HB 195

                        LAWS OF ALASKA
                                      2026
Source  Chapter No.
CSHB 195(FIN)  _______
                                      AN ACT
Changing the term "physician assistant" to "physician associate"; relating to physician
associates; relating to collaborative practice agreements for pharmacists; relating to the
prescription of opioid overdose drugs; relating to the prescription and administration of drugs
and devices by pharmacists; relating to reciprocity for pharmacists; amending the definition of
"practitioner"; and providing for an effective date.
                                  _______________
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:
                         THE ACT FOLLOWS ON PAGE 1
                                                                         Enrolled HB 195
                                             AN ACT
1  Changing the term "physician assistant" to "physician associate"; relating to physician
2  associates; relating to collaborative practice agreements for pharmacists; relating to the
3  prescription of opioid overdose drugs; relating to the prescription and administration of drugs
4  and devices by pharmacists; relating to reciprocity for pharmacists; amending the definition of
5  "practitioner"; and providing for an effective date.
6_______________
7   * Section 1. AS 08.02.130(e) is amended to read:
8(e) A physician, podiatrist, osteopath, or physician associate [ASSISTANT]
9licensed under AS 08.64 may prescribe, dispense, or administer through telehealth
10under this section a prescription for a controlled substance listed in AS 11.71.140 -
1111.71.190 if the physician, podiatrist, osteopath, or physician associate [ASSISTANT]
12complies with state and federal law governing the prescription, dispensing, or
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1administering of a controlled substance.
2   * Sec. 2. AS 08.02.130(j)(1) is amended to read:
3(1) "health care provider" means
4(A)    an audiologist or speech-language pathologist licensed
5under AS 08.11; a behavior analyst licensed under AS 08.15; a chiropractor
6licensed under AS 08.20; a professional or associate counselor licensed under
7AS 08.29; a dental hygienist licensed under AS 08.32; a dentist licensed under
8AS 08.36; a dietitian or nutritionist licensed under AS 08.38; a naturopath
9licensed under AS 08.45; a marital and family therapist licensed under
10AS 08.63; a physician licensed under AS 08.64; a podiatrist, osteopath, or
11physician associate [ASSISTANT] licensed under AS 08.64; a direct-entry
12midwife certified under AS 08.65; a nurse licensed under AS 08.68; a
13dispensing optician licensed under AS 08.71; an optometrist licensed under
14AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or
15occupational    therapist   licensed   under   AS 08.84;   a     psychologist   or
16psychological associate licensed under AS 08.86; or a social worker licensed
17under AS 08.95;
18(B) a physician licensed in another state; or
19(C) a member of a multidisciplinary care team who is licensed
20in another state;
21  * Sec. 3. AS 08.02.130(j)(4) is amended to read:
22(4) "member of a multidisciplinary care team" means an audiologist,
23speech-language pathologist, behavior analyst, professional counselor, dietitian,
24nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician
25associate [ASSISTANT], nurse, pharmacist, physical therapist, occupational therapist,
26psychologist or psychological associate, advanced nurse practitioner, or social worker
27who is a member of a team coordinated by a physician licensed in another state who
28meets the requirements of (b)(3) of this section;
29  * Sec. 4. AS 08.02 is amended by adding a new section to article 3 to read:
30Sec. 08.02.150. Regulation of collaborative practice agreements. (a) The
31department or a board may not
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1(1) require a pharmacist to pay a fee to enter into, or provide patient
2care services under, a collaborative practice agreement;
3(2) require department or board approval of a collaborative practice
4agreement;
5(3) define the nature and scope of patient care services a pharmacist
6provides under a collaborative practice agreement; or
7(4) otherwise regulate collaborative practice agreements.
8(b) In this section,
9(1) "collaborative practice agreement" means a collaborative practice
10      agreement authorized under AS 08.80.337(a); and
11(2) "patient care services" has the meaning given in AS 08.80.337(d).
12 * Sec. 5. AS 08.36.355(c) is amended by adding a new paragraph to read:
13(4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).
14 * Sec. 6. AS 08.36.355 is amended by adding a new subsection to read:
15(d) A licensee who issues a prescription for an opioid to a patient shall offer
16      the patient a prescription for an opioid overdose drug if
17(1) the prescription is for an opioid that exceeds a three-day supply;
18(2) the prescription is for a total daily opioid dosage representing a
19      morphine milligram equivalent of 50 milligrams or more;
20(3) the patient is concurrently prescribed a benzodiazepine; or
21(4) the patient has a history of overdose or substance use disorder.
22 * Sec. 7. AS 08.64.010 is amended to read:
23Sec. 08.64.010. Creation and membership of State Medical Board. The
24      governor shall appoint a board of medical examiners, to be known as the State
25      Medical Board, consisting of five physicians licensed in the state and residing in as
26      many separate geographical areas of the state as possible, one physician associate
27      [ASSISTANT] licensed under AS 08.64.107, and two persons with no direct financial
28      interest in the health care industry.
29 * Sec. 8. AS 08.64.101(a) is amended to read:
30(a) The board shall
31(1) except as provided in regulations adopted by the board under (b) of
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1this section, examine and issue licenses to applicants;
2(2) develop written guidelines to ensure that licensing requirements are
3not unreasonably burdensome and the issuance of licenses is not unreasonably
4withheld or delayed;
5(3) after a hearing, impose disciplinary sanctions on persons who
6violate this chapter or the regulations or orders of the board;
7(4) adopt regulations ensuring that renewal of licenses is contingent on
8proof of continued competency on the part of the licensee;
9(5)   under regulations adopted by the board, contract with private
10professional organizations to establish an impaired medical professionals program to
11identify, confront, evaluate, and treat persons licensed under this chapter who abuse
12alcohol, other drugs, or other substances or are mentally ill or cognitively impaired;
13(6)     adopt regulations that establish guidelines for a physician or
14physician associate [ASSISTANT] who is rendering a diagnosis, providing treatment,
15or prescribing, dispensing, or administering a prescription drug to a person without
16conducting a physical examination under AS 08.64.364; the guidelines must include a
17nationally recognized model policy for standards of care of a patient who is at a
18different location than the physician or physician associate [ASSISTANT];
19(7)     require that a licensee who has a federal Drug Enforcement
20Administration registration number register with the controlled substance prescription
21database under AS 17.30.200(n).
22  * Sec. 9. AS 08.64.106 is amended to read:
23Sec. 08.64.106. Delegation of routine medical duties. The board shall adopt
24regulations authorizing a physician, podiatrist, osteopath, or physician associate
25[ASSISTANT] licensed under this chapter to delegate routine medical duties to an
26agent of the physician, podiatrist, osteopath, or physician associate [ASSISTANT].
27The regulations must
28(1) require that an agent who is not licensed under this chapter may
29perform duties delegated under this section only if the agent meets applicable
30standards established by the board;
31(2)     require that a physician, podiatrist, osteopath, or physician
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1associate [ASSISTANT] may not delegate duties related to pain management and
2opioid use and addiction; and
3(3) define the phrase "routine medical duties."
4  * Sec. 10. AS 08.64.107 is amended to read:
5Sec. 08.64.107. Regulation of physician associates [ASSISTANTS]. The
6board shall adopt regulations regarding the licensure of physician associates
7[ASSISTANTS] and the medical services that they may perform, including the
8(1) educational and other qualifications, including education in pain
9management and opioid use and addiction;
10(2) application and licensing procedures;
11(3) scope of activities authorized; and
12(4) responsibilities of the supervising or training physician.
13 * Sec. 11. AS 08.64.170(a) is amended to read:
14(a) A person may not practice medicine, podiatry, or osteopathy in the state
15      unless the person is licensed under this chapter, except that
16(1) a physician associate [ASSISTANT] may examine, diagnose, or
17      treat persons under the supervision, control, and responsibility of either a physician
18      licensed under this chapter or a physician exempted from licensing under
19      AS 08.64.370;
20(2) a person who is licensed or authorized under another law of the
21      state may engage in a practice that is authorized under that law; and
22(3)   a person may perform routine medical duties delegated under
23      AS 08.64.106.
24 * Sec. 12. AS 08.64.360 is amended to read:
25Sec. 08.64.360. Penalty for practicing without a license or in violation of
26      law. Except for a physician associate [ASSISTANT] or a person licensed or
27      authorized under another law of the state who engages in practices for which that
28      person is licensed or authorized under that law, a person practicing medicine or
29      osteopathy in the state without a valid license or permit is guilty of a class A
30      misdemeanor. Each day of illegal practice is a separate offense.
31 * Sec. 13. AS 08.64.363(c) is amended by adding a new paragraph to read:
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1(4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).
2   * Sec. 14. AS 08.64.363 is amended by adding a new subsection to read:
3(d) A licensee who issues a prescription for an opioid to a patient shall offer
4the patient a prescription for an opioid overdose drug if
5(1) the prescription is for an opioid that exceeds a three-day supply;
6(2) the prescription is for a total daily opioid dosage representing a
7morphine milligram equivalent of 50 milligrams or more;
8(3) the patient is concurrently prescribed a benzodiazepine; or
9(4) the patient has a history of overdose or substance use disorder.
