A.R.S. tit. 32 ch. 32 — Arizona Revised Statutes Title 32 Chapter 32 — Health Professionals

32-3201. Definitions In this chapter, unless the context otherwise requires: 1. "Health professional" means a person who is certified or licensed pursuant to chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 21, 25, 27, 28, 29, 33, 34, 35, 39, 41 or 42 of this title, title 36, chapter 4, article 6, title 36, chapter 6, article 7 or title 36, chapter 17. 2. "Health profession regulatory board" means any board that regulates one or more health professionals in this state. 3. "Medical records" has the same meaning prescribed in section 12-2291 but does not include prescription orders. 32-3201.01. Definition of medication-assisted treatment In this title, unless the context otherwise requires, "medication-assisted treatment" means the use of pharmacological medications that are approved by the United States food and drug administration, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders. 32-3202. License or certificate suspension The certificate or license of a health professional who does not renew the certificate or license as prescribed by statute and who has been advised in writing that an investigation is pending at the time the certificate or license is due to expire or terminate does not expire or terminate until the investigation is resolved. The license is suspended on the date it would otherwise expire or terminate and the health professional shall not practice in this state until the investigation is resolved. The certificate is suspended on the date it would otherwise expire or terminate and the health professional shall not practice as a certified health professional in this state until the investigation is resolved. 32-3203. Malpractice claim investigation On receipt of a malpractice report and a copy of a malpractice complaint as provided in section 12-570, the health profession regulatory board shall initiate an investigation into the matter to determine if the licensee is in violation of the statutes or rules governing licensure. 32-3204. Experimental diagnosis, therapy or treatment; implied consent; definition A. Notwithstanding any provision of this title to the contrary, a health professional, within the scope of that person's profession, may use an experimental diagnosis, therapy or treatment on a patient who is unable to make or communicate health care decisions and who has an emergent life threatening condition if the requirements of 21 Code of Federal Regulations parts 50, 56, 312, 314, 601, 812 and 814 have been met. B. A health professional who performs an experimental diagnosis, therapy or treatment pursuant to this section is deemed to have obtained the patient's implied consent for the purposes of title 12, chapter 5.1, article 1. C. For purposes of this section, "experimental diagnosis" means the pharmaceuticals, devices and technology used to diagnose patients. 32-3205. Board disciplinary action; voting requirements If a disciplinary action requires a vote of board members, a health profession regulatory board shall conduct that vote by roll call. The board shall maintain a record of each member's vote. This section does not prohibit a board from using a consent agenda. 32-3206. Disciplinary action; information; disclosure A. At least ten business days before a meeting of a health profession regulatory board to review the status of an investigation, the board shall provide notice of the meeting to the health professional, including notice of the opportunity for the health professional to request a copy of the report concerning the investigation. B. At least ten business days before a disciplinary interview or a hearing, if the board does not hold a disciplinary interview, the health profession regulatory board shall notify the health professional and, at that person's request, the board shall provide the health professional or the health professional's attorney with the information listed in this section. The board shall provide the following information: 1. Any review conducted by an expert or consultant providing an evaluation of or opinion on the allegations. 2. Any records on the patient obtained by the board from other health care providers. 3. The results of any evaluations or tests of the health professional conducted at the board's direction. 4. Any other factual information that the board will use in making its determination. C. A person who obtains information from the board pursuant to this section may not release it to any other person or entity or use it in any proceeding or action except in connection with the board's review of the investigation, the disciplinary interview and any administrative proceedings or appeals related to the disciplinary interview or hearing. A person who violates this subsection commits an act of unprofessional conduct. D. The board may charge the health professional or the health professional's attorney for the cost of providing the information received up to the fee for making a copy of each page as prescribed by section 12-284, subsection A. 32-3207. Disease hazard; suspected significant exposure; testing; petition; notice of results; definition A. A health professional may petition the court to allow for the testing of a patient or deceased person if there is probable cause to believe that in the course of that health professional's practice there was a significant exposure. B. The court shall hear a petition filed pursuant to subsection A of this section promptly. If the court finds that probable cause exists to believe that significant exposure occurred between the patient or deceased person and the health professional, the court shall order that either: 1. The person who transferred blood or bodily fluids onto the health professional provide two specimens of blood for testing. 2. If the person is deceased, the medical examiner draw two specimens of blood for testing. C. On written notice from the employer of the health professional, the medical examiner or person authorized to perform the duties of a medical examiner, including a medical student, resident or fellow in pathology training under the supervision of a licensed physician who is trained in forensic pathology, is authorized to draw two specimens of blood for testing during the autopsy or other examination of the deceased person's body. The medical examiner or person authorized to perform the duties of the medical examiner shall release the specimen to the employing agency or entity for testing only after the court issues its order pursuant to subsection B of this section. If the court does not issue an order within thirty days after the medical examiner or person authorized to perform the duties of the medical examiner collects the specimen, the medical examiner shall destroy the specimen. D. Notice of the test results shall be provided as prescribed by the department of health services to the person tested, the health professional named in the petition and the health professional's employer. If the person tested is incarcerated or detained, the notice shall also be provided to the chief medical officer of the facility in which the person is incarcerated or detained. E. For the purposes of this section, "significant exposure" means contact of a person's ruptured or broken skin or mucous membranes with another person's blood or bodily fluid, other than tears, saliva or perspiration, of a magnitude that the United States centers for disease control and prevention have epidemiologically demonstrated can result in the transmission of bloodborne or bodily fluid carried diseases. 