§ 3–1201.02. Definitions of health occupations.

For the purposes of this chapter, the term:

(1) “Practice of acupuncture” means the insertion of needles, with or without accompanying electrical or thermal stimulation, at a certain point or points on or near the surface of the human body to relieve pain, normalize physiological functions, and treat ailments or conditions of the body. A licensed acupuncturist does not need to enter into a collaboration agreement with a licensed physician or osteopath to practice acupuncture.

(1A) “Practice of addiction counseling” means providing services, with or without compensation, based on theory and methods of counseling, psychotherapy, and addictionology to persons who are experiencing cognitive, affective, or behavioral psycho-social dysfunction as a direct or indirect result of addiction, chemical dependency, abuse of chemical substances, or related disorders. The practice of addiction counseling includes:

(A) Addiction prevention;

(B) Crisis intervention;

(D) Referral;

(E) Direct treatment;

(F) Follow-up, which is rendered to individuals, families, groups, organizations, schools, and communities adversely affected by addictions or related disorders; and

(G) The education and training of persons in the field of addiction counseling.

(2) “Practice of advanced practice registered nursing” means the performance of advanced-level nursing actions, with or without compensation, by a licensed registered nurse with advanced education, knowledge, skills, and scope of practice who has been certified to perform such actions by a national certifying body acceptable to the Board of Nursing. The practice of advanced practice registered nursing includes:

(A) Advanced assessment;

(B) Medical diagnosis;

(D) Selecting, administering, and dispensing therapeutic measures;

(E) Treating alterations of the health status; and

(F) Carrying out other functions identified in subchapter VI of this chapter and in accordance with procedures required by this chapter.

(2A)(A) “Practice by anesthesiologist assistants” means assisting an anesthesiologist in developing and implementing anesthesia care plans for patients under the supervision and direction of the anesthesiologist.

(B) For the purposes of this paragraph, the term “anesthesiologist” means a physician who has completed a residency in anesthesiology approved by the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology and who is currently licensed to practice medicine in the District of Columbia.

(2A-i)(A) “Practice of assisted living administration” means planning, organizing, directing, and controlling the operation of an assisted living residence.

(B) For the purposes of this chapter, the term:

(i) “Assisted living administrator” or “ALA” means a person who oversees the day-to-day operation of the facility, including compliance with all regulations for licensed assisted living residences.

(ii) “Assisted living residence” shall have the same meaning as provided in § 44-102.01(4).

(2A-ii)(A) “Practice of athletic training” means any of the following:

(i) The treatment of an athletic injury that is:

(I) For an athlete whose condition is within the professional and educational ability of the licensed athletic trainer; and

(II) Performed under the general supervision of a physician who has issued any written order, protocol, or recommendation for an athletic injury;

(ii) The immediate treatment of athletic injuries, including common emergency medical situations;

(iii) The provision of education, guidance, and counseling to athletes, coaches, parents of athletes, and athletic communities regarding athletic training and the prevention, care, and treatment of athletic injuries; and

(iv) The organization and administration of athletic training programs.

(B) Nothing in subparagraph (A) of this paragraph shall be construed as authorizing:

(i) The rendering of a medical diagnosis or opinion regarding a physical disability or the use of X rays, radium, or electricity for cauterization or surgery by an athletic trainer;

(ii) Treatment or rehabilitation of neurologic injuries, conditions, or disease other than the preventative and emergency medical treatment authorized by subparagraphs (A)(i) and (A)(ii) of this paragraph; and

(iii) The expansion of treatment beyond the determination of the supervising physician.

(i) The lawful practice of a licensed health care professional under the scope of his or her license; provided, that he or she does not hold himself or herself out as an athletic trainer;

(ii) Self-care by a patient, the provision of basic first aid services by an individual, or the gratuitous care by a friend or family member who does not represent himself or herself as an athletic trainer;

(iii) The lawful practice of a personal trainer registered with the Mayor; provided, that the person does not represent himself or herself as an athletic trainer or provide athletic trainer services, and treatment of any athletic injuries is limited to the provision of basic first aid;

(iv) Coaches and physical education instructors, health or recreation directors, health club or spa instructors, and water safety instructors that are supervising athletic activities, exercise, aerobics, weightlifting, water safety, and other recreational physical activities; provided, that the person does not represent himself or herself as an athletic trainer or provide athletic trainer services, and if any treatment of athletic injuries is limited to the provision of basic first aid;

(v) The activities of athletic training students acting under the direction of an athletic trainer licensed, certified, or registered in any state; provided, that the students are designated by a title that clearly indicates their status as athletic training students; or

(vi) The activities of athletic trainers from other nations, states, or territories when performing their duties for their respective teams or organizations and only during the course of their team’s or organization’s stay in the District; provided, that the athletic trainers are currently licensed, certified, or registered, in any state or Canada, or are currently certified by the National Athletic Trainers Association Board of Certification, Inc., or its successor.

(D) For the purposes of this paragraph, the term:

(i) “Athlete” means:

(I) A person participating in, or preparing for a competitive team or individual sport or other athletic activity being conducted by an educational institution, professional athletic organization, or a board-sanctioned amateur athletic organization;

(II) A member of an athletic team; or

(III) Any physically active person seeking treatment for athletic injuries.

(ii) "Athletic injury" means a musculoskeletal or orthopedic injury or other medical condition suffered by an athlete resulting from, or limiting participation in or training for scholastic, recreational, professional, amateur athletic activities, or other physical activities.

(iii) “Treatment” means the prevention, evaluation, recognition, management, treatment, rehabilitation, or reconditioning of an athletic injury, including the usage of appropriate preventative and supportive devices, temporary splinting and bracing, physical modalities of heat, cold, light, massage, water, electric stimulation, sound, and passive or active exercise, temporary mechanical devices, mechanical equipment, or any other therapeutic modality for which an athletic trainer has received appropriate training or education.

