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HB276 ENGROSSED
Page 0
HB276
W17PY99-2
By Representatives Oliver, Lee, Paramore, Sorrells, Lipscomb,
Shirey, Brinyark, Lamb, Mooney
RFD: Health
First Read: 15-Jan-26
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HB276 Engrossed
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First Read: 15-Jan-26
A BILL
TO BE ENTITLED
AN ACT
Relating to physician endorsements; to amend Sections
34-21-93.1 and 34-24-292, Code of Alabama 1975; to provide
that an endorsement by a certified registered nurse
practitioner, a certified nurse midwife, or an assistant to a
physician on a physical examination form for participation in
school athletics satisfies any requirement for the endorsement
of a physician on the required form; and to prohibit an
athletic association, club, or league from refusing to accept
physical examination forms for participation in school
athletics endorsed in compliance with this act.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 34-21-93.1 and 34-24-292 of the
Code of Alabama 1975, are amended to read as follows:
"§34-21-93.1
(a) When any law or rule requires a signature,
certification, stamp, verification, affidavit, or endorsement
by a physician, the document shall be deemed to authorize a
signature, certification, stamp, verification, affidavit, or
endorsement by a certified registered nurse practitioner or
certified nurse midwife for the items listed in this section.
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certified nurse midwife for the items listed in this section.
The authority in this section for a certified registered nurse
practitioner and a certified nurse midwife shall be subject to
an active collaboration agreement. This section applies to all
of the following:
(1) Certification of disability for patients to receive
special access parking or disability access parking tags or
placards.
(2) A signature required for any of the following:
a. The following documents that require a complete
history and physical examination consistent with the examining
provider's scope of practice and certification:
1. Physicals for bus drivers in this state using State
of Alabama forms.
2. Physicals to verify eligibility for students to
participate in the Special Olympics.
3. Employment and pre-employment physicals for
Transportation Security Agency (TSA) employees at an airport
or for governmental employees such as firefighters and law
enforcement officers.
4. Adoptive parent applications.
5. College or trade school physicals.
6. Boy Scout or Girl Scout physicals or physical
required by similar organizations.
7. Physicals to verify eligibility for students to
participate in K-12 school athletic activities including, but
not limited to, interscholastic athletic activities. The Board
of Nursing, on or before July 1, 2026, shall add these
physicals as an option to all certified registered nurse
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physicals as an option to all certified registered nurse
practitioner and certified nurse midwife model practice
protocols for the parties to a collaboration agreement to
select as an allowable standard skill.
b. Forms excusing a potential jury member due to an
illness.
c. Forms relating to absenteeism for employment or
school purposes, including, but not limited to, documents
associated with the federal Family and Medical Leave Act.
d. Authorizations for durable medical equipment.
e. Authorizations for diabetic testing supplies.
f. Authorization for diabetic shoes.
g. Home health recertification orders after initial
certification.
h. Within the state Medicaid system, any and all forms
for the ordering of medications, nutritional supplements, or
infant formulas, or referrals to providers of medical
specialties, home health services, and physical or occupation
therapy.
i. Death certificates.
j. Forms, including physical examination forms, needed
for certifications in residential or inpatient dwellings
within the Department of Mental Health.
k. Forms for ambulance transport.
l. Forms for donor breast milk.
m. Required documentation allowing a diabetic to renew
or obtain a driver's license.
(b) Additional forms may be approved by rule under the
Alabama Administrative Procedure Act by the State Board of
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Alabama Administrative Procedure Act by the State Board of
Medical Examiners, after consulting with the state
professional society of nurse practitioners, the state
professional society of nurse midwives, the state professional
society of physicians, or the Joint Committee of the State
Board of Medical Examiners and the Board of Nursing for
Advanced Practice Nurses as established by Section 34-21-81,
whichever is appropriate.
(c) This section shall not be construed to expand the
scope of practice for any certified registered nurse
practitioner or certified nurse midwife.