32-3208. Criminal charges; mandatory reporting requirements; civil penalty; exceptions A. A health professional who has been charged with a misdemeanor involving conduct that may affect patient safety or a felony after receiving or renewing a license or certificate must notify the health professional's regulatory board in writing within ten working days after the charge is filed. B. An applicant for licensure or certification as a health professional who has been charged with a misdemeanor involving conduct that may affect patient safety or a felony after submitting the application must notify the regulatory board in writing within ten working days after the charge is filed. C. On receipt of this information the regulatory board may conduct an investigation. D. A health professional who does not comply with the notification requirements of this section commits an act of unprofessional conduct. The health professional's regulatory board may impose a civil penalty of not more than $1,000 in addition to other disciplinary action it takes. E. The regulatory board may deny the application of an applicant who does not comply with the notification requirements of this section. F. On request, a health profession regulatory board shall provide an applicant or health professional with a list of misdemeanors that the applicant or health professional must report. G. Notwithstanding any other provision of this section, a person who is licensed or permitted pursuant to chapter 18 of this title is not subject to: 1. An investigation, a civil penalty or any other disciplinary action for failing to disclose a criminal charge if the criminal charge is more than four years old and does not involve sexual misconduct, an incident or occurrence involving a felony, diversion of a controlled substance or impairment while practicing. Diversion of a controlled substance does not include administrative errors or recordkeeping violations when there is not evidence of an actual loss of a controlled substance. 2. A civil penalty or any other disciplinary action for failing to report a criminal charge if the licensee or permittee has disclosed the charge in any manner, including a renewal application, even if the disclosure occurred after the ten-working-day period specified in subsection A of this section. 32-3209. Release of information; fees A. On request of any person, a health profession regulatory board must provide the following information to that person: 1. A copy of the minutes of any specified board meeting. 2. A copy of a board action concerning a person regulated by the board. 3. A copy of the final adjudication of a complaint against a person regulated by the board. For the purposes of this paragraph, final adjudication of a complaint does not include any complaint that was dismissed or terminated more than five years before the request was submitted. 4. The name and primary practice address of a person regulated by the board. B. A health regulatory board may charge a fee for copies of any of the information in subsection A. 32-3210. Billing for laboratory costs; unprofessional conduct; definition A. It is an act of unprofessional conduct for a health professional to request a laboratory that provides anatomic pathology services at the health professional's orders to submit a bill for anatomic pathology services, whether occurring in this state or elsewhere, to any person or entity other than the following: 1. The patient. 2. The responsible insurer or other third party payor. 3. The health care institution. 4. A referring laboratory, excluding the laboratory of the health professional who ordered the test. 5. A governmental agency or the agency's public or private agent, agency or organization that is acting on behalf of the recipient of the services. B. For the purposes of this section, "anatomic pathology services" includes cytology services, molecular pathology services, hematopathology, histopathology, surgical pathology, and blood banking services performed by a pathologist. Anatomic pathology services does not include the collection, packaging and transportation of the specimen. 32-3211. Medical records; protocol; unprofessional conduct; corrective action; exemptions A. A health professional must prepare a written protocol for the secure storage, transfer and access of the medical records of the health professional's patients. At a minimum the protocol must specify: 1. If the health professional terminates or sells the health professional's practice and the patient's medical records will not remain in the same physical location, the procedure by which the health professional shall notify each patient in a timely manner before the health professional terminates or sells the health professional's practice in order to inform the patient regarding the future location of the patient's medical records and how the patient can access those records. 2. The procedure by which the health professional may dispose of unclaimed medical records after a specified period of time and after the health professional has made good faith efforts to contact the patient. 3. How the health professional shall timely respond to requests from patients for copies of their medical records or to access their medical records. B. The protocol prescribed in subsection A of this section must comply with the relevant requirements of title 12, chapter 13, article 7.1 regarding medical records. C. A health professional shall indicate compliance with the requirements of this section on the health professional's application for relicensure in a manner prescribed by the health professional's regulatory board. D. A health professional who does not comply with this section commits an act of unprofessional conduct. E. In addition to taking disciplinary action against a health professional who does not comply with this section, the health professional's regulatory board may take corrective action regarding the proper storage, transfer and access of the medical records of the health professional's patients. For the purposes of this subsection, corrective action does not include taking possession or management of the medical records. F. For the purposes of this section, health professional does not include a veterinarian. G. This section does not apply to a health professional who is employed by a health care institution as defined in section 36-401 that is responsible for the maintenance of the medical records. 32-3212. Umbilical cord blood; patient information; definition A. Beginning January 1, 2007, if a health professional has a patient who is in her second trimester of pregnancy, the health professional must inform the patient of the following options relating to stem cells that are contained in the umbilical cord blood after the delivery of her child: 1. Discard the stem cells. 2. Donate the stem cells to a public umbilical cord blood bank. 3. Store the stem cells in a family umbilical cord blood bank for use by the immediate and extended family members. 