(E) Any person who holds a license pursuant to this chapter as an athletic trainer may use the letters “LAT” or “AT” in connection with the person’s name to denote licensure hereunder, and unlicensed persons are prohibited from using in connection with their name or business activity the words “athletic trainer,” “trainer,” “certified athletic trainer,” and “licensed athletic trainer.”

(2B)(A) “Practice of audiology” means the planning, directing, supervising, and conducting of habilitative or rehabilitative counseling programs for individuals or groups of individuals who have, or are suspected of having, disorders of hearing; any service in audiology, including prevention, identification, evaluation, consultation, habilitation or rehabilitation, instruction, and research; participating in hearing conservation, hearing aid and assistive listening device evaluation, selection, preparation, dispensing, and orientation; fabricating ear molds; providing auditory training and speech reading; or administering tests of vestibular function and tests for tinnitus. The practice of audiology includes speech and language screening limited to a pass-or-fail determination for the purpose of identification of individuals with disorders of communication. The practice of audiology does not include the practice of medicine or osteopathic medicine, or the performance of a task in the normal practice of medicine or osteopathic medicine by a person to whom the task is delegated by a licensed physician.

(B) Repealed.

(2C) “Practice by an audiology assistant” means assisting a licensed audiologist in implementing audiology care and treatment plans for patients under the direct supervision and direction of the licensed audiologist.

(2C-i) "Practice of certified midwifery" means the provision of independent management of primary maternity and well-women care by a certified midwife licensed under this chapter to a patient-client in the normal course of childbirth, including prenatal, intrapartum, postpartum, and normal new-born care. The practice of certified midwifery includes:

(A) Prescribing medications, including controlled substances and contraceptive methods;

(B) Admitting, managing, and discharging patients;

(C) Ordering and interpreting laboratory and diagnostic tests and ordering the use of medical devices in the course of care;

(D) Consulting and treating in areas such as health promotion, family planning services, disease prevention, individualized wellness education and counseling, and primary care unrelated to childbirth; and

(E) Management of common health problems that may require consultation, collaborative management, or referral as indicated by the health status of the patient-client, in accordance with standards established by the American College of Nurse-Midwives.

(2D)(A) "Practice of certified professional midwifery" means the provision of primary maternity care and well-women care by a certified professional midwife licensed under this chapter to a patient-client during the preconception, antepartum, intrapartum, and postpartum periods. The practice of certified professional midwifery includes:

(i) Discussing any general or specific risk factors pertaining to the health and circumstances of the patient-client associated with the provision of primary maternity care and well-women care;

(ii) Consulting with the patient-client regarding the conditions under which consultation, transfer of care, or transport are necessary;

(iii) Obtaining the patient-client's health history;

(iv) Performing a physical examination of the patient-client;

(v) Developing a written plan of care that must be provided to a patient-client and included in the medical record specific to the patient-client to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods, including an emergency birth plan;

(vi) Consulting, collaborating, referring, or transferring care to appropriate health care professionals in accordance with the national standard of care;

(vii) Providing care during the antepartum, intrapartum, postpartum, and newborn periods, including:

(I) Monitoring and evaluating the condition of the patient-client;

(II) Conducting the delivery of a fetus in an out-of-hospital setting or inpatient setting;

(III) Suturing episiotomy or first and second-degree lacerations, including the administration of a local anesthetic; and

(IV) Performing emergency procedures, including:

(aa) Administering approved medications;

(bb) Administering intravenous fluids for stabilization; and

(cc) Performing an emergency episiotomy;

(V) Providing routine care for a newborn, including immediate care at birth, the performance of newborn examination, and the administration of intramuscular vitamin K and eye ointment for prevention of ophthalmia neonatorum; and

(VI) Providing limited care in between pregnancies to facilitate the continuity of care, including the provision of:

(aa) Breastfeeding support and counseling;

(bb) Family planning services, but only to the extent that such services will be limited to natural family planning and the provision of cervical caps and diaphragms in consultation with an appropriate health care provider as necessary; and

(cc) Pap smears, but only to the extent that a patient-client with an abnormal pap smear result will be referred to an appropriately-licensed health care provider.

(B) Subparagraph (A) of this paragraph shall not be interpreted to set, establish, define, enumerate, or otherwise lower the applicable standard of care for a licensed physician, licensed naturopathic physician, certified professional midwife, certified nurse midwife, or licensed basic or advanced emergency medical technician.

(C) Subparagraph (A) of this paragraph shall not be construed as preventing or restricting the practices, services, or activities of:

(i) A licensed physician, licensed naturopathic physician, certified nurse-midwife, or licensed basic or advanced emergency medical technician;

(ii) A member of an American Indian community who provides traditional midwife services to the member's community;

(iii) Any person who, in good faith, engages in the practice of the religious tenets of any church or in any religious act if no fee is contemplated, charged, or received;

(iv) Any person rendering aid in an emergency; or

(v) A student midwife currently enrolled in an accredited midwifery education program and providing services to patient-clients under the direct, on-site, in-person supervision of a certified professional midwife.

(D) Subparagraph (A) of this paragraph shall not be construed to authorize an individual licensed under this chapter to practice certified professional midwifery to:

(i) Provide pharmacological induction or augmentation of labor;

(ii) Conduct surgical delivery or any surgery except an emergency episiotomy;

(iii) Utilize forceps or a vacuum extractor; except, that an individual licensed under this chapter to practice certified professional midwifery shall be authorized to administer a local anesthetic;

(iv) Administer any kind of narcotic analgesic; or

(v) Administer any prescription medication in a manner that violates the requirements of this chapter.

