Care, Treatment, and Services (CTS) (Behavioral Health / Behavioral Health Care)
History and Physical - Delegation to Non Licensed Independent Practitioners
Modify | April 11, 2016
Can the responsibility for performing the admission history and physical examination be delegated to a practitioner such as an advanced practice nurse or physician's assistant who may not recognized by the state in which they practice as a licensed independent practitioner?
Typically, this delegation is limited to the physician's assistant or the advance practice nurse practitioner. However, before allowing the responsibilities of a Licensed Independent Practitioner to be performed by a practitioner not recognized by the state as a Licensed Independent Practitioner, the organization must determine - and be able to demonstrate - whether state laws and regulations and professional practice acts allows such delegation and under what circumstances.
The glossary of the accreditation manual defines a Licensed Independent Practitioner as "An individual permitted by law and by the organization to provide care, treatment, and services without direction or supervision. A licensed independent practitioner operates within the scope of his or her license, consistent with individually granted clinical privileges. When standards reference the term licensed independent practitioner, this language is not to be construed to limit the authority of a licensed independent practitioner to delegate tasks to other qualified health care personnel (for example, physician assistants and advanced practice registered nurses) to the extent authorized by state law or a state's regulatory mechanism or federal guidelines and organizational policy".
If it is determined that state law and regulation and professional practice acts allow delegation of the Licensed Independent Practitioner history and physical examination, the exam can be delegated, provided:
- The organization has appropriate policies and procedures.
- Such delegation meets pertinent requirements for the type of history and physical examination required by the organization.
- The practitioner to whom completion of the H & P was delegated has received specific training to perform an appropriate history and physical examination.
- The organization has defined and verified that such practitioners have the appropriate competence to perform a history and physical examination as defined by organization policy and procedures or other documents.
- The medical history and physical examination is performed under the supervision of, or through appropriate delegation by, a specific qualified physician who countersigns in accordance with law, regulation and organizational policy, and retains accountability for the patient's medical history and physical examination.
- The person is specifically permitted by the organization to perform the history and physical either, as part of the supervising/delegating physician's privileges, or through an specific alternate process, such as that utilized by the organization for allied health practitioners.
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