4. Store the stem cells for family use through a family or sibling donor banking program that provides free collection, processing and storage where there is a medical need. B. If the department of health services has issued a pamphlet on this subject, the health professional must also provide the patient with this pamphlet. C. A health professional meets the notification requirements of this section by providing this information verbally or in writing or by providing the woman with a publication prepared by the department of health services. D. This section does not impose an obligation on a health professional to inform a pregnant woman regarding the option of umbilical cord blood collection if that information conflicts with the health professional's bona fide religious beliefs. E. A person who acts in good faith pursuant to this section is not subject to civil or criminal liability or professional discipline for those acts. F. For the purposes of this section, "umbilical cord blood" means the blood that remains in the umbilical cord and placenta after the birth of a newborn child. 32-3213. Health professionals; disclosure; unprofessional conduct; definition A. An advertisement for health care services that includes a health professional's name shall identify the title and type of license the health professional holds and under which the health professional is practicing. B. A health professional who violates this section commits an act of unprofessional conduct. C. For the purposes of this section, "advertisement" includes billboards, brochures, pamphlets, radio and television scripts, electronic media, printed telephone directories, telephone and direct mail solicitations and any other means of promotion intended to directly or indirectly induce any person to enter into an agreement for services with the health professional. Advertisement does not include materials that provide information about network providers and that are created by an entity regulated under title 20. 32-3214. Board actions; public access to records; website A. If a health profession regulatory board dismisses a complaint, the record of that complaint is available to that regulatory board and the public pursuant to section 39-121 but may not appear on the board's website. For the purposes of this subsection, "dismisses a complaint" means that a board does not issue a disciplinary or nondisciplinary order or action against a licensee or certificate holder. A pending complaint or investigation may not be disclosed to the public. B. All disciplinary actions against a licensee or certificate holder shall be available on the health profession regulatory board's website for not more than five years. If a health profession regulatory board issues a final nondisciplinary order or action, the record of the final nondisciplinary order or action shall be made available on the board's website for not more than five years. Letters of concern and advisory letters may not be made available on the website but a copy of such letters are available to the public pursuant to section 39-121 and shall be provided to any person on request. C. If a health profession regulatory board maintains a website, the board must display on its website a statement that a person may obtain additional public records related to any licensee or certificate holder, including dismissed complaints and nondisciplinary actions and orders, by contacting the board directly. D. This section does not prohibit a health profession regulatory board from conducting its authorized duties in a public meeting. E. Subsections A and B of this section do not apply to meeting minutes and notices kept by the board in accordance with the public meeting requirements of title 38, chapter 3, article 3.1. 32-3215. Medical marijuana; unprofessional conduct; annual reports; identifying information A. It is an act of unprofessional conduct for a health professional who is licensed pursuant to chapter 13, 14, 17 or 29 of this title to recommend medical marijuana pursuant to title 36, chapter 28.1 for other than a debilitating medical condition as defined in section 36-2801. B. The Arizona medical board, the Arizona board of osteopathic examiners in medicine and surgery, the naturopathic physicians medical board and the board of homeopathic and integrated medicine examiners shall each submit an annual report on or before November 15 to the governor, the president of the senate, the speaker of the house of representatives and the director of the department of health services that includes at least the following information: 1. The number of notifications received from the department of health services and from the public of suspected unprofessional conduct that relate to medical marijuana recommendations issued pursuant to title 36, chapter 28.1. 2. The number of investigations conducted as a result of information received pursuant to paragraph 1 and the outcome of those investigations. C. Annual reports filed pursuant to subsection B of this section shall not include identifying information about a physician. 32-3216. Health care providers; charges; public availability; direct payment; notice; definitions A. A health care provider must make available on request or online the direct pay price for at least the twenty-five most commonly provided services, if applicable, for the health care provider. The services may be identified by a common procedural terminology code or by a plain-English description. The direct pay prices must be updated at least annually and must be based on the services from a twelve-month period that occurred within the eighteen-month period preceding the annual update. The direct pay price must be for the standard treatment provided for the service and may include the cost of treatment for complications or exceptional treatment. Health care providers who are owners or employees of a legal entity with fewer than three licensed health care providers are exempt from the requirements of this subsection. B. Subsection A of this section does not apply to emergency services. C. The health care services provided by health care providers in veterans administration facilities, health facilities on military bases, Indian health services hospitals and other Indian health service facilities, tribal owned clinics, the Arizona state hospital and any health care facility determined to be exempt pursuant to section 36-437, subsection D, are exempt from the requirements of this section. D. Subsection A of this section does not prevent a health care provider from offering either additional discounts or additional lawful health care services for an additional cost to a person or an employer paying directly. E. A health care provider is not required to report the direct pay prices to a government agency or department or to a government-authorized or government-created entity for review or filing. A government agency or department or government-authorized or government-created entity may not approve, disapprove or limit a health care provider's direct pay price for services. A government agency or department or government-authorized or government-created entity may not approve, disapprove or limit a health care provider's ability to change the published or posted direct pay price for services. F. A health care system may not punish a person or employer for paying directly for lawful health care services or a health care provider