Commissioner's Regulations

Part 64, Nursing

Effective August 17, 2006

§64.1 Professional study of nursing | §64.2 Licensing examinations | §64.3 Limited permits | §64.4 Nurse practitioner certification | §64.5 Nurse practitioner practice | §64.6 Prescription and direction of nursing services | §64.7 Immunizations and emergency treatment of anaphylaxis, purified protein derivative (PPD) mantoux tuberculin skin tests and human immunodeficiency virus (HIV) tests pursuant to non-patient specific orders and protocols

§64.1 Professional study of nursing.

  1. Registered professional nursing. To meet the professional education requirement, the applicant shall have graduated from:
    1. a program in nursing registered by the department as preparation for practice as a registered professional nurse;
    2. a program in nursing approved by the licensing authority in another state, territory or possession of the United States as preparation for practice as a registered professional nurse; or
    3. a general nursing course of at least two academic years in a country outside the United States and its territories or possessions that is satisfactory to the department and that the licensing authority or appropriate governmental agency of said country certifies to the department as being preparation for practice as a registered professional nurse. For issuance of a limited permit, an applicant shall obtain a score satisfactory to the department on a proficiency examination selected by the department as evidence of equivalent training, if the applicant's nursing education was obtained in a school of nursing outside the United States and its territories and has not been determined by the department to be equivalent in quality and scope to a program of nursing education registered by the department.
  2. Licensed practical nursing. To meet the education requirements, the applicant shall have graduated from high school or its equivalent, and shall have:
    1. graduated from a program in nursing registered by the department or approved by the licensing authority in another state, territory, or possession of the United States as preparation for practice as a licensed practical nurse;
    2. completed preparation in a program determined by the department to be equivalent to the programs described in paragraph (1) of this subdivision;
    3. graduated from a program in practical nursing of at least nine months in a country outside the United States and its territories or possessions, which program is satisfactory to the department and which program the licensing authority of said country certifies to the department as being preparation for practice as a licensed practical nurse; or
    4. graduated from a general nursing course in a country outside the United States and its territories that is satisfactory to the department and that the licensing authority of said country certifies to the department as being preparation for practice as a professional nurse.

§64.2 Licensing examinations.

  1. Registered professional nursing.
    1. All parts of the registered professional nurse licensing examination shall be taken each time the candidate is examined.
    2. Each candidate for licensure as a registered professional nurse examined after November 22, 1961 shall have taken an examination acceptable to the State Board for Nursing. Except as provided in Section 64.3 of this Part, each candidate examined after May 31,1974 shall have taken the same examination on the same dates such examination was given in this State.
    3. The registered professional nurse licensing examination results shall be reported as a single score. Applicants who have passed a part or parts of the registered professional nurse licensing examination prior to July 1,1982 may not retain credit for such part or parts beyond that date.
  2. Licensed practical nursing.
    1. A candidate for licensure as a practical nurse shall pass an examination acceptable to the State Board for Nursing. Each candidate examined after September 11, 1974 shall have taken the same examination on the same dates such examination was given in this State.
    2. The passing score as determined by the State Board for Nursing for the licensed practical nurse licensing examination shall be reported as a single score.

§64.3 Limited permits.

A limited permit to practice as a registered professional nurse or licensed practical nurse may be issued after the applicant has met requirements of age, moral character, education and proficiency examination, if applicable, provided that the applicant has not failed the professional licensing examination. Failure on a registered professional nurse licensing examination shall not preclude issuance of a limited permit to practice as a licensed practical nurse.


§64.4 Nurse practitioner certification.

