Section 1305.EXHIBIT B   Sample Written Practice Agreement for Office Based Anesthesia Services

WRITTEN PRACTICE AGREEMENT FOR OFFICE-BASED ANESTHESIA SERVICES

[A WRITTEN PRACTICE AGREEMENT IS REQUIRED AT A MINIMUM FOR A CERTIFIED REGISTERED NURSE ANESTHETIST TO PRACTICE IN AN OFFICE OF A LICENSED PHYSICIAN, LICENSED DENTIST OR LICENSED PODIATRIST.  A WRITTEN COLLABORATIVE AGREEMENT MAY ALSO BE USED IN THESE SETTINGS.  HOWEVER, A CERTIFIED REGISTERED NURSE ANESTHETIST IS NOT REQUIRED TO POSSESS PRESCRIPTIVE AUTHORITY OR A WRITTEN COLLABORATIVE AGREEMENT TO PROVIDE ANESTHESIA SERVICES ORDERED BY A LICENSED PHYSICIAN, DENTIST OR PODIATRIST.]

C.        WORKING RELATIONSHIP OF THE PARTIES

Under this agreement, the CRNA will deliver anesthesia services to designated patients in an active practice working with the anesthesiologist, physician, dentist or podiatrist pursuant to a mutually agreed upon anesthesia plan.

1.         A licensed certified registered nurse anesthetist may provide anesthesia services pursuant to the order of a licensed physician, licensed dentist, or licensed podiatrist in the office of a licensed physician, the office of a licensed dentist, or the office of a licensed podiatrist.  For anesthesia services, an anesthesiologist, physician, dentist, or podiatrist shall participate through discussion of and agreement with the anesthesia plan and shall remain physically present and be available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions.  (See 225 ILCS 65/15-25(a).)

2.         A certified registered nurse anesthetist is not required to possess prescriptive authority or a written collaborative agreement meeting the requirements of Section 15-15 of the Act to provide anesthesia services ordered by a licensed physician, dentist, or podiatrist.  (See 225 ILCS 65/15-25(d).)  Certified registered nurse anesthetists are authorized to select, order, and administer drugs and apply the appropriate medical devices in the provision of anesthesia services under the anesthesia plan agreed with by the anesthesiologist, physician, dentist or podiatrist.  In a physician's office, dentist's office, or podiatrist's office, the anesthesiologist, operating physician, operating dentist, or operating podiatrist shall agree with the anesthesia plan, in accordance with the written practice agreement.  (See 225 ILCS 65/15-25(d).)

3.         In a physician's office, the certified registered nurse anesthetist may only provide anesthesia services if the physician has training and experience in the delivery of anesthesia services to patients.  (See 68 Ill. Adm. Code 1305.50(e)).

4.         In a dentist's office, the Certified Registered Nurse Anesthetist may only provide those services the dentist is authorized to provide pursuant to the Illinois Dental Practice Act and 68 Ill. Adm. Code 1220.  Licensed dentists are required to hold permits to administer anesthesia pursuant 68 Ill. Adm. Code 1220: Subpart D.

5.         In a podiatrist's office, the certified registered nurse anesthetist may only provide those services the podiatrist is authorized to provide pursuant to the Podiatric Medical Practice Act of 1987 and 68 Ill. Adm. Code 1360.  Podiatrists may not administer general anesthetics.  (See 68 Ill. Adm. Code 1305.45(f).)

6.         A CRNA providing anesthesia services in a physician, dental or podiatrist office shall do so with the active participation, approval, presence and availability of the physician, dentist or podiatrist as well as in accordance with Standards 1-11 of the "Standards for Office Based Anesthesia Practice", American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, Illinois 60068 (1999), which are hereby incorporated by reference, with no later editions or amendments.  If there is a conflict between the Nursing and Advanced Practice Nursing Act or this Part and the Standards for Office Based Anesthesia Practice of the American Association of Nurse Anesthetists, the Act and this Part shall prevail.

D.        CATEGORIES OF CARE, TREATMENT OR PROCEDURES TO BE PERFORMED

A licensed Certified Registered Nurse Anesthetist may provide anesthesia services pursuant to the order of a licensed physician, licensed dentist, or licensed podiatrist in the office of a licensed physician, the office of a licensed dentist, or the office of a licensed podiatrist. For anesthesia services, an anesthesiologist, physician, dentist, or podiatrist shall participate through discussion of and agreement with the anesthesia plan and shall remain physically present and be available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions.  (See 225 ILCS 65/15-25(a).)

A Certified Registered Nurse Anesthetist is not required to possess prescriptive authority or a written collaborative agreement meeting the requirements of Section 15-15 of the Act to provide anesthesia services ordered by a licensed physician, dentist, or podiatrist. (See 225 ILCS 65/15-25(d).)  Certified registered nurse anesthetists are authorized to select, order, and administer drugs and apply the appropriate medical devices in the provision of anesthesia services under the anesthesia plan agreed with by the anesthesiologist, physician, dentist or podiatrist.  In a physician's office, dentist's office, or podiatrist's office, the anesthesiologist, operating physician, operating dentist, or operating podiatrist shall agree with the anesthesia plan, in accordance with the written practice agreement. (See 225 ILCS 65/15-25(d).)

In a physician's office, the certified registered nurse anesthetist may only provide anesthesia services if the physician has training and experience in the delivery of anesthesia services to patients.  (See 68 Ill. Adm. Code 1305.45(e).)

In a dentist's office, the Certified Registered Nurse Anesthetist may only provide those services the dentist is authorized to provide pursuant to the Illinois Dental Practice Act and 69 Ill. Adm. Code 1220.  Licensed dentists are required to hold permits to administer anesthesia pursuant 68 Ill. Adm. Code 1220: Subpart D.  In a podiatrist's office, the Certified Registered Nurse Anesthetist may only provide those services the podiatrist is authorized to provide pursuant to the Podiatric Medical Practice Act of 1987 and 68 Ill. Adm. Code 1360.  Podiatrists may not administer general anesthetics.  (See 68 Ill. Adm. Code 1305.45(e).)

The anesthesia service that the CRNA may provide in the anesthesiologist's, physician's, dentist's or podiatrist's office setting shall be set forth in the attached pages.

(Source:  Amended at 30 Ill. Reg. 4657, effective March 1, 2006)