ARIZONA BOARD OF OSTEOPATHIC EXAMINERS

 IN MEDICINE AND SURGERY

Revised (February 1, 2021, 11:41 am)


COVID-19 FAQS: In response to the State and Federal public health emergency associated with COVID -19, the Arizona Board of Osteopathic Examiners will continue to update this document as we continue to move through this situation together. Due to the nature of this situation and the changes taking place rapidly, please monitor the Board website for updates.

If you have questions that do not appear in this FAQ, please email questions@azdo.gov .


COVID-19 INFORMATION AND RESOURCES

Arizona Governor’s Executive Orders

Arizona Department of Health Services (ADHS)

ADHS's Guidance for Healthcare Providers & Long-term Care Facilities

U.S. Centers for Disease Control and Prevention (CDC)

 Johns Hopkins COVID-19

WHO’s COVID-19 Info

COVID-19 HOTLINE (FOR PATIENTS AND HEALTHCARE PROVIDERS): 1-844-542-8201


Update on COVID-19 Vaccine

From Maricopa County Public Health:

On Dec. 1st, the CDC Advisory Council on Immunization Practices (ACIP) voted to approve the recommendation of healthcare workers and long-term care facility residents as priority groups to receive initial doses of vaccine once it is approved by the FDA.

The Arizona Department of Health Services is convening an advisory committee that will review ACIP recommendations and make recommendations for Arizona and local health departments. Maricopa County Department of Public Health will finalize its distribution plans once these recommendations are issued, pending approval of the vaccine by the FDA. Additional groups will be identified for vaccine prioritization as more information becomes available.

AZDHS Vaccine Information: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-vaccine

Maricopa County Public Health Vaccine Information:

https://www.maricopa.gov/5641/COVID-19-Vaccine#healthcare

We encourage you to reach out to your county health departments for vaccine distribution in your area.

COVID-19 Vaccine Distribution

Maricopa and Pima Counties

 Maricopa County Public Health

The Maricopa County Department of Public Health (MCDPH) is in the final planning stages for providing COVID-19 vaccine to people who are at highest risk of contracting COVID-19 based on their occupational and individual risk factors. This includes many of you, who provide direct care and services to people who are or could be COVID-positive.

 

Because supply will be limited at the outset and to ensure equitable distribution of those limited doses,(MCDPH) is following the guidance of the CDC’s Advisory Council on Immunization Practices (ACIP) and the Arizona Department of Health Services Vaccine and Antiviral Prioritization Advisory Committee (ADHS VAPAC).

 

The first allocation of vaccine doses will be prioritized to individuals that ACIP has recommended to be in Phase 1A: those working in a healthcare setting, especially those with the most potential exposure to COVID-19, as well as residents and staff of long-term care facilities.

 

To determine your eligibility, please complete this pre-screen survey as the first step to scheduling an appointment. Your response will help MCDPH determine your eligibility and connect you with your assigned regional vaccine provider, based on the location of your primary worksite.

 

Things to know about the pre-screening:

  • COVID-19 vaccine will be available to Phase 1A individuals by appointment only, and completing this pre-screening survey is required to make your appointment.
  • Long term care residents/staff are mostly being vaccinated through a federal pharmacy vaccine program.
  • You will be asked to provide your employee ID or other ID (such as a driver's license number) as part of the screening process. This will be used for identification purposes only.
  • COVID-19 vaccines are free, however, insurance information will be requested during appointment scheduling so that an administration fee can be billed to insurance if you are insured. There will be no out-of-pocket costs requested during your appointment time and you should not receive a bill.
  • Priority will be given to those who meet exposure and risk thresholds. You will be notified when vaccine is available to you. The process may take several days, so please be patient while you await your notification.
  • Any healthcare provider who provides direct patient care of any type (including environmental services and laboratory workers) will be included in Phase 1A. If you are determined to be eligible for vaccine in Phase 1A, you will receive a notification with details on where and how to set up an appointment.
  • Healthcare providers who do not provide in-person, direct patient care (administrators and telemedicine providers) will be included as essential workers early in Phase 1B but are not eligible for vaccine in 1A since they are not at increased risk of exposure in their work.
  • The information collected in this screening tool will only be accessed by MCDPH and will not be shared outside of public health.
  • Vaccination sites for healthcare workers will not be open for an extended period of time, so we encourage you to sign up today or you may have to wait until later phases.

 

If you have any questions regarding COVID-19 vaccine pre-screening or need help filling out this form, please email COVID19prescreen@maricopa.gov

Still deciding if you want to get the vaccine? Take a look at Maricopa.gov/COVID19vaccine1A and please complete the prescreening survey. The survey does not commit you to getting the vaccine, and after you complete it, you will receive more information about how and when you can get the vaccine.

