Sec. 10.32.03.05. Delegation Agreements — Contents

A. Before a physician may delegate medical acts and before a physician assistant may perform medical acts, the physician assistant and primary supervising physician shall file with the Board:

(1) A delegation agreement on the Board-approved form; and

(2) The required fee as specified in Regulation .16 of this chapter.

B. The delegation agreement shall include the following information:

(1) The primary supervising physician's Maryland license number;

(2) A description of the supervising physician’s qualifications to supervise a physician assistant;

(3) The physician assistant’s Maryland license number;

(4) The location and settings where the physician assistant will practice;

(5) The scope of the primary and alternate physicians’ practices;

(6) The delegated medical acts which the physician assistant will perform, including:

(a) Core duties; and

(b) Any advanced duties;

(7) A description of the continuous supervision mechanisms that the primary supervising physician will use;

(8) A description of how the physician assistant's performance will be evaluated; and

(9) Any other information deemed necessary by the Board to carry out the provisions of Health Occupations Article, Title 15, Annotated Code of Maryland.

C. The primary supervising physician shall make the following attestations as a part of the delegation agreement:

(1) All medical acts to be delegated to the physician assistant are within the scope of practice of the primary or alternate supervising physician and appropriate to the physician assistant's education, training, and level of competence;

(2) The primary supervising physician will utilize the mechanisms of continuous supervision as described in the delegation agreement;

(3) The primary supervising physician will accept responsibility for any care given by the physician assistant;

(4) The primary supervising physician will respond in a timely manner when contacted by the physician assistant;

(5) The primary supervising physician may not supervise more than four physician assistants at any one time, except as permitted in a:

(a) Hospital;

(b) Correctional facility;

(c) Detention center; or

(d) Public health facility; and

(6) The following statement: “The primary supervising physician and the physician assistant attest that:

(a) They will establish a plan for the types of cases that require a physician plan of care or require that the patient initially or periodically be seen by the supervising physician; and

(b) The patient will be provided access to the supervising physician on request.”

D. Except as provided in §E of this regulation, if a delegation agreement includes delegation of one or more advanced duties, the delegation agreement shall include the following additional information and documentation:

(1) In a special facility:

(a) A description of the advanced duty and the education, training, and experience that qualifies the physician assistant to perform the advanced duty; and

(b) A copy of the approved delineation of duties from the governing board of the health care facility stating that the physician assistant has been approved by the facility to perform the advanced duty; or

(2) In a setting other than a special facility:

(a) A description of the advanced duties to be delegated;

(b) Documentation of the specialized education, training, or experience received by the physician assistant in order to perform the advanced duties;

(c) The level of supervision that the primary supervising physician will use when the physician assistant is performing the advanced duty; and

(d) Documentation described in of Regulation .06F of this chapter if the delegation agreement includes a request for a temporary practice letter allowing the physician assistant to perform an advanced duty before approval by the Board.

E. If a delegation agreement includes the delegation of general anesthesia or neuroaxial anesthesia, the delegation agreement shall include all of the information specified in §D(2) of this regulation.

F. A physician assistant who has filed a delegation agreement with the Board for approval to perform the advanced duty of nonfluoroscopic X-ray procedures using a mini C-arm or similar low-level radiation machine shall present the Board with evidence of completion of a course on those procedures. The required course shall include:

(1) Didactic instruction of at least 8 hours on the following subject matters:

(a) Principles of radiography;

(b) Image acquisition;

(c) Principles of exposure;

(d) Image evaluation;

(e) Radiation safety;

(f) Equipment overview; and

(g) Documentation; and

(2) Clinical instruction, which shall:

(a) Include anterior-posterior and lateral radiographic studies of extremities, not including the head, on at least 20 separate patients; and

(b) Be under the direct supervision of the delegating physician or radiologist.