(3)(A) “Practice of Chiropractic” means the detecting and correcting of subluxations that cause vertebral, neuromuscular, or skeletal disorder, by adjustment of the spine or manipulation of bodily articulations for the restoration and maintenance of health; the use of x-rays, physical examination, and examination by noninvasive instrumentation for the detection of subluxations; and the referral of a patient for diagnostic x-rays, tests, and clinical laboratory procedures in order to determine a regimen of chiropractic care or to form a basis or referral of patients to other licensed health care professionals. “Practice of Chiropractic” does not include the use of drugs, surgery, or injections, but may include, upon certification by the Board, counseling about hygienic and other noninvasive ancillary procedures authorized by rules issued pursuant to this chapter.

(B) Nothing in this paragraph shall be construed as preventing or restricting the services or activities of any individual engaged in the lawful practice of cosmetology or massage, provided that the individual does not represent by title or description of services that he or she is a chiropractor.

(3A) “Practice of cytotechnology” means the microscopic study or examination of body fluids, tissues, or cells desquamated from a body surface or lesion for the practice of clinical laboratory science, including detecting malignancy and microbiologic changes and the measurement of hormonal levels.

(4)(A) “Practice of dental hygiene” means the performance of any of the following activities in accordance with the provisions of subparagraph (B) of this paragraph:

(i) A preliminary dental examination; a complete prophylaxis, including the removal of any deposit, accretion, or stain from the surface of a tooth or a restoration; or the polishing of a tooth or a restoration;

(ii) The charting of cavities during preliminary examination, prophylaxis, or polishing;

(iii) The application of a medicinal agent to a tooth for a prophylactic purpose;

(iv) The taking of a dental X-ray;

(v) The instruction of individuals or groups of individuals in oral health care; and

(vi) Any other functions included in the curricula of approved educational programs in dental hygiene.

(B) A dental hygienist may perform the activities listed in subparagraph (A) of this paragraph only under the general supervision of a licensed dentist, in his or her office or any public school or institution rendering dental services. The Mayor may issue rules identifying specific functions authorized by subparagraph (A)(vi) of this paragraph and may require higher levels of supervision for the performance of these functions by a dental hygienist. The license of a dentist who permits a dental hygienist, operating under his or her supervision, to perform any operation other than that permitted under this paragraph, may be suspended or revoked, and the license of a dental hygienist violating this paragraph may also be suspended or revoked, in accordance with the provisions of this chapter.

(C) For the purpose of subparagraph (B) of this paragraph, the term “general supervision” means the performance by a dental hygienist of procedures permitted by subparagraph (A) of this paragraph based on instructions given by a licensed dentist, but not requiring the physical presence of the dentist during the performance of these procedures.

(5) “Practice of dentistry” means:

(A) The diagnosis, treatment, operation, or prescription for any disease, disorder, pain, deformity, injury, deficiency, defect, or other physical condition of the human teeth, gums, alveolar process, jaws, maxilla, mandible, or adjacent tissues or structures of the oral cavity, including the removal of stains, accretions, or deposits from the human teeth;

(B) The extraction of a human tooth or teeth;

(C) The performance of any phase of any operation relative or incident to the replacement or restoration of all or a part of a human tooth or teeth with an artificial substance, material, or device;

(D) The correction of the malposition or malformation of the human teeth;

(E) The administration of an appropriate anesthetic agent, by a dentist properly trained in the administration of the anesthetic agent, in the treatment of dental or oral diseases or physical conditions, or in preparation for or incident to any operation within the oral cavity;

(F) The taking or making of an impression of the human teeth, gums, or jaws;

(G) The making, building, construction, furnishing, processing, reproduction, repair, adjustment, supply or placement in the human mouth of any prosthetic denture, bridge, appliance, corrective device, or other structure designed or constructed as a substitute for a natural human tooth or teeth or as an aid in the treatment of the malposition of malformation of a tooth or teeth, or to advertise, offer, sell, or deliver any such substitute or the services rendered in the construction, reproduction, repair, adjustment, or supply thereof to any person other than a licensed dentist;

(H) The use of an X-ray machine or device for dental treatment or diagnostic purposes, or the giving of interpretations or readings of dental X-rays;

(I) The performance of any of the clinical practices included in the curricula of accredited dental schools or colleges or qualifying residency or graduate programs; or

(J) To be a manager, proprietor, operator, or conductor of a business or place where dental or dental-hygiene services are performed; provided, that this provision shall not apply to:

(i) Federal or District of Columbia government agencies providing dental services within affiliated facilities or engaged in providing public health measures to prevent disease;

(ii) Schools of dentistry, dental hygiene, or dental assisting accredited by the Commission on Dental Accreditation of the American Dental Association and providing dental services solely in an educational setting;

(iii) Federally Qualified Health Centers, as designated by the United States Department of Health and Human Services, providing dental services;

(iv) Nonprofit community-based entities or organizations that use a majority of public funds to provide dental and dental-hygiene services for indigent persons;

(v) Hospitals licensed by the Department of Health;

(vi) Partnerships, professional corporations, or professional limited liability companies solely consisting of and operated by dentists licensed under this chapter for the purpose of providing dental services;

(vii) Spouses and domestic partners of deceased licensed dentists for a period of one year following the death of the licensee;

(viii) If all of the ownership interest of the deceased, licensed dentist in a dental office or clinic is held by an administrator, executor, personal representative, guardian, conservator, or receiver of the estate (“appointee”), the appointee may retain the ownership interest for a period of one year following the creation of the ownership interest; and

(ix) An individual or entity acting as the manager, proprietor, operator, or conductor of a business or place where dental or dental-hygiene services are performed who does not have a license to practice dentistry and is not excepted pursuant to sub-subparagraphs (i) through (viii) of this subparagraph may continue to act as the manager, proprietor, operator, or conductor of the business or place where dental or dental-hygiene services are performed for a period of one year following July 7, 2009.

