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NEW JERSEY REGISTER
VOLUME 38, ISSUE 13
ISSUE DATE: JULY 3, 2006
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY STATE BOARD OF OPTOMETRISTS

Proposed Amendments: N.J.A.C. 13:38-2.4, 3.5, 4.1 through 4.4, 5.1, 7.3 and 7.4 Proposed Repeal and New Rule: N.J.A.C. 13:38-4.5

Requirements for Issuing Prescriptions and Dispensing of Medications;
Requirements for Applications for Licensure; Therapeutic Pharmaceutical
Agents (TPA) Certification; Fee Schedule; Continuing Education

Authorized By: State Board of Optometrists, Susan Gartland, Executive Director.

Authority: N.J.S.A. 45:12-4.

Calendar Reference: See Summary below for explanation of exception to the calendar requirements.

Proposal Number: PRN 2006-212.

Submit written comments by September 1, 2006 to:

Susan Gartland, Executive Director
State Board of Optometrists
124 Halsey Street
Post Office Box 45012
Newark, New Jersey 07101

The agency proposal follows:

Summary

Pursuant to the rulemaking authority set forth in N.J.S.A. 45:12-4, the State Board of Optometrists (the Board) proposes a new rule and amendments to N.J.A.C. 13:38-2.4; 3.5; 4.1 through 4.5; 5.1; 7.3 and 7.4, relating to the implementation of the general requirements for optometrists who prescribe therapeutic pharmaceutical agents (TPA). Credentialing requirements for optometrists to use and prescribe pharmaceutical agents were established pursuant to P.L. 2004, c. 115, which created a new section N.J.S.A. 45:12-9.13. As required by this law, an interim advisory panel of experts in ocular pharmacology was established to prepare or endorse credentialing requirements for Board approval. The proposed amendments and new rule are responsive to the recommendations of the four-member advisory panel of experts in ocular pharmacology. P.L. 2004, c. 115 became effective August 7, 2005.

Since P.L. 2004, c. 115 creates new section N.J.S.A. 45:12-9.13, which provides for the credentialing requirements for optometrists to use and prescribe pharmaceutical agents, the Board proposes to replace references to N.J.S.A. 45:12-9.12 with references to N.J.S.A. 45:12-9.13 throughout the proposal.

N.J.A.C. 13:38-2.4(c)1 requires optometrists to provide patients with notice that the patient can request that the optometrist substitute a generic drug for any prescribed medication. The Board is proposing to amend N.J.A.C. 13:38-2.4(c)1 to clarify that a generic drug may be substituted for any prescribed medication only when a substitute is available. At N.J.A.C. 13:38-2.4(e), the Board is proposing to include a reference to N.J.A.C. 13:45A-27 which outlines the prescription blank regulations. The Board is proposing new N.J.A.C. 13:38-2.4(f)) which requires licensees, who are certified to prescribe therapeutic pharmaceutical agents on a topical level only, to include language on the prescription blank that informs that the prescription is valid for topical pharmaceutical agents and prescription eyewear only. Although this language already exists on optometrists' prescription blanks, the Board believes that the inclusion of this requirement in the regulations is necessary to avoid any confusion when optometrists have the authority to prescribe oral medications as well. The Board believes that the required language distinguishes those optometrists who can prescribe only topical pharmaceutical agents from those who can prescribe topical and oral pharmaceutical agents. The required language also notifies pharmacists and patients of an optometrist's level of prescriptive authority.

As a protective measure for patients and to ensure that optometrists are aware of the penalty if they practice outside their scope of practice, the Board is proposing new rule N.J.A.C. 13:38-2.4(g) to provide that any licensee who practices outside his or her scope of practice will be deemed to have engaged in professional misconduct.

The Board is also proposing N.J.A.C. 13:38-2.4(h) to permit only one controlled dangerous substance on a prescription blank. The Board is proposing N.J.A.C. 13:38-2.4(i) to provide that no prescribing of Schedule I and II controlled dangerous substances is authorized. The Board is also proposing N.J.A.C. 13:38-2.4(j) which establishes that each prescription for a pharmaceutical agent must only be for the purposes of diagnosing and treating deficiencies, deformities, diseases, or abnormalities of the human eye and adnexae.

