<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.27.28.02" title_num="10" subtitle_num="27" chapter_num="28" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Advanced practice registered nurse (APRN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Assistant” means an individual:</text>
      <paragraph num="(a)">
        <text>To whom only routine nursing and technical tasks are delegated by an advanced practice registered nurse;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Who is trained as defined in §B(12) of this regulation; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Who is not licensed, certified, registered, or otherwise authorized by law by the Board, or any other State health occupations board, to practice any health occupation in the State.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Asynchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Board” means the Maryland Board of Nursing.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Delegating APRN” means an advanced practice registered nurse who directs an assistant to perform nursing and technical tasks.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Direct supervision” means oversight exercised by a delegating APRN who is:</text>
      <paragraph num="(a)">
        <text>Personally treating the patient; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the physical presence of the patient and the assistant.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Mechanical Act.</text>
      <paragraph num="(a)">
        <text>“Mechanical act” means an act which does not require professional judgment, medical or pharmaceutical training, or discretion.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Mechanical act” does not include:</text>
        <paragraph num="(i)">
          <text>Selecting a drug;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Labeling;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Measuring or calculating dosages;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Substituting one drug for another, including substituting a generic or brand drug for the prescribed drug;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Substituting one dosage form of a drug for another;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Altering the route of administration; or</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Counseling patients.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>“On-site supervision” means oversight exercised by a delegating APRN who is present at the same site as the assistant and the patient and is:</text>
      <paragraph num="(a)">
        <text>Able to be immediately available in person during the assistant’s performance of a delegated act;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>In the context of a synchronous telehealth interaction, able to be immediately available via secure telecommunications technology to the telehealth visit during the assistant’s performance of a delegated act; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>In the context of an asynchronous telehealth interaction, able to review the assistant’s work and interact with the assistant before communication with the patient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>“Site” means any facility or location, including those defined in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, used for the delivery of health care services.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Synchronous telehealth interaction” has meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Technical task” means a routine clinical act or task that does not require clinical or nursing judgment and is performed with supervision as specified within this chapter.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Trained” means possessing the knowledge, skills, and abilities, as determined by the delegating APRN, to perform delegated nursing and technical tasks.</text>
    </paragraph>
  </paragraph>
</regulation>