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Chapter 410-11 REGULATION OF ADVANCED PRACTICE REGISTERED NURSES

Rule 410-11-.01 Purpose, Definitions, Title, and Authority for Advanced Nursing Practice

(1) Purpose.
(a) To promote, preserve, and protect public health, safety, and welfare by regulating advanced nursing practice.
(2) Definitions:
(a) The advanced practice registered nurse is a certified nurse-midwife (CNM), nurse practitioner (NP), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS) or clinical nurse specialist in psychiatric/mental health (CNS/PMH), and is authorized to practice by the Georgia Board of Nursing ("the Board").
(b) "Advanced nursing practice" means practice by a registered professional nurse who meets those educational, practice, certification requirements, or any combination of such requirements, as specified by the Board and includes certified nurse-midwives, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists in psychiatric/mental health, and others required by the Board.
(3) Title.
(a) Advanced practice registered nurses are authorized to practice in the categories of certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist and clinical nurse specialist in psychiatric/mental health. Each advanced practice registered nurse shall use the category designation for purposes of identification and documentation.
(4) Authority to Practice:
(a) Only a registered professional nurse authorized to practice according to these rules shall use the specified title, and practice or offer to practice, as a certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist clinical nurse specialist or clinical nurse specialist, psychiatric/mental health unless otherwise authorized to do so by the Board.
(b) The advanced practice registered nurse is authorized to perform advanced nursing functions and certain medical acts which include, but are not limited to, ordering drugs, treatments, and diagnostic studies as provided in O.C.G.A. § 43-34-26.1 and Chapter 410-11.

Rule 410-11-.02 Rules for Certified Nurse-Midwives

(1) Definition.
(a) A certified nurse-midwife is a registered professional Nurse who has completed/graduated from a post-basic educational program for nurse midwives which included theoretical and practical components and evidence of advanced pharmacology within the curriculum or as a separate course. The certified nurse-midwife is certified by the ACNM Certification Council and is authorized to practice by the Board.
(2) Scope and Standards of Practice for the Certified Nurse-Midwife.
(a) The certified nurse-midwife (CNM) provides independent management of women's health care, focusing particularly on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women. The certified nurse-midwife practices within a health care system that provides for consultation, collaborative management, or referral as indicated by the health status of the client. The certified nurse-midwife must practice in accordance with the Board-approved American College of Nurse-Midwives' current Standards for the Practice of Nurse-Midwifery.
(3) Requirements to Practice as a Certified Nurse-Midwife:
(a) Prior to January 1, 1999, and applicant who submits the following items may be authorized to practice as a certified nurse-midwife:
1. Evidence of current licensure as a registered professional nurse in Georgia;
2. A completed Board application with required fee;
3. Official transcript which verifies graduation from a post-basic educational program for nurse-midwives which includes theoretical and practical components and evidence of advanced pharmacology within the curriculum or as a separate course, and;
4. Verification of current national certification from the ACNM Certification Council. If certified prior to January 1, 1996, evidence of enrollment in the Continuing Competency Assessment Program of the American College of Nurse-Midwives, which bears current cycle dates, must be provided.
(b) Beginning January 1, 1999, for initial authority to practice as a certified nurse midwife, and applicant must submit an official transcript which verifies completion/graduation with a master's or higher degree in nursing or a graduate degree with a concentration in nurse-midwifery, evidence of advanced pharmacology within the curriculum or as a separate course, in addition to the requirements stated in 410-11-.02(3)(a)1., 2. and 4.
(4) Biennial Renewal of Board Authorization to Practice as a Certified Nurse-midwife:
(a) The date for renewal of Board authorization as a certified nurse-midwife will coincide with the renewal of the registered professional nurse license.
(b) Authorization to practice as a certified nurse-midwife shall expire on January 31st of odd-numbered years and shall be administratively revoked if not renewed.
(c) For continued authority to practice, the certified nurse-midwife must submit:
1. A completed renewal application for advanced nursing practice;
2. A copy of current national certification with expiration date from the ACNM Certification Council. If certified prior to January 1, 1996, evidence of enrollment in the Continuing Competency Assessment Program of the American College of Nurse-Midwives, which bears current cycle dates must be provided.
3. Payment of the renewal fee.
(d) A renewal application, received with a postmark date after January 31 of odd numbered years, will be returned to the applicant. Thereafter, the applicant must apply to reinstate the authorization.