The Board is proposing an amendment to N.J.A.C. 13:38-3.5(c) which establishes that an applicant seeking licensure and TPA certification at the same time shall only be required to pay one application fee of $ 125.00. The Board is proposing to amend N.J.A.C. 13:38-4.1(a) and (b) and 4.2(a) and (c) to correct the statutory reference and nomenclature. The Board is proposing to amend N.J.A.C. 13:38-4.2(b)1 through 4 which establishes the application procedure for those optometrists who are applying for initial TPA certification on or after (the effective date of the amendments). The proposed amendments require that any applicant applying for initial TPA certification must, along with the application and application fee, verify successful completion of the educational requirements at N.J.A.C. 13:38-4.3(a) and (b) and that he or she has successfully passed the examination requirements of N.J.A.C. 13:38-4.3 and 4.4. The Board is proposing these amendments to require all initial applicants to be certified in both oral and topical TPA because such a certification is best for the health, safety and welfare of the public. The Board is proposing new N.J.A.C. 13:38-4.2(d) to allow optometrists, who have been TPA certified prior to August 7, 2005, to have the option of renewing every biennial period at the topical TPA level. However, if a TPA certified optometrist elects to obtain the oral TPA certification, then the optometrist must complete the requirements outlined in N.J.A.C. 13:38-4.2(b).

Proposed new N.J.A.C. 13:38-4.2(e) establishes that if an applicant graduates from a college of optometry on or after August 7, 2005 and applies for initial TPA certification, that applicant need not re-take the required credentialing courses outlined in N.J.A.C. 13:38-4.3(b)2 since that applicant completed this coursework in order to earn his or her degree. The proposed amendments at N.J.A.C. 13:38-4.3 establish the educational requirements for TPA certification. N.J.A.C. 13:38-4.3(b) establishes the appropriate credentialing courses an applicant seeking TPA certification must successfully complete. These courses are the Advisory Panel's recommended courses. Pursuant to proposed N.J.A.C. 13:38-4.3(c), the credentialing courses must be offered by a school that is accredited by the U.S. Department of Education and the Council on Postsecondary Accreditation and approved by the New Jersey State Board of Optometrists. The proposed amendment at N.J.A.C. 13:38-4.4 establishes that each applicant must successfully pass the Treatment and Management of Ocular Disease Examination (TMOD) prior to certification by the Board.

The proposed repeal and new rule at N.J.A.C. 13:38-4.5 require applicants to submit a certification renewal application to the Board every two years in which the applicant certifies that he or she has completed the continuing education requirements as outlined in N.J.A.C. 13:38-7.3, Credit hour requirements. Since the Board is proposing a reference to Subchapter 7, the Board is deleting the continuing education specifics for biennial TPA certification at N.J.A.C. 13:38-4.5.

The proposed amendments at N.J.A.C. 13:38-5.1 increase certification fees to cover the administrative costs associated with certifying optometrists in oral and topical TPA. The initial certification fee is increased from $ 210.00 to $ 250.00 if paid during the first year of a biennial renewal period, and from $ 105.00 to $ 125.00 if paid during the second year of a biennial renewal period. The biennial renewal fee-certification to prescribe is increased from $ 210.00 to $ 250.00.

The proposed amendments at N.J.A.C. 13:38-7.3(a) increase the number of continuing education credits a licensee must complete in TPA. The Board is proposing to increase the number of TPA credits from 25 to 30, of which 10 of the 30 continuing professional optometric education credits must be in oral TPA. According to N.J.A.C. 13:38-7.3(b), an applicant who initially obtains a certificate within the first year of a biennial period must complete at least 25 of the minimum required credits of continuing professional optometric education. The Board is proposing to increase the number of credits that must be in TPA from 12.5 to 15 TPA credits. The proposed amendment to N.J.A.C. 13:38-7.3(d) is for clarification. The Board believes that the insertion of the word "general" clarifies that TPA credits can not be carried over into any succeeding biennial period. Proposed new N.J.A.C. 13:38-7.4(d) establishes that a continuing professional optometric education program or course pre-approved by the Board will only be acceptable for the biennial period in which it was approved. The sponsor must re-apply and receive an approval by the Board each biennial year. The new subsection also requires the sponsor to notify the Board, in writing, of any change in course or program venue. If a course or program is given in multiple locations during the current biennial year, the course or program must be identical in course title, speaker and content as that pre-approved by the Board.