for accepting direct payment from a person or employer for lawful health care services. G. Except as provided in subsection N of this section, a health care provider who receives direct payment from a person or employer for a lawful health care service is deemed paid in full if the entire fee for the service is paid and shall not submit a claim for payment or reimbursement for the service to any health care system. This subsection does not prevent a health care provider from pursuing a health care lien for customary charges pursuant to title 33. This subsection does not affect the ability of a health care provider to submit claims for the same service provided on other occasions to the same or a different person if no direct payment occurs. This subsection does not require a health care provider to refund or adjust any capitated payment, bundled payment or other form of prepayment or global payment made by a health care system to the health care provider for lawful health care services to be provided by the health care provider for the person who makes, or on whose behalf an employer makes, direct payment to the health care provider. H. Before a health care provider who is contracted as a network provider for a health care system accepts direct payment from a person or an employer, and the person is an enrollee of the same health care system, the health care provider shall obtain the person's or employer's signature on a notice in a form that is substantially similar to the following: Important notice about direct payment for your health care services The Arizona Constitution permits you to pay a health care provider directly for health care services. Before you make any agreement to do so, please read the following important information: If you are an enrollee of a health care system (more commonly referred to as a health insurance plan) and your health care provider is contracted with the health insurance plan, the following apply: 1. You may not be required to pay the health care provider directly for the services covered by your plan, except for cost share amounts that you are obligated to pay under your plan, such as copayments, coinsurance and deductible amounts. 2. Your provider's agreement with the health insurance plan may prevent the health care provider from billing you for the difference between the provider's billed charges and the amount allowed by your health insurance plan for covered services. 3. If you pay directly for a health care service, your health care provider will not be responsible for submitting claim documentation to your health insurance plan for that claim. Before paying your claim, your health insurance plan may require you to provide information and submit documentation necessary to determine whether the services are covered under your plan. 4. If you do not pay directly for a health care service, your health care provider may be responsible for submitting claim documentation to your health insurance plan for the health care service. Your signature below acknowledges that you received this notice before paying directly for a health care service. I. A health care provider who receives direct payment for a lawful health care service and who complies with subsection H of this section is not responsible for submitting documentation of any kind for purposes of reimbursement to any health care system for that claim if the failure to submit such documentation does not conflict with the terms of any federal or state contracts to which the health care system is a party and the health care provider has agreed to serve patients under or with applicable state or federal programs in which a health care provider and health care system participate. J. A health care provider who receives direct payment pursuant to this section shall provide the person making the direct payment with a receipt that includes the following information: 1. The amount of the direct payment. 2. The applicable procedure and diagnosis codes for the services rendered. 3. A clear notation that the services were subject to direct payment under this section. K. If an enrollee pays to a health care provider who is an out-of-network provider the direct pay price for a lawful health care service that is covered under the enrollee's health care plan, pursuant to the requirements of this section, the amount paid by the enrollee shall be applied first to the enrollee's in-network deductible with any remaining monies being applied to the enrollee's out-of-network deductible, if applicable. The amount applied to the in-network deductible shall be the amount paid directly or the insurer's prevailing contracted commercial rate for the enrollee's health care plan in this state for the service or services. If the service or services do not match standard codes or bundled payment programs in use in this state by the insurer, the amount applied to the in-network deductible shall be the amount paid directly. For the purposes of this subsection, "prevailing contracted commercial rate" means the most usual and customary rate that an insurer offers as payment for a specific service under a specific health care plan, not including a plan offered under medicare or medicaid or on a health insurance exchange. L. If an enrollee is enrolled in a high deductible plan that qualifies the enrollee for a health savings account as defined in 26 United States Code section 223, the health care system is not liable if the enrollee submits a claim for deductible application of a direct pay amount pursuant to subsection K of this section that jeopardizes the enrollee's status as an individual eligible for favorable tax treatment of the health savings account. M. This section does not create any private right or cause of action for or on behalf of any person against the health insurer. This section provides solely an administrative remedy for any violation of this section or any related rule. N. This section does not impair the provisions of a health care system's private health care network provider contract, except that a health care provider may accept direct payment from a person or employer or may decline to bill the health care system directly for services paid directly by a person or employer if the health care provider has complied with subsection H of this section and the health care provider's receipt of direct payment and the declination to bill the health care system do not conflict with the terms of any federal or state contract to which the health care system is a party and the health care provider has agreed to serve patients under or with applicable state or federal programs in which both a health care provider and health care system participate. O. A health care provider who does not comply with the requirements of this section commits unprofessional conduct. Any disciplinary action taken by the health professional's licensing board may not include revocation of the health care provider's license. P. For the purposes of this section: 1. "Direct pay price" means the price that will be charged by a health care provider for a lawful health care service, regardless of the health insurance status of the person, if the entire fee for the service is paid in full directly to a health care provider by the person, including the person's health savings account, or by the person's employer and that does not prohibit a provider from establishing a payment plan with the person paying directly for services. 