  1. Certificates.
    1. Nurse practitioner certificates issued to a registered professional nurse will reflect the specialty area of nurse practitioner academic preparation.
    2. The certificate will specify the specialty area of practice and, when applicable, that prescriptive privileges have been granted.
    3. A nurse practitioner may apply for certification in more than one specialty area of practice. A complete application and fee shall be required for each certificate.
  2. Professional study. To meet the professional education requirements for certification in this State, the applicant shall present evidence of:
    1. i. completion of an educational program registered by the department, or a program determined by the department to be equivalent to a registered program, which is designed and conducted to prepare graduates to practice as nurse practitioners; or ii. certification as a nurse practitioner by a national certifying body acceptable to the department; and
    2. completion of not less than three semester hours or the equivalent in pharmacology either in an acceptable nurse practitioner program or after other educational requirements for certification as nurse practitioner have been satisfied. An acceptable course in pharmacology shall be equivalent in scope and content to that required by Section 52.12 of this Title.
  3. Alternative criteria for certification.
    1. For applicants whose professional education as a nurse practitioner was completed prior to April 1, 1989, the department may accept as alternative educational criteria the following qualifications:
      1. A program of education preparation for the provision of primary health care services as nurse practitioner of at least four weeks in duration, and completed prior to April 1,1989; and
      2. a course of instruction in pharmacotherapeutics management as required by this subdivision; and either:
      3. two years of experience prior to April 1, 1989, at least one year of which shall be subsequent to April 1, 1986, in the provision of primary health care services in a health care facility licensed pursuant to Article 28 of the Public Health Law or in a school health demonstration project; or
      4. satisfactory completion of a supplemental educational program culminating in the successful completion of a comprehensive examination or clinical evaluation.
    2. the department may accept as alternative criteria for satisfaction of the pharmacotherapeutics requirement set forth in paragraph 2 of subdivision (b) of this section any of the following:
      1. an educational program or a combination of courses which is the substantial equivalent in content and scope to the pharmacotherapeutics component of a registered program; or
      2. satisfactory completion of an examination in pharmacotherapeutics satisfactory to the department; or
      3. satisfactory completion of a nationally recognized examination acceptable for licensure in New York State as a physician assistant or as a midwife.
    3. The department may issue a certificate upon the receipt of satisfactory evidence that an applicant licensed or certified in another state or country has met the substantial equivalent of the New York requirements for certification. An applicant who does not have the substantial equivalent of all of the New York requirements may be required to make up specific deficiencies and/or pass a proficiency examination.
  4. Alternative criteria for certification in additional specialty areas of practice.
    1. The alternative requirements of this subdivision are only available to applicants who apply to the department for certification in the additional specialty area of practice on or before September 15, 2006 and who meet all requirements for certification under this subdivision by September 15, 2007. These alternative requirements for certification shall not be available to applicants who do not meet these conditions and shall not be available to applicants who apply for certification after September 15, 2006.
    2. An applicant who has been certified as a nurse practitioner may be certified in an additional specialty or specialties upon the submission of evidence satisfactory to the department that the criteria for initial certification in the additional specialty or specialties has been met, or in the alternative, that the applicant has met the following alternative education and experience requirements:
      1. Alternative education. The department may accept 60 hours of continuing education obtained in the specialty area of practice in which certification is sought. Such continuing education may be obtained through the completion of any of the following:
        1. academic courses or continuing education programs approved by the department or by a nursing or medical organization or accrediting agency acceptable to the department; or
        2. evidence of preparation for the specialty by service as a presenter or lecturer in an academic or continuing education program, or by the publication in a professional journal of clinical information related to the specialty. Credit for such services or publication may not exceed 30 contact hours;
        3. independent study in an academic course or continuing education program may be accepted but may not exceed 12 contact hours;
        4. for the purposes of this paragraph one contact hour shall include at least 50 minutes of study and one academic semester hour shall equal 15 contact hours and one academic quarter hour shall equal 12.5 contact hours.
      2. Alternative experience. The department may accept either:
        1. one thousand hours of clinical practice after April 1, 1986 in the specialty for which additional certification is sought. Such practice shall be in a health care facility licensed pursuant to article 28 of the Public Health Law or in a school health demonstration project; or
        2. three hundred hours of clinical practice as part of a clinical practicum affiliated with a nurse practitioner program registered by the department, or accredited by an accrediting agency acceptable to the department.
    3. Evidence of completion of educational programs, experience and examinations submitted to meet alternative criteria for certification as a nurse practitioner must be satisfactory to the department, and the overall preparation of the applicant must be comparable by assessment and substantially equivalent to the preparation provided by a registered or approved program. The department may require verification of the content and completion of the program or experience and of the satisfactory performance of the applicant by the person or institution conducting the program or in which the experience was acquired.
  5. Prescriptive privilege. An applicant who satisfies all requirements for certification as a nurse practitioner may be authorized to issue prescriptions pursuant to Section 6902(3)(b) of the Education Law after completing instruction, satisfactory to the department, in New York State and Federal laws and regulations relating to prescriptions and recordkeeping.