The Board is proposing to recodify N.J.A.C. 13:38-7.4(d) as (e). At new N.J.A.C. 13:38-7.4(e)8, the Board is proposing to permit licensees to obtain a maximum of six continuing professional optometric education credits per biennial renewal period for CPR certification. As the Division has provided a 60-day comment period on this notice of proposal, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3.

Social Impact

Based upon the statutory amendments authorizing optometrists to be certified in oral TPA, the proposed amendments, repeal and new rule will have a social impact upon any applicant applying for initial TPA certification on or after August 7, 2005. In addition to completing the application and submitting the required fee, the applicant must verify that the educational requirements for topical and oral TPA levels have been completed. The applicant must also verify successful completion of the TMOD examination and the credentialing examination.

The proposed amendments, repeal and new rule will also have a social impact upon any applicant certified by the Board prior to August 7, 2005 to use or prescribe topical TPA and who elects to obtain oral TPA certification. The applicant must successfully comply with the requirements of N.J.A.C. 13:38-4.2(b).

In addition, the proposed amendments, repeal and new rule will have a social impact upon any applicant applying for initial TPA certification who graduated from a college of optometry prior to 2005 and has not been licensed as an optometrist. The applicant must successfully complete the credentialing courses and examination and the TMOD examination outlined in the regulations.

The proposed amendments, repeal and new rule will have a social impact upon optometric patients since optometrists have the authority to prescribe oral and topical TPA. The proposed amendments, repeal and new rule authorize a qualified optometrist to prescribe medications without having the patient wait to see another eye-care professional if oral medications are needed. Thus, the proposed amendments, repeal and new rule will have a social impact upon optometric patients since it is in the best interest of the health, safety and welfare of the public to have newly certified optometrists certified in oral and topical TPA, while giving currently certified licensees the option to retain topical only certification.

Economic Impact

The proposed amendments, repeal and new rule will have an economic impact upon applicants applying for TPA certification. These applicants will incur the cost of completing the credentialing coursework and examination. In addition, these applicants will incur the cost of initial certification and the biennial renewal fee. However, the increase in these fees are necessary to cover the administrative cost of reviewing applications.

Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments, repeal and new rule do not involve any Federal standards or requirements.

Jobs Impact

The Board does not anticipate that the proposed amendments, repeal and new rule will result in the creation or loss of any jobs.

Agriculture Industry Impact

The Board does not anticipate that the proposed amendments, repeal and new rule will have any impact on the agriculture industry in the State.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., requires the Board to give a description of the types and an estimate of the number of small businesses to which the proposed amendments will apply. Currently, the Board licenses approximately 1,200 active optometrists. If, for the purposes of the Act, Board licensees are considered "small businesses," then the following analysis applies.

The proposed new subsection at N.J.A.C. 13:38-2.4 impose compliance requirements upon licensees. N.J.A.C. 13:38-2.4(f) imposes a compliance requirement upon licensees who are certified to prescribe therapeutic pharmaceutical agents on a topical level only. Such licensees must include the language outlined in the regulation on each prescription blank. N.J.A.C. 13:38-2.4(g) also imposes compliance requirements upon licensees, in general, since the proposed new rule deems any licensee who practices outside his or her scope of practice as engaging in professional misconduct. In addition, proposed new N.J.A.C. 13:38-2.4(h) imposes compliance requirements upon licensees since it requires that each prescription for a controlled dangerous substance be written on a separate NJPB. If an NJPB contains prescriptions for two or more controlled dangerous substances, the prescription will be deemed invalid. If an NJPB contains a prescription for only one controlled dangerous substance and contains other prescription(s) other than another controlled dangerous substance, the prescription is valid. Proposed new N.J.A.C. 13:38-2.4(i) also imposes compliance requirements upon licensees since it prohibits licensees from prescribing controlled dangerous substances as outlined in Schedule I and Schedule II. The Board also proposes new N.J.A.C. 13:38-2.4(j) which imposes compliance requirements upon licensees since it establishes that each prescription for a pharmaceutical agent shall be for the purposes of diagnosing and treating deficiencies, deformities, diseases, or abnormalities of the human eye and adnexae.

The proposed amendments to N.J.A.C. 13:38-4.2(b) will impose compliance requirements upon applicants applying for initial TPA certification. The proposed amendments require successful completion of educational/credentialing requirements. In addition, the proposed amendments also require these applicants to successfully pass the TMOD and the credentialing examination.