2. "Emergency services" means lawful health care services needed to evaluate and stabilize an emergency medical condition as defined in 42 United States Code section 1396u-2(b)(2)(C). 3. "Enrollee" means a person who is enrolled in a health care plan provided by a health insurer. 4. "Health care plan" means a policy, contract or evidence of coverage issued to an enrollee. Health care plan does not include limited benefit coverage as defined in section 20-1137. 5. "Health care provider" means a person who is licensed pursuant to chapter 7, 8, 13, 16, 17, 19 or 34 of this title. 6. "Health care system" means a public or private entity whose function or purpose is the management, processing or enrollment of individuals or the payment, in full or in part, of health care services. 7. "Health insurer": (a) Means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation as defined in title 20. (b) Does not include a governmental plan as defined in the employee retirement income security act of 1974 (P.L. 93-406; 88 Stat. 829; 29 United States Code section 1002). 8. "Lawful health care services" means any health-related service or treatment, to the extent that the service or treatment is permitted or not prohibited by law or regulation, that may be provided by persons or businesses otherwise permitted to offer the services or treatments. 9. "Punish" means to impose any penalty, surcharge or named fee with a similar effect that is used to discourage the exercise of rights under this section. 32-3217. Volunteer health services registration; health professionals; free medical clinic A. A health profession regulatory board in this state may issue a volunteer health services registration to allow a health professional who is not a licensee to practice in this state for a total of up to fourteen days each calendar year if the health professional meets all of the following requirements: 1. Holds an active and unrestricted license in a state, territory or possession of the United States. 2. Has never had a license revoked or suspended. 3. Is not the subject of an unresolved complaint. 4. Applies for registration every two years as prescribed by the board. 5. Agrees to render services at a free medical clinic that does not provide abortions and restricts the health professional's authorized services and duties to the provision of care or service at a free medical clinic. 6. Provides only the care or services that the health professional is licensed or authorized to provide by the health professional's regulatory agency or this state's regulatory board for the same health profession, whichever is more stringent. B. The fourteen days of practice prescribed by subsection A of this section may be performed consecutively or cumulatively during each calendar year. C. For the purpose of meeting the requirements of subsection A of this section, an applicant shall provide the appropriate health profession regulatory board the name of each state in which the person is licensed or has held a license and the board shall verify with the applicable regulatory agency of each state that the applicant is licensed or has held a license, has never had the license revoked or suspended and is not the subject of an unresolved complaint. The board may accept the verification of the information required by subsection A, paragraphs 1, 2 and 3 of this section from each of the other state's regulatory agencies either electronically or by hard copy. D. A health profession regulatory board issuing a volunteer health services registration pursuant to this section may not charge a fee. E. A health profession regulatory board may immediately suspend or revoke a registration issued pursuant to this section on receiving proof satisfactory to the health profession regulatory board that the holder of the registration has engaged in practice in this state that is outside the scope of the registration or that grounds exist for action against the holder of the registration under the relevant chapter of this title. The holder of a registration may request a hearing to challenge the suspension or revocation of a registration in the manner permitted for appealable agency actions under title 41, chapter 6, article 10. 32-3218. Health profession regulatory boards; members; training; definitions A. Beginning January 1, 2015, each member of a health profession regulatory board shall complete a twelve-hour training within one year after the member's initial appointment to the board. Any member of a health profession regulatory board whose initial appointment was before January 1, 2015 has until January 1, 2016 to complete the training required by this subsection. The training must include the subjects of governance and administrative management, disciplinary procedures, conduct of quasi-judicial proceedings, administrative procedure and rule adoption and licensure as they apply to the health profession regulatory board. Any training completed by a current board member on and after January 1, 2014 on the topics specified in this subsection may count toward the requirements of this subsection. B. The training of board members required by this section may be provided by the staff of any health profession regulatory board, the office of the attorney general, the department of administration, the auditor general or an outside educational institution or any other provider that is approved by the health profession regulatory board on which the member is serving. C. Any board action taken by a health profession regulatory board is not subject to challenge or invalidation because a board member has not completed the training required by this section. D. For the purposes of this section: 1. "Health profession regulatory board" means any board that regulates one or more health professional in this state. 2. "Health professional" means a person who is certified or licensed pursuant to chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 21, 25, 28, 29, 34, 35, 39, 41 or 42 of this title. 32-3219. Licensure; renewal; notification; definitions A. A medical practitioner regulatory board shall notify each medical practitioner who receives an initial or renewal license and who intends to apply for registration or has an active registration under the controlled substances act (21 United States Code section 801 through 904) of the medical practitioner's responsibility to register with the Arizona state board of pharmacy and be granted access to the controlled substances prescription monitoring program's central database tracking system. The Arizona state board of pharmacy shall provide access to the central database tracking system to each medical practitioner who has a valid license pursuant to this title and who possesses an Arizona registration under the controlled substances act (21 United States Code section 801 through 904). B. For the purposes of this section: 1. "Medical practitioner" means any person who is licensed and authorized by law to use and prescribe drugs and devices for the treatment of sick and injured human beings or for the diagnosis or prevention of sickness in human beings in this state or any state, territory or district of the United States and who possesses an Arizona registration under the controlled substances act (21 United States Code sections 801 through 904). 