(6)(A) “Practice of dietetics and nutrition” means the application of scientific principles and food management techniques to assess the dietary or nutritional needs of individuals and groups, make recommendations for short-term and long-term dietary or nutritional practices which foster good health, provide diet or nutrition counseling, and develop and manage nutritionally sound dietary plans and nutrition care systems consistent with the available resources of the patient or client.

(B) Nothing in this paragraph shall be construed as preventing or restricting the practices, services, or activities of dietetic technicians and dietetic assistants working under the supervision of a licensed dietitian or nutritionist, other health professionals licensed pursuant to this chapter, or other persons who in the course of their responsibilities offer dietary or nutrition information or deal with nutritional policies or practices on an occasional basis incidental to their primary duties, provided that they do not represent by title or description of services that they are dietitians or nutritionists.

(6A) “Practice by histologic technicians” means the preparation of human and animal tissue samples for microscopic examination.

(6A-i) “Practice of histotechnology” means the preparation and processing of sections of body tissue for examination through the processes of fixation, dehydration, embedding, sectioning, decalcification, microincineration, mounting, and routine staining, and includes the identification of tissue structures, cell components, and their staining characteristics, and relating them to physiologic functions.

(6A-ii)(A) “Practice of home health care administration” means planning, organizing, directing, and controlling the provision of skilled and paraprofessional home health care, including related services, to individuals in out-of-hospital settings, such as private homes, boarding homes, hospices, and shelters.

(B) For the purposes of this chapter, the term “home health care administrator” means a person who oversees the day-to-day operation of the provision of home health care, including compliance with all regulations for home care agency and home health agency administration.

(6B)(A) “Practice of marriage and family therapy” means the diagnosis and treatment of mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of marriage and family systems. The practice of marriage and family therapy involves the professional application of psychotherapeutic and family systems theories and techniques in the delivery of services to individuals, couples, and families, singly or in groups, whether the services are offered directly to the general public or through organizations, either public or private, for a fee, monetary or otherwise, for the purpose of treating the diagnosed nervous and mental disorders.

(B) Nothing in subparagraph (A) of this paragraph shall be construed as preventing or restricting the practices, services, or activities of:

(i) A person practicing marriage and family therapy within the scope of the person’s employment or duties at:

(I) A recognized academic institution, or a federal, state, county, or local governmental institution or agency; or

(II) A nonprofit organization that is determined by the Board to meet community needs;

(ii) A person who is a marriage and family therapy intern or person preparing for the practice of marriage and family therapy under qualified supervision in a training institution or facility or under another supervisory arrangement recognized and approved by the Board; provided, that the person is designated by a title clearly indicating the training status, such as “marriage and family therapy intern,” “marriage therapy intern,” or “family therapy intern”; or

(iii) A person who has been issued a temporary permit by the Board to engage in the activities for which licensure is required.

(C) Nothing in this chapter shall be construed as preventing or restricting members of the clergy, or other health professionals licensed under this chapter, including clinical social workers, psychiatric nurses, psychiatrists, psychologists, physicians, or professional counselors, from practicing marriage and family therapy consistent with the accepted standards of their professions; provided, that no such persons shall represent by title or description of services that they are marriage and family therapists.

(6B-i) “Practice by medical laboratory technicians” means performing tests on tissue, blood, and body fluids for the purpose of assisting in the diagnosis and treatment of diseases while working under the supervision of a medical technologist or physician.

(6B-ii) “Practice of medical laboratory technology” means performing clinical laboratory tests and procedures, including: monitoring tests and procedures, and preparing blood, urine, and tissue specimens for analysis; using sophisticated laboratory equipment to look for bacteria, parasites, and other microorganisms; analyzing the chemical content of fluids, matching blood for transfusions; and, testing for drug levels in the blood to show how a patient is responding to treatment, in areas of a clinical laboratory, with the exception of cytotechnology.

(6C)(A) “Practice of massage therapy” means the:

(i) Performance of therapeutic maneuvers in which the practitioner applies massage techniques, including use of the hand or limb to apply touch and pressure to the human body through tapping, stroking, kneading, compression, friction, stretching, vibrating, holding, positioning, or causing movement of an individual’s body to positively affect the health and well-being of the individual;

(ii) Use of adjunctive therapies, including the application of heat, cold, water, and mild abrasives, but excluding galvanic stimulation, ultra sound, doppler vascularizers, diathermy, transcutaneous electrical nerve stimulation, or traction; and

(iii) Education and training of persons in massage therapy techniques.

(B) A licensed massage therapist shall not diagnose disease or injury; prescribe medicines, drugs, or other treatments of disease; or perform adjustments of the articulations of the osseous structure of the body or spine.

(D) Repealed.