Proposed new N.J.A.C. 13:38-4.2(d) imposes a compliance requirement upon applicants who have been TPA certified by the Board prior to August 7, 2005 and wish to obtain the oral TPA certification. These applicants must comply with the rules established at N.J.A.C. 13:38-4.2, application for therapeutic pharmaceutical agents (TPA) certification and general requirements.

The proposed amendments to Subchapter 7 impose compliance requirements upon licensees. The proposed amendment requires that 30 of the 50 credits of continuing education be in TPA and that 10 credits of the 30 be in oral TPA. Proposed new N.J.A.C. 13:38-7.4(d) imposes compliance requirements upon continuing education sponsors that receive Board pre-approval for courses or programs. Every biennial period these sponsors must get Board pre-approval. These sponsors must also notify the Board if there is any change in course or program venue.

The proposed amendments and new rule will not impose recordkeeping and reporting requirements. No additional professional services will be needed to comply with the proposed amendments and new rule. Moreover, the Board does not believe that there will be any significant, additional economic impact upon licensees as a result of the proposed amendments, repeal and new rule. The Board also believes that the proposed new rule and amendments should be uniformly applied to all licensees in order to ensure the health, welfare and safety of the general public in the practice of optometry; and, therefore, no differing compliance requirements for any licensee are provided.

Smart Growth Impact

The Board does not anticipate that the proposed amendments, repeal and new rule will have an impact of the achievement of smart growth and the implementation of the State Development and Redevelopment Plan.

Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):

13:38-2.4 Requirements for issuing prescriptions and dispensing of medications

(a)-(b) (No change.)

(c) In addition to the provisions of (a) and (b) above, optometrists certified to prescribe pharmaceutical agents pursuant to the provisions of N.J.A.C. 13:38-4 and N.J.S.A. 45:12-9.8 through [9.12] 9.13 shall comply with the following:

1. The optometrist shall advise all patients by sign or pamphlet or similar notice available in a conspicuous location in the optometrist's office that the patient may request that the optometrist substitute a generic drug, when available, for any prescribed medication.

2.-3. (No change.)

(d) (No change.)

(e) Written prescriptions shall be issued only on New Jersey Prescription Blanks (NJPB), secured from an approved vendor and subject to the required security mandates of the prescription blank program pursuant to N.J.S.A. 45:14-14 and N.J.A.C. 13:45A-27.

(f) All licensees who are certified to prescribe therapeutic pharmaceutical agents on a topical level only, shall include the following language on the prescription blank:

"NOT VALID FOR CONTROLLED SUBSTANCES. VALID FOR TOPICAL PHARMACEUTICAL AGENTS (IF TPA CERTIFIED) AND PRESCRIPTION EYEWEAR ONLY."

(g) Any licensee who practices outside his or her scope of practice, as defined in N.J.S.A. 45:12-1, will be deemed to have engaged in professional misconduct pursuant to N.J.S.A. 45:1-21(e).

(h) Each prescription for a controlled dangerous substance shall be written on a separate NJPB.

1. An NJPB that contains prescriptions for two or more controlled dangerous substances shall be invalid.

2. An NJPB that contains a prescription for only one controlled dangerous substance and contains other prescriptions(s) other than another controlled substance shall be valid.

(i) All licensees are prohibited from prescribing controlled dangerous substances as outlined in N.J.S.A. 24:21-5, Schedule I, and 24:21-6, Schedule II.

(j) Each prescription for a pharmaceutical agent shall be for the purpose of diagnosing and treating deficiencies, deformities, diseases, or abnormalities of the human eye and adnexae.

13:38-3.5 Requirements for application for licensure

(a) (No change.)

(b) An applicant seeking licensure shall submit the following to the Board:

1. (No change.)

2. A non-refundable application fee as set forth in N.J.A.C. 13:38-5.1;

3.-5. (No change.)

(c) When an applicant is seeking licensure and is also seeking therapeutic pharmaceutical agents (TPA) certification at the same time, the licensee shall comply with (b) above and the TPA certification requirements set forth at N.J.A.C. 13:38-4.2[(b) and (c)], except that the applicant [is not required to pay two application fees] shall only be required to pay one application fee.

