# COMAR Title 10 — Maryland Department of Health

## Subtitle 32 — Board of Physicians

### Chapter 03 — Physician Assistant

#### Regulation .07 Collaboration Agreements—Advanced Duties.

*COMAR 10.32.03.07*

A. A physician assistant that has sufficient education, training, and experience in the performance of an advanced duty, may perform that advanced duty under a collaboration agreement without Board approval if:

  (1) The physician assistant is practicing at an exempt facility in accordance with Health Occupations Article, §15–302.1, Annotated Code of Maryland and meets the conditions in §A(4) of this regulation;

  (2) The physician assistant has previously received Board approval to perform the advanced duty; or

  (3) The physician assistant has at least 7,000 hours of clinical practice experience as attested to by the physician assistant.

  (4) For a physician assistant practicing at an exempt facility the following shall be met:

    (a) The patient care team physician listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment;

    (b) The physician assistant listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment; and

    (c) The advanced duty to be delegated by the patient care team physician to the physician assistant is reviewed and approved in a process approved by the exempt facility before the physician assistant performs the advanced duty.

B. Except as provided under §A of this regulation, a physician assistant shall receive Board approval to perform an advanced duty prior to performing the advanced duty.

C. A physician assistant performing X-Ray duties in accordance with Health Occupations Article, §14–306(e), Annotated Code of Maryland, shall:

  (1) Notify the Board of an executed collaboration agreement in a manner approved by the Board;

  (2) Maintain a copy of the collaboration agreement on file at the practice location;

  (3) Obtain Board approval for the X-Ray duty as an advanced duty if practicing at a location other than an exempt facility;

  (4) Perform the X-Ray duty in the medical office of a patient care team physician; and

  (5) Be limited to nonfluoroscopic X-Ray procedures of the extremities, anterior-posterior and lateral, not including the head.

D. In addition to the requirements of §C of this regulation, a physician assistant performing the advanced duty of nonfluoroscopic X-ray procedures using a mini C-arm or similar low-level radiation machine shall be required to present the Board with evidence of completion of a course that includes:

  (1) Didactic instruction of at least eight hours on the following subject matters:

    (a) Principles of radiography;

    (b) Image acquisition;

    (c) Principles of exposure;

    (d) Image evaluation;

    (e) Radiation safety;

    (f) Equipment overview; and

    (g) Documentation; and

  (2) Clinical instruction, which shall:

    (a) Include anterior-posterior and lateral radiographic studies of extremities, not including the head, on at least 20 separate patients; and

    (b) Be under the direct supervision of the delegating physician or radiologist.