(7)(A) “Practice of medicine” means suggesting, recommending, prescribing, or administering, with or without compensation, any form of treatment, operation, drug, medicine, manipulation, electricity, or any physical, mechanical, or healing treatment by other means, for the prevention, diagnosis, correction, or treatment of a physical or mental disease, ailment, injury, condition, or defect of any person, including:

(i) The management of pregnancy and parturition;

(ii) The interpretation of tests, including primary diagnosis of pathology specimens, images, or photographs;

(iii) Offering or performing a surgical operation upon another person;

(iv) Offering or performing any type of invasive procedure of the body, whether through a body opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum, for surgical, therapeutic, or cosmetic purposes, excluding procedures known as body tattooing or body piercing;

(v) Rendering a written or otherwise documented medical opinion relating to the diagnosis and treatment of a person within the District, or the actual rendering of treatment to a person within the District, by a physician located outside the District as a result of transmission of the person’s medical data by electronic or other means from within the District to the physician or to the physician’s agent;

(vi) Maintaining an office or other place for the purpose of examining persons afflicted with disease, injury, or defect of body or mind;

(vii) Advertising or representing in any manner that one is authorized to practice medicine; or

(viii) Using the designation “Doctor of Medicine,” “Doctor of Osteopathy,” “physician,” “surgeon,” “physician and surgeon,” “M.D.,” or “D.O.,” or a similar designation, or any combination thereof, in the conduct of an occupation or profession pertaining to the prevention, diagnosis, or treatment of human disease or condition, unless the designation additionally contains the description of another branch of the healing arts for which one holds a valid license.

(B) Nothing in this paragraph shall be construed as preventing or restricting other health professionals from offering or undertaking any type of invasive procedure of the body, whether through a body opening or a cutting of the skin, or otherwise affecting the layer of skin below the stratum corneum, for surgical, therapeutic, or cosmetic purposes, if the procedure:

(i) Has been authorized by a licensed physician; or

(ii) Is performed by an advanced practice registered nurse, an anesthesiologist assistant, a dentist, a physician assistant, a podiatrist, a practical nurse, a registered nurse, or a surgical assistant who has received the necessary training and experience to perform the procedure in a safe and effective manner.

(C) Nothing in this paragraph shall be construed as preventing or restricting advanced practice registered nurses from performing their duties as advanced practice registered nurses.

(7A)(A) “Practice of naturopathic medicine” means a system of health care that utilizes education, natural medicines, and natural therapies to support and stimulate a patient’s intrinsic self-healing processes to prevent, diagnose, and treat human conditions and injuries.

(B) The term “practice of naturopathic medicine” does not include the practices of physical therapy, physical rehabilitation, acupuncture, or chiropractic.

(7B) “Practice by nursing assistive personnel” means the performance by unlicensed personnel of assigned patient care tasks that do not require professional skill or judgment within a health care, residential, or community support setting; provided, that the patient care tasks are performed under the general supervision of a licensed health care professional. Nursing assistive personnel includes:

(A) Nursing assistants;

(B) Health aides;

(D) Nurse aides;

(E) Trained medication employees;

(F) Dialysis technicians; and

(G) Any other profession as determined by the Mayor through rulemaking.

(8)(A) “Practice of nursing home administration” means the administration, management, direction, or the general administrative responsibility for an institution or part of an institution that is licensed as a nursing home.

(B) Within the meaning of this paragraph, the term “nursing home” means a 24-hour inpatient facility, or distinct part thereof, primarily engaged in providing professional nursing services, health-related services, and other supportive services needed by the patient or resident.

(9)(A) “Practice of occupational therapy” means:

(i) The therapeutic use of everyday life activities with individuals or groups, with or without compensation, for the purpose of participation in roles and situations in homes, schools, workplaces, communities, and other settings to promote health and welfare for those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction;

(ii) Addressing the physical, cognitive, psycho-social, sensory, or other aspects of performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life;

(iii) The education and training of persons in the direct care of patients through the use of occupational therapy; and

(iv) The education and training of persons in the field of occupational therapy.

(B) An individual licensed as an occupational therapy assistant pursuant to this chapter may assist in the practice of occupational therapy under the general supervision of a licensed occupational therapist.

(C) Nothing in this paragraph shall be construed as preventing or restricting the practices, services, or activities of an occupational therapy aide who works under the immediate supervision of a licensed occupational therapist or licensed occupational therapy assistant, and whose activities do not require advanced training in the basic anatomical, biological, psychological, and social sciences involved in the practice of occupational therapy.

(10)(A) “Practice of optometry” means the application of the scientific principles of optometry in the examination of the human eye, its adnexa, appendages, or visual system, with or without the use of diagnostic pharmaceutical agents to prevent, diagnose, or treat defects or abnormal conditions; the prescription or use of lenses, prisms, orthoptics, vision training or therapy, low vision rehabilitation, therapeutic pharmaceutical agents, or prosthetic devices; or the application of any method, other than invasive surgery, necessary to prevent, diagnose, or treat any defects or abnormal conditions of the human eye, its adnexa, appendages, or visual system.

(B) The Mayor shall issue rules identifying which, and under what circumstances, diagnostic and therapeutic pharmaceutical agents may be used by optometrists pursuant to this paragraph.

(C) An individual licensed to practice optometry pursuant to this chapter may use diagnostic and therapeutic agents only if certified to do so by the Board of Optometry in accordance with the provisions of § 3-1202.07.

(D) Nothing in this paragraph shall be construed to authorize an individual licensed to practice optometry to use surgical lasers; to perform any surgery including cataract surgery or cryosurgery; or to perform radial keratotomy. For the purpose of this subparagraph, the term “surgery” shall not include punctal plugs, superficial foreign body removal, epilation, or dialation and irrigation.

(E) Nothing in this paragraph shall be construed to authorize an individual licensed to practice optometry to administer or prescribe any oral systemic drug except for antibiotics, appropriate analgesics, antihistamines, non-steroidal anti-inflammatories, or medication for the emergency treatment of angle closure glaucoma; to administer or prescribe any injectable systemic drug except for an injection to counter an anaphylactic reaction; or to administer or prescribe any drug for any purpose other than that authorized by this paragraph. For the purposes of this subparagraph, the term “antibiotics” shall not include antiviral or antifungal agents.