SUBCHAPTER 4. THERAPEUTIC PHARMACEUTICAL AGENTS (TPA) CERTIFICATION

13:38-4.1 Purpose and scope

(a) The rules of this subchapter implement the provisions of the Consumer Access to Eye Care Act of 1991, N.J.S.A. 45:12-9.8 through [9.12] 9.13.

(b) This subchapter shall apply to a licensed optometrist utilizing therapeutic pharmaceutical agents, as defined and limited in N.J.S.A. 45:12-9.8 through [9.12] 9.13.

13:38-4.2 Application for therapeutic pharmaceutical agents (TPA) certification; general requirements

(a) An optometrist licensed in this State who wishes to use therapeutic pharmaceutical agents for treatment purposes as permitted by N.J.S.A. 45:12-9.8 through [9.12] 9.13 shall be certified by the Board prior to prescribing or dispensing such agents.

(b) [An applicant seeking therapeutic pharmaceutical agents (TPA) certification shall submit the following to the Board] Any applicant applying for initial TPA certification on or after (the date of promulgation) shall submit the following to the Board:

1. (No change.)

2. A non-refundable application fee as set forth in N.J.A.C. 13:38-5.1;

3. Verification that the applicant has successfully completed the educational requirements set forth in N.J.A.C. 13:38-4.3(a) and (b). The applicant shall obtain the required verification from the school where the applicant completed the educational requirements; and

4. Verification of test scores that the applicant has successfully passed the examination requirements as set forth in N.J.A.C. 13:38-4.3 and 4.4.

(c) An applicant who satisfies all of the requirements set forth in (b) above shall, upon payment of the initial certification fee set forth in N.J.A.C. 13:38-5.1, be certified by the Board to use therapeutic pharmaceutical agents as defined and limited in N.J.S.A. 45:12-9.8 through [9.12] 9.13.

(d) Any applicant certified by the Board prior to August 7, 2005 to use or prescribe topical TPA may choose to renew his or her certification every biennial period at the topical TPA level. The applicant shall certify in the renewal application that he or she has completed the continuing professional optometric education requirements as outlined in N.J.A.C. 13:38-7.3. If such applicant wishes to obtain the oral TPA certification, then he or she shall comply with the requirements set forth in (b) above.

(e) Any applicant who is applying for initial TPA certification and has graduated from a college of optometry on or after August 7, 2005 does not have to complete the credentialing course(s) requirement of N.J.A.C. 13:38-4.3(b)2 since this coursework is required to earn the degree.

13:38-4.3 Educational requirements for TPA certification

(a) Each applicant seeking TPA certification shall be required to successfully complete all educational requirements in ocular pharmacology at a school duly accredited by the United States Department of Education and the Council on Postsecondary Accreditation. This education shall be no less than that required of currently enrolled students as part of their requirements for graduation from that school. If an applicant attends a school other than a college of optometry, the education necessary to satisfy the ocular pharmacology educational requirement shall be substantially equivalent to that of a college of optometry.

(b) Each applicant seeking TPA certification shall be required to successfully complete credentialing courses consisting of the following:

1. All educational requirements as outlined in (a) above; and

2. A minimum of 30 hours distributed amongst the following credentialing course(s), with successful completion of an examination covering the following topics:

i. General pharmacology of appropriate agents;

ii. Pharmacokinetics, which includes drug absorption, distribution, metabolism, and elimination;

iii. Special populations including pediatrics and geriatrics;

iv. Prescription writing and appropriate dosages;

v. Appropriate and ethical uses of off-label medications;

vi. Safety issues, adverse drug reactions and interactions; recognition of systemic side-effects; awareness of medication errors (look-alike, sound-alike names), inappropriate use of medical abbreviations, proper notification of FDA MedWatch, and prevention of errors;

vii. Addiction recognition of patient, self and impaired practitioner;

viii. Recordkeeping; and

ix. CPR.

(c) The credentialing course(s) as set forth in (b) above shall be offered by a school that is accredited by the U.S. Department of Education and the Council on Postsecondary Accreditation and approved by the New Jersey State Board of Optometrists to ensure that the credentialing course(s) cover the topics in (b) above.

13:38-4.4 Examination requirements for TPA certification

Each applicant for TPA certification shall be required to successfully pass the Treatment and Management of Ocular Disease Examination, or any successive examination, administered by the National Board of Examiners in Optometry, prior to certification by the New JerseyState Board of Optometrists.

