SUBCHAPTER 42E ‑ MODE OF PRACTICE

 

SECTION .0100 ‑ RESPONSIBILITY FOR PATIENTS

 

21 NCAC 42E .0101          PROFESSIONAL CODE

The optometrist shall keep the visual welfare of the patient

uppermost at all times, promote the best care of the visual needs of mankind, strive

continuously to develop educational, professional, clinical, and technical

proficiency and keep himself informed as to new developments within his

profession.

 

History Note:        Authority G.S. 90‑121.2(a);

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. September 30, 1981;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

21 NCAC 42E .0102          PROFESSIONAL

RESPONSIBILITY

In keeping with the professional code, the optometrist

shall:

(1)           attend to the visual needs of all those seeking his

services without regard to financial remuneration;

(2)           maintain adequate equipment and instruments in his

office at all times to assure proper and complete examination of patients. 

Such equipment and instruments shall include, but not be limited to, the

following:  a direct ophthalmoscope; an indirect ophthalmoscope; condensing

lenses; proper instrumentation for foreign body removal; biomicroscope;

instrument for plotting central and peripheral fields; applanation tonometer;

distance and near acuity charts; test objects for stereopsis and fusion; color

vision testing apparatus; refractor, trial frame or phorometer with trial case

lenses; keratometer; and retinoscope;

(3)           sterilize according to usage all instruments or

equipment used in the treatment of optometric patients, including those

instruments or equipment used for the removal of foreign bodies from the

external eye or its adnexa. All optometric offices shall follow infection

control recommendations as set forth in the infection control manual as

recommended by the American Optometric Association's Committee on Primary Care

and Ocular Disease, or in the clinical guidelines of the American Optometric

Association's Clinical Guidelines and Quality Assurance Coordinating Committee

or their successors including subsequent adoptions, amendments, and editions.  These

materials are incorporated herein by reference.  Copies are available for

inspection at the Board's office and may be obtained by paying a fee of ten

dollars ($10.00) to the Board;

(4)           assist his patients in whatever manner possible in

obtaining further care when in his opinion other than his care is needed;

(5)           maintain adequate and available records on every

patient containing case history, findings, diagnosis, treatment, and

disposition.  In compliance with this requirement, the patient record shall

include the name of the patient's family physician or any other physician who

may be consulted with regard to the care of the patient.  The name and dosage

of any medication prescribed shall be recorded with the diagnosis and

instructions to the patient concerning follow-up;

(6)           retain full and independent control of and

responsibility for patient records.  This requirement does not preclude the

licensee from providing copies of patient spectacle prescriptions for

subsequent optical services, nor does it preclude the licensee from providing

copies of patient records to any entity with the consent and authorization of

the patient.  Patient records shall be maintained by the optometrist

responsible for such records for a period of not less than 5 years following

the last entry into the patient's chart; 

(7)           treat all information concerning his patients as

confidential and not to be communicated to others except when authorized to do

so by the patient or required by law;

(8)           have an established and appropriate procedure for

the provision of eye care to his patients in the event of an emergency outside

of normal professional hours, or when the licensee is not available due to

vacation, personal illness, attendance at professional meetings or continuing

education programs, or other absences of a similar nature. Patients shall be

informed of such procedure.  The procedure referred to herein may include, but

is not limited to, cooperative arrangements with another licensed optometrist

or a physician licensed under North Carolina General Statutes Chapter 90,

Article 1, a telephone answering system or pager; or written or posted

instructions to the patient;

(9)           maintain full and independent control of the terms

and conditions of any professional liability insurance coverage pertaining to

his services.

 

History Note:        Authority G.S. 90-18; 90-114; 90-121.2;

90-127.2;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. April 1, 1993; June 1, 1989, September 30,

1981;

Temporary Amendment Eff. September 15, 1997;

Amended Eff. August 1, 1998;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

 

21 NCAC 42E .0103          PRESCRIPTIONS

(a)  All prescription forms shall conform to state and

federal statutes governing such forms and shall include the name, address,

state licensure number, and the Drug Enforcement Administration number of the

prescriber, if applicable.  The optometrist shall be responsible for providing

appropriate safeguards within his practice to prevent the unauthorized use or

diversion of his prescription forms, and shall immediately notify the Board

upon determining that prescription blanks might be missing or misused.  Should

missing prescription blanks bear his DEA number, the optometrist shall also

notify the North Carolina State Board of Pharmacy, giving that board the date

he determined that the prescriptions blanks were missing or misused, the number

missing, and any information that could be of help in preventing unauthorized

use of the prescription blanks.