2. "Medical practitioner regulatory board" means any board established pursuant to chapter 7, 11, 13, 14, 15, 16, 17, 25 or 29 of this title that regulates one or more medical practitioners in this state. 32-3220. Health professionals; requirements for licensure; prohibition A health professional is not required to participate in any public or private third-party reimbursement program as a condition of licensure under this title. 32-3221. Lawful health care services; patient education; exceptions; definitions A. This state, any political subdivision of this state or any department or agency of this state, including a health profession regulatory board, or a private entity contracted with a health profession regulatory board to carry out functions of the board may not punish a health professional, directly or indirectly through a subcontractor or otherwise, for making a patient aware of or educating or advising a patient about lawful health care services for which there is a reasonable basis, including the off-label use of health care services or health care-related research or data, or for offering, providing or making available lawful health care services, including the off-label use of health care services for which there is a reasonable basis that is allowed under state law. B. Unless an entity has a sincerely held religious or moral belief, the entity may not restrict a health professional who is an employee of or affiliated or contracted with the entity for making a patient aware of or educating or advising a patient about lawful health care services, including the off-label use of health care services, or health care-related research or data. C. Making a patient aware of or educating or advising a patient about lawful health care services, including the off-label use of health care services, does not require the health care service to be covered under the health care plan or the health care system through which the patient receives care. D. Making a patient aware of or educating or advising a patient about lawful health care services, including the off-label use of health care services, does not require a health professional, an entity that employs the health professional or a health care system to offer, provide or make the lawful health care service, including the off-label use of health care services, available to the patient. E. This section does not: 1. Impair the rights established in article II, Constitution of Arizona, or impair any right or limitation on medical liability. 2. Prevent any reporting to a health profession regulatory board regarding medical liability cases, settlements or decisions. 3. Impair or contradict any other state law regarding lawful health care services. 4. Prohibit a health profession regulatory board from taking action if a health professional commits unprofessional conduct arising out of the conduct specified in this section. F. For the purposes of this section: 1. "Lawful health care service" means any health-related service or treatment, to the extent that the service or treatment is allowed or not prohibited by law or regulation, including the off-label use of medications during a public health emergency, that may be provided by persons or businesses that are otherwise allowed to offer such services. 2. "Off-label use" means any use if the intent is the practice of medicine and the use is not specified in the labeling or indications for use for prescription drugs, biologics, approved medical devices and dietary supplements approved by the United States food and drug administration. For the purposes of this paragraph, "labeling" includes any written material that accompanies, supplements or explains a product. 3. "Punish" means to impose any penalty, sanction or disciplinary action to discourage the exercise of a right under this section. 4. Sincerely held religious or moral belief does not include a belief that restricts the access by a patient to a lawful health care service based on the cost of the lawful health care service for that patient. 5. Unprofessional conduct does not include conduct by a health professional who is acting within the minimum standards of practice as determined by the health professional's health profession regulatory board. 32-3222. Health profession regulatory boards; terms of members; board meeting recordings; employment opportunities; websites A. Notwithstanding any other provision of this title and except as provided in this subsection, a member of a health profession regulatory board is not eligible for reappointment to that board once the person has been appointed for two full terms, in addition to any time served on the board to fill a vacancy. A person may be reappointed to a health profession regulatory board once the person has not been on the board for a period of at least two full terms. This subsection applies to the state board of dental examiners, the Arizona medical board, the Arizona state board of nursing and the Arizona state board of pharmacy. A board member who is serving on an affected board on January 1, 2018 may complete any term to which the member has been appointed regardless of the number of terms the member has served. B. Each health profession regulatory board shall make a digital recording of all open meetings of the board and shall maintain these recordings for three years after the date of the recording. The health profession regulatory board, within five business days after the board meeting that is the subject of the recording, shall either: 1. Post the digital recording on the board's website. 2. Post a notice on the board's website of the availability of the digital recording. C. Each health profession regulatory board shall provide on the board's website a list of all board-specific contract employment opportunities and a link to the state procurement office to apply for those positions. 32-3223. Health profession regulatory boards; nondisciplinary confidential monitoring programs A. Each health profession regulatory board may establish a nondisciplinary confidential program, including enrollment criteria for participation in the program, for the monitoring of a licensee or certificate holder who has been reported to or who voluntarily reports to the licensee's or certificate holder's regulatory board and who may be chemically dependent or have a substance misuse history or who may have a medical, psychiatric, psychological or behavioral health disorder that may impact the licensee's or certificate holder's ability to safely practice or perform health care tasks. B. A program established pursuant to subsection A of this section may include education, intervention, therapeutic treatment and posttreatment monitoring and support. The licensee or certificate holder is responsible for the costs associated with any treatment, rehabilitation or monitoring under a program established pursuant to subsection A of this section. The health profession regulatory board and the licensee or certificate holder may agree to enter into a nondisciplinary confidential stipulated agreement for participation in a program established pursuant to subsection A of this section. C. The board may take further action if the licensee or certificate holder refuses to enter into a nondisciplinary confidential stipulated agreement with the board or fails to comply with the agreement's terms. The confidentiality requirements of this section do not apply if the licensee or certificate holder does not comply with the stipulated agreement. 