§64.5 Nurse practitioner practice.

  1. Practice agreements and practice protocols shall be maintained in the practice setting of the nurse practitioner and collaborating physician and shall be available to the department for inspection.
  2. Practice agreements shall include provisions for referral and consultation, coverage for emergency absences of either the nurse practitioner or collaborating physician, resolution of disagreements between the nurse practitioner and collaborating physician regarding matters of diagnosis and treatment, and the review of patient records at least every three months by the collaborating physician; and may include such other provisions as determined by the nurse practitioner and collaborating physician to be appropriate.
  3. Protocols shall identify the area of practice to be performed by the nurse practitioner in collaboration with the physician and shall reflect accepted standards of nursing and medical practice. Protocols shall include provisions for case management, including diagnosis, treatment, and appropriate recordkeeping by the nurse practitioner; and may include such other provisions as are determined by the nurse practitioner and collaborating physician to be appropriate. Such protocols may be updated periodically.
  4. The department in its discretion or upon request of a nurse practitioner or collaborating physician may review practice protocols for the purpose of insuring that they are in conformance with accepted medical and nursing practice and with the statutes and regulations governing the practice of medicine, nursing, and the prescribing of drugs, and may render an opinion which shall be binding upon the parties to the protocol. A practice and protocol committee designated by the Deputy Commissioner for the Professions shall review practice protocols and shall recommend findings as to their adequacy and conformity with current accepted medical and nursing practice. If the department determines that a protocol is inadequate or contrary to current accepted medical and nursing practice it shall communicate that determination, and the reasons therefor, to the nurse practitioner and to the collaborating physician in writing. The nurse practitioner and collaborating physician shall conform to accepted medical and nursing practice immediately, and shall submit a revised protocol within 30 days of receipt of the department's determination, unless an extension of time is requested and granted by the department. Continuation of practice in violation of the determination shall constitute unprofessional conduct by either or both licensees.
  5. An appeal from a determination that a practice protocol is inadequate or contrary to current accepted medical and nursing practice may be taken within 30 days after receipt of the notice of determination by a petition setting forth the reasons for the appeal, and signed by both the nurse practitioner and the collaborating physician. Such joint appeal shall be filed with the Division of Professional Licensing Services and determined by the Committee on the Professions whose determination shall be final.
  6. In addition to the requirements of Section 6810 of the Education Law, prescription forms used by nurse practitioners shall be printed with the name, nurse practitioner certificate number, office address, and office telephone number of the nurse practitioner.

§64.6 Prescription and direction of nursing services.

  1. Health care providers authorized to prescribe medical regimens to be executed by a registered professional nurse shall include persons licensed or authorized to practice pursuant to a limited permit or statutory exemption from the licensure requirement in the following licensed professions: medicine, including physician's assistant and specialist's assistant; dentistry; podiatry; midwifery; and nurse practitioner.
  2. Health care providers authorized to direct the performance of professional services by licensed practical nurses shall include persons licensed or authorized to practice pursuant to a limited permit or statutory exemption from the licensure requirement in the following licensed professions: medicine, including physician's assistant and specialist's assistant; dentistry; podiatry; midwifery; and registered professional nursing, including but not limited to nurse practitioners.

