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31.0403 Definitions of health occupations.

Cite as [A.S.A.C. § 31.0403]

For purposes of this chapter, unless the context clearly requires otherwise:

(a) “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. The practice of acupuncture by a non-physician acupuncturist shall be carried out in general collaboration with a licensed physician, osteopath, or dentist.

(b) “Practice of advanced registered nursing” means the performance of advanced-level

nursing actions by a nurse midwife, a nurse anesthetist, or a nurse-practitioner certified pursuant to this chapter which, by virtue of post-basic specialized education, training, and experience, are proper to be performed. The advanced registered nurse may perform actions of nursing diagnosis and nursing treatment of alterations of the health status. The advanced registered nurse may also perform actions of medical diagnosis and treatment, prescription, and other functions which are identified in this chapter and carried out in accordance with the procedures required by this chapter.

(c) “Practice of dental hygiene” means:

(1) the performance of 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; the polishing of a tooth or of a restoration;

(2) the charting of cavities during preliminary examination, prophylaxis, or polishing;

(3) the application of a medicinal agent to a tooth for a prophylactic purpose;

(4) the taking of a dental X-ray;

(5) the instruction of individuals or groups of individuals in oral health care; and

(6) any other functions included in the curricula of approved educational programs in dental hygiene. A dental hygienist may perform the activities listed in paragraphs (c)(l) through (c)(6) of this subsection only under the general supervision of a licensed dentist, in the dentist’s office or any public school or institution rendering dental services. The board may issue rules identifying other specific functions which may be performed by a dental hygienist, and authorizing levels of supervision for the performance of these additional functions by a dental hygienist. The license of a dentist who permits a dental hygienist, operating under that dentist’s 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.

(d) The “Practice of dental therapy” means the application of certain diagnostic and thera¬peutic dental procedures under the general supervision of a dentist. Such procedures may include a combination of any of the following: the cleaning of teeth, individual or group instruction in oral hygiene, topical application of medicaments, examining patients and charting their dental conditions, taking of dental X-rays, performance of restorative work with application of composites in classes I, II and III, (application of class IV composites and TMS pins is not allowed), simple suturing, pulp capping and pulpotomy.

Simple extractions of deciduous and permanent teeth under local anesthesia may be performed on individuals under the age of 16, but such procedures may be carried out only after direct evaluation of the patient and clearance to do so by a dentist. Interpretation of dental X-rays is to be done only by a dentist or medical radiologist.

For the purpose of subsection, the term “general supervision” means the performance by a dental therapist of procedure permitted by paragraph (d) of this subsection based on instructions given by a licensed dentist, but not requiring the physical presence of the dentist during the performance of these procedures. The license of a dentist who permits a dental therapist, operating under that dentist’s supervision, to perform any operation other than that permitted under this paragraph, may be suspended or revoked, and the license of a dental therapist violating this paragraph, may also be suspended or revoked, in accordance with the provisions of this chapter.

(e) “Practice of dentistry” means:

(1) 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;

(2) the extraction of a human tooth or teeth;

(3)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;

(4) the correction of the malposition or malformation of the human teeth; (5)the administration of 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;

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

(7) 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 or malformation of a tooth or teeth;

(8) 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; or

(9) the performance of any of the clinical practices included in the curricula of accredited dental schools or colleges or qualifying residency or graduate programs in dentistry.

(f) “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. Nothing in the 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.

(g) “Practice of medicine” means the application of scientific principles to prevent, diagnose, and treat physical and mental diseases, disorders, and conditions and to safeguard the life and health of any woman and infant through pregnancy and parturition.

(h) “Practice of occupational therapy” means the evaluation and treatment of individuals whose ability to manage normal daily functions is threatened or impaired by developmental deficits, the aging process, poverty and cultural differences, physical injury or illness, or psychological and social disability, utilizing task-oriented activities to prevent or correct physical or emotional disabilities and enhance developmental and functional skills rendered on the prescription of or referral by a licensed physician, osteopath, dentist, or by a licensed registered nurse certified to practice as an advanced registered nurse as authorized pursuant to Section 2 of this chapter. Specific therapeutic and diagnostic techniques used in occupational therapy include:

(l) self-care and other activities of daily living;

(2) developmental, perceptual-motor, and sensory integrative activities;

(3) training in basic work habits;

(4) prevocational evaluation and treatment;

(5) fabrication and application of splints;

(6) selection and use of adaptive equipment, and exercise and other modalities to enhance functional performance; and

(7) performing and interpreting manual muscle and range of motion tests.

(8) an individual working as an occupational therapy assistant pursuant to this chapter may assist in the practice of occupational therapy under the supervision of or in consultation with a licensed occupational therapist.

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

An individual licensed to practice occupational therapy pursuant to this chapter may apply to the director of health for authorization to evaluate and treat patients without prescription or referral as required in paragraph (h). Such authorization may be granted by the director of health, at his discretion, to an individual occupational therapist, for a specified period of time, and under such limitations and conditions as the director of health deems appropriate.