Rule 410-11-.03 Rules for Nurse Practitioners

(1) Definition.
(a) A nurse practitioner is a registered professional nurse who is recognized by the Board to engage in advanced practice registered nursing.
(b) The nurse practitioner practices in a manner consistent with Chapter 410-13 of the Georgia Board of Nursing Rules and Regulations.
(2) Scope and Standards of Practice for the Nurse Practitioner:
(a) The nurse practitioner provides advanced practice nursing care and medical services specific to the nurse practitioner respective specialty to individuals, families and groups, emphasizing health promotion and disease prevention as well as the diagnosis and management of acute and chronic diseases. The nurse practitioner collaborates as necessary with a variety of individuals to diagnose and manage clients' health care problems.
(b) The nurse practitioner practices in a manner consistent with the nationally recognized nursing practice standards for the respective nurse practitioner specialty that is consistent with the Board-recognized national certification organization identified in Rule 410-11-.12.
(3) Requirements for initial authority to Practice as a Nurse Practitioner:
(a) Evidence of current licensure as a registered professional nurse in Georgia;
(b) A completed Board application with required fee;
(c) Official transcript which verifies graduation with a master's or higher degree in nursing for the respective nurse practitioner specialty or a graduate level post-master's certificate in an advanced practice registered nurse practitioner specialty and evidence of advanced pharmacology within the curriculum or as a separate course, advanced physical assessment, and pathophysiology.
(d) Nerification of current national certification from the respective Board-recognized certifying organization.
(4) The applicant must document one of the following within in four (4) years immediately preceding the date of current application:
(a) 500 hours of practice as an advanced practice registered nurse;
(b) Graduation from a nursing education program or a graduate level post-master's certificate in an advanced practice registered nurse practitioner specialty; or
(c) Completion of a Georgia Board-approved advanced practice registered nurse reentry/refresher program.
(5) An applicant who is unable to meet the requirements of (4)(a), (b), or (c) must satisfactorily complete the following:
(a) 40 hours of study relevant to advanced registered nursing practice within one (1) year of the date of application. Relevant advanced practice registered nurse study must include at least four (4) Different content areas. The Board may waive the 40 hours of study if the applicant has passed a national recognized certification organization examination within the four (4) years immediately preceding the date of current application.
(b) Current health care provider course of cardio-pulmonary resuscitation unless completed within one (1) year of the date of application with a Georgia Board of Nursing approved RN reentry;
(c) Study of the Georgia Registered Professional Nurse Practice Act, O.C.G.A. §§ 43-26-1et seq. and Board rules; and
(d) 160 hours of relevant advanced practice registered nursing supervised by an advanced practice registered nurse in a comparable specialty area and in accordance with other Board criteria.
(6) Biennial Renewal of Board Authorization to Practice as a Nurse Practitioner:
(a) The date for renewal of Board authorization as a nurse practitioner will coincide with the renewal license period. Authorization shall be administratively revoked if not renewed.
(b) For continued authority to practice, the nurse practitioner must:
1. Renew licensure as a registered professional nurse in Georgia;
2. Submit a completed renewal application for advanced nursing practice;
3. Attest to advanced practice registered nurse practice in accordance with applicable Georgia laws and rules; and
4. Submit payment of the renewal fee.
(c) Any licensee who fails to renew authorization must apply to reinstate the authorization.

Rule 410-11-.04 Rules for Certified Registered Nurse Anesthetists

(1) Definition
(a) A certified registered nurse anesthetist is a registered professional nurse who has completed/graduated from a post-basic educational program for nurse anesthetists which includes theoretical and practical components and evidence of advanced pharmacology, is currently certified/recertified by the National Board of Certification and Recertification for Nurse Anesthetists, and is authorized to practice by the Board.
(2) Scope and Standards of Practice for the Certified Registered Nurse Anesthetist. The certified registered nurse anesthetist (CRNA) provides anesthesia and related care services in four general categories:
(a) Preanesthetic preparation and evaluation;
(b) Anesthesia induction, maintenance, and emergence;
(c) Perianesthetic and clinical support functions; and
(d) Postanesthesia care.

The certified registered nurse anesthetist must practice in accordance with Board approved American Association of Nurse Anesthetists' current Guidelines and Standards for Nurse Anesthesia Practice.

