wa-law.org > bill > 2025-26 > HB 1784 > Substitute Bill

HB 1784 - Certified medical assistants

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Section 1

(1) A medical assistant-certified may perform the following duties delegated by, and under the supervision of, a health care practitioner:

Section 2

  1. A medical assistant-certified may enter an order for health care services into an entry-order system and activate such order if:

    1. There is a standing written protocol that authorizes designated medical assistants-certified to enter and activate an order for certain health care services, and the protocol:

      1. Details the clinical criteria that would initiate an order; and

      2. Is reviewed and revised annually, or more frequently as needed;

    2. The standing written protocol authorizes the medical assistant-certified to enter and activate orders for the following:

      1. Routine adult immunizations that do not require clinical judgment;

      2. Routine screening tests, such as mammograms, fecal occult stool cards, and bone density scans;

      3. Routine labs for chronic disease monitoring, such as diabetes, hypertension, and hypothyroidism;

      4. Routine diagnostic imaging tests, such as x-ray, magnetic resonance imaging, computed tomography, and ultrasound;

    3. Therapeutic procedures, such as osteoporosis treatment, nebulizer treatments, and cryotherapy;

    1. Procedure and surgical treatment orders, including minor in-office procedures, such as wound closure, lesion excision, joint injections, and aspirations, as well as orders for surgical interventions and other operative procedures as medically indicated;

    2. Point of care tests and tests waived under the federal clinical laboratory improvement amendments program, as included in the authorized duties of a medical assistant-certified under RCW 18.360.050, such as rapid strep, urinalysis, pregnancy, and blood glucose monitoring;

    3. Routine medication refills that have no changes in dosage or frequency;

     ix. Referrals;
    1. Perioperative order sets including referrals, labs, new medications, durable medical equipment, and radiologic exams; and

    1. Supportive devices and therapeutic applications, such as durable medical equipment, including glucometers, walkers, shower chairs, continuous positive airway pressure machines, and the application or removal of splints and casts;

    2. The medical assistant-certified has completed training regarding order-entry systems as specified in subsection (2) of this section;

    3. The delegated order is in compliance with RCW 18.360.060; and

    1. The order is not a prescription for a controlled substance, as defined in RCW 69.50.101. If the order is for a prescription for a controlled substance, the medical assistant-certified may enter, but not activate, the order.

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    1. A medical assistant-certified may only enter and activate orders in accordance with this section if the medical assistant-certified has received training from a supervising health care practitioner regarding order-entry systems. The training must take place annually and must cover the scope of permitted tasks, when to obtain clarification from a supervising health care practitioner, and compliance with regulatory requirements.

    2. The employer of a medical assistant-certified must maintain records regarding participation in annual order-entry training.

  3. Upon department request, including during any on-site facility surveys conducted by the department, an employer of a medical assistant-certified must provide documentation to the department demonstrating compliance with the training and countersignature requirements of this section.

  4. The department may adopt rules to implement this section.

Section 3

  1. Prior to delegation of any of the functions in RCW 18.360.050, a health care practitioner shall determine to the best of his or her ability each of the following:

    1. That the task is within that health care practitioner's scope of licensure or authority;

    2. That the task is indicated for the patient;

    3. The appropriate level of supervision;

    4. That no law prohibits the delegation;

    5. That the person to whom the task will be delegated is competent to perform that task; and

    6. That the task itself is one that should be appropriately delegated when considering the following factors:

      1. That the task can be performed without requiring the exercise of judgment based on clinical knowledge;

      2. That results of the task are reasonably predictable;

      3. That the task can be performed without a need for complex observations or critical decisions;

      4. That the task can be performed without repeated clinical assessments; and

    v.(A) For a medical assistant other than a medical assistant-hemodialysis technician, that the task, if performed improperly, would not present life-threatening consequences or the danger of immediate and serious harm to the patient; and

(B) For a medical assistant-hemodialysis technician, that the task, if performed improperly, is not likely to present life-threatening consequences or the danger of immediate and serious harm to the patient.

  1. Nothing in this section prohibits the use of protocols that do not involve clinical judgment and do not involve the administration of medications, other than vaccines.

  2. The entry and activation of orders by a medical assistant-certified in accordance with section 2 of this act is not considered a task that requires the exercise of judgment based on clinical experience.

Section 4

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

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