(i) “Practice of optometry” means the application of the scientific principles of optometry in the examination of the eye and visual system to detect defects or abnormal conditions; the prescription or use of lenses, prisms, or ocular exercises to correct or alleviate defects or abnormal conditions of the eye or visual system; the use of approved therapeutic and diagnostic pharmaceutical agents in accordance with the provisions of this paragraph as an aid to the detection and treatment of visual defects or abnormal conditions; and the appropriate referral of patients to licensed physicians for the medical diagnosis and treatment of abnormal conditions.

The director of health shall issue regulations identifying the diagnostic pharmaceutical agents which may be used by optometrists pursuant to this paragraph if the director determines that the use of diagnostic pharmaceutical agents by optometrists are in the best interest of the public.

An individual licensed to practice optometry pursuant to this chapter may use diagnostic pharmaceutical agents only if certified to do so by the board.

Optometrists may use therapeutic pharmaceutical agents in a government hospital only, with prior approval of the hospital’s pharmacy committee, which shall prepare a list of such pharmaceutical agents which may be used by optometrists for both in-patients, and patients treated in the hospital’s outpatient eye-care clinics. It shall be the responsibility of the director of health to give written approval for each optometrist on the staff of the hospital to use and/or prescribe the medications listed by the pharmacy committee. Such use of pharmaceutical agents by optometrists in a non-government hospital will require additional regulation by the board.

Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of a licensed physician or an optician to provide eyeglasses or lenses on the prescription of a licensed physician or optometrist, or a dealer to sell 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.

(j) “Practice of pharmacy” means the interpretation and evaluation of prescription orders; the compounding, dispensing, and labeling of drugs and devices, and the maintenance of proper records therefor; the responsibility of advising, where regulated or otherwise necessary, of therapeutic values and content, hazards, and use of drugs and devices; and the offering or performance of those acts, services, operations, and transactions necessary in the conduct, operation, management, and control of a pharmacy. Within the meaning of this paragraph

(l) “Pharmacy” means any establishment or institution, or arty 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;

(2) “Prescription” means any order for a drug, medicinal, chemical, or combination or mixtures thereof, or for a medically prescribed medical device, in writing, 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, specifying the address of the person for whom the drug or device is ordered and directions for use to be placed on the label.

The pharmacist shall have the right to substitute medications approved as “generic equiva¬lents” for any prescribed medication written by a health professional who is an employee of the American Samoa Government in his function as a health professional, provided that such “generic equivalents” be limited only to medications approved by the Pharmacy Committee of the government hospital(s) for such substitution.

(k) “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.

An individual, licensed to practice physical therapy pursuant to this chapter may apply to the director of health for authorization to evaluate and treat patients without prescription or referral as required in paragraph (h). Such authorization may be granted by the director of health, at his discretion to an individual physical therapist, for a specified period of time, and under such limitations and conditions as the director health deems appropriate.

(l) “Practice by physician assistants” means the performance, in general 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 pursuant to 31.0404.

(m) “Practice of practical nursing” means the performance of actions of preventive health care, health maintenance, and the care of persons who are ill, injured, or experiencing alterations in health processes, requiring a knowledge of and skill in nursing procedures gained through successful completion of an approved educational program in practical nursing.

(n) “Practice of clinical psychology” means the application of established scientific methods and principles, including the principles of psychophysiology, learning, perception, motivation, emotions, organizational and social behaviors for the purpose of understanding, assessing, treating, explaining, predicting, preventing, or influencing behavior; the application of psychological methods and procedures for interviewing, counseling, psychotherapy, including behavior therapy, behavior modification, or hypnotherapy; or the application of psychological methods or procedures for constructing, administering, or interpreting tests of intelligence, mental abilities and disorders, neuropsychological functioning, aptitudes, interests, attitudes, personality characteristics, emotions, or motivations. Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of:

(1) an individual bearing the title of psychologist in the employ of any, academic institution if the services are offered within the confines of the academic institution and if the services do not include psychotherapy; or

(2) a school psychologist employed by and working in accordance with regulations of the American Samoa Department of Education.

(o) “Practice of registered nursing” means the performance of acts requiring substantial specialized knowledge, judgment and skill based upon the principles of the biological, physical, behavioral, and social sciences in:

(1) the observation, assessment, and recording of physiological and behavioral signs and symptoms of health, disease, and injury, including the performance of examinations and testing and their evaluation for the purpose of differentiating normal and abnormal.

(2) the provision of direct and indirect registered nursing services of a therapeutic, preventive, and restorative nature in response to an assessment of the patient’s requirements;

(3) the performance of services, counseling, and education for the safety, comfort, personal hygiene, and protection of patients, the prevention of disease and injury, and the promotion of health in individuals, families and communities;

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

(5) the education and training of persons in the direct nursing care of patients; or

(6) the pursuit of nursing research to improve methods of practice.

(p) “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 rule, the professional services may include, but shall not be limited to, the formulation of psychosocial evaluation and assessment, counseling, referral, advocacy, consultation, research, administration, education, and community organization. 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.

History: Rule 2-88, eff 27 Mar 88 § 1.