Certified medical assistants

AN ACT Relating to certified medical assistants; amending RCW 1
18.360.060; reenacting and amending RCW 18.360.050; and adding a new 2
section to chapter 18.360 RCW. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 18.360.050 and 2024 c 248 s 3 and 2024 c 217 s 5 are 5
each reenacted and amended to read as follows: 6
(1) A medical assistant-certified may perform the following 7
duties delegated by, and under the supervision of, a health care 8
practitioner: 9
(a) Fundamental procedures: 10
(i) Wrapping items for autoclaving; 11
(ii) Procedures for sterilizing equipment and instruments;12
(iii) Disposing of biohazardous materials; and13
(iv) Practicing standard precautions. 14
(b) Clinical procedures: 15
(i) Performing aseptic procedures in a setting other than a 16
hospital licensed under chapter 70.41 RCW; 17
(ii) Preparing of and assisting in sterile procedures in a 18
setting other than a hospital under chapter 70.41 RCW;19
(iii) Taking vital signs; 20
(iv) Preparing patients for examination; 21
H-1034.1
HOUSE BILL 1784
State of Washington 69th Legislature 2025 Regular Session
By Representatives Marshall, Simmons, Parshley, and Schmidt
Read first time 02/03/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1784
(v) Capillary blood withdrawal, venipuncture, and intradermal, 1
subcutaneous, and intramuscular injections; and 2
(vi) Observing and reporting patients' signs or symptoms.3
(c) Specimen collection: 4
(i) Capillary puncture and venipuncture; 5
(ii) Obtaining specimens for microbiological testing; and6
(iii) Instructing patients in proper technique to collect urine 7
and fecal specimens. 8
(d) Diagnostic testing: 9
(i) Electrocardiography; 10
(ii) Respiratory testing; and 11
(iii)(A) Tests waived under the federal clinical laboratory 12
improvement amendments program on July 1, 2013. The department shall 13
periodically update the tests authorized under this subsection (1)(d) 14
based on changes made by the federal clinical laboratory improvement 15
amendments program; and 16
(B) Moderate complexity tests if the medical assistant-certified 17
meets standards for personnel qualifications and responsibilities in 18
compliance with federal regulation for nonwaived testing.19
(e) Patient care: 20
(i) Telephone and in-person screening limited to intake and 21
gathering of information without requiring the exercise of judgment 22
based on clinical knowledge; 23
(ii) Obtaining vital signs; 24
(iii) Obtaining and recording patient history;25
(iv) Preparing and maintaining examination and treatment areas;26
(v) Preparing patients for, and assisting with, routine and 27
specialty examinations, procedures, treatments, and minor office 28
surgeries; 29
(vi) Maintaining medication and immunization records; and30
(vii) Screening and following up on test results as directed by a 31
health care practitioner. 32
(f)(i) Administering medications. A medical assistant-certified 33
may only administer medications if the drugs are: 34
(A) Administered only by unit or single dosage, or by a dosage 35
calculated and verified by a health care practitioner. For purposes 36
of this section, a combination or multidose vaccine shall be 37
considered a unit dose; 38
(B) Limited to legend drugs, vaccines, and Schedule III-V 39
controlled substances as authorized by a health care practitioner 40
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under the scope of his or her license and consistent with rules 1
adopted by the secretary under (f)(ii) of this subsection; and2
(C) Administered pursuant to a written order from a health care 3
practitioner. 4
(ii) A medical assistant-certified may not administer 5
experimental drugs or chemotherapy agents. The secretary may, by 6
rule, further limit the drugs that may be administered under this 7
subsection (1)(f). The rules adopted under this subsection must limit 8
the drugs based on risk, class, or route. 9
(iii) A medical assistant-certified may administer intramuscular 10
injections for the purposes of treating known or suspected syphilis 11
infection without immediate supervision if a health care practitioner 12
is providing supervision through interactive audio or video 13
telemedicine technology in accordance with RCW 18.360.010(((11))) 14
(12)(c)(ii). 15
(g) Intravenous injections. A medical assistant-certified may 16
establish intravenous lines for diagnostic or therapeutic purposes, 17
without administering medications, under the supervision of a health 18