10  * Sec. 15. AS 08.64.364(a) is amended to read:
11(a)   The board may not impose disciplinary sanctions on a physician or
12physician associate [ASSISTANT] for rendering a diagnosis, providing treatment, or
13prescribing, dispensing, or administering a prescription drug that is not a controlled
14substance to a person without conducting a physical examination if
15(1)   the physician, physician associate [ASSISTANT], or another
16licensed health care provider in the medical practice is available to provide follow-up
17care; and
18(2) the physician or physician associate [ASSISTANT] requests that
19the person consent to sending a copy of all records of the encounter to the person's
20primary care provider if the prescribing physician or physician associate
21[ASSISTANT] is not the person's primary care provider and, if the person consents,
22the physician or physician associate [ASSISTANT] sends the records to the person's
23primary care provider.
24  * Sec. 16. AS 08.64.364(b) is amended to read:
25(b)   The board may not impose disciplinary sanctions on a physician or
26physician associate [ASSISTANT] for prescribing, dispensing, or administering a
27prescription drug that is a controlled substance if the requirements under (a) of this
28section and AS 08.64.363 are met.
29  * Sec. 17. AS 08.64.364(c) is amended to read:
30(c) Notwithstanding (a) and (b) of this section,
31(1) a physician may not prescribe, dispense, or administer an abortion-
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1inducing drug under (a) of this section unless the physician complies with
2AS 18.16.010; and
3(2)   a physician or physician associate [ASSISTANT] may not
4prescribe, dispense, or administer a prescription drug in response to an Internet
5questionnaire or electronic mail message to a person with whom the physician or
6physician associate [ASSISTANT] does not have a prior physician-patient
7relationship.
8  * Sec. 18. AS 08.64.369(d) is amended to read:
9(d) In this section, "health care professional" includes an emergency medical
10      technician certified under AS 18.08, health aide, physician, nurse, mobile intensive
11      care paramedic licensed under AS 18.08, and physician associate [ASSISTANT], but
12      does not include a practitioner of religious healing.
13 * Sec. 19. AS 08.65.140 is amended to read:
14Sec. 08.65.140. Required practices. The board shall adopt regulations
15      regarding the practice of direct-entry midwifery. At a minimum, the regulations must
16      require that a certified direct-entry midwife
17(1) recommend, before care or delivery of a client, that the client
18      undergo a physical examination performed by a physician, physician associate
19      [ASSISTANT], or advanced practice registered nurse who is licensed in this state;
20(2) obtain informed consent from a client before onset of labor;
21(3) comply with AS 18.15.150 regarding taking of blood samples,
22      AS 18.15.200 regarding screening of phenylketonuria (PKU), AS 18.50.160 regarding
23      birth registration, AS 18.50.230 regarding registration of deaths, AS 18.50.240
24      regarding fetal death registration, and regulations adopted by the Department of
25      Health concerning prophylactic treatment of the eyes of newborn infants;
26(4)   not knowingly deliver a woman with certain types of health
27      conditions, prior history, or complications as specified by the board.
28 * Sec. 20. AS 08.68.265 is amended to read:
29Sec. 08.68.265. Supervision of practical nurses. A practical nurse shall work
30      under the supervision of a licensed registered or advanced practice registered nurse, a
31      licensed physician, a licensed physician associate [ASSISTANT], or a licensed
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1dentist.
2   * Sec. 21. AS 08.68.700(a) is amended to read:
3(a) A registered nurse licensed under this chapter may make a determination
4and pronouncement of death of a person under the following circumstances:
5(1) an attending physician, an attending advanced practice registered
6nurse, or an attending physician associate [ASSISTANT] has documented in the
7person's medical or clinical record that the person's death is anticipated due to illness,
8infirmity, or disease; this prognosis is valid for purposes of this section for not more
9than 120 days from the date of the documentation;
10(2) at the time of documentation under (1) of this subsection, the
11physician, the advanced practice registered nurse, or the physician associate
12[ASSISTANT] authorized in writing a specific registered nurse or nurses to make a
13determination and pronouncement of the person's death; however, if the person is in a
14health care facility and the health care facility has complied with (d) of this section,
15the physician, the advanced practice registered nurse, or the physician associate
16[ASSISTANT] may authorize all nurses employed by the facility to make a
17determination and pronouncement of the person's death.
18  * Sec. 22. AS 08.68.700(b) is amended to read:
19(b) A registered nurse who has determined and pronounced death under this
20section shall document the clinical criteria for the determination and pronouncement in
21the person's medical or clinical record and notify the physician, the advanced practice
22registered nurse, or the physician associate [ASSISTANT] who determined that the
23prognosis for the patient was for an anticipated death. The registered nurse shall sign
24the death certificate, which must include the
25(1) name of the deceased;
26(2) presence of a contagious disease, if known; and
27(3) date and time of death.
28  * Sec. 23. AS 08.68.700(c) is amended to read:
29(c)   Except as otherwise provided under AS 18.50.230, a physician or
30physician associate [ASSISTANT] licensed under AS 08.64 or an advanced practice
31registered nurse licensed under this chapter shall certify a death determined under (b)
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1of this section within 24 hours after the pronouncement by the registered nurse.
2  * Sec. 24. AS 08.68.700(d) is amended to read:
3(d)   In a health care facility in which a physician, an advanced practice
4registered nurse, or a physician associate [ASSISTANT] chooses to proceed under (a)
5of this section, written policies and procedures shall be adopted that provide for the
6determination and pronouncement of death by a registered nurse authorized by a
7physician, an advanced practice registered nurse, or a physician associate
8[ASSISTANT] under this section. A registered nurse employed by a health care
9facility and authorized by a physician, an advanced practice registered nurse, or a
10      physician associate [ASSISTANT] to make a determination and pronouncement of
11      death under this section may not make the determination or pronouncement unless the
12      facility has written policies and procedures implementing and ensuring compliance
13      with this section.
14 * Sec. 25. AS 08.68.705(d) is amended by adding a new paragraph to read:
15(4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).
16 * Sec. 26. AS 08.68.705 is amended by adding a new subsection to read:
17(e) An advanced practice registered nurse who issues a prescription for an
18      opioid to a patient shall offer the patient a prescription for an opioid overdose drug if
19(1) the prescription is for an opioid that exceeds a three-day supply;
20(2) the prescription is for a total daily opioid dosage representing a
21      morphine milligram equivalent of 50 milligrams or more;
22(3) the patient is concurrently prescribed a benzodiazepine; or
23(4) the patient has a history of overdose or substance use disorder.
24 * Sec. 27. AS 08.72.276 is amended by adding new subsections to read:
25(c) A licensee who issues a prescription for an opioid to a patient shall offer
26      the patient a prescription for an opioid overdose drug if
27(1) the prescription is for an opioid that exceeds a three-day supply;
28(2) the prescription is for a total daily opioid dosage representing a
29      morphine milligram equivalent of 50 milligrams or more;
30(3) the patient is concurrently prescribed a benzodiazepine; or
31(4) the patient has a history of overdose or substance use disorder.
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1(d)    In this section, "opioid overdose drug" has the meaning given in
2AS 17.20.085(g).
3   * Sec. 28. AS 08.80.030(b) is amended to read:
4(b) In order to fulfill its responsibilities, the board has the powers necessary
5for implementation and enforcement of this chapter, including the power to
6(1) elect a president and secretary from its membership and adopt rules
7for the conduct of its business;
8(2) license by examination or by license transfer the applicants who are
9qualified to engage in the practice of pharmacy;
10(3)    assist the department in inspections and investigations for
11violations of this chapter, or of any other state or federal statute relating to the practice
12of pharmacy;
13(4) adopt regulations to carry out the purposes of this chapter;
14(5) establish and enforce compliance with professional standards and
15rules of conduct for pharmacists engaged in the practice of pharmacy;
16(6)    determine standards for recognition and approval of degree
17programs of schools and colleges of pharmacy whose graduates shall be eligible for
18licensure in this state, including the specification and enforcement of requirements for
19practical training, including internships;
20(7) establish for pharmacists and pharmacies minimum specifications
21for the physical facilities, technical equipment, personnel, and procedures for the
22storage, compounding, and dispensing of drugs or related devices, and for the
23monitoring of drug therapy, including independent monitoring of drug therapy;
24(8) enforce the provisions of this chapter relating to the conduct or
25competence of pharmacists practicing in the state, and the suspension, revocation, or
26restriction of licenses to engage in the practice of pharmacy;
27(9) license and regulate the training, qualifications, and employment of
28pharmacy interns and pharmacy technicians;
29(10) license and regulate the qualifications of entities and individuals
30engaged in the manufacture or distribution of drugs and related devices;
31(11)    establish and maintain a controlled substance prescription
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1database as provided in AS 17.30.200;
2(12)     establish standards for the independent prescribing and
3administration of vaccines and related emergency medications under AS 08.80.168,
4including the completion of an immunization training program approved by the board
5and an epinephrine auto-injector training program under AS 17.22.020(b);
6(13) establish standards for the independent prescribing and dispensing
7by a pharmacist of an opioid overdose drug under AS 17.20.085, including the
8completion of an opioid overdose training program approved by the board;
9(14) require that a licensed pharmacist who prescribes, administers,
10      or dispenses a schedule II, III, or IV controlled substance under federal law to a
11      person in the state register with the controlled substance prescription database under
12      AS 17.30.200(n);
13(15)     establish the qualifications and duties of the executive
14      administrator and delegate authority to the executive administrator that is necessary to
15      conduct board business;
16(16) license and inspect the facilities of pharmacies, manufacturers,
17      wholesale drug distributors, third-party logistics providers, and outsourcing facilities
18      located outside the state under AS 08.80.159;
19(17) license Internet-based pharmacies providing services to residents
20      in the state;
21(18) adopt regulations pertaining to retired pharmacist status.