32-3223.01. Health profession regulatory board; mental health inquiry; prohibition; definition A. A health profession regulatory board may not include any question on an application for a license, permit, certificate or endorsement that requests information about whether the applicant has sought mental health assistance or received a mental health diagnosis or treatment. The health profession regulatory board may ask if the applicant is currently under a regulatory entity's order in another state for the monitoring of a health condition, including substance abuse. The applicant is not required to respond if the monitoring is part of a confidential program. B. For the purposes of this section, "health profession regulatory board" includes the department of health services relating to health professionals who are regulated by the department. 32-3224. Complaints; time limit on filing; exceptions Notwithstanding any time limit to the contrary in this title, a health profession regulatory board may not act on its own motion or on any complaint received by the board in which an allegation of unprofessional conduct or any other violation of the chapter that applies to a professional who holds an Arizona license or certificate occurred more than four years before the complaint is received by the board. This time limit does not apply to: 1. Medical malpractice settlements or judgments, allegations of sexual misconduct or an incident or occurrence that involved a felony, diversion of a controlled substance or impairment while practicing by the licensee or certificate holder. 2. The board's consideration of the specific unprofessional conduct related to the licensee's or certificate holder's failure to disclose conduct or a violation as required by law. This paragraph does not apply to a person who is licensed or permitted pursuant to chapter 18 of this title unless the conduct or violation is related to sexual misconduct, an incident or occurrence involving a felony, diversion of a controlled substance or impairment while practicing. Diversion of a controlled substance does not include administrative errors or recordkeeping violations when there is not evidence of an actual loss of a controlled substance. 32-3225. Types of disciplinary action; reimbursement In addition to any other disciplinary actions that may be taken, a health profession regulatory board may impose a requirement for a reimbursement of fees paid to a licensee or certificate holder by or on behalf of the patient, if requested by the patient on a complaint form prescribed by the board. 32-3226. Address of record; disclosure; telephone number or email address; definition A. A health profession regulatory board shall have, for each licensee under the board's regulation, an address of record designated by the licensee that may be disclosed to the public. If the licensee designates the licensee's residential address as the address of record, the board shall notify the licensee of the public disclosure and allow the licensee to opt out of the disclosure. B. Each licensee who is required to maintain patient medical records must have on file with the licensee's health profession regulatory board a telephone number or email address for the board to provide to a patient who is seeking medical records. C. A health profession regulatory board shall designate associations of licensed health professionals that may receive on request the contact information and addresses of record for all health professionals under the board's regulation, including health professionals who have opted out of public disclosure. An association of licensed health professions that receives contact information and addresses of record from a health profession regulatory board may not transfer or sell that information. D. This section does not prohibit a health profession regulatory board from providing to the department of health services or a university under the jurisdiction of the Arizona board of regents information and data concerning the health profession regulatory board's licensees for research purposes if the information and data are not distributed to the public in a format that includes a licensee's personally identifiable information. E. For the purposes of this section, "address of record" means either: 1. The address where a health professional practices the person's health profession or is otherwise employed. 2. The health professional's residential address. 32-3227. Unauthorized practice of a health profession; verification; posting; violation; classification; definition A. A health profession regulatory board shall regulate the unauthorized practice of the health profession the board regulates. B. A health profession regulatory board or the executive director of the board, if delegated and consistent with each regulatory board's statutory authority, shall do all of the following after receiving a complaint regarding a person who is alleged to have engaged in the unauthorized practice of a health profession: 1. Verify all of the person's licensure or certification documentation with the primary source of the documentation. 2. Retain all records of the complaint and documentation verification for at least ten years. 3. Post on the board's public website for five years information regarding the person who the board verifies has engaged in the unauthorized practice of a health profession. The person may petition the board to have the information removed earlier than five years. C. A health profession regulatory board may issue a cease and desist order to stop a person from engaging in the unauthorized practice of a health profession. D. A health profession regulatory board shall notify each complainant that the person may submit additional information at any time during the investigation if the information was not initially submitted. E. If a complainant requests to have the complainant's identifying information withheld from the person against whom the allegation of unauthorized practice of a health profession is being made, the board shall keep the complainant's identifying information confidential. F. A person who engages in the unauthorized practice of a health profession is guilty of a class 5 felony. A health profession regulatory board shall refer each verified complaint for the unauthorized practice of a health profession to the county attorney or attorney general for prosecution. G. For the purposes of this section, "unauthorized practice of a health profession" means to engage in the practice of a health profession without having the licensure or certification required to practice in that health profession in this state. 32-3228. Informed consent; breast implant surgery; requirements; unprofessional conduct; work group; definition A. Before performing breast implant surgery, a physician who is licensed pursuant to chapter 13 or 17 of this title must provide the patient with the following, in writing or in an electronic format, based on the information that is then generally available to physicians who perform breast implant surgery: 1. A description of the risks of breast implants and of the surgical procedures used in breast implant surgery. 