(b)  In the event that legend drugs being prescribed by the

optometrist are dispensed by the optometrist, the optometrist shall cause the

following written or printed information to be given to the patient for each

such drug dispensed at the time the drug is dispensed:

(1)           date of issuance;

(2)           name and address of patient;

(3)           name, address and telephone number of

prescriber;

(4)           name, strength, dosage form and quantity of

drug dispensed;

(5)           the number of refills, if authorized;

(6)           route of administration of drug dispensed;

and

(7)           directions for use.

(c)  Within one year of examination, a patient may request

and is entitled to and shall receive a copy of his spectacle prescription.  The

prescription may show a statement of caution or a disclaimer if such a

statement or disclaimer is supported by appropriate findings and documented

patient records.  An expiration date of not less than one year from the date of

the prescribing examination shall appear on every such prescription.

(d)  A prescription for contact lenses shall explicitly

state that it is for contact lenses and specify the lens type and all

specifications necessary for the ordering and fabrication of the lenses.  Words

or phrases such as "OK for contact lenses", "fit with contact

lenses", "contact lenses may be worn", or similar wording do not

constitute a contact lens prescription.  Until all the requirements of a satisfactory

fit of contact lenses have been determined by the prescriber, the contact lens

prescription cannot be written.  All contact lenses used in the determination

of a contact lens prescription are considered to be diagnostic lenses.  At such

time that it has been determined that a prescription can be written, such

prescription may show a statement of caution or a disclaimer if such a

statement or disclaimer is supported by appropriate findings and documented

patient records.  An expiration date consistent with the type and modality of

use of the contact lens being prescribed shall appear on every such

prescription.  In the event that in the professional opinion of the prescribing

optometrist, a patient is not adhering to appropriate regimens of care and follow-up

with regard to the continuing use of contact lenses, the optometrist may

terminate his optometric care of that patient and notify the patient that he is

terminating such relationship and the reasons for doing so.

 

History Note:        Authority G.S. 90‑114; 90-117.5; 90‑127.2;

90‑127.3;

Eff. June 1, 1989;

Amended Eff. April 1, 1993;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

 

21 NCAC 42E .0104          ACCESS TO AND CONTROL OVER PRACTICE

(a)  The licensee shall maintain full and independent

control of the scheduling and provision of his optometric services.

(b)  Each licensee is responsible for and shall retain full

and independent control of information disseminated to the public through any

advertising or other commercial medium when such information relates to

optometric services being provided by the licensee whether or not such

advertising is paid for or sponsored by the optometrist.  Provided however, it

shall not be a violation of this subsection to include in an advertisement not

disseminated by the licensee a statement advertising the availability of

optometric services, including eye examinations, by an independent doctor of

optometry adjacent to or in proximity to a retail optical establishment, or a

statement containing substantially similar language.

(c)  The licensee shall have physical access to his practice

location at all times.

(d)  Whenever any licensee enters into a lease or rental

agreement to locate his practice within the exterior walls of a commercial or

retail establishment, that practice location shall include an outside entrance

to assure such access as may be needed by the optometrist and his patients to

his optometric practice at all times.  Further, the practice location within

the commercial or retail establishment may have interior access from and to a

public aisle, but such interior access shall not pass through or into any

retail optical space within the establishment to the effect that the optometric

practice shall be operated under the complete control of the optometrist.

(e)  A licensee shall not enter into any lease, rental

agreement, or agreement or contract of employment for the provision of optometric

services which infringes upon his independent professional judgment with regard

to the operation of his practice or the care of his patients.  Provisions

within a lease, rental agreement, or agreement or contract of employment for

the provision of optometric services or provisions within any master lease to

which a lease is subject which would violate this Rule include, but are not

limited to, provisions which control or attempt to control: malpractice

liability insurance beyond a requirement that the licensee maintain a

professionally-reasonable amount of malpractice liability insurance; regulation

of the optometrist's business hours beyond 50 hours a week, except that the

optometrist may agree to furnish coverage in excess of 50 hours a week either personally

or by providing a temporary or relief optometrist to provide such coverage;

custody and control of the optometrist's patient records; the scheduling or

rescheduling of patient examinations or follow‑up care; the setting or

discounting of professional fees, except for participation in managed care or

other third-party programs; or the specification of particular drugs or optical

goods to be dispensed to or prescribed for a patient.  Any lease which is

subject to a master lease to which the optometrist does not have ready access

for purposes of assuring compliance with this Rule shall be deemed in violation

of this Rule and Rule .0201 of Section .0200 of this Subchapter.

 

History Note:        Authority G.S. 90-117.5; 90-121.2;

Eff. June 1, 1993;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

 

SECTION .0200 ‑ ETHICS

 

21 NCAC 42E .0201          GENERAL

(a)  The optometrist shall conduct his practice in a

decorous, dignified and professional manner and in keeping with the rules as

adopted by the Board.

(b)  It is the continuing responsibility of the optometrist

to maintain control over his practice to the end that this independent

professional judgment is not compromised in the rendering of patient care.