22 * Sec. 29. AS 08.80.110 is amended to read:
23Sec. 08.80.110. Qualifications for licensure by examination. An applicant
24      for licensure as a pharmacist shall
25(1) be fluent in the reading, writing, and speaking of the English
26      language;
27(2) be a graduate of a college in a degree program approved by the
28      board;
29(3)    pass an examination or examinations given by the board or
30      acceptable to the board under the score transfer process administered by the National
31      Association of Boards of Pharmacy;
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1(4) have completed internship training or another program that has
2been approved by the board or demonstrated to the board's satisfaction that the
3applicant has experience in the practice of pharmacy that meets or exceeds the
4minimum internship requirements of the board; and
5(5) receive education in pain management and opioid use and
6addiction, unless the applicant has demonstrated to the satisfaction of the board
7that the applicant does not currently hold a valid federal Drug Enforcement
8Administration registration number; an applicant may include past professional
9experience or professional education as proof of professional competence.
10  * Sec. 30. AS 08.80.145 is amended to read:
11Sec. 08.80.145. Reciprocity; license transfer. If another jurisdiction allows
12licensure in that jurisdiction of a pharmacist licensed in this state under conditions
13similar to those in this section, the board may license as a pharmacist in this state a
14person licensed as a pharmacist in the other jurisdiction if the person
15(1) submits a written application to the board on a form required by the
16board;
17(2) is at least 18 years of age;
18(3) possesses at the time of the request for licensure as a pharmacist in
19this state the qualifications necessary to be eligible for licensure in this state;
20(4) has engaged in the practice of pharmacy for at least one year
21immediately before applying for a license under this section;
22(5) presents proof satisfactory to the board that the person is currently
23licensed as a pharmacist in the other jurisdiction and does not currently have a
24pharmacist license suspended, revoked, or otherwise restricted except for failure to
25apply for renewal or failure to obtain the required continuing education credits;
26(6) has passed an examination approved by the board that tests the
27person's knowledge of Alaska laws relating to pharmacies and pharmacists and the
28regulations adopted under those laws; [AND]
29(7) meets the requirements of AS 08.80.110(5); and
30(8) pays all required fees.
31  * Sec. 31. AS 08.80.157(j) is amended to read:
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1(j)   This section does not apply to the offices of physicians, osteopaths,
2podiatrists, physician associates [ASSISTANTS], advanced nurse practitioners,
3dentists, veterinarians, dispensing opticians, or optometrists.
4  * Sec. 32. AS 08.80.165 is amended to read:
5Sec. 08.80.165. Continuing education requirements. The board shall
6establish requirements for continuing education in pharmacy that must be satisfied
7before a license issued under this chapter may be renewed. The continuing education
8requirements must include at least two hours of education in pain management
9and opioid use and addiction during the concluding licensing period. The board
10      may exempt a licensee from the requirement to receive at least two hours of
11      education in pain management and opioid use and addiction if the licensee
12      demonstrates to the satisfaction of the board that
13(1) the licensee's practice does not include pain management and
14      opioid prescription or administration; or
15(2)   the licensee does not currently hold a valid federal Drug
16      Enforcement Administration registration number.
17 * Sec. 33. AS 08.80.337(a) is amended to read:
18(a) A pharmacist may, under a collaborative practice agreement with a written
19      protocol approved by a practitioner who is not a pharmacist, provide patient care
20      services. The collaborative practice agreement must define the nature and scope
21      of patient care services the pharmacist may provide under the agreement.
22 * Sec. 34. AS 08.80.337(b) is amended to read:
23(b) A pharmacist may independently provide patient care services for
24(1) general health and wellness;
25(2) disease prevention; or
26(3) a condition that
27(A) is minor and generally self limiting;
28(B) does not require a new diagnosis;
29(C) requires a new diagnosis only if
30(i) the pharmacist uses [(B) HAS] a test [THAT IS
31USED] to guide the pharmacist's diagnosis or clinical decision-
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1making; and
2(ii) the test is waived under 42 U.S.C. 263a (Clinical
3Laboratory Improvement Amendments of 1988); or
4(D) [(C)] falls under a statewide standing order from the chief
5medical officer in the Department of Health.
6   * Sec. 35. AS 08.80.337(d) is amended to read:
7(d) In this section, "patient care services"
8(1)      means medical care services, including the prescription or
9administration of a drug or device to a patient, that are given in exchange for
10compensation and intended to achieve outcomes related to the cure or prevention of a
11disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a
12disease process;
13(2)   does not include the prescription or administration of the
14following drugs unless the drug is being used for the treatment of an opioid use
15disorder in a clinic:
16(A) a schedule IA or IIA controlled substance under state
17law or a schedule II controlled substance under federal law;
18(B) a drug that may only be prescribed or administered
19after completing a certified education program required by
20(i) the manufacturer; or
21(ii)     the   United    States    Food    and    Drug
22Administration, including by a risk evaluation and mitigation
23strategy; or
24(C) a drug that is not generally available at pharmacies and
25may only be dispensed at a pharmacy that
26(i) is authorized by the manufacturer to dispense the
27drug; or
28(ii) meets a requirement to dispense the drug under
29federal law.
30  * Sec. 36. AS 08.80.337 is amended by adding a new subsection to read:
31(e) A pharmacist prescribing or administering a drug or device under this
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1section shall recognize the limits of the pharmacist's education, training, and
2experience and consult with and refer to other practitioners as appropriate.
3  * Sec. 37. AS 08.80.400 is amended to read:
4Sec. 08.80.400. Other licensees not affected. This chapter does not affect the
5practice of medicine by a licensed medical doctor and does not limit a licensed
6medical doctor, osteopath, podiatrist, physician associate [ASSISTANT], advanced
7practice registered nurse, dentist, veterinarian, dispensing optician, or optometrist in
8supplying a patient with any medicinal preparation or article within the scope of the
9person's license.
10 * Sec. 38. AS 08.80.480(30) is amended to read:
11(30) "practice of pharmacy" means the interpretation, evaluation, and
12      dispensing of prescription drug orders in the patient's best interest; participation in
13      drug and device selection, drug administration, drug regimen reviews, and drug or
14      drug-related research; provision of patient counseling and the provision of those acts
15      or services necessary to provide pharmaceutical care; the independent prescribing,
16      dispensing, and administration of drugs in accordance with AS 08.80.168; providing
17      patient care services in accordance with AS 08.80.337; the responsibility for
18      compounding and labeling of drugs and devices except labeling by a manufacturer,
19      repackager, or distributor of nonprescription drugs and commercially packaged legend
20      drugs and devices; proper and safe storage of drugs and devices; and maintenance of
21      proper records for them;
22 * Sec. 39. AS 08.80.480 is amended by adding a new paragraph to read:
23(40) "opioid" includes the opium and opiate substances and opium and
24      opiate derivatives listed in AS 11.71.140 and 11.71.160.
25 * Sec. 40. AS 09.55.560(2) is amended to read:
26(2)   "health care provider" means an acupuncturist licensed under
27      AS 08.06; an audiologist or speech-language pathologist licensed under AS 08.11; a
28      chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a
29      dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing
30      optician licensed under AS 08.71; a naturopath licensed under AS 08.45; an
31      optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a
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1physical therapist or occupational therapist licensed under AS 08.84; a physician or
2physician associate [ASSISTANT] licensed under AS 08.64; a podiatrist; a
3psychologist and a psychological associate licensed under AS 08.86; a hospital as
4defined in AS 47.32.900, including a governmentally owned or operated hospital; an
5employee of a health care provider acting within the course and scope of employment;
6an ambulatory surgical facility and other organizations whose primary purpose is the
7delivery of health care, including a health maintenance organization, individual
8practice association, integrated delivery system, preferred provider organization or
9arrangement, and a physical hospital organization;
10  * Sec. 41. AS 09.65.300(c)(1) is amended to read:
11(1)   "health care provider" means a physician, physician associate
12[ASSISTANT], dentist, dental hygienist, osteopath, optometrist, chiropractor,
13registered nurse, practical nurse, advanced practice registered nurse, naturopath,
14physical therapist, occupational therapist, marital and family therapist, psychologist,
15psychological associate, behavior analyst, assistant behavior analyst, licensed clinical
16social worker, athletic trainer, certified direct-entry midwife, licensed professional
17counselor, or licensed associate counselor;
18  * Sec. 42. AS 09.65.340(d)(1) is amended to read:
19(1)   "health care provider" means a licensed physician, osteopath,
20dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village
21health aide, or pharmacist operating within the scope of the health care provider's
22authority;
23  * Sec. 43. AS 09.68.120 is amended to read:
24Sec. 09.68.120. Definition of death. An individual is considered dead if, in the
25opinion of a physician licensed or exempt from licensing under AS 08.64 or a
26registered nurse authorized to pronounce death under AS 08.68.700, based on
27acceptable medical standards, or in the opinion of a mobile intensive care paramedic,
28physician associate [ASSISTANT], or emergency medical technician authorized to
29pronounce death based on the medical standards in AS 18.08.089, the individual has
30sustained irreversible cessation of circulatory and respiratory functions, or irreversible
31cessation of all functions of the entire brain, including the brain stem. Death may be
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1pronounced in this circumstance before artificial means of maintaining respiratory and
2cardiac function are terminated.
