) the name, license number, and signature of the licensed physician or certified nurse practitioner that has issued the order.

(iii) The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:

(a) the registered professional nurse shall ensure that each potential recipient is assessed for conditions that would preclude HIV testing and ensure that each recipient's record of the HIV test with manufacturer and lot number or a potential recipient's refusal to be tested is documented in accordance with section 29.2(a)(3) of this Title;

(b) the registered professional nurse shall execute the order to administer an HIV test in accordance with applicable State laws and regulations, including but not limited to, article 27-F of the Public Health Law and 10 NYCRR Part 63;

(c) the registered professional nurse shall certify that he/she obtained the written, informed consent of the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual, prior to ordering the performance of the HIV test. Informed consent shall include pre-test counseling to the recipient, or if the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual. The written informed consent and the pre-test counseling shall be obtained and conducted in accordance with article 27-F of the Public Health Law and 10 NYCRR Part 63;

(d) a physician or nurse practitioner who issues a non-patient specific order for HIV testing shall retain responsibility for communication of a confirmatory, positive HIV test result to the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual. A registered professional nurse is not authorized to deliver a final confirmatory HIV positive test result through a non-patient specific order. A registered professional nurse may only deliver a confirmatory, positive HIV test result through a patient specific order as directed by the treating physician or nurse practitioner;

(e) the registered professional nurse shall, upon request, ensure that the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual, is provided with a signed certificate of HIV testing and results, with the recipient's name, date of the test, address where the test was administered, the name of the administering nurse, manufacturer and product lot number;

(f) with the consent of the recipient or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for such individual, and with an appropriate authorization for the release of confidential HIV information, the registered professional nurse shall ensure that this information is communicated to the recipient's primary health care provider if one exists in accordance with the requirements of article 27-F of the Public Health Law and 10 NYCRR Part 63; and

(g) each registered professional nurse shall ensure that a record of all persons so tested including the recipient's name, date of the test, address where the test was administered, administering nurse, test results, manufacturer, lot numbers and such other information as may be necessary pursuant to the protocol is recorded and maintained in accordance with section 29.2(a)(3) of this Title and article 27-F of the Public Health Law and 10 NYCRR Part 63.

(e) Opioid related overdose treatment.

(1) As used in this subdivision, opioid related overdose treatment shall include the administration of naloxone or another drug approved by the Federal Food and Drug Administration to treat opioid related overdose.

(2) A registered professional nurse may administer opioid related overdose treatment for the urgent or emergency treatment of opioid related overdose or suspected opioid related overdose pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name, dose and route of administration of the drug to be administered to treat opioid related overdose;

(c) a protocol for administering the ordered opioid related overdose treatment or a specific reference to a separate written protocol for administering the ordered opioid related overdose treatment, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be treated; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the opioid related overdose treatment; or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurses execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, include instructions for administering the opioid related overdose treatment and require the registered professional nurse to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered opioid related overdose treatment;

(b) consent to administer treatment is obtained, pursuant to criteria in the protocol, if the potential recipient is capable of providing it;

(c) the opioid related overdose treatment is documented, pursuant to criteria in the protocol, and includes the name and dose of drug administered, the date, time and location of the treatment, the recipient's name and the administering registered professional nurse's name and this medical documentation relating to opioid related overdose treatment is maintained in accordance with paragraph 29.2(a)(3) of this Title; and

(d) when opioid related overdose treatment is administered outside of a general hospital, the recipient of the treatment is transferred to a hospital for follow-up care to the extent possible along with documentation describing the opioid related overdose treatment that was administered, in accordance with criteria in the protocol.

(f) Hepatitis C tests.

(1) As used in this subdivision, hepatitis C tests mean one or more laboratory or point of care tests approved by the Federal Food and Drug Administration to detect the presence of antibodies or antigens to hepatitis C or the hepatitis C virus.

(2) A registered professional nurse may administer hepatitis C tests pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name of the specific hepatitis C tests to be administered;

(c) a protocol for administering the ordered hepatitis C tests or a specific reference to a separate written protocol for administering the ordered hepatitis C tests, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be tested; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the hepatitis C tests; or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurses execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered hepatitis C tests;

(b) informed consent for administering the ordered hepatitis C tests or disclosing the hepatitis C test results to a third party (if applicable) has been obtained pursuant to the criteria in the protocol from the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient;

(c) confirmatory, positive hepatitis C test results are not disclosed to the test recipient or the recipient's authorized representative by the registered professional nurse without a patient specific order from a licensed physician, licensed physician assistant or certified nurse practitioner; and

(d) the administration of the ordered hepatitis C test(s) is documented in the recipient's medical record in accordance with criteria in the protocol and that documentation relating to the hepatitis C testing is maintained in accordance with section 29.2(a)(3) of this Title.

(g) Screening for syphilis, gonorrhea and/or chlamydia infections.

(1) As used in this subdivision, screening means an assessment of an individual to ascertain his or her risk of having a syphilis, gonorrhea and/or chlamydia infection and may include the administration of one or more laboratory or point of care tests approved by the Federal Food and Drug Administration to detect or screen for syphilis, gonorrhea and/or chlamydia infections.