2. Manufacturer patient information materials, in a hard copy or an electronic format, on the implants that will be used in the surgery, including warning requirements prescribed by the United States food and drug administration. 3. The informed consent checklist developed pursuant to subsection D of this section that includes, at a minimum, information on: (a) Breast implant-associated anaplastic large cell lymphoma. (b) Breast implant illness. (c) The national breast implant registry. 4. Information on how the patient can report adverse events associated with breast implants through the United States food and drug administration's medwatch program or any similar program. B. A physician must provide the information required by subsection A of this section and obtain written informed consent for the procedure from the patient before performing the breast implant surgery. C. A physician who knowingly violates this section commits an act of unprofessional conduct and is subject to disciplinary action. D. The Arizona medical board and the Arizona board of osteopathic examiners in medicine and surgery shall convene a work group that includes licensee representatives and patient advocates to jointly develop an informed consent checklist for physicians to discuss with patients before breast implant surgery. The informed consent checklist shall include the information prescribed in subsection A of this section and any other information the boards and the work group determine to be necessary. The work group shall review the checklist and provide updates as necessary. E. For the purposes of this section, "breast implant surgery" means the surgical placement of a breast implant for cosmetic or reconstructive purposes. 32-3229. Unprofessional conduct; informed consent; pelvic examinations It is an act of unprofessional conduct for a physician who is licensed pursuant to chapter 13 or 17 of this title, a nurse practitioner who is licensed pursuant to chapter 15 of this title or a physician assistant who is licensed pursuant to chapter 25 of this title to perform or supervise an individual who performs a pelvic examination on an anesthetized or unconscious patient without first obtaining the patient's informed consent to the pelvic examination, unless performing the pelvic examination is one of the following: 1. Within the scope of the surgical procedure or diagnostic examination to be performed on the patient for which informed consent has otherwise been obtained. 2. In the case of an unconscious patient, required for diagnostic purposes and is medically necessary. 3. A forensic medical examination requested by law enforcement arising out of the need to secure evidence that the patient has been the victim of a criminal offense as prescribed in title 13, chapter 14. 32-3229.01. Health professional wellness programs; confidentiality; definition A. Any statewide association that is exempt from taxation under 26 United States Code section 501(c)(3) or 501(c)(6) and that primarily represents health professionals who are licensed to practice pursuant to chapter 13, 15 or 17 of this title may establish a health professional wellness program. B. A record of a health professional's participation in a health professional wellness program is confidential and not subject to discovery, subpoena or a reporting requirement to the applicable health profession regulatory board, unless either: 1. The health professional voluntarily provides for written release of the information. 2. The disclosure is required to meet a person's obligation: (a) To report criminal conduct. (b) To report an act of unprofessional conduct. (c) To report that the health professional is not able to safely practice. (d) To warn an individual of an imminent threat of harm. C. For the purposes of this section, "health professional wellness program": 1. Means a program of evaluation, counseling, including substance abuse counseling, or another modality to address an issue related to career fatigue or wellness in a health professional who is licensed pursuant to chapter 13, 15 or 17 of this title. 2. Does not include providing services that are intended to monitor for impairment. 32-3230. Prohibition of irreversible gender reassignment surgery for minors; definitions A. A physician may not provide irreversible gender reassignment surgery to any individual who is under eighteen years of age. B. A physician may provide any of the following to an individual who is under eighteen years of age: 1. Services to an individual born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, such as being born with forty-six XX chromosomes with virilization or forty-six XY chromosomes with undervirilization or having both ovarian and testicular tissue. 2. Services provided when a physician has otherwise diagnosed a disorder of sexual development and has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure, sex steroid hormone production or sex steroid hormone action. 3. The treatment of any infection, injury, disease or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with state and federal law. 4. Any procedure undertaken because the individual suffers from a physical disorder, physical injury or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed. C. For the purposes of this section: 1. "Biological sex" means the biological indication of male and female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads and nonambiguous internal and external genitalia present at birth, without regard to an individual's psychological, chosen or subjective experience of gender. 2. "Gender" means the psychological, behavioral, social and cultural aspects of being male or female. 3. "Gender transition" means the process in which a person goes from identifying with and living as a gender that corresponds to the person's biological sex to identifying with and living as a gender different from the person's biological sex and may involve social, legal or physical changes. 4. "Irreversible gender reassignment surgery" means a medical procedure performed for the purpose of assisting an individual with a gender transition, including any of the following: (a) Penectomy, orchiectomy, vaginoplasty, clitoroplasty or vulvoplasty for biologically male patients or hysterectomy or ovariectomy for biologically female patients. (b) Metoidioplasty, phalloplasty, vaginectomy, scrotoplasty or implantation of erection or testicular prostheses for biologically female patients. (c) Augmentation mammoplasty for biologically male patients and subcutaneous mastectomy for female patients. 5. "Physician" means a person who is licensed pursuant to chapter 13 or 17 of this title. 32-3230.01. Health professionals; practice; employment; business entities Except as provided in section 32-1753, a health professional may engage in the practice for which the health professional is licensed in any form of business entity in this state or as an employee of any form of business entity in this state. 32-3230.02. Renewal applications; suspension; extension; renewal fee waiver If a health profession regulatory board suspends the processing of renewal applications for licensure or certification: 1. All current licenses and certificates that were previously issued by that health profession regulato