 

 

 

 

Pima County Health Department

Pima County and area hospital partners will prioritize front-line health care workers treating COVID-19 patients, and residents and staff of long-term care facilities in initial distribution of the COVID-19 vaccine.

Pima County is expecting more than 50,000 doses in the first distribution of the Pfizer vaccine, including about 11,000 doses this week, followed by 17,000 about a week later.

The first vaccinations are scheduled for December 17, 2020.

 

This initial Phase 1A distribution, announced at a joint press conference of officials from the Pima County Health Department, Tucson Medical Center and Banner – University Medicine, follows recommendations from the Centers for Disease Control and Prevention (CDC).

 

The CDC says on its website:

 

“Healthcare personnel are defined as paid and unpaid people serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. Long-term care facility residents are defined as adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently.”

 

Banner and TMC will serve as initial vaccinators and will be distributing vaccines to health care workers across all Pima County providers who meet the criteria. Other hospitals and health care partners are expected to receive the Moderna vaccine before the end of the month for distribution to their employees.

 

Health care workers are advised to look for communication from their employer about which priority groups they fall under and when they can begin scheduling their vaccine appointments.

 

Vaccinations are voluntary but are encouraged by health officials in order to protect those on the front line from becoming sick while helping us control the pandemic and ensure the community has continued access to necessary health care services.

 

The initial Phase 1A rollout will include two distribution sites – one each at TMC and Banner. According to Crystal Rambaud, the Pima County Health Department Manager for Vaccine Preventable Diseases, a partnership between Walgreens, CVS and long-term care facilities in the County will allow staff and residents to receive direct vaccination.

 

For the 1C group and later, there will be much broader distribution, most notably at doctor’s offices and clinics.

 

A chart for the overview of the vaccine prioritization, including the general population in Phase 2, can be found here.

 

The timeline for the rollout of vaccinations to the priority groups is in flux, with the amount of vaccine made available to the County one of several variables. Dr. Theresa Cullen, the Pima County Health Director, said the period of vaccination for all of the priority groups identified in Phase 1 (A, B and C) could take at least five months.

 

For more and updated information about vaccine distribution/safety and FAQs, visit www.pima.gov/covid19vaccine

As of January 19, 2021, Maricopa County has the following information on the phased approach:


COVID-19 Vaccine & Allergic Reactions - Second Dose

It is more common to have an increased immune response (side effects/symptoms) after the 2nd dose of COVID-19 vaccine than the first since the body is responding to foreign material that it has already seen. It can be hard to tease out COVID-19 vaccine side effects from acute SARS-CoV-2 infection since both can produce systemic symptoms such as fever, chills, fatigue, myalgia, and arthralgia.

You may get questions about this from individuals who recently received their COVID-19 vaccine. The CDC has a Post Vaccine Considerations for Healthcare Personnel webpage that demonstrates the thought process of considering if a person is just having post-vaccination symptoms or if an infection should be considered.

Highlights include the following:

For complete information about this CDC update, please refer to the following sources:


COVID-19 Antibody Testing for Health Care Workers


AZDHS and CDC Guidance on Isolation and Return to work for patients


KEEPING PERSONNEL SAFE

CDC’s Personnel Recommendations

ADHS’s Healthcare Personnel Handout

ADHS’s PPE Guidance

CDC’s Information for Healthcare Professionals


LICENSING

Q: I am licensed in another state as a Osteopathic Physician without any discipline. Can I receive a temporary license in Arizona to help? How can I help the residents of Arizona?

A: The Board has several options to apply for a license.


Medical Volunteer 

Q: COVID-19 is a crisis and I want to help. How can I help?

A: Thank you so much for your willingness to help amid the crisis. At the direction of the Dept. of Health Services, at this time one way in which you can help it to register with Arizona Disasters Healthcare Volunteers.

This is an organization that is currently mobilizing due to the COVID-19 crisis.

Here is their website:

https://esar-vhp.health.azdhs.gov/


Executive Order 2020-32 - Requesting Exemption from Executive Order 2020-10 “Elective Surgeries”

Beginning May 1st, 2020, clinics may resume elective surgeries by requesting an exemption from Executive Order 2020-10 that temporarily suspended elective surgeries in Arizona. Clinics that wish to resume elective surgeries will need to contact the Arizona Department of Health Services to receive an exemption. The criteria is provided in Executive Order 2020-32.