(F) Prior to initiating treatment for glaucoma, an optometrist shall consult with the patient’s physician or other appropriate physician. The treatment of angle closure glaucoma by an optometrist shall be limited to the initiation of immediate emergency treatment.

(G) Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of a licensed physician or as prohibiting an optician from providing eyeglasses or lenses on the prescription of a licensed physician or optometrist or a dealer from selling eyeglasses or lenses; provided, that the optician or dealer does not represent by title or description of services that he or she is an optometrist.

(10A)(A) “Practice of pharmaceutical detailing” means the practice by a representative of a pharmaceutical manufacturer or labeler of communicating in person with a licensed health professional, or an employee or representative of a licensed health professional, located in the District of Columbia, for the purposes of selling, providing information about, or in any way promoting a pharmaceutical product.

(B) For the purposes of this paragraph, the term:

(i) “Labeler” means an entity or person that receives pharmaceutical products from a manufacturer or wholesaler and repackages them for later retail sale and that has a labeler code from the federal Food and Drug Administration under 21 C.F.R. § 207.20.

(ii) “Manufacturer” means a maker of pharmaceutical products and includes a subsidiary or affiliate of a manufacturer.

(iii) “Pharmaceutical product” means a drug or biologic for human use regulated by the federal Food and Drug Administration.

(11)(A) “Practice of pharmacy” means the interpretation and evaluation of prescription orders; the compounding, dispensing, and labeling of drugs and devices, including self-administered hormonal contraceptives; drug and device selection; responsibility for advising and providing information, where regulated or otherwise necessary, concerning drugs and devices and their therapeutic values, content, hazards, and uses in the treatment and prevention of disease; responsibility for conducting drug-regimen reviews; responsibility for the proper and safe storage and distribution of drugs and devices; the administration of immunizations and vaccinations upon receipt of a written physician protocol and a valid prescription or standing order of a physician when certified by the Board of Pharmacy to do so; conducting health screenings, including obtaining finger-stick blood samples; the offering or performance of those acts, services, operations, and transactions necessary in the conduct, operation, management, and control of a pharmacy; the initiating, modifying, or discontinuing a drug therapy in accordance with a duly executed collaborative practice agreement; and the maintenance of proper records.

(B) Within the meaning of this paragraph, the term:

(i) “Collaborative practice agreement” means a voluntary written agreement between a licensed pharmacist and a licensed physician that has been approved by the Board of Pharmacy and the Board of Medicine, or between a licensed pharmacist and another health practitioner with independent prescriptive authority licensed by a District health occupation board, that defines the scope of practice between the licensed pharmacist and licensed physician, or other health practitioner, for the initiation, modification, or discontinuation of a drug therapy regimen.

(ii) “Pharmacy” means any establishment or institution, or any part thereof, where the practice of pharmacy is conducted; drugs are compounded or dispensed, offered for sale, given away, or displayed for sale at retail; or prescriptions are compounded or dispensed.

(iii) “Prescription” means any order for a drug, medicinal chemical, or combination or mixtures thereof, or for a medically prescribed medical device, in writing, or on an approved electronic form, dated and signed by an authorized health professional, or given orally to a pharmacist by an authorized health professional or the person’s authorized agent and immediately reduced to writing by the pharmacist or pharmacy intern, specifying the address of the person for whom or, with respect to auto-injectable epinephrine, the school to which the drug or device is ordered and directions for use to be placed on the label.

(12)(A) “Practice of physical therapy” means the independent evaluation of human disability, injury, or disease by means of noninvasive tests of neuromuscular functions and other standard procedures of physical therapy, and the treatment of human disability, injury, or disease by therapeutic procedures, embracing the specific scientific application of physical measures to secure the functional rehabilitation of the human body. These measures include the use of therapeutic exercise, therapeutic massage, heat or cold, air, light, water, electricity, or sound for the purpose of correcting or alleviating any physical or mental disability, or preventing the development of any physical or mental disability, or the performance of noninvasive tests of neuromuscular functions as an aid to the detection or treatment of any human condition.

(B) “Practice by physical therapy assistants” means the performance of selected physical therapy procedures and related tasks under the direct supervision of a physical therapist by a person who has graduated from a physical therapy assistant program accredited by an agency recognized for that purpose by the Secretary of the Department of Education or the Council of Postsecondary Accreditation.

(C) Nothing in this paragraph shall be construed as preventing or restricting the practices, services, or activities of a physical therapy aide who works only under the direct supervision of a physical therapist, and whose activities do not require advanced training in, or complex application of, therapeutic procedures or other standard procedures involved in the practice of physical therapy.

(13) “Practice by physician assistants” means the performance, in collaboration with a licensed physician or osteopath, of acts of medical diagnosis and treatment, prescription, preventive health care, and other functions which are authorized by the Board of Medicine pursuant to § 3-1202.03.

(13A) “Practice by physicians-in-training” means the practice of medicine by a medical resident or fellow, or other similar designation, enrolled in a nationally accredited training program or a training program in the District that is approved by the District of Columbia Board of Medicine.

(14) “Practice of podiatry” means to diagnose or surgically, medically, or mechanically treat, with or without compensation, the human foot or ankle, the anatomical structures that attach to the human foot, or the soft tissue below the mid-calf. The term “practice of podiatry” does not include the administration of an anesthetic, other than a local anesthetic.

(14A)(A) “Practice of polysomnography” means the process of analyzing, monitoring, and recording physiologic data during sleep and wakefulness, with or without compensation, to assist in the assessment and diagnosis of sleep-wake disorders and other disorders, syndromes, and dysfunctions that are sleep-related, manifest during sleep, or that disrupt normal sleep-wake cycles and activities.