3  * Sec. 44. AS 11.41.470(1) is amended to read:
4(1) "health care worker" includes a person who is or purports to be an
5acupuncturist, advanced practice registered nurse, anesthesiologist, certified direct-
6entry midwife, chiropractor, dentist, health aide, hypnotist, massage therapist, mental
7health counselor, midwife, nurse, occupational therapist, occupational therapy
8assistant, osteopath, naturopath, physical therapist, physical therapist assistant,
9physician, physician associate [ASSISTANT], psychiatrist, psychological associate,
10      psychologist, radiologist, religious healing practitioner, surgeon, x-ray technician, or a
11      substantially similar position;
12 * Sec. 45. AS 11.71.900(20) is amended to read:
13(20) "practitioner" means
14(A) a physician, dentist, advanced practice registered nurse,
15optometrist, veterinarian, scientific investigator, or other person licensed,
16registered, or otherwise permitted to distribute, dispense, conduct research with
17respect to, or to administer or use in teaching or chemical analysis a controlled
18substance in the course of professional practice or research in the state;
19(B) a pharmacist prescribing or administering a controlled
20substance in the course of professional practice in the state; or
21(C) [(B)] a pharmacy, hospital, or other institution licensed,
22registered, or otherwise permitted to distribute, dispense, conduct research with
23respect to, or to administer a controlled substance in the course of professional
24practice or research in the state;
25 * Sec. 46. AS 12.55.135(k)(3) is amended to read:
26(3) "medical professional" means a person who is an advanced practice
27      registered nurse, anesthesiologist, chiropractor, dental hygienist, dentist, health aide,
28      nurse, nurse aide, mental health counselor, osteopath, physician, physician associate
29      [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist,
30      surgeon, or x-ray technician, or who holds a substantially similar position.
31 * Sec. 47. AS 13.52.065(a) is amended to read:
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1(a)   A physician, an advanced practice registered nurse, or a physician
2associate [ASSISTANT] may issue a do not resuscitate order for a patient of the
3physician, the advanced practice registered nurse, or the physician associate
4[ASSISTANT] with the consent of the patient or the parent or guardian of the patient
5if the patient is under 18 years of age. The physician, the advanced practice registered
6nurse, or the physician associate [ASSISTANT] shall document the grounds for the
7order in the patient's medical file.
8   * Sec. 48. AS 13.52.065(c) is amended to read:
9(c) The department shall develop standardized designs and symbols for do not
10resuscitate identification cards, forms, necklaces, and bracelets that signify, when
11carried or worn, that the carrier or wearer is an individual for whom a physician, an
12advanced practice registered nurse, or a physician associate [ASSISTANT] has issued
13a do not resuscitate order.
14  * Sec. 49. AS 13.52.065(d) is amended to read:
15(d)   A health care provider other than a physician, an advanced practice
16registered nurse, or a physician associate [ASSISTANT] shall comply with the
17protocol adopted under (b) of this section for do not resuscitate orders when the health
18care provider is presented with a do not resuscitate identification, an oral do not
19resuscitate order issued directly by a physician, an advanced practice registered nurse,
20or a physician associate [ASSISTANT] if the applicable hospital allows oral do not
21resuscitate orders, or a written do not resuscitate order entered on and as required by a
22form prescribed by the department.
23  * Sec. 50. AS 13.52.065(f) is amended to read:
24(f) A do not resuscitate order may not be made ineffective unless a physician,
25an advanced practice registered nurse, or a physician associate [ASSISTANT] revokes
26the do not resuscitate order, a patient for whom the order is written and who has
27capacity requests that the do not resuscitate order be revoked, or the patient for whom
28the order is written is under 18 years of age and the parent or guardian of the patient
29requests that the do not resuscitate order be revoked. Any physician, advanced practice
30registered nurse, or physician associate [ASSISTANT] of a patient for whom a do not
31resuscitate order is written may revoke the do not resuscitate order if the person for
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1whom the order is written requests that the physician, the advanced practice registered
2nurse, or the physician associate [ASSISTANT] revoke the do not resuscitate order.
3  * Sec. 51. AS 13.52.080(a) is amended to read:
4(a) A health care provider or health care institution that acts in good faith and
5in accordance with generally accepted health care standards applicable to the health
6care provider or institution is not subject to civil or criminal liability or to discipline
7for unprofessional conduct for
8(1)    providing health care information in good faith under
9AS 13.52.070;
10(2) complying with a health care decision of a person based on a good
11      faith belief that the person has authority to make a health care decision for a patient,
12      including a decision to withhold or withdraw health care;
13(3) declining to comply with a health care decision of a person based
14      on a good faith belief that the person then lacked authority;
15(4) complying with an advance health care directive and assuming in
16      good faith that the directive was valid when made and has not been revoked or
17      terminated;
18(5) participating in the withholding or withdrawal of cardiopulmonary
19      resuscitation under the direction or with the authorization of a physician, an advanced
20      practice registered nurse, or a physician associate [ASSISTANT] or upon discovery of
21      do not resuscitate identification on [UPON] an individual;
22(6) causing or participating in providing cardiopulmonary resuscitation
23      or other life-sustaining procedures
24(A) under AS 13.52.065(e) when an individual has made an
25anatomical gift;
26(B) because an individual has made a do not resuscitate order
27ineffective under AS 13.52.065(f) or another provision of this chapter; or
28(C) because the patient is a woman of childbearing age and
29AS 13.52.055 applies; or
30(7) acting in good faith under the terms of this chapter or the law of
31      another state relating to anatomical gifts.
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1   * Sec. 52. AS 13.52.100(c) is amended to read:
2(c) An individual who is a qualified patient, including an individual for whom
3a physician, an advanced practice registered nurse, or a physician associate
4[ASSISTANT] has issued a do not resuscitate order, has the right to make a decision
5regarding the use of cardiopulmonary resuscitation and other life-sustaining
6procedures as long as the individual is able to make the decision. If an individual who
7is a qualified patient, including an individual for whom a physician, advanced practice
8registered nurse, or physician associate [ASSISTANT] has issued a do not resuscitate
9order, is not able to make the decision, the protocol adopted under AS 13.52.065 for
10do not resuscitate orders governs a decision regarding the use of cardiopulmonary
11resuscitation and other life-sustaining procedures.
12  * Sec. 53. AS 13.52.300 is amended to read:
13Sec. 13.52.300. Optional form. The following sample form may be used to
14create an advance health care directive. The other sections of this chapter govern the
15effect of this or any other writing used to create an advance health care directive. This
16form may be duplicated. This form may be modified to suit the needs of the person, or
17a different form that complies with this chapter may be used, including the mandatory
18witnessing requirements:
19ADVANCE HEALTH CARE DIRECTIVE
20Explanation
21You have the right to give instructions about your own health
22care to the extent allowed by law. You also have the right to name
23someone else to make health care decisions for you to the extent
24allowed by law. This form lets you do either or both of these things. It
25also lets you express your wishes regarding the designation of your
26health care provider. If you use this form, you may complete or modify
27all or any part of it. You are free to use a different form if the form
28complies with the requirements of AS 13.52.
29Part 1 of this form is a durable power of attorney for health
30care.   A "durable power of attorney for health care" means the
31designation of an agent to make health care decisions for you. Part 1
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1  lets you name another individual as an agent to make health care
2  decisions for you if you do not have the capacity to make your own
3  decisions or if you want someone else to make those decisions for you
4  now even though you still have the capacity to make those decisions.
5  You may name an alternate agent to act for you if your first choice is
6  not willing, able, or reasonably available to make decisions for you.
7  Unless related to you, your agent may not be an owner, operator, or
8  employee of a health care institution where you are receiving care.
9Unless the form you sign limits the authority of your agent,
10 your agent may make all health care decisions for you that you could
11 legally make for yourself. This form has a place for you to limit the
12 authority of your agent. You do not have to limit the authority of your
13 agent if you wish to rely on your agent for all health care decisions that
14 may have to be made. If you choose not to limit the authority of your
15 agent, your agent will have the right, to the extent allowed by law, to
16(a) consent or refuse consent to any care, treatment, service, or
17 procedure to maintain, diagnose, or otherwise affect a physical or
18 mental condition, including the administration or discontinuation of
19 psychotropic medication;
20(b) select or discharge health care providers and institutions;
21(c) approve or disapprove proposed diagnostic tests, surgical
22 procedures, and programs of medication;
23(d) direct the provision, withholding, or withdrawal of artificial
24 nutrition and hydration and all other forms of health care; and
25(e) make an anatomical gift following your death.