§64.7 Immunizations and emergency treatment of anaphylaxis, purified protein derivative (PPD) mantoux tuberculin skin tests and human immunodeficiency virus (HIV) tests pursuant to non-patient specific orders and protocols.

  1. Immunizations.
    1. Pursuant to subdivision (5) of section 6909 of the Education Law, a registered professional nurse shall be authorized to administer immunization agents prescribed in paragraph (2) of this subdivision to patients therein specified, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner, provided the registered nurse meets the prerequisite requirements prescribed in paragraph (3) of this subdivision and the order and protocol meets the requirements of paragraph (4) of this subdivision.
    2. Authorized immunization agents.
      1. Adult immunizations. A registered professional nurse that meets the requirements of paragraph (3) of this subdivision shall be authorized to administer the following immunization agents to patients 18 years of age or older, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner that meets the requirements of paragraph (4) of this subdivision: Hepatitis A, Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, Inactivated Polio, Acellular Pertussis, Human Papilloma Virus, Smallpox vaccine, and additional immunizations 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 who are 18 years or older, pursuant to a nonpatient 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 who are 18 years or older, pursuant to a nonpatient 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.
      2. Child immunizations. A registered professional nurse that meets the requirements of paragraph (3) of this subdivision and who is employed or is acting as an agent for the Visiting Nurses Association or other equivalent organization as determined by the department that is legally authorized to provide nursing services, or for a State, county, municipal or other government agency, shall be authorized to administer the following immunization agents to patients under the age of 18, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner that meets the requirements of paragraph (4) of this subdivision: Diphtheria, Tetanus, Acellular Pertussis, Measles, Mumps, Rubella, Varicella, Haemophilus Influenzae Type b (Hib), Inactivated Polio, Hepatitis B, Rotovirus, Human Papilloma Virus, and additional immunizations 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 who are under the age of 18 years old, 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 safety and effectiveness 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 who are under the age of 18 years old, pursuant to a non-patient specific order and protocol 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.
      3. Epidemics. Notwithstanding the requirements of subparagraphs (i) and (ii) of this paragraph, a registered professional nurse that meets the requirements of paragraph (3) of this subdivision shall be authorized to administer to patients, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a nurse practitioner that meets the requirements of paragraph (4) of this subdivision, any immunization agents authorized under such order and protocol to be administered as part of an immunization program maintained, authorized, or under the auspices of the Commissioner of Health, a county commissioner of health, or a county public health director, when such an immunization program is instituted pursuant to an epidemic declared by such official.
    3. Prerequisite requirements. For a registered professional nurse authorized to administer immunization agents prescribed in paragraph (2) of this subdivision to recipients therein specified, pursuant to a non-patient specific order and protocol prescribed by a licensed physician or a certified nurse practitioner, such registered professional nurse shall be currently certified in cardio-pulmonary resuscitation by a program of the American Red Cross or 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.
    4. Order and Protocol.
      1. 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 immunization agents, 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 is immunized and maintained as a record for the period of time prescribed in paragraph 29.2(a)(3) of this Title.
      2. 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 immunization 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 immunizations outside of such employment or contract. The order shall contain but shall not be limited to the following information:
        1. the specific immunization agents that the registered professional nurse(s) is permitted to administer;
        2. the period of time that the order is effective, including the beginning and ending dates;
        3. the name and license number of the registered professional nurse(s) authorized to administer the immunization 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 immunization agent(s) pursuant to the order;
        4. 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 immunizations only in the course of such employment or pursuant to such contract; and
        5. the name, license number, and signature of the licensed physician or nurse practitioner who has issued the order.
      3. The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:
        1. The registered professional nurse shall ensure that each potential recipient is assessed for untoward conditions that would preclude immunization(s) and each recipient's record of immunization with manufacturer and lot number or a potential recipient's refusal to be immunized shall be documented in accordance with paragraph 29.2(a)(3) of this Title.