care practitioner, and administer intravenous injections for 19
diagnostic or therapeutic agents under the direct visual supervision 20
of a health care practitioner if the medical assistant-certified 21
meets minimum standards established by the secretary in rule. The 22
minimum standards must be substantially similar to the qualifications 23
for category D and F health care assistants as they exist on July 1, 24
2013. 25
(h) Urethral catheterization when appropriately trained.26
(i) Enter and approve orders for health care services, as 27
delegated by a supervising health care practitioner in accordance 28
with section 2 of this act.29
(2) A medical assistant-hemodialysis technician may perform 30
hemodialysis when delegated and supervised by a health care 31
practitioner. A medical assistant-hemodialysis technician may also 32
administer drugs and oxygen to a patient when delegated and 33
supervised by a health care practitioner and pursuant to rules 34
adopted by the secretary. 35
(3) A medical assistant-phlebotomist may perform:36
(a) Capillary, venous, or arterial invasive procedures for blood 37
withdrawal when delegated and supervised by a health care 38
practitioner and pursuant to rules adopted by the secretary;39
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(b) Tests waived under the federal clinical laboratory 1
improvement amendments program on July 1, 2013. The department shall 2
periodically update the tests authorized under this section based on 3
changes made by the federal clinical laboratory improvement 4
amendments program; 5
(c) Moderate and high complexity tests if the medical assistant-6
phlebotomist meets standards for personnel qualifications and 7
responsibilities in compliance with federal regulation for nonwaived 8
testing; and 9
(d) Electrocardiograms. 10
(4) A medical assistant-registered may perform the following 11
duties delegated by, and under the supervision of, a health care 12
practitioner: 13
(a) Fundamental procedures: 14
(i) Wrapping items for autoclaving; 15
(ii) Procedures for sterilizing equipment and instruments;16
(iii) Disposing of biohazardous materials; and17
(iv) Practicing standard precautions. 18
(b) Clinical procedures: 19
(i) Preparing for sterile procedures; 20
(ii) Taking vital signs; 21
(iii) Preparing patients for examination; and 22
(iv) Observing and reporting patients' signs or symptoms.23
(c) Specimen collection: 24
(i) Obtaining specimens for microbiological testing; and25
(ii) Instructing patients in proper technique to collect urine 26
and fecal specimens. 27
(d) Patient care: 28
(i) Telephone and in-person screening limited to intake and 29
gathering of information without requiring the exercise of judgment 30
based on clinical knowledge; 31
(ii) Obtaining vital signs; 32
(iii) Obtaining and recording patient history;33
(iv) Preparing and maintaining examination and treatment areas;34
(v) Preparing patients for, and assisting with, routine and 35
specialty examinations, procedures, treatments, and minor office 36
surgeries, including those with minimal sedation. The department may, 37
by rule, prohibit duties authorized under this subsection (4)(d)(v) 38
if performance of those duties by a medical assistant-registered 39
would pose an unreasonable risk to patient safety;40
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(vi) Maintaining medication and immunization records; and1
(vii) Screening and following up on test results as directed by a 2
health care practitioner. 3
(e) Diagnostic testing and electrocardiography.4
(f)(i) Tests waived under the federal clinical laboratory 5
improvement amendments program on July 1, 2013. The department shall 6
periodically update the tests authorized under subsection (1)(d) of 7
this section based on changes made by the federal clinical laboratory 8
improvement amendments program. 9
(ii) Moderate complexity tests if the medical assistant-10
registered meets standards for personnel qualifications and 11
responsibilities in compliance with federal regulation for nonwaived 12
testing. 13
(g) Administering eye drops, topical ointments, and vaccines, 14
including combination or multidose vaccines. 15
(h) Urethral catheterization when appropriately trained.16
(i) Administering medications: 17
(i) A medical assistant-registered may only administer 18
medications if the drugs are: 19
(A) Administered only by unit or single dosage, or by a dosage 20