(d) This section does not expand the scope of a
collaborative physician's responsibility with regard to nurse
practitioners or nurse midwives under the laws of this state.
(e)(1) For purposes of this subsection, an athletic
association has the same meaning as provided in Section
16-1-52.1.
(2) An athletic association, club, or league shall not
refuse to accept physical examination forms to verify
eligibility for students to participate in K-12 school
athletic activities which are endorsed by a certified
registered nurse practitioner or certified nurse midwife in
compliance with this section. "
"§34-24-292
(a) Notwithstanding any other provision of law, a
licensed assistant to a physician may perform medical services
when the services are rendered under the supervision of a
licensed physician or physicians approved by the board;
except, that no medical services may be performed under this
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except, that no medical services may be performed under this
article except under the supervision of an ophthalmologist in
the office in which the physician normally actually practices
his or her profession and nowhere else in any of the following
areas:
(1) The measurement of the powers or range of human
vision or the determination of the accommodation and
refractive state of the human eye or the scope of its
functions in general or the fitting or adaptation of lenses or
frames for the aid thereof.
(2) The prescribing or directing the use of or using
any optical device in connection with ocular exercises, visual
training, or orthoptics.
(3) The prescribing of contact lenses for or the
fitting or adaptation of contact lenses to the human eye.
Nothing in this section shall preclude the performance of
routine visual screening.
(b) In the performance of any medical service
contemplated by this article, an assistant to a physician
shall be conclusively presumed to be the agent, servant, or
employee solely of the licensed physician or physicians under
whose supervision he or she performs the service, and no other
person, firm, corporation, or other organization shall be held
liable or responsible for any act or omission of the assistant
arising out of the performance of the medical service.
(c) A licensed assistant to a physician registered to a
licensed physician practicing under a job description approved
in the manner prescribed by this article may prescribe legend
drugs to patients, subject to both of the following
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drugs to patients, subject to both of the following
conditions:
(1) The drug type, dosage, quantity prescribed, and
number of refills shall be authorized in an approved job
description signed by the physicians to whom the assistant is
registered.
(2) The drug shall be on the formulary approved under
the guidelines of the Board of Medical Examiners.
(d) Assistants to physicians may administer any legend
drug which they are authorized to prescribe under this
section. An assistant to a physician may not initiate a
call-in prescription in the name of his or her physician for
any drug, whether legend drug or controlled substance, which
the assistant is not authorized to prescribe under the job
description signed by his or her physician and approved under
this section, unless the drug is specifically ordered for the
patient by the physician either in writing or by a verbal
order which has been reduced to writing and which has been
signed by the physician within a time specified in the
guidelines of the Board of Medical Examiners.
(e)(1) An assistant to a physician who has successfully
completed the Physician Assistant National Certification
Examination and is registered to a physician practicing under
a job description approved in the manner prescribed by this
article may sign physicals to verify eligibility for students
to participate in K-12 school athletic activities including,
but not limited to, interscholastic athletic activities,
without requiring the additional signature of a physician. The
State Board of Medical Examiners, on or before July 1, 2026,
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State Board of Medical Examiners, on or before July 1, 2026,
shall update its forms to include these physicals as an option
for the supervising physician and eligible assistant to a
physician to select as an allowable standard skill.
(2)a. For purposes of this subdivision, an athletic
association has the same meaning as provided in Section
16-1-52.1.
b. An athletic association, club, or league shall not
refuse to accept physical examination forms to verify
eligibility for students to participate in K-12 school
athletic activities which are endorsed by an assistant to a
physician in compliance with this section. "
Section 2. This act shall become effective on June 1,
2026.
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2026.
House of Representatives
Read for the first time and referred
to the House of Representatives
committee on Health
................15-Jan-26
Read for the second time and placed
on the calendar:
0 amendments
................05-Feb-26
Read for the third time and passed
as amended
Yeas 99
Nays 0
Abstains 6
................10-Feb-26
John Treadwell
Clerk
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