        2. The registered professional nurse shall be responsible for having emergency anaphylaxis treatment agents, related syringes and needles available at the immunization site.
        3. The registered professional nurse shall inform each recipient of potential side effects and adverse reactions, orally and in writing, prior to immunization. The registered professional nurse shall provide written instructions to the recipient regarding the appropriate course of action in the event of untoward or adverse reactions, which statements are required to be developed by a competent entity knowledgeable about the untoward or adverse reactions of the immunization agent which shall be administered, such as the Centers for Disease Control of the U.S. Department of Health and Human Services, which issues vaccine information statements. The registered professional nurse shall not administer immunizations unless the recipient is adequately informed as prescribed in this clause and the recipient consents to the immunization; except for minors or other recipients incapable of consenting to the administration of an immunization, in which case a person legally responsible for the recipient shall have given prior written consent to the immunization after having been informed in writing as prescribed in this clause before it may be administered; or shall be in attendance during the immunization, informed as prescribed in this clause, and have consented to the immunization before it may be administered.
        4. The registered professional nurse shall provide to each recipient or other person legally responsible when the recipient is a minor or otherwise incapable of consenting to immunization, a signed certificate of immunization with the recipient's name, date of immunization, address of administration, administering nurse, immunization agent, manufacturer and lot number and recommendations for future immunizations recorded thereon. With the consent of the recipient or a person legally responsible when the recipient is a minor or otherwise incapable of consenting, the registered professional nurse shall communicate this information to the recipient's primary health care provider, if one exists.
        5. Each registered professional nurse shall report any adverse outcomes as may be required by Federal law on the Vaccine Adverse Event Reporting System form of the Centers for Disease Control of the U.S. Department of Health and Human Services, or on the successor form.
        6. Each registered professional nurse shall ensure that a record of all persons immunized including the recipient's name, date, address of administration, administering nurse, immunization agent, manufacturer, lot number and recommendations for future immunizations is recorded and maintained in accordance with paragraph 29.2(a)(3) of this Title.
  2. Anaphylaxis treatment agents.
    1. Pursuant to subdivision (5) of section 6909 of 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) of this subdivision.
    2. Order and Protocol.
      1. 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 paragraph 29.2(a)(3) of this Title.
      2. 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:
        1. the specific anaphylaxis treatment agents that the registered professional nurse(s) is permitted to administer;
        2. the period of time that the order is effective, including the beginning and end date; and
        3. 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;
        4. 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
        5. the name, license number, and signature of the licensed physician or certified nurse practitioner who has issued the order.
      3. The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:
        1. 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 paragraph 29.2(a)(3) of this Title.
        2. 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.
        3. 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.
  3. Purified protein derivative (PPD) mantoux tuberculin skin tests.
    1. Pursuant to section 6909 (5) of the Education Law, a registered professional nurse shall be authorized to execute the order to administer purified protein derivative (PPD) mantoux tuberculin skin 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 meets the requirements of paragraph (2) of this subdivision.
    2. Order and Protocol.
      1. 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 the purified protein derivative (PPD) mantoux tuberculin skin test, 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 has received a purified protein derivative (PPD) mantoux tuberculin skin test and maintained as a record for the period of time prescribed in paragraph 29.2(a)(3) of this Title.
      2. 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 purified protein derivative (PPD) mantoux tuberculin skin 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 purified protein derivative (PPD) mantoux tuberculin skin tests outside of such employment or contract. The order shall contain but shall not be limited to the following information:
        1. identification of the purified protein derivative (PPD) mantoux tuberculin skin test;
        2. the period of time that the order is effective, including the beginning and ending dates;
        3. the name and license number of the registered professional nurse(s) authorized to execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin 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 prescribed purified protein derivative (PPD) mantoux tuberculin skin test;
        4. 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 purified protein derivative (PPD) mantoux tuberculin skin tests only in the course of such employment or pursuant to such contract; and