(c)  In any printed or oral reference by an optometrist to

his practice, the primary designation must be "optometrist",

"optometry", or "doctor of optometry".

 

History Note:        Authority G.S. 90‑121.2;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. June 1, 1993; June 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

 

21 NCAC 42E .0202          ADVERTISING

 

History Note:        Authority G.S. 90‑117.5;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. September 30, 1981;

Repealed Eff. June 1, 1989.

 

 

 

21 NCAC 42E .0203           CONSULTANT: ADVISOR, STAFF OPTOMETRIST,

OR INDEPENDENT CONTRACTOR

(a)  An optometrist may:

(1)           be engaged as a consultant, advisor, or

independent contractor for industrial plants where industrial vision programs

are being or have been instituted; or

(2)           be engaged as a staff optometrist,

independent contractor, or optometric administrator for health programs

sponsored or funded by any agency of municipal, county, state or federal

government, or research organizations educational institutions, insurance

companies, health maintenance organization, or hospitals.

(b)  In acting in the capacity of consultant, advisor,

independent contractor, or staff optometrist, the optometrist shall at all

times remain cognizant of his professional responsibilities and shall with

demeanor, decorum and determination retain his right of independent

professional judgment and title in all situations and circumstances as he would

in his own office.  If at any time the right of independent professional title

and judgment is abridged by the party or parties engaging the optometrist's

services, it shall be mandatory upon the optometrist to resign or terminate the

position as consultant, advisor, staff optometrist, or independent contractor

and in so doing the intent of G.S. 90-125 would not be violated.

 

History Note:        Authority G.S. 90‑117.5; 90‑125;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. April 1, 1993; June 1, 1989; September 30,

1981;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive

public interest Eff. May 23, 2015.

 

SECTION .0300 ‑ UNETHICAL PRACTICES DEFINED: REVOCATION

OF LICENSE

 

21 NCAC 42E .0301          PUNISHMENT FOR VIOLATION OF RULES

The Board may invoke such disciplinary measures as it deems

appropriate, including issuing a letter of warning or caution, reprimand, censure,

suspension of a license, revocation of a license, and probation for violation

of any statute governing the practice of optometry or of any Rule adopted by

the Board.

 

History Note:        Authority G.S. 90‑117.5; 90‑121.2;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. April 1, 1993; June 1, 1989;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.

 

21 NCAC 42E .0302          UNETHICAL PRACTICES

It is unethical for an optometrist to:

(1)           solicit by means of advertising considered by the

Board to be untruthful, false, misleading, deceptive, bait-and-switch, or

fraudulent;

(2)           allow, permit, or otherwise condone by his failure

to act in a timely manner to prevent his name, his practice, or his practice

location from being presented to the public through any type of advertising

which is false, deceptive, or misleading;

(3)           offer to discount his professional fees as a

condition to the sale of optical goods by himself or any optical dispensary

located adjacent to or in close proximity to his practice;

(4)           fail to use the word "optometrist", the

abbreviation "O.D.", or the words "doctor of optometry"

whenever the optometrist's name appears in connection with his practice of

optometry;

(5)           fail to list the name of each practitioner on any

sign or lettering denoting the location of the practice or in any advertising

promoting a practice when there is more than one optometrist practicing at the

same location; the lettering of the optometrist's name and the lettering

denoting the optometrist's designation as an optometrist shall be of comparable

size and readability;

(6)           use the title "Optometrist" in connection

with a profession or business considered foreign to the practice of optometry;

(7)           present his practice or practice location to the

public as an optical store in order to entice the public to avail themselves of

his professional optometric service while shopping for optical goods.  In

keeping with this Rule, an optometrist may make use of frame bars or selection

cabinets provided such frame bars or selection cabinets are so placed within an

office that they are not visible from outside the office;

(8)           allow his professional judgment to be unreasonably

influenced by someone not directly responsible for the patient's well-being or

welfare.  Persons directly responsible for the patient's welfare would include

another optometrist, a physician, or a member of the patient's family;

(9)           give or accept rebates in any form to or from any

person in return for an opportunity to generate or receive a professional fee;

(10)         practice or use his license in a manner deemed to be

in violation of G.S. 90-121.2 or 90-125;

(11)         knowingly aid another person to violate the laws

governing optometry;

(12)         engage in practice involving conduct which is

inconsistent with the dignity of the profession or the rules of the Board. 

Such "unprofessional conduct" includes, but is not limited to, conduct

which violates or does not meet any standard of behavior which through

professional experience has become established in the profession of optometry

in North Carolina.

 

History Note:        Authority G.S. 90‑117.5; 90‑121.2;

Eff. February 1, 1976;

Readopted Eff. May 30, 1978;

Amended Eff. June 1, 1993; June 1, 1989; September 30,

1981;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. May 23, 2015.