(B) For the purposes of this paragraph, the term:

(i) “Polysomnographic technician” means a person who is registered with the Board of Medicine and is authorized to perform certain polysomnography procedures as determined by the Board while generally supervised by either a physician who is licensed in the District of Columbia or a polysomnographic technologist who is licensed by the District of Columbia who is on-site or available through voice communication.

(ii) “Polysomnographic technologist” means a person who is licensed with the Board of Medicine and is authorized to practice polysomnography; provided, that a polysomnographic technologist shall practice under the general supervision of a physician who is licensed in the District of Columbia.

(iii) “Polysomnographic trainee” means a person who is registered with the Board of Medicine and authorized to perform basic polysomnography procedures, as determined by the Board, while directly supervised by a physician who is licensed in the District of Columbia, a polysomnographic technologist who is licensed in the District of Columbia, or a polysomnographic technician who is registered in the District of Columbia and on the premises and immediately available for consultation.

(C) Nothing in this paragraph shall be construed as limiting a qualified licensed respiratory care practitioner or licensed physician in his or her scope of practice, including care in connection with the provision of polysomnography services.

(15) “Practice of practical nursing” means the performance of specific nursing services, with or without compensation, designed to promote and maintain health, prevent illness and injury, and provide care based on standards established or recognized by the Board of Nursing; provided, that performance of the services is under the supervision of a registered nurse, advanced practice registered nurse, licensed physician, or other health care provider, as authorized by the Board of Nursing. The practice of practical nursing includes:

(A) Collecting data on the health status of patients;

(B) Evaluating a patient’s status and situation at hand;

(D) Supporting ongoing data collection;

(E) Planning nursing care episodes for patients with stable conditions;

(F) Participating in the development and modification of the comprehensive plan of care for all types of patients;

(G) Implementing appropriate aspects of the strategy of care within a patient-centered health care plan;

(H) Participating in nursing care management through delegating to assistive personnel and assigning to other licensed practical nurses nursing interventions that may be performed by others and do not conflict with this chapter;

(I) Maintaining safe and effective nursing care rendered directly or indirectly;

(J) Promoting a safe and therapeutic environment;

(K) Participating in health teaching and counseling to promote, attain, and maintain optimum health levels of patients;

(L) Serving as an advocate for patients by communicating and collaborating with other health care service personnel; and

(M) Participating in the evaluation of patient responses to interventions.

(15A) "Practice of professional art therapy" means the integrative application of psychotherapeutic principles and methods with specialized training in art media, the neurobiological implications of art-making, and art-based assessment models to assist an individual or group to improve cognitive and sensory-motor functions, increase self-awareness and self-esteem, cope with grief and traumatic experience, resolve conflicts and distress, and enhance social functioning. The practice of professional art therapy includes:

(A) Therapeutic interventions to facilitate alternative modes of receptive and expressive communication, which can circumvent the limitations of verbal articulation; and

(B) Evaluation and assessment to define and implement art-based treatment plans to address developmental, behavioral, cognitive, and emotional needs.

(15B) “Practice of professional counseling” means engaging in counseling or psychotherapy activities, including cognitive behavioral therapy or other modality, with or without compensation, to facilitate human development and to identify and remediate mental, emotional, or behavioral conditions and associated difficulties that interfere with mental health and wellness. The practice of professional counseling includes:

(A) The processes of conducting interviews, tests, and other forms of assessment for the purpose of diagnosing individuals, families, and groups, as outlined in the Diagnostic and Statistical Manual of Disorders or other appropriate classification schemes, and determining treatment goals and objectives; and

(B) Assisting individuals, families, and groups through a professional relationship to achieve long-term effective mental, emotional, physical, spiritual, social, educational, or career development and adjustment.

(16)(A)(i) “Practice of psychology” means the development and application, with or without compensation, of scientific concepts, theories, methods, techniques, procedures, and principles of psychology to aid in the understanding, measuring, explaining, predicting, preventing, fostering, and treating of abilities, disabilities, attributes, or behaviors that are:

(I) Principally cognitive, such as aptitudes, perceptions, attitudes, or intelligence;

(II) Affective, such as happiness, anger, or depression; or

(III) Behavioral, such as physical abuse.

(ii) The term “practice of psychology” includes:

(I) Coaching, consulting, counseling, and various types of therapy, such as behavior therapy, group therapy, hypnotherapy, psychotherapy, and marriage, couples, and family therapy;

(II) Intellectual, personality, behavioral, educational, neuropsychological, and psycho-physiological testing; and

(III) Professional activities, such as research, teaching, training, interviewing, assessment, evaluation, pharmacology, and biofeedback.

(B) Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of:

(i) An individual bearing the title of psychologist in the employ of an academic institution, research organization, or laboratory, if the psychology-based activities or services offered are within the scope of employment, are consistent with his or her professional training and experience, and provided within the confines of employment; or

(ii) A school psychologist employed by District of Columbia Public Schools or a public charter school and working in accordance with regulations issued by the Office of the State Superintendent of Education.