26Part 2 of this form lets you give specific instructions for any
27 aspect of your health care to the extent allowed by law, except you may
28 not authorize mercy killing, assisted suicide, or euthanasia. Choices are
29 provided for you to express your wishes regarding the provision,
30 withholding, or withdrawal of treatment to keep you alive, including
31 the provision of artificial nutrition and hydration, as well as the
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1provision of pain relief medication. Space is provided for you to add to
2the choices you have made or for you to write out any additional
3wishes.
4Part 3 of this form lets you express an intention to make an
5anatomical gift following your death.
6Part 4 of this form lets you make decisions in advance about
7certain types of mental health treatment.
8Part 5 of this form lets you designate a physician to have
9primary responsibility for your health care.
10After completing this form, sign and date the form at the end
11and have the form witnessed by one of the two alternative methods
12listed below. Give a copy of the signed and completed form to your
13physician, to any other health care providers you may have, to any
14health care institution at which you are receiving care, and to any health
15care agents you have named. You should talk to the person you have
16named as your agent to make sure that the person understands your
17wishes and is willing to take the responsibility.
18You have the right to revoke this advance health care directive
19or replace this form at any time, except that you may not revoke this
20declaration when you are determined not to be competent by a court, by
21two physicians, at least one of whom shall be a psychiatrist, or by both
22a physician and a professional mental health clinician. In this advance
23health care directive, "competent" means that you have the capacity
24(1) to assimilate relevant facts and to appreciate and
25understand your situation with regard to those facts; and
26(2) to participate in treatment decisions by means of a
27rational thought process.
28PART 1
29DURABLE POWER OF ATTORNEY FOR
30HEALTH CARE DECISIONS
31(1)   DESIGNATION OF AGENT.  I designate the
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1  following individual as my agent to make health care decisions for me:
2  _________________________________________________________
3  (name of individual you choose as agent)
4  _________________________________________________________
5  (address) (city) (state) (zip code)
6  _________________________________________________________
7  (home telephone) (work telephone)
8OPTIONAL: If I revoke my agent's authority or if my agent is
9  not willing, able, or reasonably available to make a health care decision
10 for me, I designate as my first alternate agent
11 _________________________________________________________
12 (name of individual you choose as first alternate agent)
13 _________________________________________________________
14 (address) (city) (state) (zip code)
15 _________________________________________________________
16 (home telephone) (work telephone)
17OPTIONAL: If I revoke the authority of my agent and first
18 alternate agent or if neither is willing, able, or reasonably available to
19 make a health care decision for me, I designate as my second alternate
20 agent
21 _________________________________________________________
22 (name of individual you choose as second alternate agent)
23 _________________________________________________________
24 (address) (city) (state) (zip code)
25 _________________________________________________________
26 (home telephone) (work telephone)
27(2) AGENT'S AUTHORITY. My agent is authorized
28 and directed to follow my individual instructions and my other wishes
29 to the extent known to the agent in making all health care decisions for
30 me. If these are not known, my agent is authorized to make these
31 decisions in accordance with my best interest, including decisions to
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1provide, withhold, or withdraw artificial hydration and nutrition and
2other forms of health care to keep me alive, except as I state here:
3_________________________________________________________
4_________________________________________________________
5_________________________________________________________
6(Add additional sheets if needed.)
7Under this authority, "best interest" means that the benefits to you
8resulting from a treatment outweigh the burdens to you resulting from
9that treatment after assessing
10(A) the effect of the treatment on your physical,
11emotional, and cognitive functions;
12(B) the degree of physical pain or discomfort
13caused to you by the treatment or the withholding or withdrawal
14of the treatment;
15(C) the degree to which your medical condition,
16the treatment, or the withholding or withdrawal of treatment,
17results in a severe and continuing impairment;
18(D)   the effect of the treatment on your life
19expectancy;
20(E)      your prognosis for recovery, with and
21without the treatment;
22(F) the risks, side effects, and benefits of the
23treatment or the withholding of treatment; and
24(G) your religious beliefs and basic values, to
25the extent that these may assist in determining benefits and
26burdens.
27(3)      WHEN AGENT'S AUTHORITY BECOMES
28EFFECTIVE. Except in the case of mental illness, my agent's authority
29becomes effective when my primary physician determines that I am
30unable to make my own health care decisions unless I mark the
31following box.       In the case of mental illness, unless I mark the
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1  following box, my agent's authority becomes effective when a court
2  determines I am unable to make my own decisions, or, in an
3  emergency, if my primary physician or another health care provider
4  determines I am unable to make my own decisions. If I mark this box
5  [ ], my agent's authority to make health care decisions for me takes
6  effect immediately.
7(4) AGENT'S OBLIGATION. My agent shall make
8  health care decisions for me in accordance with this durable power of
9  attorney for health care, any instructions I give in Part 2 of this form,
10 and my other wishes to the extent known to my agent. To the extent
11 my wishes are unknown, my agent shall make health care decisions for
12 me in accordance with what my agent determines to be in my best
13 interest. In determining my best interest, my agent shall consider my
14 personal values to the extent known to my agent.
15(5) NOMINATION OF GUARDIAN. If a guardian of
16 my person needs to be appointed for me by a court, I nominate the
17 agent designated in this form. If that agent is not willing, able, or
18 reasonably available to act as guardian, I nominate the alternate agents
19 whom I have named under (1) above, in the order designated.
20PART 2
21INSTRUCTIONS FOR HEALTH CARE
22If you are satisfied to allow your agent to determine what is best
23 for you in making health care decisions, you do not need to fill out this
24 part of the form. If you do fill out this part of the form, you may strike
25 any wording you do not want. There is a state protocol that governs the
26 use of do not resuscitate orders by physicians, advanced practice
27 registered nurses, physician associates [ASSISTANTS], and other
28 health care providers. You may obtain a copy of the protocol from the
29 Alaska Department of Health. A "do not resuscitate order" means a
30 directive from a licensed physician, advanced practice registered nurse,
31 or physician associate [ASSISTANT] that emergency cardiopulmonary
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1resuscitation should not be administered to you.
2(6) END-OF-LIFE DECISIONS. Except to the extent
3prohibited by law, I direct that my health care providers and others
4involved in my care provide, withhold, or withdraw treatment in
5accordance with the choice I have marked below: (Check only one
6box.)
7[ ] (A) Choice To Prolong Life
8I want my life to be prolonged as long as
9possible within the limits of generally accepted health care
10standards; OR
11[ ] (B) Choice Not To Prolong Life
12I want comfort care only and I do not want my
13life to be prolonged with medical treatment if, in the judgment
14of my physician, I have (check all choices that represent your
15wishes)
16[      ]     (i)    a condition of permanent
17unconsciousness: a condition that, to a high degree of
18medical certainty, will last permanently without
19improvement; in which, to a high degree of medical
20certainty, thought, sensation, purposeful action, social
21interaction,   and        awareness    of   myself   and   the
22environment are absent; and for which, to a high degree
23of medical certainty, initiating or continuing life-
24sustaining procedures for me, in light of my medical
25outcome, will provide only minimal medical benefit for
26me; or
27[     ]      (ii)   a terminal condition:   an
28incurable or irreversible illness or injury that without the
29administration of life-sustaining procedures will result in
30my death in a short period of time, for which there is no
31reasonable prospect of cure or recovery, that imposes
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1severe pain or otherwise imposes an inhumane burden
2on me, and for which, in light of my medical condition,
3initiating or continuing life-sustaining procedures will
4provide only minimal medical benefit;
5[ ] Additional instructions: ________________
6  ___________________________________________________
7(C) Artificial Nutrition and Hydration. If I am
8  unable to safely take nutrition, fluids, or nutrition and fluids
9  (check your choices or write your instructions),
10[ ] I wish to receive artificial nutrition and
11 hydration indefinitely;
12[ ] I wish to receive artificial nutrition and
13 hydration indefinitely, unless it clearly increases my suffering
14 and is no longer in my best interest;
15[ ] I wish to receive artificial nutrition and
16 hydration on a limited trial basis to see if I can improve;
17[ ] In accordance with my choices in (6)(B)
18 above, I do not wish to receive artificial nutrition and hydration.
19[ ] Other instructions:_____________________
20 ___________________________________________________
21(D) Relief from Pain.
22[ ] I direct that adequate treatment be
23provided at all times for the sole purpose of the
24alleviation of pain or discomfort; or
25[ ] I give these instructions:
26_____________________________________________
27_____________________________________________
28(E)   Should I become unconscious and I am
29 pregnant, I direct that ________________________
30_____________________________________________
31_____________________________________________
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1(7) OTHER WISHES. (If you do not agree with any of
2the optional choices above and wish to write your own, or if you wish
3to add to the instructions you have given above, you may do so here.) I
4direct that
5_________________________________________________________
6_________________________________________________________
7Conditions or limitations: ______________________________
8_________________________________________________________.
9(Add additional sheets if needed.)
10PART 3
11ANATOMICAL GIFT AT DEATH
12(OPTIONAL)
13If you are satisfied to allow your agent to determine whether to
14make an anatomical gift at your death, you do not need to fill out this
15part of the form.