(3) Requirements to practice as a Certified Registered Nurse Anesthetist.
(a) An applicant who has graduated from an approved nurse anesthesia educational program prior to January 1, 1999, who submits the following items may be authorized to practice as a certified registered nurse anesthetist:
1. Evidence of current licensure as a registered professional nurse in Georgia;
2. A completed Board application with required fee;
3. Official transcript which verifies completion/graduation from a post-basic educational program for certified registered nurse anesthetists which includes theoretical and practical components and evidence of advanced pharmacology; and
4. Verification of current national certification/recertification from the National Board of Certification and Recertification for Nurse Anesthetists.
(b) An applicant who graduates from an approved nurse anesthesia education program on or after January 1, 1999, who submits the following items may be authorized to practice as a certified registered nurse anesthetist:
1. Evidence of current licensure as a registered professional nurse in Georgia;
2. A completed Board application with required fee;
3. Official transcript which verifies completion/graduation with a master's or higher degree in nursing with a concentration in anesthesia and evidence of advance pharmacology or a graduate degree with a concentration in anesthesia and evidence of advance pharmacology; and
4. Verification of current national certification/recertification from the National Board of Certification and Recertification for Nurse Anesthetists
(4) Biennial Renewal of Board authorization to practice as a Certified Registered Nurse Anesthetist.
(a) The data for renewal of Board authorization as a certified registered nurse anesthetist will coincide with the renewal of the registered professional nurse license.
(b) Authorization to practice as a certified registered nurse anesthetist shall expire on January 31st of odd-numbered years and shall be administratively revoked if not renewed.
(c) For continued authority to practice, the certified registered nurse anesthetist must submit:
1. A completed renewal application for advanced nursing practice;
2. A copy of current national certification/recertification as a certified registered nurse anesthetist which bears the expiration date; and
3. Payment of the renewal fee.
(d) A renewal application, received with a postmark date after January 31 of odd numbered years, will be returned to the applicant. Thereafter, the applicant must apply to reinstate the authorization.

Rule 410-11-.05 Rules for Clinical Nurse Specialists, Psychiatric/Mental Health

(1) Definition
(a) A clinical nurse specialist, psychiatric/mental health, is a registered professional nurse who has graduated from a program of graduate study and supervised practice; has demonstrated depth and breadth of knowledge, competence and skill in the advanced practice of psychiatric/mental health nursing; and is authorized to practice by the Board.
(2) Scope and Standards of Practice for the Clinical Nurse Specialist, Psychiatric/Mental Health.
(a) The clinical nurse specialist, psychiatric/mental health, (CNS/PMH), is an advanced practice registered nurse who provides a full range of nursing services from mental health promotion to mental illness rehabilitation. As a primary mental health care provider, the clinical nurse specialist, psychiatric/mental health, provides psychotherapy, clinical supervision, consultation, and liaison services. The clinical nurse specialist, psychiatric/mental health, must practice in accordance with the Board-approved current standards of the American Nurses Association's A Statement on Psychiatric-Mental Health Clinical Nursing Practice and Standards of Psychiatric-Mental Health Clinical Nursing Practice.
(3) Requirements to Practice as a Clinical Nurse Specialist, Psychiatric/Mental Health.
(a) Prior to January 1, 1999, an applicant who submits the following items may be authorized to practice as a clinical nurse specialist in psychiatric/mental health:
1. Evidence of current licensure as a registered professional nurse in Georgia;
2. Completed Board application with required fee; and
3. Official transcript which verifies a master's or higher degree in nursing with specialization in psychiatric/mental health nursing which includes a minimum of two (2) graduate courses in psychiatric/mental health nursing, supervised practice for each of the two (2) graduated courses and evidence of advanced pharmacology within the curriculum or as a separate course; or verification of current national certification as a clinical nurse specialist in psychiatric/mental health from the American Nurses Credentialing Center and evidence of advance pharmacology.
(b) Beginning January 1, 1999, an applicant requesting initial authority to practice as a clinical nurse specialist, psychiatric/mental health must submit the following:
1. Evidence of current licensure as a registered professional nurse in a Georgia;
2. A completed Board application with required fee;
3. Official transcript which verifies a master's or higher degree in nursing with specialization in psychiatric/mental health nursing which includes a minimum of two (2) graduate courses in psychiatric/mental health nursing, supervised practice for each of the two (2) graduate courses and evidence of advanced pharmacology within the curriculum or as a separate course; and
4. Verification of current national certification as a clinical nurse specialist in psychiatric/mental health from the American Nurses Credentialing Center.
(4) Biennial renewal of Board Authorization to Practice as a Clinical Nurse Specialist, Psychiatric/Mental Health:
(a) The date for renewal of Board Authorization as a clinical nurse specialist, psychiatric/mental health, will coincide with the renewal of the registered professional nurse license.
(b) Authorization to practice as a clinical nurse specialist, psychiatric/mental health, shall expire on January 31 of odd-numbered years and shall be administratively revoked if not renewed.
(c) For continued authority to practice, the clinical nurse specialist, psychiatric/mental health, must submit:
1. A completed renewal application for advanced nursing practice;
2. A copy of current national certification as a clinical nurse specialist, psychiatric/mental health which bears the expiration date, if initial authorization was based on national certification; and
3. Payment of the renewal fee.
(d) A renewal application, received with a postmark date after January 31 of odd numbered years, will be returned to the applicant. Thereafter, the applicant must apply to reinstate the authorization.