calculated and verified by a health care practitioner. For purposes 21
of this section, a combination or multidose vaccine shall be 22
considered a unit dose; 23
(B) Limited to legend drugs, vaccines, and Schedule III through V 24
controlled substances as authorized by a health care practitioner 25
under the scope of his or her license and consistent with rules 26
adopted by the secretary under (i)(ii) of this subsection; and27
(C) Administered pursuant to a written order from a health care 28
practitioner. 29
(ii) A medical assistant-registered may only administer 30
medication for intramuscular injections. A medical assistant-31
registered may not administer experimental drugs or chemotherapy 32
agents. The secretary may, by rule, further limit the drugs that may 33
be administered under this subsection (4)(i). The rules adopted under 34
this subsection must limit the drugs based on risk, class, or route.35
(j)(i) Intramuscular injections. A medical assistant-registered 36
may administer intramuscular injections for diagnostic or therapeutic 37
agents under the immediate supervision of a health care practitioner 38
if the medical assistant-registered meets minimum standards 39
established by the secretary in rule. 40
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(ii) A medical assistant-registered may administer intramuscular 1
injections for the purposes of treating known or suspected syphilis 2
infection without immediate supervision if a health care practitioner 3
is providing supervision through interactive audio or video 4
telemedicine technology in accordance with RCW 18.360.010(((11))) 5
(12)(c)(ii). 6
(5)(a) A medical assistant-EMT may perform the following duties 7
delegated by, and under the supervision of, a health care 8
practitioner if the duties are within the scope, training, and 9
endorsements of the medical assistant-EMT's emergency medical 10
technician, advanced emergency medical technician, or paramedic 11
certification: 12
(i) Fundamental procedures: 13
(A) Disposing of biohazardous materials; and 14
(B) Practicing standard precautions; 15
(ii) Clinical procedures: 16
(A) Taking vital signs; 17
(B) Preparing patients for examination; 18
(C) Observing and reporting patients' signs or symptoms;19
(D) Simple eye irrigation; 20
(E) Hemorrhage control with direct pressure or hemostatic gauze;21
(F) Spinal and extremity motion restriction and immobilization;22
(G) Oxygen administration; 23
(H) Airway maintenance, stabilization, and suctioning;24
(I) Cardiopulmonary resuscitation; and 25
(J) Use of automated external defibrillators and semiautomated 26
external defibrillators; 27
(iii) Specimen collection: 28
(A) Capillary puncture and venipuncture; and 29
(B) Instructing patients in proper technique to collect urine and 30
fecal specimens; 31
(iv) Diagnostic testing: 32
(A) Electrocardiography; and 33
(B) Respiratory testing, including nasopharyngeal swabbing for 34
COVID-19; 35
(v) Patient care: 36
(A) Telephone and in-person screening, limited to intake and 37
gathering of information without requiring the exercise of judgment 38
based on clinical knowledge; 39
(B) Obtaining vital signs; 40
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(C) Obtaining and recording patient history; and1
(D) Preparing and maintaining examination and treatment areas;2
(vi) Administering medications: A medical assistant-EMT may only 3
administer medications if the drugs are: 4
(A) Administered only by unit or single dosage, or by a dosage 5
calculated and verified by a health care practitioner. For purposes 6
of this subsection, a combination or multidose vaccine shall be 7
considered a unit dose; 8
(B) Limited to vaccines, opioid antagonists, and oral glucose, as 9
authorized by a health care practitioner under the scope of his or 10
her license and consistent with rules adopted by the secretary under 11
(b) of this subsection; and 12
(C) Administered pursuant to a written order from a health care 13
practitioner; and 14
(vii) Establishing intravenous lines: A medical assistant-EMT may 15
establish intravenous lines for diagnostic or therapeutic purposes, 16
without administering medications, and remove intravenous lines under 17
the supervision of a health care practitioner. 18
(b) The secretary may, by rule, further limit the drugs that may 19
be administered under this subsection. The rules adopted under this 20
subsection must limit the drugs based on risk, class, or route.21