16(8) Upon my death: (mark applicable box)
17[ ] (A) I give any needed organs, tissues, or
18other body parts, OR
19[ ] (B) I give the following organs, tissues, or
20other body parts only ________________________________
21__________________________________________________
22[ ] (C) My gift is for the following purposes
23(mark any of the following you want):
24[ ] (i) transplant;
25[ ] (ii) therapy;
26[ ] (iii) research;
27[ ] (iv) education.
28[ ] (D) I refuse to make an anatomical gift.
29PART 4
30MENTAL HEALTH TREATMENT
31This part of the declaration allows you to make decisions in
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1  advance about mental health treatment.       The instructions that you
2  include in this declaration will be followed only if a court, two
3  physicians that include a psychiatrist, or a physician and a professional
4  mental health clinician believe that you are not competent and cannot
5  make treatment decisions. Otherwise, you will be considered to be
6  competent and to have the capacity to give or withhold consent for the
7  treatments.
8If you are satisfied to allow your agent to determine what is best
9  for you in making these mental health decisions, you do not need to fill
10 out this part of the form. If you do fill out this part of the form, you
11 may strike any wording you do not want.
12(9) PSYCHOTROPIC MEDICATIONS. If I do not
13 have the capacity to give or withhold informed consent for mental
14 health treatment, my wishes regarding psychotropic medications are as
15 follows:
16________ I consent to the administration of the following
17 medications: ______________________________________________
18________ I do not consent to the administration of the
19 following medications: ______________________________________
20Conditions or limitations:_______________________________
21 _________________________________________________________.
22(10) ELECTROCONVULSIVE TREATMENT. If I do
23 not have the capacity to give or withhold informed consent for mental
24 health treatment, my wishes regarding electroconvulsive treatment are
25 as follows:
26________ I consent to the administration of electroconvulsive
27 treatment.
28________ I do not consent to the administration of
29 electroconvulsive treatment.
30Conditions or limitations: ______________________________
31 _________________________________________________________.
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1(11)      ADMISSION TO AND RETENTION IN
2FACILITY. If I do not have the capacity to give or withhold informed
3consent for mental health treatment, my wishes regarding admission to
4and retention in a mental health facility for mental health treatment are
5as follows:
6________ I consent to being admitted to a mental health facility
7for mental health treatment for up to ________ days. (The number of
8days not to exceed 17.)
9________ I do not consent to being admitted to a mental health
10facility for mental health treatment.
11Conditions or limitations: ______________________________
12_________________________________________________________.
13OTHER WISHES OR INSTRUCTIONS
14_________________________________________________________
15_________________________________________________________
16_________________________________________________________
17Conditions or limitations: ______________________________
18_________________________________________________________.
19PART 5
20PRIMARY PHYSICIAN
21(OPTIONAL)
22(12) I designate the following physician as my primary
23physician:
24_________________________________________________________
25(name of physician)
26_________________________________________________________
27(address) (city) (state) (zip code)
28_________________________________________________________
29(telephone)
30OPTIONAL: If the physician I have designated above is
31not willing, able, or reasonably available to act as my primary
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1  physician, I designate the following physician as my primary physician:
2  _________________________________________________________
3  (name of physician)
4  _________________________________________________________
5  (address) (city) (state) (zip code)
6  _________________________________________________________
7  (telephone)
8(13) EFFECT OF COPY. A copy of this form has the
9  same effect as the original.
10(14) SIGNATURES. Sign and date the form here:
11 _________________________________________________________
12 (date) (sign your name)
13 _________________________________________________________
14 (print your name)
15 _________________________________________________________
16 (address) (city) (state) (zip code)
17(15) WITNESSES. This advance care health directive
18 will not be valid for making health care decisions unless it is
19(A) signed by two qualified adult witnesses who
20are personally known to you and who are present when you sign
21or acknowledge your signature; the witnesses may not be a
22health care provider employed at the health care institution or
23health care facility where you are receiving health care, an
24employee of the health care provider who is providing health
25care to you, an employee of the health care institution or health
26care facility where you are receiving health care, or the person
27appointed as your agent by this document; at least one of the
28two witnesses may not be related to you by blood, marriage, or
29adoption or entitled to a portion of your estate upon your death
30under your will or codicil; or
31(B) acknowledged before a notary public in the
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1state.
2ALTERNATIVE NO. 1
3Witness Who is Not Related to or a Devisee of the Principal
4I swear under penalty of perjury under AS 11.56.200
5that the principal is personally known to me, that the principal signed or
6acknowledged this durable power of attorney for health care in my
7presence, that the principal appears to be of sound mind and under no
8duress, fraud, or undue influence, and that I am not
9(1) a health care provider employed at the health care
10institution or health care facility where the principal is receiving health
11care;
12(2) an employee of the health care provider providing
13health care to the principal;
14(3) an employee of the health care institution or health
15care facility where the principal is receiving health care;
16(4) the person appointed as agent by this document;
17(5)   related to the principal by blood, marriage, or
18adoption; or
19(6) entitled to a portion of the principal's estate upon the
20principal's death under a will or codicil.
21________________________________________________________
22(date) (signature of witness)
23________________________________________________________
24(printed name of witness)
25________________________________________________________
26(address) (city) (state) (zip code)
27Witness Who May be Related to or a Devisee of the Principal
28I swear under penalty of perjury under AS 11.56.200
29that the principal is personally known to me, that the principal signed or
30acknowledged this durable power of attorney for health care in my
31presence, that the principal appears to be of sound mind and under no
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1duress, fraud, or undue influence, and that I am not
2(1) a health care provider employed at the health care
3institution or health care facility where the principal is receiving health
4care;
5(2) an employee of the health care provider who is
6providing health care to the principal;
7(3) an employee of the health care institution or health
8care facility where the principal is receiving health care; or
9(4) the person appointed as agent by this document.
10_______________________________________________________
11(date) (signature of witness)
12_______________________________________________________
13(printed name of witness)
14_______________________________________________________
15(address) (city) (state) (zip code)
16ALTERNATIVE NO. 2
17State of Alaska
18________________ Judicial District
19On this ____ day of ___________________, in the year
20______________, before me, _______________________________
21(insert  name        of  notary       public)        appeared
22_______________________________, personally known to me (or
23proved to me on the basis of satisfactory evidence) to be the person
24whose name is subscribed to this instrument, and acknowledged that
25the person executed it.
26Notary Seal
27___________________________
28(signature of notary public)
29 * Sec. 54. AS 13.52.390(13) is amended to read:
30(13)   "do not resuscitate order" means a directive from a licensed
31      physician, advanced practice registered nurse, or physician associate [ASSISTANT]
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1that emergency cardiopulmonary resuscitation should not be administered to a
2qualified patient;
3   * Sec. 55. AS 13.52.390(24) is amended to read:
4(24)    "life-sustaining procedures" means any medical treatment,
5procedure, or intervention that, in the judgment of the primary physician, advanced
6practice registered nurse, or physician associate [ASSISTANT], when applied to a
7patient with a qualifying condition, would not be effective to remove the qualifying
8condition, would serve only to prolong the dying process, or, when administered to a
9patient with a condition of permanent unconsciousness, may keep the patient alive but
10is not expected to restore consciousness; in this paragraph, "medical treatment,
11procedure, or intervention" includes assisted ventilation, renal dialysis, surgical
12procedures, blood transfusions, and the administration of drugs, including antibiotics,
13or artificial nutrition and hydration;
14  * Sec. 56. AS 13.52.390(31) is amended to read:
15(31)     "physician associate [ASSISTANT]" means an individual
16licensed under AS 08.64.107;
17  * Sec. 57. AS 14.30.141(e) is amended to read:
18(e)   In this section, "health care provider" means a licensed physician,
19advanced practice registered nurse, physician associate [ASSISTANT], village health
20aide, or pharmacist operating within the scope of the health care provider's authority.
21  * Sec. 58. AS 17.20.085(g)(1) is amended to read:
22(1)    "health care provider" means a licensed physician, osteopath,
23dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village
24health aide, or pharmacist operating within the scope of the health care provider's
25authority;
26  * Sec. 59. AS 18.08.087 is amended to read:
27Sec. 18.08.087. Disclosure of medical records. When requested for the
28purpose of evaluating the performance of an emergency medical technician, mobile
29intensive care paramedic, or physician who provided emergency medical care or other
30assistance to a sick or injured person, a licensed physician, advanced practice
31registered nurse, or physician associate [ASSISTANT] may disclose to an emergency
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1medical technician, a mobile intensive care paramedic, or physician the medical or
2hospital records of a sick or injured person to whom the paramedic, technician, or
3physician is providing or has rendered emergency medical care or assistance.
4However, the disclosing physician, advanced practice registered nurse, or physician
5associate [ASSISTANT] shall limit disclosure under this section to the records that
6are considered necessary by the discloser for evaluation of the paramedic's,
7technician's, or physician's performance in providing the emergency medical care or
8assistance. A mobile intensive care paramedic, emergency medical care technician, or
9physician to whom confidential records are disclosed under this section may not
10      further disclose the information to a person not entitled to receive that information
11      under this section or another law.