(17) “Practice of registered nursing” means the performance of the full scope of nursing services, with or without compensation, designed to promote and maintain health, prevent illness and injury, and provide care to all patients in all settings based on standards established or recognized by the Board of Nursing. The practice of registered nursing includes:

(A) Providing comprehensive nursing assessment of the health status of patients, individuals, families, and groups;

(B) Addressing anticipated changes in a patient’s condition as well as emerging changes in a patient’s health status;

(D) Synthesizing biological, psychological, spiritual, and social nursing diagnoses;

(E) Planning nursing interventions and evaluating the need for different interventions and the need for communication and consultation with other health care team members;

(F) Collaborating with health care team members to develop an integrated client-centered health care plan as well as providing direct and indirect nursing services of a therapeutic, preventive, and restorative nature in response to an assessment of the patient’s requirements;

(G) Developing a strategy of nursing care for integration within the patient-centered health plan that establishes nursing diagnoses, sets goals to meet identified health care needs, determines nursing interventions, and implements nursing care through the execution of independent nursing strategies and regimens requested, ordered, or prescribed by authorized health care providers;

(H) Performing services such as:

(i) Counseling;

(ii) Educating for safety, comfort, and personal hygiene;

(iii) Preventing disease and injury; and

(iv) Promoting the health of individuals, families, and communities;

(I) Delegating and assigning interventions to implement a plan of care;

(J) Administering nursing services within a health care facility, including the delegation and supervision of direct nursing functions and the evaluation of the performance of these functions;

(K) Delegating and assigning nursing interventions in the implementation of a plan of care along with evaluation of the delegated interventions;

(L) Providing for the maintenance of safe and effective nursing care rendered directly or indirectly as well as educating and training persons in the direct nursing care of patients;

(M) Engaging in nursing research to improve methods of practice;

(N) Managing, supervising, and evaluating the practice of nursing;

(O) Teaching the theory and practice of nursing; and

(P) Participating in the development of policies, procedures, and systems to support the patient.

(17A) “Practice of respiratory care” means the performance in collaboration with a licensed physician, of actions responsible for the treatment, management, diagnostic testing, control, and care of patients with deficiencies and abnormalities associated with the cardiopulmonary system, including, but not limited to:

(A) Therapeutic and diagnostic use of medical gases, humidity, and aerosols, including the maintenance of associated apparatus;

(B) Administration of medications to the cardiorespiratory system; provision of ventilatory assistance, ventilatory control, including high frequency ventilation; postural drainage, chest physiotherapy, breathing exercises, and other respiratory rehabilitation procedures;

(C) Cardiopulmonary resuscitation and maintenance of natural airways, the insertion and maintenance of artificial airways and the transcription and implementation of a physician’s written or verbal orders pertaining to the practice of respiratory care;

(D) Testing techniques utilized in respiratory care to assist in diagnosis, monitoring, treatment, and research; and

(E) Measurement of ventilatory volumes, pressures and flows, specimen collection of blood and other materials, pulmonary function testing pH and blood gas analysis, hemodynamic and other related physiological monitoring of the cardiopulmonary system.

(18)(A) “Practice of social work” means rendering or offering to render professional services to individuals, families, or groups of individuals that involve the diagnosis and treatment of psychosocial problems according to social work theory and methods. Depending upon the level at which an individual social worker is licensed under this chapter, the professional services may include, but shall not be limited to, the formulation of psychosocial evaluation and assessment, counseling, psychotherapy, referral, advocacy, mediation, consultation, research, administration, education, and community organization.

(B) Nothing in this paragraph shall be construed to authorize any person licensed as a social worker under this chapter to engage in the practice of medicine.

(19)(A) “Practice of speech-language pathology” means the application of principles, methods, or procedures related to the development and disorders of human communication, including any condition, whether of organic or non-organic origin, that impedes the normal process of human communication including disorders and related disorders of speech, articulation, fluency, voice, oral, or written language; auditory comprehension and processing; oral, pharyngeal or laryngeal sensorimotor competencies; swallowing; auditory or visual processing; auditory or visual memory or cognition; communication; and assisted augmentative communication treatment and devices.

(B) The term practice of speech-language pathology also includes the planning, directing, supervising, and conducting of a habilitative and rehabilitative counseling program for individuals or groups of individuals who have, or are suspected of having, disorders of communication, and any service in speech-language pathology including prevention, identification, evaluation, consultation, habilitation or rehabilitation, instruction, or research.

(C) The practice of speech-language pathology may include pure-tone air conduction hearing screening, screening tympanometry, and acoustic reflex screening, limited to a pass-or-fail determination for the identification of individuals with other disorders of communication and may also include aural habilitation or rehabilitation, which means the provision of services and procedures for facilitating adequate auditory, speech, and language skills in individuals with hearing impairment. The practice of speech-language pathology does not include the practice of medicine or osteopathic medicine, or the performance of a task in the normal practice of medicine or osteopathic medicine by a person to whom the task is delegated by a licensed physician.

(D) Repealed.

(19A) “Practice by a speech-language pathology assistant” means assisting a licensed speech-language pathologist in implementing speech-language pathology care and treatment plans for patients under the direct supervision and direction of the licensed speech-language pathologist.

(19B) “Practice by a speech-language pathology clinical fellow” means the practice of speech-language pathology by a participant in a clinical fellowship that meets the definition set forth in § 3-1209.11.

(20) “Practice by surgical assistants” means the provision of aid by a person who is not a physician licensed to practice medicine, under the direct supervision of a surgeon licensed in the District of Columbia, in exposure, hemostasis, closures, and other intraoperative technical functions that assist a physician in performing a safe operation with optimal results for the patient.

(21) “Practice by trauma technologists” means the provision of emergency medical care to trauma patients in a Level 1 trauma facility as designated by the Director of the Department of Health pursuant to Chapters 27 and 28 of Subtitle B of Title 22 of the District of Columbia Municipal Regulations (22-B DCMR § 2700 et seq. and § 2800 et seq.), under either the direct or indirect supervision of a physician licensed to practice medicine in the District of Columbia.

(22) “Practice of veterinary medicine” means:

(A) The diagnosis, prognosis, prevention, testing, or treatment of a disease, pain, deformity, defect, injury, or any other physical condition of an animal;

(B) Performing a surgical, medical, or dental procedure, or rendering surgical, medical, or dental aid to, for, or upon an animal;

(D) Prescribing, administering, or dispensing of drugs or medications for use on animals or for euthanasia of an animal.