Rule 410-11-.06 Rules for Clinical Nurse Specialists

(1) Definition:

A clinical nurse specialist ("CNS") is a registered professional nurse who has graduated from a program of graduate study and supervised practice; who holds a master's degree or other graduate degree from an approved nursing education program; who holds national board certification in his or her area of specialty; and is authorized to practice as an advanced practice registered nurse by the Board.

(2) Scope and Standards of Practice for the Clinical Nurse Specialist.

The clinical nurse specialist ("CNS") is an advanced practice registered nurse who provides a full range of nursing services from health promotion to illness rehabilitation. The clinical nurse specialist provides clinical supervision, consultation, and liaison services to nurses, patients and healthcare systems. The clinical nurse specialist must practice in accordance with the current standards of the national certifying organizations listed in Rule 410-11-.12 by which clinical nurse specialists are currently certified.

(3) Requirements to Practice as a Clinical Nurse Specialist.
(a) Beginning January 1, 2012, all applicants seeking initial authorization as an advance practice registered nurse to practice as a clinical nurse specialist ("CNS") shall meet the following requirements:
1. Evidence of current licensure as a registered professional nurse in Georgia;
2. Completed Board authorization application with required fee;
3. Official transcript which verifies a master's or higher degree in nursing or a post-masters certificate from an approved nursing education program with specialization as a Clinical Nurse Specialist that includes evidence of advanced pharmacology, advanced physical assessment, and advanced pathophysiology within the curriculum or as a separate course.
4. Verification of current national certification as a clinical nurse specialist from the American Nurses Credentialing Center or approved national certifying body listed in Rule 410-12-.12.
(b) All applicants must document one of the following within four (4) years immediately preceding the date of the current authorization application:
1. 500 hours of practice as a CNS;
2. An official transcript which verifies a masters or higher degree in nursing or a post master's certificate from an approved nursing education program with a specialization as a Clinical Nurse Specialist; or
3. Completion of a Board approved advanced practice registered nurse reentry/refresher program consisting of forty (40) hours of study and one hundred and sixty hours (160) hours of supervised clinical practice within the four (4) years immediately preceding the date of application.
(c) Biennial renewal of board authorization to practice as a clinical nurse specialist:
1. The date for renewal of board authorization as a clinical nurse specialist will coincide with the renewal of the registered professional nurse license.
2. Authorization to practice as a clinical nurse specialist shall be administratively revoked if not renewed prior to the date of expiration.
3. For renewal of APRN-CNS authority to practice, the clinical nurse specialist must submit:
(i) A completed authorization renewal application for advanced nursing practice;
(ii) Maintain current national certification as a clinical nurse specialist;
(iii) Upon notification of Board audit, submit proof of current national certification as a clinical nurse specialist which bears the certification expiration date; and
(iv) Payment of the authorization renewal fee.
4. A renewal application, received with a postmark date after the date of authorization expiration, will not be accepted by the Board for renewal purposes. Thereafter, the applicant must apply to reinstate the authorization.
5. Renewal of a license to practice as a registered professional nurse shall not constitute renewal of authorization to practice as a CNS.

Rule 410-11-.07 Failure of the Examination

An applicant who fails the national certification examination shall not engage in advanced nursing practice until such time as all requirements are met and written authorization to practice as a certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist or clinical nurse specialist in psychiatric/mental health is issued by the Board.

Rule 410-11-.08 Temporary Authority to Practice

(1) Temporary authority to practice as a certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist or clinical nurse specialist in psychiatric/mental health may be issued to a registered nurse who is an applicant for authorization for advanced practice nursing under the following circumstances:
(a) The Applicant has met all requirements for Board authorization but the Board review of the application is delayed due to an investigation of a possible period of questionable unauthorized nursing practice; or
(b) The Applicant has met all the requirements for Board authorization except current national certification because such certification has expired, and the applicant must meet specific practice requirements for recertification.
(2) Temporary authorization may be issued for a period of up to six (6) months, and may be renewable once for a period of up to six (6) months.

