The Joint Commission
Tuesday 9:48 CST, February 9, 2016

Standards FAQ Details

Provision of Care, Treatment, and Services (PC) (Ambulatory Health Care / Ambulatory Health Care)

Delegation of the History and Physical Examination
Current | April 22, 2015
Q: Can the responsibility for performing the admission history and physical examination be delegated to a practitioner such as an advanced practice nurse, physician's assistant, or registered nurse who are not licensed independent practitioners?  

A: Typically, this delegation is limited to the physician's assistant or the advance practice nurse practitioner. However, before allowing the responsibilities of an Licensed Independent Practitioner to be performed by a non-Licensed Independent Practitioner the organizations must determine and be able to demonstrate whether state laws and regulations and professional practice acts allow the such delegation and under what circumstances.

If it is determined that state law and regulation and professional practice acts allow delegation of the Licensed Independent Practitioner history and physical examination, the exam can be delegated, provided:

  • the organization has appropriate policies and procedures
  • such delegation meets pertinent requirements for the type of history and physical examination required by the organization
  • the non-licensed independent practitioner has received specific training to perform an appropriate history and physical examination
  • the organization has defined and verified that the non-licensed independent practitioner has the appropriate competence to perform a history and physical examination as defined by organization policy and procedures or other documents 
  • the medical history and physical examination is performed under the supervision of, or through appropriate delegation by, a specific qualified physician who countersigns in accordance with law, regulation and organizational policy, and retains accountability for the patient's medical history and physical examination.
  • the person is specifically permitted by the organization to perform the history and physical either,
    • as part of the supervising/delegating physician's privileges, or
    • through an specific alternate process, such as that utilized by the organization for allied health practitioners.
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