Washington Administrative Code

A military spouse may receive an expedited temporary license while completing any specific additional requirements that are not related to training or practice standards for physicians under the following conditions.(1) An expedited temporary license may be issued to an applicant…

A licensed physician shall renew his or her license every two years in compliance with WAC 246-12-030. A licensed physician must also submit information about his or her current professional practice as required by RCW 18.71.080 (1)(b).[Statutory Authority: RCW 18.71.002, 18.71.0…

In order to obtain full license status, a physician with a post-graduate limited Washington license will pay the fee difference between the limited license application and the full license application. This license will expire on their second birth date after issuance and every t…

A licensed physician must complete one of the following to satisfy maintenance of licensure requirements during renewal:(1) Complete two hundred hours of continuing education every four years as required in chapter 246-12 WAC and as described in WAC 246-919-460. Participation in …

(1) A licensed physician, other than a resident holding a limited license issued under RCW 18.71.095(3), must complete a one-time training in suicide assessment, treatment, and management. The training must be at least six hours in length and may be completed in one or more sessi…

(1) A physician must complete two hours of health equity continuing education training every four years as described in WAC 246-12-800 through 246-12-830.(2) The two hours of health equity continuing education a physician completes count toward meeting applicable continuing educa…

(1) Category I: Continuing medical education activities with accredited sponsorship. The licensed physician may earn all two hundred credit hours in Category I. The commission will accept attendance at a continuing education program that is recognized as Category I credit and is …

(1) Except as required by law, the commission will not give prior approval for any continuing medical education. The commission will accept any continuing medical education that reasonably falls within these rules and relies upon each individual physician's integrity to comply wi…

(1) If the license has been expired for three years or less, the physician must meet the requirements of chapter 246-12 WAC, Part 2.(2) If the license has been expired for over three years, the physician must:(a) Reapply for licensing under current requirements as stipulated in R…

(1) To obtain a retired active license a physician must comply with chapter 246-12 WAC, Part 5, excluding WAC 246-12-120 (2)(c) and (d).(2) A physician with a retired active license may not receive compensation for health care services;(3) A physician with a retired active licens…

A physician may request a review by the commission of its decision to revoke the physician's license under RCW 18.71.019:(1) If the commission issues a final order revoking a physician's license following an adjudicative proceeding, the physician may request a review of the decis…

(1) Purpose. The purpose of this rule is to promote and establish consistent standards, continuing competency, and to promote patient safety. The commission establishes the following rule for physicians licensed under this chapter who perform surgical procedures and use anesthesi…

(1) Purpose. The purpose of this section is to govern the administration of deep sedation and general anesthesia by physicians in dental offices. The commission establishes these standards to promote effective perioperative communication and appropriately timed interventions, and…

(1) For the purposes of this rule, laser, light, radiofrequency, and plasma devices (hereafter LLRP devices) are medical devices that:(a) Use a laser, noncoherent light, intense pulsed light, radiofrequency, or plasma to topically penetrate skin and alter human tissue; and(b) Are…

(1) The purpose of this rule is to establish the duties and responsibilities of a physician who delegates the injection of medication or substances for cosmetic purposes or the use of prescription devices for cosmetic purposes. These procedures can result in complications such as…

(1) A physician shall not prescribe, administer or dispense anabolic steroids, growth hormones, testosterone or its analogs, human chorionic gonadotropin (HCG), other hormones, or any form of autotransfusion for the purpose of enhancing athletic ability.(2) A physician shall comp…

(1) A physician must comply with a request, under RCW 70.02.050, for health care records or documents from an investigator who is acting on behalf of the disciplining authority under RCW 18.130.050(2).(a) The physician shall submit the requested items within twenty-one calendar d…

(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.(a) "Patient" means a person who is receiving health care or treatment, or has received health care or treatment without a termination of the physician-patient relat…

(1) A physician commits unprofessional conduct if the physician abuses a patient. A physician abuses a patient when he or she:(a) Makes statements regarding the patient's body, appearance, sexual history, or sexual orientation that have no legitimate medical or therapeutic purpos…

The commission adopts the rules for mandatory reporting in chapter 246-16 WAC.[Statutory Authority: RCW 18.71.017 and 18.130.050. WSR 20-22-003, § 246-919-700, filed 10/21/20, effective 11/21/20. Statutory Authority: RCW 18.71.017 and 18.71A.020. WSR 96-03-073, § 246-919-700, fil…

The rules in WAC 246-919-850 through 246-919-985 govern the prescribing of opioids in the treatment of pain.The Washington state medical quality assurance commission (commission) recognizes that principles of quality medical practice dictate that the people of the state of Washin…

WAC 246-919-850 through 246-919-985 do not apply to:(1) The treatment of patients with cancer-related pain;(2) The treatment of patients with sickle cell disease;(3) The provision of palliative, hospice, or other end-of-life care;(4) The provision of procedural medications;(5) Th…

The following definitions apply to WAC 246-919-850 through 246-919-985 unless the context clearly requires otherwise.(1) "Aberrant behavior" means behavior that indicates current misuse, diversion, unauthorized use of alcohol or other controlled substances, or multiple early refi…

(1) The physician shall discuss with the patient the following information at the first issuance of a prescription for opioids and at the transition from acute to subacute, and subacute to chronic:(a) Risks associated with the use of opioids, including the risk of dependence and …

The physician shall exercise their professional judgment in selecting appropriate treatment modalities for acute nonoperative, acute perioperative, subacute, or chronic pain including the use of multimodal pharmacologic and nonpharmacologic therapy as an alternative to opioids wh…

