OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 81 Bill Analysis
135th General Assembly
Click here for S.B. 81’s Fiscal Note
Version: As Passed by the Senate
Primary Sponsor: Sen. Romanchuk
Effective Date:
Elizabeth Molnar, Attorney
SUMMARY
 Authorizes the following practitioners to sign documents related to patient admission,
treatment, and discharge, if certain conditions are met: physician assistants, certified
nurse practitioners, clinical nurse specialists, and certified nurse-midwives.
 With respect to physician assistants, limits their signing authority to hospital patients,
while for certified nurse practitioners, clinical nurse specialists, and certified nurse-
midwives, limits their signing authority to inpatients receiving psychiatric or other
behavioral health care services.
DETAILED ANALYSIS
Authority to sign documents relating to patient admission,
treatment, and discharge
The bill authorizes physician assistants and advanced practice registered nurses (APRNs)
who are certified nurse practitioners, clinical nurse specialists, or certified nurse-midwives to
sign documents relating to a patient’s admission, treatment, or discharge – if certain conditions
are met.1 The documents may include treatment plans and medication orders that are part of
treatment plans.
Types of patients
In the case of physician assistants, the bill authorizes the signing of documents related
to hospital patients. For APRNs, this authority applies to documents concerning individuals
receiving psychiatric or other behavioral health care services at a facility on an inpatient basis.
1 R.C. 4723.436(A) and 4730.204(A).
November 16, 2023
Office of Research and Drafting LSC Legislative Budget Office
Conditions on signing authority
The following conditions must be satisfied in order for a physician assistant or APRN to
be eligible to sign the documents:
 The physician assistant must be employed by the hospital, while the APRN must either
be employed, or granted appropriate credentials, by the facility;
 The physician assistant’s supervising physician or the APRN’s collaborating physician
must either be employed by the hospital or facility or be a member of its medical staff;
 The supervising or collaborating physician must have authorized the physician assistant
or APRN to sign documents relating to the admission, treatment, or discharge of the
physician’s patients;
 In the case of a physician assistant, the hospital’s policies must allow the physician
assistant to sign the documents;
 In the case of an APRN, the nurse’s standard care arrangement must specify in writing
that the nurse is authorized to sign documents for the physician’s patients.2
Physician immunity
The bill states that a supervising physician, in the case of a physician assistant, or a
collaborating physician, in the case of an APRN, who authorizes the physician assistant or APRN
to sign documents under the bill’s provisions is not subject to civil liability, administrative
action, or criminal prosecution for an act or omission that arises from the physician assistant or
APRN signing the document.3
Physician supervision and collaboration – background
Physician supervision – physician assistants
Existing law unchanged by the bill requires a physician assistant to practice only under
the supervision, control, and direction of a physician with whom the physician assistant has
entered into a supervision agreement. The physician assistant also must practice in accordance
with that agreement and if applicable, the policies of the health care facility where the
physician assistant practices.4
Physician collaboration − APRNs
Current law unchanged by the bill requires an APRN who is a certified nurse
practitioner, clinical nurse specialist, or certified nurse-midwife to practice in collaboration with
a physician, meaning that the physician is continuously available to communicate with the
2 R.C. 4723.431(C), 4723.436(B), 4730.204(A) and (B).
3 R.C. 4723.436(D) and 4730.204(C).
4 R.C. 4730.08, not in the bill.
P a g e |2 S.B. 81
As Passed by the Senate
Office of Research and Drafting LSC Legislative Budget Office
nurse either in person or by electronic communication.5 The APRN also must enter into a
standard care arrangement with one or more collaborating physicians and practice in
accordance with it. A standard care arrangement is a written, formal guide for planning and
evaluating a patient’s health care that is developed by one or more collaborating physician and
the APRN.
HISTORY
Action Date
Introduced 03-07-23
Reported, S. Health 11-15-23
Passed Senate (29-1) 11-15-23
ANSB0081PS-135/ks
5 R.C. 4723.01 and 4723.43, not in the bill, and 4723.431.
P a g e |3 S.B. 81
As Passed by the Senate