The guidance from the Arizona Department of Health Services can be found here: https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/healthcare-providers/waiver-faq.pdf


Executive Order 2020-27 - The “Good Samaritan” Order


GENERAL FAQs

COVID-19 Emergency and Pricing

Governor Ducey issued Executive Order 2020-07 on March 10, 2020. The Executive Order states that the licensing Boards shall investigate all complaints of “price gouging” or a provider or institution charging a price grossly higher than that price that was in effect prior to the emergency.

COVID-19 Treatment and Malpractice Concerns

All questions regarding treatment and COVID-19 should be directed to the Arizona Dept of Health Service Website or the DHS COVID-19 hotline: 1-844-542-8201.

If you have questions about malpractice concerns you should speak with an attorney as Board staff is prohibited from providing legal advice.

Telemedicine and Executive Order 2020-15

On March 25, 2020 the Governor issued Executive Order 2020-15 which  expands coverage of telemedicine for the citizens of Arizona. The Order specifies that an in person consultation is not required. Additionally, some other agencies have received calls about the requirement of medical marijauna certification and this applicability of the Executive Order on the in person requirement for certification. The executive order is applicable to COVID-19 and treatment related to COVID-19. An argument that this executive order applies to medical marijauna would appear contradictory to the order. Please contact DHS at (602) 542-1025 with questions on Medical Marijuana Certification.

Q: Can a clinic change hours of operation?

A: Yes, a clinic may adjust the hours of operations. Please make sure to post the hours and properly notify your patients.

Updated:

Q: Has the Governor issued an executive order delaying elective surgeries during this time?

A: Yes, beginning on March 21, 2020 the Governor issued Executive Order 2020-10 delaying all non-essential or elective surgeries to conserve PPE for the purpose of increasing testing, diagnosing and treating COVID-19 in Arizona. The Executive Order defines non-essential or elective surgeries. This Executive is currently in effect. On Wednesday, April 15, 2020, the Governor noted that he was considering lifting this Executive Order in a phased approach. On April 22, 2020, the Governor has issued Executive Order 2020-32 and provided the ability to request an exemption to perform elective surgeries. Please contact the Arizona Department of Health Services at (602) 542-1025.


Executive Order 2020-23 - Enhanced Surveillance Advisory COVID-19


DISPENSING PRESCRIPTIONS IN COMPLIANCE WITH EXECUTIVE ORDER 2020-20 

Q: A pharmacist has a patient who is out of refills for maintenance medication. The pharmacy has been unable to get a refill authorization because the prescriber's clinic is closed as a result of COVID-19. Can the pharmacy refill the prescription without authorization from the prescriber?

A: Yes based on guidance from the Arizona Board of Pharmacy, The Executive Order 2020-20 allows a pharmacist to utilize their professional judgment to dispense emergency refills of maintenance medications for up to a 90-day supply and an additional 90-day supply if necessary. This does not include refills on any controlled substances. It is recommended that a pharmacist always make an attempt to contact the prescriber prior to dispensing an emergency refill and document in an EHR that a contact attempt was made and that the prescription was filled. It should be noted that the Executive Order specifies that this is for maintenance medication.

Guidance from the Arizona Board of Pharmacy states “...in the event that a pharmacist is unable to reach a prescriber, they may utilize their professional judgement to dispense emergency refills of maintenance medications for up to a 90-day supply and an additional 90-day supply if necessary. This does not include refills on any controlled substances. A pharmacist should always make an attempt to contact the prescriber prior to dispensing an emergency refill. The prescription must be reduced to writing and contain the name of the original prescriber, the pharmacist's name and the statement “emergency refill’ on the hardcopy. The prescription should be processed under the prescriber’s name.”

For additional information from the Arizona Board of Pharmacy please refer to https://pharmacy.az.gov/ and review their home page for “COVID-19 FAQs

Q: During the state of emergency, can a pharmacist or a physician with a current dispensing registration from the Arizona Board of Osteopathic Examiners dispense a CII opioid prescription with a hardcopy rather than an electronic prescription?

A: Yes, the electronic prescribing requirements outlined in A.R.S. § 36-2525(D) are not required for the duration of the state of emergency in accordance with Executive Order 2020-20.

Q: Can a prescriber phone-in (fax, scan, or photo) a CII medication during the state of emergency?

A: Yes in accordance with Executive Order 2020-20, a phone-in prescription for a CII medication. Pursuant to the new DEA guidance on Emergency Oral CII prescriptions a hard copy must be provided to the pharmacy within 15 days, the hard copy may be provided as a physical prescription, fax, scanned copy or photo to the pharmacy and the original, hard copy prescription is kept by the prescriber. It is not the pharmacist’s responsibility to ensure this is kept by the prescriber. The quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period.

Q: Can a hospital send a patient home with an inhaler or a multidose medication that doesn’t meet the labeling requirements outlined in §32-1934(B)(4)?