(2) A registered professional nurse may screen persons at increased risk for syphilis, gonorrhea and/or chlamydia pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the non-patient specific order and protocol;

(b) the name of the specific laboratory or point of care test(s) or assessment procedures to be administered;

(c) a protocol for administering the ordered screening for syphilis, gonorrhea and/or chlamydia infections or a specific reference to a separate written protocol for administering the ordered screening for syphilis, gonorrhea and/or chlamydia, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be screened; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to screen for syphilis, gonorrhea and/or chlamydia infections; or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol, provided that the registered professional nurses execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, include instructions for screening for syphilis, gonorrhea and/or chlamydia infections and require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered screening tests for syphilis, gonorrhea and/or chlamydia infections;

(b) informed consent for administering the ordered screening for syphilis, gonorrhea and/or chlamydia has been obtained from the recipient pursuant to the criteria in the protocol, or when the recipient lacks capacity to consent, from a person authorized pursuant to law to consent to health care for the recipient;

(c) positive test results for syphilis, gonorrhea and/or chlamydia infections are not disclosed to the test recipient or the recipient's authorized representative by the registered professional nurse without a patient specific order from a licensed physician, licensed physician assistant or certified nurse practitioner; and

(d) the administration of the ordered screening for syphilis, gonorrhea and/or chlamydia is documented in the recipient's medical record in accordance with criteria in the protocol and that documentation relating to the screening for syphilis, gonorrhea and/or chlamydia is maintained in accordance with section 29.2(a)(3) of this Title.

(h) COVID-19 tests and influenza tests.

(1) As used in this subdivision:

(i) COVID-19 test means one or more laboratory or point of care tests that have been fully approved or have received emergency use authorization by the Federal Food and Drug Administration to detect COVID-19 or its antibodies or to detect COVID-19 and influenza virus; and

(ii) influenza test means one or more laboratory or point of care tests approved by the Federal Food and Drug Administration to detect influenza virus.

(2) A registered professional nurse may administer a COVID-19 test or an influenza test pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The non-patient specific order shall include, at a minimum, the following:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the nonpatient specific order and protocol;

(b) the name of the specific COVID-19 or influenza test to be administered;

(c) a protocol for administering the ordered COVID-19 or influenza test or a specific reference to a separate written protocol for administering the ordered test, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be tested; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the ordered COVID-19 or influenza test, or the name of the entity that employs or contracts with registered professional nurse(s) to execute the non-patient specific order and protocol, provided that the registered professional nurse(s) execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the registered professional nurse(s) to ensure that:

(a) each potential recipient is assessed, pursuant to criteria in the protocol, for conditions that would qualify or preclude him or her from receiving the ordered test;

(b) informed consent for administering the ordered test or disclosing the test results to a third party (if applicable) has been obtained pursuant to the criteria in the protocol from the recipient, or when the recipient lacks capacity to consent, a person authorized pursuant to law to consent to health care for the recipient;

(c) positive diagnostic test results shall be disclosed to the test recipient, or the recipient's authorized representative, by the registered professional nurse as specifically authorized by the protocol or pursuant to a patient specific order from a licensed physician, licensed physician assistant, or certified nurse practitioner; and

(d) the administration of the ordered test(s) is documented in the recipient's medical record in accordance with criteria in the protocol. Such documentation shall be maintained in accordance with section 29.2(a)(3) of this Title.

(i) Emergency medical care.

(1) As used in this subdivision:

(i) Hospital means a general hospital as defined in subdivision 10 of section 2801 of the public health law.

(ii) Standing order means a written non-patient specific order and protocol prescribed or ordered by a licensed physician or certified nurse practitioner for providing emergency medical care to patients.

(iii) Patient means a person receiving medical care in a hospital or from another health care provider.

(v) Emergency medical care means medical care that is ordered or prescribed to expedite the detection of signs and symptoms of certain emergency medical conditions in patients or expedite medical intervention for emergency medical conditions or suspected emergency medical conditions. Such emergency medical care includes:

(a) administering an electrocardiogram to detect electrocardiographic changes and/or arrythmias associated with acute coronary syndrome, as set forth in a standing order;

(b) administering point-of-care tests that are approved by the United States Food and Drug Administration to determine blood glucose levels in patients with suspected hypoglycemia for the purpose of evaluating acute mental status changes, as set forth in a standing order;

(c) administering tests, which may include laboratory or point-of-care tests that are approved by the United States Food and Drug Administration or the department of health, to patients who meet criteria for severe sepsis and septic shock as set forth in a standing order; and

(d) establishing peripheral venous access on patients who meet severe sepsis and septic shock criteria as set forth in a standing order.

(2) A registered professional nurse may provide emergency medical care pursuant to a standing order, provided that the requirements of this subdivision are met. The registered professional nurse shall:

(i) be certified in cardio-pulmonary resuscitation, basic life support or more advanced life support by the American Red Cross, the American Heart Association, or an equivalent organization, acceptable to the department, which provides cardio-pulmonary resuscitation or life support training programs; or

(ii) be trained in or credentialed in basic or more advanced life support in a hospital if the registered professional nurse works in the hospital.