12 * Sec. 60. AS 18.08.089(a) is amended to read:
13(a) A mobile intensive care paramedic licensed under this chapter, a physician
14      associate [ASSISTANT] registered or licensed under AS 08.64.107, or an emergency
15      medical technician certified under this chapter may make a determination and
16      pronouncement of death of a person under the following circumstances:
17(1)   the mobile intensive care paramedic or emergency medical
18      technician is an active member of an emergency medical service certified under this
19      chapter;
20(2)   neither a physician licensed under AS 08.64 nor a physician
21      exempt from licensure under AS 08.64 is immediately available for consultation by
22      radio or telephone communications;
23(3)    the mobile intensive care paramedic, physician associate
24      [ASSISTANT], or emergency medical technician has determined, based on acceptable
25      medical standards, that the person has sustained irreversible cessation of circulatory
26      and respiratory functions.
27 * Sec. 61. AS 18.08.089(b) is amended to read:
28(b) A mobile intensive care paramedic, physician associate [ASSISTANT], or
29      emergency medical technician who has determined and pronounced death under this
30      section shall document the clinical criteria for the determination and pronouncement
31      on the person's emergency medical service report form and notify the appropriate
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1medical director or collaborative physician as soon as communication can be
2established. The paramedic, physician associate [ASSISTANT], or emergency
3medical technician shall provide to the person who signs the death certificate the
4(1) name of the deceased;
5(2) presence of a contagious disease, if known; and
6(3) date and time of death.
7   * Sec. 62. AS 18.08.089(c) is amended to read:
8(c) Except as otherwise provided under AS 18.50.230, a physician licensed
9under AS 08.64 shall certify a death determined under (b) of this section within 24
10hours after the pronouncement by the mobile intensive care paramedic, physician
11associate [ASSISTANT], or emergency medical technician.
12  * Sec. 63. AS 18.15.310(a) is amended to read:
13(a) The withdrawal of blood for a test under AS 18.15.300 - 18.15.320 shall be
14performed in a medically approved manner. Only a physician or physician associate
15[ASSISTANT] licensed under AS 08.64, registered or advanced practice registered
16nurse, licensed practical nurse, or certified emergency medical technician may
17withdraw blood specimens for the purposes of AS 18.15.300 - 18.15.320.
18  * Sec. 64. AS 18.15.395(11) is amended to read:
19(11) "health care practitioner" means a physician, advanced practice
20registered nurse, or physician associate [ASSISTANT] licensed or otherwise
21authorized to practice their respective professions in this state;
22  * Sec. 65. AS 18.15.395(12) is amended to read:
23(12) "health care provider" means any person that provides health care
24services; "health care provider" includes a hospital, medical clinic or office, special
25care facility, medical laboratory, physician, pharmacist, dentist, physician associate
26[ASSISTANT], nurse, paramedic, emergency medical or laboratory technician,
27community health worker, and ambulance and emergency medical worker;
28  * Sec. 66. AS 18.20.095(e)(2) is amended to read:
29(2) "licensed staff member" means a person who is employed by the
30hospital to provide direct patient care and who is licensed or certified in the state as a
31physician or physician associate [ASSISTANT] under AS 08.64, direct-entry midwife
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1under AS 08.65, nurse or nurse aide under AS 08.68, or physical therapist or
2occupational therapist under AS 08.84;
3  * Sec. 67. AS 18.29.190(9) is amended to read:
4(9) "tier II health care professional" means a person who spends not
5less than 50 percent of the person's time on direct patient health care services and who
6is licensed or exempt from licensure in the state as a dental hygienist, advanced
7practice registered nurse, registered nurse, physician associate [ASSISTANT],
8physical therapist, professional counselor, associate counselor, board certified
9behavior analyst, marital and family therapist, clinical social worker, or other health
10      care professional as determined by the commissioner;
11 * Sec. 68. AS 18.50.230(c) is amended to read:
12(c) The medical certification shall be completed and signed within 24 hours
13      after death by the physician, the advanced practice registered nurse, or the physician
14      associate [ASSISTANT] in charge of the patient's care for the illness or condition that
15      resulted in death except when an official inquiry or inquest is required and except as
16      provided by regulation in special problem cases.
17 * Sec. 69. AS 18.65.310(m) is amended to read:
18(m)    The department shall provide a method for a person to designate
19      voluntarily on an identification card that the person has a disability, including a
20      cognitive, mental, neurological, or physical disability, or a combination of those
21      disabilities. The department shall create a discreet symbol to place on the
22      identification card of a person requesting the designation. The method must provide a
23      means by which the person may cancel the designation. The department may not
24      charge a fee solely for the designation. To receive the designation, the person shall
25      provide proof of the disability from a person licensed as a physician or physician
26      associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45, as an
27      advanced practice registered nurse under AS 08.68, or as a licensed psychologist
28      under AS 08.86. Notwithstanding (a) of this section, the department may charge a fee
29      of $5 for replacement of a valid identification card with a new identification card with
30      a disability designation and may charge a fee of $5 for replacement of an identification
31      card with a disability designation with a new identification card without a disability
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1designation.
2   * Sec. 70. AS 18.67.020(a) is amended to read:
3(a) The Violent Crimes Compensation Board is composed of three members to
4be appointed by the governor. One of the members shall be designated as chair by the
5governor. At least one member must be a medical or osteopathic physician, a
6physician associate [ASSISTANT], or an advanced nurse practitioner licensed to
7practice in this state or retired from practice in this state, and one member must be an
8attorney licensed to practice in this state or retired from practice in this state.
9   * Sec. 71. AS 21.36.090(d) is amended to read:
10(d)    Except to the extent necessary to comply with AS 21.42.365 and
11AS 21.56, a person may not practice or permit unfair discrimination against a person
12who provides a service covered under a group health insurance policy that extends
13coverage on an expense incurred basis, or under a group service or indemnity type
14contract issued by a health maintenance organization or a nonprofit corporation, if the
15service is within the scope of the provider's occupational license. In this subsection,
16"provider" means a state licensed physician, physician associate [ASSISTANT],
17dentist, osteopath, optometrist, chiropractor, advanced practice registered nurse,
18pharmacist, naturopath, physical therapist, occupational therapist, marital and family
19therapist, psychologist, psychological associate, licensed clinical social worker,
20licensed professional counselor, licensed associate counselor, certified direct-entry
21midwife, or dental hygienist holding an advanced practice permit.
22  * Sec. 72. AS 21.42.351(b)(2) is amended to read:
23(2) "health care professional" means a health aide, physician, nurse,
24and physician associate [ASSISTANT], but does not include a practitioner of
25religious healing;
26  * Sec. 73. AS 23.30.395(3) is amended to read:
27(3) "attending physician" means one of the following designated by the
28employee under AS 23.30.095(a) or (b):
29(A) a licensed medical doctor;
30(B) a licensed doctor of osteopathy;
31(C) a licensed dentist or dental surgeon;
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1(D) a licensed physician associate [ASSISTANT] acting under
2supervision of a licensed medical doctor or doctor of osteopathy;
3(E) a licensed advanced practice registered nurse; or
4(F) a licensed chiropractor;
5  * Sec. 74. AS 28.10.181(d) is amended to read:
6(d) Vehicles owned by veterans with disabilities, including persons disabled in
7the line of duty while serving in the Alaska Territorial Guard, or other persons with
8disabilities. Upon the request of a person with a disability that limits or impairs the
9ability to walk, as defined in 23 C.F.R. 1235.2, the department shall (1) register one
10      motor vehicle in the name of the person without charge; and (2) issue a specially
11      designed registration plate that displays (A) recognition of the disabled veteran if the
12      applicant's disability originated from the applicant's service with the Alaska Territorial
13      Guard or the armed forces of the United States; (B) the international symbol of
14      accessibility (the wheelchair logo); and (C) if the applicant is a veteran, the Alaska and
15      United States flags and red, white, and blue colors. A person who is not otherwise
16      qualified under this subsection, but who meets the qualifications of a disabled veteran
17      under AS 29.45.030(i), may register one motor vehicle without charge, and the
18      department shall issue a specially designed registration plate that displays recognition
19      of the disabled veteran that does not display the international symbol of accessibility
20      and does not carry with it special parking privileges. A disabled veteran who
21      otherwise qualifies for a registration plate under this subsection may elect to receive a
22      plate under (p) or (q) of this section for which the person is otherwise qualified that
23      does not display the international symbol of accessibility and does not carry with it
24      special parking privileges. A disabled person who otherwise qualifies for a registration
25      plate under (2)(B) of this subsection may elect to receive a plate under another
26      provision of this section for which the person is otherwise qualified that does not
27      display the international symbol of accessibility and does not carry with it special
28      parking privileges. For purposes of this subsection, proof of disability may be
29      provided by a person licensed as a speech-language pathologist under AS 08.11, as a
30      chiropractor under AS 08.20, as a physician or physician associate [ASSISTANT]
31      under AS 08.64, as an advanced practice registered nurse under AS 08.68, or as a
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1physical therapist or occupational therapist under AS 08.84.