Rule 410-11-.09 Unauthorized Practice

An applicant who is employed or engaged in advanced nursing practice as a certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist or clinical nurse specialist in psychiatric/mental health in Georgia prior to Board authorization for such practice shall be in violation of 410-11-.01(4). Such conduct may result in action taken by the Board which may include a reprimand and fine as follows:

(a) A private or public reprimand and
(b) A fine:
1. Of $50.00 per month (up to $250.00) for practice between two (2) and six (6) months, or any portion thereof;
2. Of $75.00 per month each additional month, or portion thereof, between seven (7) and twelve (12) months;
3. At the Board's discretion for unauthorized practice extending over one (1) year.

Rule 410-11-.10 Revocation or Suspension

As provided on O.C.G.A. §§ 43-1-19 and 43-26-11, the Board my revoke, suspend, or otherwise discipline the registered professional nurse license and/or the authority to practice as a certified nurse-midwife, nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist in psychiatric/mental health, or anyone so authorized who demonstrates unprofessional conduct according to 410-10-.03, fails to comply with current scope and standards of practice according to 410-11-.02(2), 410-11-.03(2), 410-11-.04(2), or 410-11-.05(2), or who fails to maintain national certification and/or continuing competency requirements.

Rule 410-11-.11 Reinstatement of Authorization

(1) An advanced practice registered nurse whose authorization has expired may be eligible for reinstatement of authorization.
(2) The applicant must:
(a) Submit a completed reinstatement application, photograph and required fee;
(b) Request the appropriate national certifying organization to verify current certification on a form provided by the Board; and
(c) Be able to document three (3) months or 500 hours of licensed practice as a registered nurse (or advanced practice registered nurse) during the four (4) years immediately preceding the date of current application.
(3) An applicant who is unable to meet the requirement of 410-11-(2)(c) must comply with similar requirements of 410-4-.04 for an advanced practice registered nurse.

Rule 410-11-.12 Recognition of National Certifying Organizations for Advanced Nursing Practice

(1) The Board recognizes certification by: The American Midwifery Certification Board; American Academy of Nurse Practitioners; National Certification Corporation; Pediatric Nursing Certification Board; National Board of Certification and Recertification for Nurse Anesthetists; American Nurses Credentialing Center; and the American Association of Critical-Care Nurses Certification Corporation for titles recognized in Rules Chapter 410-11.
(2) The Board may discontinue recognition of a certifying organization if it deems that the respective certification process does not provide an accurate evaluation of the individual's ability to engage in advanced nursing practice.

Rule 410-11-.13 Regulation of Protocol Use By Advanced Practice Registered Nurses as Authorized by O.C.G.A. Section 43-34-26.1

(1) The general purpose of these rules is to assist in protecting and safeguarding the public by regulating the practice of advanced practice registered nurses who use protocols as authorized by O.C.G.A. § 43-34-23.
(2) An advanced practice registered professional nurse who uses a protocol as authorized by O.C.G.A. § 43-34-23 shall:
(a) Hold a current license to practice as a registered nurse in Georgia;
(b) Hold a current authorization as an advanced practice registered nurse in Georgia;
(c) Adhere to a written nurse protocol which is a written document mutually agreed upon and signed by the nurse and licensed physician which specifies delegated medical acts delegated by the physician to the nurse and provides for immediate consultation with the delegating physician or a physician designated in the absence of the delegating physician; and
(d) Document preparation and performance specific to each medical act authorized by a written nurse protocol, including the ordering and administering of controlled substances, ordering and dispensing of dangerous drugs, and ordering medical treatments and diagnostic studies in accordance with O.C.G.A. § 43-34-23.
(3) The nurse protocol agreement used by an advanced practice registered nurse under the provisions of O.C.G.A. § 43-34-23 shall comply with the following criteria:
(a) Shall be in writing and signed by the advanced practice nurse and the delegating physician;
(b) Shall be dated, available upon request and specify parameters under which medical acts delegated by the physician may be performed;
(c) Shall include provisions for periodic review of patient records by the delegating physician;
(d) Shall be reviewed, revised or updated annually;
(e) Shall include a provision for immediate consultation with the delegating physician or a physician designated in the absence of the delegating physician;
(f) Shall contain written provisions regarding the procedure for dispensing dangerous drugs which comply with O.C.G.A. §§ 43-34-23(a)(3), (3.1), (4), and (5), if the dispensing of dangerous drugs is included as a delegated medical act in the nurse protocol agreement; and
(g) Shall contain written provisions regarding the procedure for ordering controlled substances which comply with paragraph (b)(1) of O.C.G.A. § 43-34-23, if the ordering of controlled substances is included as a delegated medical act in the nurse protocol agreement.