13:38-4.5 Biennial TPA certification renewal

[(a) An application for certification renewal shall be issued by the Board upon the applicants submission of proof that during the two calendar years immediately preceding application for renewal the applicant successfully completed 20 continuing professional education credits in Board-approved courses devoted to ocular pharmacology, ocular manifestation of systemic disease treatable by pharmacological agents, or ocular pathology treatable by pharmacological agents. Each credit shall represent or be equivalent to one hour of actual course attendance.

(b) Ten credits of the 20-credit continuing education requirement set forth in (a) above shall be in addition to the 50-credit continuing education requirement for license renewal. Credit for a continuing education course which is approved as fulfilling either the certification or the license renewal requirements shall be applied only once, either to the certification or to the license renewal requirement.]

An application for certification renewal shall be submitted to the Board every biennial period. The applicant shall certify in the renewal application that he or she has completed the continuing education requirements as outlined in N.J.A.C. 13:38-7.3.

13:38-5.1 Fee schedule

(a) The following fees shall be charged by the Board:

1.-6. (No change.)

7. Initial certification fee:

i. If paid during the first year of a biennial $[210.00] 250.00 renewal period:

ii. If paid during the second year of a $[105.00] 125.00 biennial renewal period:

8. Biennial renewal fee--certification to $[210.00] 250.00 prescribe:

9.-17. (No change.)

SUBCHAPTER 7. CONTINUING PROFESSIONAL OPTOMETRIC EDUCATION

13:38-7.3 Credit hour requirements

(a) An applicant for an active registration renewal certificate shall complete, during the preceding biennial period, a minimum of 50 credits of continuing professional optometric education. At least [25] 30 of the 50 credits shall consist of courses or programs classified as therapeutic pharmaceutical agents (TPA) credits and shall be primarily devoted to the diagnosis, treatment and management of ocular disease, ocular pathology or the ocular manifestation of systemic disease, of which 10 of the 30 continuing professional optometric education credits shall be in oral TPA. The remaining 20 general continuing professional optometric education credits shall be in content areas set forth in N.J.A.C. 13:38-7.4.

(b) An applicant who initially obtains a certificate within the first year of a biennial period shall complete at least 25 of the minimum required credits of continuing professional optometric education. At least [12.5] 15 of the 25 credits shall consist of courses or programs classified as TPA credits and shall be devoted to the subject matter set forth in (a) above.

(c) (No change.)

(d) A licensee who completes more than the required 50 credits in any biennial period may carry up to 20 credits into any succeeding biennial period. Any credits to be carried over shall be earned in the last one year of the biennial renewal period and shall be applied to the general continuing professional optometric education requirements and shall not be applied to the TPA requirements.

(e) (No change.)

13:38-7.4 Approved course offerings

(a)-(c) (No change.)

(d) A continuing professional optometric education program or course pre-approved by the Board pursuant to (c) above shall only be acceptable for the biennial period in which it was approved. In order to continue to offer a pre-approved continuing professional optometric education program or course, the sponsor shall re-apply and receive an approval by the Board. If a pre-approved continuing professional optometric education program or course is given in multiple locations during the then current biennial period, the course or program shall be identical in course titles speaker and content as that pre-approved by the Board. The sponsor shall notify the Board, in writing, of any change in course or program venue.

[(d)] (e) The Board shall grant a maximum of 20 of the mandatory 50 continuing professional optometric education credits, including a maximum of 10 of the mandatory [25] 30 TPA credits required, from any or all of the following:

1.-5. (No change.)

6. Preparation of an educational or scientific article authored and published in a professional refereed journal. TPA credits may be obtained from preparing an educational or scientific article authored and published in a professional refereed journal that is primarily devoted to the diagnosis, treatment and management of ocular disease, ocular pathology or the ocular manifestation of systemic disease; [or]

7. The Board shall grant a maximum of 10 continuing professional optometric education credits per biennial renewal period for optometric practice management or managed care courses or programs relating to the practice of optometry. Continuing professional optometric education credit shall not be granted in courses or programs taken in the following subjects: estate planning, financial or investment/tax planning, personal health, the selling of ophthalmic materials, or other similar subjects[.]; or

8. The Board shall grant a maximum of six continuing professional optometric education credits per biennial renewal period for CPR certification.



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