NEW SECTION. Sec. 2. A new section is added to chapter 18.360 22
RCW to read as follows: 23
(1) A medical assistant-certified may enter an order for health 24
care services into an entry-order system and approve such order if:25
(a) The supervising health care practitioner directs the medical 26
assistant-certified to enter and approve the order as a delegated 27
task, using explicit verbal or written instructions that enable the 28
medical assistant-certified to enter and approve the order without 29
exercising judgment based on clinical knowledge; 30
(b) The medical assistant-certified enters and approves the order 31
in accordance with the instructions of the supervising health care 32
practitioner, without exercising judgment based on clinical 33
knowledge; 34
(c) The order is reviewed by the supervising health care 35
practitioner during the same business day and countersigned by the 36
supervising health care practitioner within 72 hours of approval by 37
the medical assistant-certified; 38
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(d) The medical assistant-certified has completed training 1
regarding order-entry systems as specified in subsection (2) of this 2
section; 3
(e) The delegated order is in compliance with RCW 18.360.060; and4
(f) The order is not a prescription for a controlled substance, 5
as defined in RCW 69.50.101. If the order is for a prescription for a 6
controlled substance, the medical assistant-certified may enter, but 7
not approve, the order. 8
(2)(a) A medical assistant-certified may only enter and approve 9
orders in accordance with this section if the medical assistant-10
certified has received training from a supervising health care 11
practitioner regarding order-entry systems. The training must take 12
place annually and must cover the scope of permitted tasks, when to 13
obtain clarification from a supervising health care practitioner, and 14
compliance with regulatory requirements. 15
(b) The employer of a medical assistant-certified must maintain 16
records regarding participation in annual order-entry training.17
(3) Upon department request, including during any on-site 18
facility surveys conducted by the department, an employer of a 19
medical assistant-certified must provide documentation to the 20
department demonstrating compliance with the training and 21
countersignature requirements of this section. 22
(4) The department may adopt rules to implement this section.23
Sec. 3. RCW 18.360.060 and 2013 c 128 s 4 are each amended to 24
read as follows: 25
(1) Prior to delegation of any of the functions in RCW 26
18.360.050, a health care practitioner shall determine to the best of 27
his or her ability each of the following: 28
(a) That the task is within that health care practitioner's scope 29
of licensure or authority; 30
(b) That the task is indicated for the patient;31
(c) The appropriate level of supervision; 32
(d) That no law prohibits the delegation; 33
(e) That the person to whom the task will be delegated is 34
competent to perform that task; and 35
(f) That the task itself is one that should be appropriately 36
delegated when considering the following factors: 37
(i) That the task can be performed without requiring the exercise 38
of judgment based on clinical knowledge; 39
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(ii) That results of the task are reasonably predictable;1
(iii) That the task can be performed without a need for complex 2
observations or critical decisions; 3
(iv) That the task can be performed without repeated clinical 4
assessments; and 5
(v)(A) For a medical assistant other than a medical assistant-6
hemodialysis technician, that the task, if performed improperly, 7
would not present life-threatening consequences or the danger of 8
immediate and serious harm to the patient; and 9
(B) For a medical assistant-hemodialysis technician, that the 10
task, if performed improperly, is not likely to present life-11
threatening consequences or the danger of immediate and serious harm 12
to the patient. 13
(2) Nothing in this section prohibits the use of protocols that 14
do not involve clinical judgment and do not involve the 15
administration of medications, other than vaccines.16
(3) The entry and approval of orders by a medical assistant-17
certified in accordance with section 2 of this act is not considered 18
a task that requires the exercise of judgment based on clinical 19
experience.20
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