Rule 410-11-.14 Regulation of Protocol Use By Advanced Practice Registered Nurses as Authorized by O.C.G.A. Section 43-34-26.3

(1) An advanced practice registered nurse ("APRN") who uses a protocol authorized by O.C.G.A. § 43-34-25 shall:
(a) Hold a current license to practice as a registered professional nurse in Georgia;
(b) Hold a current authorization to practice as an advanced practice registered nurse in Georgia;
(c) Adhere to a written nurse protocol agreement that is dated and signed by the APRN, the delegating physician, and any other designated physician(s); the APRN's area of practice shall be in the same or comparable specialty as that of the delegating physician; the protocol shall specify the medical acts delegated to the APRN as provided by O.C.G.A. § 43-34-25 and shall provide for immediate consultation with the delegating physician or a designated physician if the delegating physician is not available; and
(d) Document preparation and performance specific to each medical act authorized by the written nurse protocol agreement including ordering drugs, medical treatments or diagnostic studies, medical devices, or, in life threatening situations, radiographic imaging tests.
(2) An APRN may practice under a nurse protocol agreement authorized by O.C.G.A. § 43-34-25 if the nurse protocol agreement adheres to the following criteria:
(a) Shall bear a current review date; be available upon request; and specify parameters under which delegated medical acts may be performed to include kinds of diagnostic studies which may be ordered, the extent to which radio logic image tests may be ordered, provisions for the reading and interpretation of such tests by a physician who is trained in the reading and interpretation of the tests, circumstances under which prescription drugs orders may be executed, number of refills which may be ordered, include a frequency of follow up review of the patient by the physician, including patients who are on controlled substances;
(b) Shall include a schedule for periodic review of patient records by the delegating physician, which records review may be achieved with a sampling of such records as determined by the delegating physician;
(c) Shall be reviewed, revised or updated annually by the APRN, the delegating physician, and any designated physician;
(d) Shall include a provision for immediate consultation with the delegating physician or a physician designated in the absence of the delegating physician; and
(e) Shall comply with the provisions of O.C.G.A. § 43-34-25 regarding prescription drug orders placed by an APRN for a drug or medical device including, but not limited to, the following:
1. No prescription drug orders submitted by an APRN for Schedule I or II controlled substances;
2. No refills of any drug for more than 12 months from the date of the original Order, except in the case of oral contraceptives, hormone replacement therapy, or prenatal vitamins, which may be refilled for a period of 24 months;
3. No drug order or medical device that may result in the performance or occurrence of an abortion, including the administration, prescription or issuance of a drug order that is intended to cause an abortion to occur pharmacologically;
4. Written prescription drug orders shall be signed by the APRN, be written on forms that comply with the nurse protocol agreement, and such forms shall contain the information required by paragraph (d) of O.C.G.A. § 43-34-25;
5. A written provision in the nurse protocol agreement authorizing the APRN to request, receive, and sign for professional samples, and to distribute them to patients in accordance with a list of professional samples approved by the delegating physician that is maintained by the office or facility where the APRN works and that requires the documentation of each sample received and dispensed; and
6. Compliance with applicable state and federal laws and regulations pertaining to the ordering, maintenance, and dispensing of drugs.
(3) Only four (4) advanced practice registered nurses may enter into a nurse protocol agreement with a delegating physician at any one time under O.C.G.A § 43-34-25, except this limitation shall not apply to an APRN that is practicing in the following settings:
(a) In a hospital licensed under Title 31;
(b) In any college or university as defined in Code Section 20-8-1;
(c) In the Department of Public Health;
(d) In any county board of health;
(e) In any free health clinic;
(f) In a birthing center;
(g) In any entity:
1. Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or indigent Medicaid and Medicare patients; or
2. Which has been established under the authority of or is receiving funds pursuant to 42 U.S.C. Section 254 b or 254c of the United States Public Health Service Act;
(h) In any local board of education which has a school nurse program; or
(i) In a health maintenance organization that has an exclusive contract with a medical group practice and arranges for the provision of substantially all physician services to enrollees in health benefits of the health maintenance organization.