A: Yes in accordance with Executive Order 2020-20, during the state of emergency, the labeling restrictions outlined in A.R.S. § 32-1934(B) are waived for multidose medications such as an inhaler.


MEDICATION LIMITATIONS

Q: What is required by a pharmacy in order to fill hydroxychloroquine and chloroquine during the state of emergency?

A: In accordance with Executive Order 2020-20, the following is required when filling hydroxychloroquine and chloroquine:

  

vi* (i.e. autoimmune disease) or to prescriptions written prior to April 2, 2020.


WORKING BY REMOTE ACCESS

Q: Will the Board allow telemedicine during this time?

A: Yes, the Governor has issued an Executive Order (2020-15) expanding and encouraging telemedicine within the State.  You may wish to refer to A.R.S.§§32-3601 to 32-3604.

General Recommendations or inquiries include

System: 

• Levels of password protection/password changes

• Communication (for instance is e-mail communication intranet only)

• Is CD drive read only

• Is printer port disabled

• System time out when personnel not active-usually not more than 5 minutes

• Who owns and maintains the system

Standard Operating Procedures:

• Policies and procedures must be available to at home personnel

• Computer access, problems, maintenance

• Supervision

• Quality Assurance procedures

• Maintain a list of personnel working remotely


Guidance on use of PPE

CDC’s Interim Guidance on preventing COVID-19 from spreading, which includes Strategies for Optimizing the Supply of N95 Respirators

Healthcare Supply of Personal Protective Equipment

FDA’s Surgical Mask and Gown Conservation Strategies - Letter to Healthcare Providers

USP Guidance on PPE and Garb Shortages


MEDICATION DELIVERY

Q: Can medications be delivered to patients? What about delivering to patients who have tested positive for COVID-19?

A: Yes, delivery of medication is allowed. Please make sure to take extra precautions and develop a policy to minimize exposure.


Fingerprinting

At this time, you must submit a standard FD-258 (REV.3-1-10) Card or a digitally printed fingerprint card on Form FD-258 is also acceptable. The ORI, OCA, Employer and Address, and Reason Fingerprinted must be left blank. Please refer to the Board’s instruction sheet on Fingerprint for your use and submission.

Livescan is acceptable if the fingerprints are then digitally printed on a Form FD-258 card. There is not a restriction on in-state or out-of-state Livescan.

No changes have been made to the fingerprint process at this time.

Local police departments, sheriff’s offices, Departments of Public Safety and some private agencies offer this service.


CME:

Q: Since all AOA conventions have been cancelled this year due to COVID-19, will there be CME exceptions for the upcoming renewal?

A:The Board accepts CME courses completed online. If you believe you need an exemption you will need to contact the Board during the renewal period. You are strongly encouraged to find online CME courses in the interim to complete your renewal process.


Governor’s Office Clarifies CRNA Opt-Out Letter:

On March 23, Governor Ducey sent a letter to CMS Administrator Seema Verma requesting that Arizona be exempt from the requirement that CRNAs be supervised by a physician. Under federal law, one of the requirements in making such a request is that it be in accordance with existing state law. After concerns were raised by ArMA members that the Governor’s letter would expand the scope of practice for CRNAs, the ArMA advocacy team contacted the Governor’s Senior Policy Advisor Christina Corieri. She confirmed in writing that the Arizona law stating that a CRNA may only “administer anesthetics under the direction of and in the presence of a physician or surgeon” remains in full effect.

 

Clarifying further, Ms. Corieri indicated the Governor’s letter seeking to opt out of the supervision requirement was intended to reconcile CMS with Arizona's “direction and presence” standard, but specifically reiterated that “nowhere in [the CMS] letter or anywhere else” has the Governor waived Arizona law (A.R.S. 32-1634.04) establishing scope of practice for CRNAs.

 


Governor’s Press Release on Antibody Tests For Health Professionals and First Responders

FOR IMMEDIATE RELEASE

April 14, 2020

Governor Ducey Announces Antibody Tests For Health Professionals, First Responders

State To Partner With University Of Arizona On 250,000 Tests

PHOENIX⁠ — Governor Doug Ducey today announced a partnership between the state of Arizona and the University of Arizona to provide antibody tests for 250,000 health care professionals and first responders who are on the frontlines in the battle against COVID-19.

The University of Arizona will administer the antibody tests to check for antibodies through an individual’s blood sample to determine if they were exposed to COVID-19, had the virus and recovered. The state and the university are working together to quickly get approval from the federal government to move forward with the testing.


October 6, 2020

FSMB STATEMENT ON WEARING FACE COVERINGS DURING PATIENT CARE


Additionally Information from the NBOME on applying for Residency


Provider Bridge