2   * Sec. 75. AS 28.15.111(d) is amended to read:
3(d) The department shall provide a method, at the time that a driver's license is
4issued, by which the owner of a license may voluntarily designate on the license that
5the owner has a disability, including a cognitive, mental, neurological, or physical
6disability, or a combination of those disabilities. The department shall create a discreet
7symbol to place on the driver's license of a person requesting the designation. The
8method must provide a means by which the owner may cancel the designation. The
9department may not charge a fee solely for the designation. To receive the designation,
10the person shall provide proof of the disability from a person licensed as a physician or
11physician associate [ASSISTANT] under AS 08.64, as a naturopath under AS 08.45,
12as an advanced practice nurse under AS 08.68, or as a licensed psychologist under
13AS 08.86. The department may charge a fee of $5 for replacement of a valid driver's
14license with a new driver's license with a disability designation and may charge a fee
15of $5 for replacement of a driver's license with a disability designation with a new
16driver's license without a disability designation.
17  * Sec. 76. AS 33.30.901(10) is amended to read:
18(10) "health care provider" means
19(A) a physician associate [ASSISTANT] licensed to practice in
20the state and working under the direct supervision of a licensed physician or
21psychiatrist;
22(B) a mental health professional as defined in AS 47.30.915; or
23(C)   an advanced practice registered nurse as defined in
24AS 08.68.850;
25  * Sec. 77. AS 47.17.290(14) is amended to read:
26(14)      "practitioner of the healing arts" includes athletic trainers,
27chiropractors, mental health counselors, social workers, dental hygienists, dentists,
28health aides, nurses, nurse practitioners, certified nurse aides, occupational therapists,
29occupational therapy assistants, optometrists, osteopaths, naturopaths, physical
30therapists,   physical     therapist   assistants,   physicians,   physician   associates
31[ASSISTANTS], psychiatrists, psychologists, psychological associates, audiologists
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1and speech-language pathologists licensed under AS 08.11, hearing aid dealers
2licensed under AS 08.55, marital and family therapists licensed under AS 08.63,
3behavior analysts, assistant behavior analysts, religious healing practitioners,
4acupuncturists, and surgeons;
5  * Sec. 78. AS 47.30.705(a) is amended to read:
6(a) A peace officer, health officer, mental health professional, or physician
7associate [ASSISTANT] licensed by the State Medical Board to practice in this state
8who has probable cause to believe that a person is gravely disabled or is suffering
9from mental illness and is likely to cause serious harm to self or others of such
10      immediate nature that considerations of safety do not allow initiation of involuntary
11      commitment procedures set out in AS 47.30.700, may cause the person to be taken
12      into custody by a peace officer or health officer and delivered to the nearest crisis
13      stabilization center, crisis residential center, evaluation facility, or treatment facility. A
14      person taken into custody for emergency evaluation may not be placed in a jail or
15      other correctional facility except for protective custody purposes and only while
16      awaiting transportation to a crisis stabilization center, crisis residential center,
17      evaluation facility, or treatment facility. However, protective custody under this
18      section may not include placement of a minor in a jail or secure facility. The peace
19      officer, health officer, mental health professional, or physician associate
20      [ASSISTANT] shall complete an application for examination of the person in custody
21      and be interviewed by a mental health professional at the crisis stabilization center,
22      crisis residential center, evaluation facility, or treatment facility.
23 * Sec. 79. AS 47.30.838(a) is amended to read:
24(a) Except as provided in (c) and (d) of this section, an evaluation facility or
25      designated treatment facility may administer psychotropic medication to a patient
26      without the patient's informed consent, regardless of whether the patient is capable of
27      giving informed consent, only if
28(1) there is a crisis situation, or an impending crisis situation, that
29      requires immediate use of the medication to preserve the life of, or prevent significant
30      physical harm to, the patient or another person, as determined by a physician,
31      physician associate [ASSISTANT], or advanced practice registered nurse; the
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1behavior or condition of the patient giving rise to a crisis under this paragraph and the
2staff's response to the behavior or condition must be documented in the patient's
3medical record; the documentation must include an explanation of alternative
4responses to the crisis that were considered or attempted by the staff and why those
5responses were not sufficient; and
6(2)   the medication is ordered by a physician, physician associate
7[ASSISTANT], or advanced practice registered nurse; the order
8(A) may be written or oral and may be received by telephone,
9facsimile machine, or in person;
10(B) may include an initial dosage and may authorize additional,
11as needed, doses; if additional, as needed, doses are authorized, the order must
12specify the medication, the quantity of each authorized dose, the method of
13administering the medication, the maximum frequency of administration, the
14specific conditions under which the medication may be given, and the
15maximum amount of medication that may be administered to the patient in a
1624-hour period;
17(C)   is valid for only 24 hours and may be renewed by a
18physician, physician associate [ASSISTANT], or advanced practice registered
19nurse for a total of 72 hours, including the initial 24 hours, only after a
20personal assessment of the patient's status and a determination that there is still
21a crisis situation as described in (1) of this subsection; upon renewal of an
22order under this subparagraph, the facts supporting the renewal shall be written
23into the patient's medical record.
24  * Sec. 80. AS 47.37.180(b) is amended to read:
25(b) The certifying physician, physician associate [ASSISTANT], advanced
26practice registered nurse, spouse, guardian, or relative of the person to be committed,
27or any other responsible person, may make a written application for commitment
28under this section, directed to the administrator of the approved public treatment
29facility. The application must state facts to support the need for emergency treatment
30and be accompanied by a physician's, physician associate's [ASSISTANT'S], or
31advanced practice registered nurse's certificate supporting the need for emergency
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1treatment and stating that the physician, physician associate [ASSISTANT], or
2advanced practice registered nurse has examined the person sought to be committed
3within two days before the certificate's date.
4  * Sec. 81. AS 47.37.180(f) is amended to read:
5(f) A copy of the written application for commitment and of the physician's,
6physician associate's [ASSISTANT'S], or advanced practice registered nurse's
7certificate, and a written explanation of the person's right to legal counsel, shall be
8given to the person within 24 hours after commitment by the administrator, who shall
9provide a reasonable opportunity for the person to consult with legal counsel.
10 * Sec. 82. AS 47.37.190(a) is amended to read:
11(a)   A spouse or guardian, a relative, the certifying physician, physician
12      associate, or [ASSISTANT,] advanced practice registered nurse, or the administrator
13      in charge of an approved public treatment facility may petition the court for a 30-day
14      involuntary commitment order. The petition must allege that the person is an alcoholic
15      or drug abuser who (1) has threatened, attempted to inflict, or inflicted physical harm
16      on another and that unless committed is likely to inflict physical harm on another; or
17      (2) is incapacitated by alcohol or drugs. A refusal to undergo treatment does not
18      constitute evidence of lack of judgment as to the need for treatment. The petition must
19      be accompanied by a certificate of a licensed physician, physician associate
20      [ASSISTANT], or advanced practice registered nurse who has examined the person
21      within two days before submission of the petition, unless the person whose
22      commitment is sought has refused to submit to a medical examination, in which case
23      the fact of refusal must be alleged in the petition. The certificate must set out the
24      physician's, physician associate's [ASSISTANT'S], or advanced practice registered
25      nurse's findings of the examination in support of the allegations of the petition.
26 * Sec. 83. AS 47.37.200(a) is amended to read:
27(a) At the hearing for a 30-day commitment required under AS 47.37.190(b),
28      the court shall hear all relevant testimony, including, if possible, the testimony of at
29      least one person who has examined the person whose commitment is sought under
30      AS 47.37.180(b) or 47.37.190(a). The person whose commitment is sought shall be
31      present unless the court believes that being present is likely to be injurious to the
                                              -43-  Enrolled HB 195
1person, in which case the court may conduct the hearing telephonically. The court may
2examine the person in open court, or, if advisable, examine the person out of court. If
3the person has refused to be examined under AS 47.37.180(b) or 47.37.190(a), the
4person shall be given an opportunity to request examination by a court-appointed
5licensed physician, physician associate [ASSISTANT], or advanced practice
6registered nurse. If the person fails to request a medical examination and there is
7sufficient evidence to believe that the allegations of the petition are true, or, if the
8court believes that more medical evidence is necessary, the court may issue a
9temporary order committing the person to a private or public facility for a period of
10not more than five days for purposes of a diagnostic examination.
11  * Sec. 84. AS 08.80.337(c) is repealed.
12  * Sec. 85. The uncodified law of the State of Alaska is amended by adding a new section to
13 read:
14REVISOR'S INSTRUCTION. If SB 89, as passed by the Thirty-Fourth Alaska State
15 Legislature, is enacted into law, the revisor of statutes shall replace all occurrences of
16 "physician assistant" in SB 89 with "physician associate," except for occurrences of
17 "physician assistant" when used in "Accreditation Review Commission on Education for the
18 Physician Assistant" and "National Commission on Certification of Physician Assistants."
19  * Sec. 86. The uncodified law of the State of Alaska is amended by adding a new section to
20 read:
21CONDITIONAL EFFECT. Sections 7, 10, 12, 56, 60, 73, and 76 of this Act take
22 effect only if SB 89, as passed by the Thirty-Fourth Alaska State Legislature, is not enacted
23 into law.
24  * Sec. 87. Sections 4 - 6, 13, 14, 25 - 30, 32 - 36, 38, 39, 45, and 84 of this Act take effect
25 January 1, 2027.
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