(3) Standing order.

(i) The standing order shall include, at a minimum:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the standing order;

(b) the name of the medical condition(s) for which the emergency medical care is ordered or prescribed to screen for;

(c) the name of the specific laboratory or point of care test(s), other medical test(s), or medical procedure(s) to be performed;

(d) a protocol for providing the ordered emergency medical care or a specific reference to a separate written protocol for providing the ordered emergency medical care, which shall meet the requirements of subparagraph (ii) of this paragraph;

(e) the period of time that the order is effective, including the beginning and ending dates;

(f) a description of the group(s) of patients or persons who may receive the ordered emergency medical care; and

(g) the name and license number of the registered professional nurse(s) authorized to execute the standing order or the name of the entity that employs or contracts with registered professional nurses to execute the standing order, provided that the registered professional nurses execute the standing order only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the standing order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, ensure that:

(a) each potential recipient of ordered emergency medical care is assessed, pursuant to measurable criteria in the protocol, for conditions that would qualify or preclude them from receiving the ordered emergency medical care;

(b) consent to provide the ordered emergency medical care pursuant to criteria in the protocol if the potential recipient is capable of providing it or from a person authorized by law to consent to health care on behalf of the potential recipient, if immediately available;

(c) instructions necessary for providing the ordered emergency medical care;

(d) any follow up actions to be undertaken by the registered professional nurse are described, including, but not limited to, disclosing test results to a third party or the recipient of the ordered test;

(e) when ordered emergency medical care is provided outside of a hospital, the recipient of the medical care is transferred to a general hospital for follow-up care in accordance with criteria in the protocol; and

(f) the provision of the ordered emergency medical care is documented in the patient's medical record and the documentation relating to the ordered emergency medical care is maintained in accordance with section 29.2(a)(3) of this Title.

(iii) Nothing in this subdivision shall construed to authorize a registered professional nurse to determine or rule out any medical diagnosis or determine any medical treatment to be provided.

(iv) Nothing in this subdivision shall be construed to delay access to medical services to be provided by a licensed physician, or emergency transportation to a hospital.

(j) Pregnancy tests.

(1) As used in this subdivision, pregnancy test means a laboratory or point-of-care test that is approved by the United States Food and Drug Administration to determine pregnancy.

(2) A registered professional nurse may administer a pregnancy test pursuant to a non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner, provided that the requirements of this subdivision are met.

(3) Order and protocol.

(i) The order shall include, at a minimum:

(a) the name, license number and signature of the licensed physician or certified nurse practitioner who orders or prescribes the nonpatient specific order and protocol;

(b) the name of the specific pregnancy test to be administered;

(c) a protocol for administering the ordered pregnancy test or a specific reference to a separate written protocol administering the ordered pregnancy test, which shall meet the requirements of subparagraph (ii) of this paragraph;

(d) the period of time that the order is effective, including the beginning and ending dates;

(e) a description of the group(s) of persons to be tested; and

(f) the name and license number of the registered professional nurse(s) authorized to execute the non-patient specific order and protocol to administer the pregnancy test, or the name of the entity that employs or contracts with registered professional nurses to execute the non-patient specific order and protocol only in the course of such employment or pursuant to such contract and provided further that the entity is legally authorized to employ or contract with registered professional nurses to provide nursing services.

(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, ensure that:

(a) each potential recipient is screened, pursuant to criteria in the protocol, for conditions that would qualify or preclude them from receiving the ordered pregnancy test;

(b) informed consent for administering the ordered pregnancy test or disclosing the test results to a third party (if applicable) has been obtained pursuant to criteria in the protocol from the recipient or when the recipient lacks capacity to consent, a person authorized by law to consent to health care for the recipient;

(c) any follow up actions to be undertaken by the registered professional nurse are described, including, but not limited to, disclosing test results to a third party or the recipient of the ordered test; and

(d) the administration of the ordered pregnancy tests is documented in the recipient's medical record in accordance with criteria in the protocol, and that documentation relating to the pregnancy test is maintained in accordance with section 29.2(a)(3) of this Title.

N.Y. Comp. Codes R. & Regs. Tit. 8 § 64.7

Amended New York State Register October 7, 2015/Volume XXXVII, Issue 40, eff. 10/7/2015

Amended New York State Register June 1, 2016/Volume XXXVIII, Issue 22, eff. 6/1/2016

Amended New York State Register June 28, 2017 /Volume XXXIX, Issue 26, eff. 6/28/2017

Amended New York State Register September 25, 2019/Volume XLI, Issue 39, eff. 9/25/2019

Amended New York State Register March 2, 2022/Volume XLIV, Issue 09, eff. 3/2/2022

Amended New York State Register January 25, 2023/Volume XLIV, Issue 04, eff. 1/25/2023

Amended New York State Register February 28, 2024/Volume XLVI, Issue 9, eff. 2/28/2024

Amended New York State Register March 27, 2024/Volume XLVI, Issue 13, eff. 3/11/2024, exp. 5/9/2024 (Emergency)

Amended New York State Register May 1, 2024/Volume XLVI, Issue 18, eff. 5/1/2024