(1) To prescribe an opioid in Washington state, a physician licensed to prescribe opioids shall complete a one-time continuing education requirement regarding best practices in the prescribing of opioids or the opioid prescribing rules in this chapter. The continuing education mu…

Prior to issuing an opioid prescription for acute nonoperative pain or acute perioperative pain, the physician shall:(1) Conduct and document an appropriate history and physical examination including screening for risk factors for overdose and severe postoperative pain;(2) Evalua…

The physician shall comply with the requirements in this section when prescribing opioids for acute nonoperative pain.(1) The physician should consider prescribing nonopioids as the first line of pain control in patients unless not clinically appropriate in accordance with the pr…

The physician shall comply with the requirements in this section when prescribing opioids for perioperative pain.(1) The physician should consider prescribing nonopioids as the first line of pain control in patients, unless not clinically appropriate, in accordance with the provi…

The physician shall comply with the requirements in this section when prescribing opioids for subacute pain.(1) Prior to issuing an opioid prescription for subacute pain, the physician shall assess the rationale for continuing opioid therapy as follows:(a) Conduct an appropriate …

The physician, having recognized the progression of a patient from the acute nonoperative or acute perioperative phase to the subacute phase shall develop an opioid treatment plan.(1) If tapering has not begun prior to the six- to twelve-week subacute phase, the physician shall r…

When the patient enters the chronic pain phase, the patient shall be reevaluated as if presenting with a new disease. The physician shall include in the patient's record:(1) An appropriate history including:(a) The nature and intensity of the pain;(b) The effect of pain on physic…

The physician, having recognized the progression of a patient from the subacute phase to the chronic phase, shall develop an opioid treatment plan as follows:(1) Treatment plan and objectives including:(a) Documentation of any medication prescribed;(b) Biologic specimen testing o…

The physician shall use a written agreement that outlines the patient's responsibilities for opioid therapy. This written agreement for treatment must include the following provisions:(1) The patient's agreement to provide samples for biological specimen testing when requested by…

(1) The physician shall periodically review the course of treatment for chronic pain. The frequency of visits, biological testing, and PMP queries in accordance with the provisions of WAC 246-919-985, must be determined based on the patient's risk category:(a) For a high-risk pat…

Long-acting opioids should only be prescribed by a physician who is familiar with its risks and use, and who is prepared to conduct the necessary careful monitoring. Special attention should be given to patients who are initiating such treatment. The physician prescribing long-ac…

(1) The physician shall consider referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic pain patients who are under eighteen years of age or who are potential high-risk patients.(…

A physician is not required to consult with a pain management specialist as defined in WAC 246-919-945 when the physician has documented adherence to all standards of practice as defined in WAC 246-919-905 through 246-919-925, and when one or more of the following conditions are …

The physician is exempt from the consultation requirement in WAC 246-919-930 if one or more of the following qualifications is met:(1) The physician is a pain management specialist under WAC 246-919-945;(2) The physician has successfully completed a minimum of twelve category I c…

A pain management specialist shall meet one or more of the following qualifications:(1) If an allopathic physician or osteopathic physician:(a) Is board certified or board eligible by an American Board of Medical Specialties-approved board (ABMS) or by the American Osteopathic As…

Not all chronic pain patients will need their opioid prescriptions tapered. Relying on medical decision making and patient-centered treatment, the physician shall consider tapering or referral for a substance use disorder evaluation when:(1) The patient requests;(2) The patient e…

(1) When a patient receiving chronic opioid pain medications changes to a new physician, it is normally appropriate for the new physician to initially maintain the patient's current opioid doses. Over time, the physician may evaluate if any tapering or other adjustments in the tr…

(1) Children or adolescent patients. In the treatment of pain for children or adolescent patients, the physician shall treat pain in a manner equal to that of an adult but must account for the weight of the patient and adjust the dosage prescribed accordingly.(2) Pregnant patient…

(1) When providing episodic care for a patient who the physician knows is being treated with opioids for chronic pain, such as for emergency or urgent care, the physician or their designee, shall review the PMP and document their review and any concerns.(2) A physician providing …

(1) The physician shall not knowingly prescribe opioids in combination with the following medications without documentation of medical decision making:(a) Benzodiazepines;(b) Barbiturates;(c) Sedatives;(d) Carisoprodol; or(e) Nonbenzodiazepine hypnotics.(2) If, because of a prior…

(1) Where practicable, the physician providing acute nonoperative pain or acute perioperative pain treatment to a patient who is known to be receiving MAT medications shall prescribe opioids when appropriate for pain relief either in consultation with a MAT prescribing practition…

The opioid prescribing physician shall confirm or provide a current prescription for naloxone when opioids are prescribed to a high-risk patient.[Statutory Authority: RCW 18.71.017, 18.71.800, 18.71A.800 and 2017 c 297. WSR 18-23-061, § 246-919-980, filed 11/16/18, effective 1/1/…

(1) The physician shall register to access the PMP or demonstrate proof of having assured access to the PMP if they prescribe Schedule II-V medications in Washington state.(2) The physician is permitted to delegate performance of a required PMP query to an authorized designee.(3)…

(1) Licenses must be renewed every two years on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2, except postgraduate training limited licenses.(2) Postgraduate training limited licenses must be renewed every year to correspond to the program's date.(3) A ret…

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise:(1) "Anesthesiologist" means an actively practicing, board-eligible physician licensed under chapter 18.71, 18.71B, or 18.57 RCW who has completed a residency or equivalent…