        5. the name, license number, and signature of the licensed physician or certified nurse practitioner that has issued the order.
      3. The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:
        1. The registered professional nurse shall ensure that each potential recipient is assessed for untoward conditions that would preclude purified protein derivative (PPD) mantoux tuberculin skin testing and each recipient's record of the purified protein derivative (PPD) mantoux tuberculin skin test with manufacturer and lot number or a potential recipient's refusal to be tested shall be documented in accordance with paragraph 29.2(a)(3) of this Title.
        2. The registered professional nurse shall be responsible for having emergency anaphylaxis treatment agents, related syringes and needles available at the purified protein derivative (PPD) mantoux tuberculin skin testing site, except in an emergency as determined by the Commissioner of Health, a county commissioner of health, or a county public health director.
        3. When the recipient of the test is legally capable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the recipient is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. In the case of minors or other recipients incapable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the person legally responsible for the recipient of the test is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. Prior to the registered professional nurse executing the order to administer the test, the recipient of the test, or the person legally responsible for the recipient of the test in the case of minors or other recipients incapable of consenting to the test, shall be informed in writing about the potential side effects of and adverse reactions to the test, the appropriate course of action in the event of untoward or adverse reactions to the test, and the need for test evaluation within 48 to 72 hours after the test is administered.
        4. The registered professional nurse shall ensure that the recipient, or other person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting to the test, is provided with a signed certificate of purified protein derivative (PPD) mantoux tuberculin skin testing and results, with the recipient's name, date of the test, address where the test was administered, administering nurse, manufacturer and lot number and recommendations for future tests recorded thereon. With the consent of the recipient or a person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting, the registered professional nurse shall ensure that this information is communicated to the recipient's primary health care provider if one exists.
        5. 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 number and recommendations for future tests is recorded and maintained in accordance with paragraph 29.2(a)(3) of this Title.
  4. 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 the Rules and Regulations of the New York State Department of Health (10 NYCRR 63.1).
    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.
    3. Order and Protocol.
      1. The registered professional nurse shall either maintain or ensure the maintenance of a copy of the non-pat ient 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 paragraph 29.2(a)(3) of this Title.
      2. 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:
        1. identification of the HIV test;
        2. the period of time that the order is effective, including the beginning and ending dates;
        3. the name and license number of the registered professional nurse(s) authorized to execute the order to adm inister 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;
        4. 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
        5. the name, license number, and signature of the licensed physician or certified nurse practitioner that has issued the order.
      3. The protocol, incorporated into the order prescribed in subparagraph (ii) of this paragraph, shall require the registered professional nurse to meet the following requirements:
        1. 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 paragraph 29.2(a)(3) of this Title.
        2. The registered professional nurse shall execute the order to administer a HIV test in accordance with applicable state laws and regulations, including, but not limited to Article 27-F of the Public Health Law and Part 63 of the Rules and Regulations of the New York State Department of Health.
        3. 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 Part 63 of the Rules and Regulations of the New York State Department of Health.
        4. 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.
        5. When a confirmatory, positive HIV test result is communicated to a recipient, the registered professional nurse shall 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 post-test counseling in conformance with the requirements of Article 27-F of the Public Health Law and Part 63 of the Rules and Regulations of the New York State Department of Health.
        6. 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. If the recipient has a confirmatory, positive HIV test result, the registered nurse shall not provide a signed certificate of HIV testing and results until after the physician or nurse practitioner who issued the non-patient specific order for the HIV test communicates the 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.
        7. 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 Part 63 of the Rules and Regulations of the New York State Department of Health.
        8. 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 Part 63 of the Rules and Regulations of the New York State Department of Health.
Last Updated: June 24, 2009