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S.B. 48 Enrolled

                 

OPTOMETRY LICENSING ACT AMENDMENTS

                 
2000 GENERAL SESSION

                 
STATE OF UTAH

                 
Sponsor: L. Alma Mansell

                  AN ACT RELATING TO OCCUPATIONS AND PROFESSIONS; IMPOSING DISCLOSURE
                  REQUIREMENTS ON HEALTH INSURERS WHO OFFER VISION BENEFITS; INCLUDING
                  OPTOMETRISTS IN THE LIST OF HEALTH CARE PROVIDERS COVERED BY HEALTH
                  INSURANCE AND THE GOOD SAMARITAN ACT; PERMITTING A CONTACT LENS
                  PRESCRIPTION TO BE GIVEN VERBALLY AND SPECIFYING THE COMPONENTS OF
                  SUCH A PRESCRIPTION; ESTABLISHING A GENERAL EXEMPTION FROM LICENSURE
                  FOR CONTACT LENS SELLERS AND THE MANNER FOR FILLING PRESCRIPTIONS
                  BASED ON NOTIFICATION; CLARIFYING THE EXEMPTION FOR PERSONS WHO FIT
                  CONTACT LENSES; REQUIRING AN OPTOMETRIST TO PROVIDE CONTACT LENS
                  PRESCRIPTION TO A PATIENT AND A SELLER OF CONTACT LENSES; LIMITING THE
                  LIABILITY OF AN OPTOMETRIST FOR PROVIDING A PRESCRIPTION TO A PATIENT;
                  AND MAKING TECHNICAL AND CONFORMING AMENDMENTS.
                  This act affects sections of Utah Code Annotated 1953 as follows:
                  AMENDS:
                      31A-22-613, as last amended by Chapter 38, Laws of Utah 1996
                      58-13-2, as last amended by Chapter 288, Laws of Utah 1998
                      58-13-3, as last amended by Chapter 288, Laws of Utah 1998
                      58-16a-102, as last amended by Chapter 13, Laws of Utah 1997
                      58-16a-305, as renumbered and amended by Chapter 13, Laws of Utah 1997
                      58-16a-306, as enacted by Chapter 13, Laws of Utah 1997
                      58-16a-501, as enacted by Chapter 13, Laws of Utah 1997
                      58-16a-502, as enacted by Chapter 13, Laws of Utah 1997
                      58-16a-503, as renumbered and amended by Chapter 13, Laws of Utah 1997
                      58-16a-601, as renumbered and amended by Chapter 13, Laws of Utah 1997
                      58-17a-305, as enacted by Chapter 247, Laws of Utah 1996


                  ENACTS:
                      58-16a-801, Utah Code Annotated 1953
                  Be it enacted by the Legislature of the state of Utah:
                      Section 1. Section 31A-22-613 is amended to read:
                       31A-22-613. Permitted provisions for disability insurance policies.
                      The following provisions may be contained in a disability insurance policy, but if they are in
                  that policy, they shall conform to at least the following minimum requirements for the policyholder:
                      (1) Any provision respecting change of occupation may provide only for a lower maximum
                  benefit payment and for reduction of loss payments proportionate to the change in appropriate
                  premium rates, if the change is to a higher rated occupation, and this provision shall provide for
                  retroactive reduction of premium rates from the date of change of occupation or the last policy
                  anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
                      (2) Section 31A-22-405 applies to misstatement of age in disability policies, with the
                  appropriate modifications of terminology.
                      (3) Any policy which contains a provision establishing, as an age limit or otherwise, a date
                  after which the coverage provided by the policy is not effective, and if that date falls within a period
                  for which a premium is accepted by the insurer or if the insurer accepts a premium after that date, the
                  coverage provided by the policy continues in force, subject to any right of cancellation, until the end
                  of the period for which the premium was accepted. This Subsection (3) does not apply if the
                  acceptance of premium would not have occurred but for a misstatement of age by the insured.
                      (4) Any provision dealing with preexisting conditions shall be consistent with Subsections
                  31A-22-605 (9)(a) and 31A-22-609 (2), and any applicable rule adopted by the commissioner.
                      (5) (a) If an insured is otherwise eligible for maternity benefits, a policy may not contain
                  language which requires an insured to obtain any additional preauthorization or preapproval for
                  customary and reasonable maternity care expenses or for the delivery of the child after an initial
                  preauthorization or preapproval has been obtained from the insurer for prenatal care. A requirement
                  for notice of admission for delivery is not a requirement for preauthorization or preapproval,
                  however, the maternity benefit may not be denied or diminished for failure to provide admission

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                  notice. The policy may not require the provision of admission notice by only the insured patient.
                      (b) This Subsection (5) does not prohibit an insurer from:
                      (i) requiring a referral before maternity care can be obtained;
                      (ii) specifying a group of providers or a particular location from which an insured is required
                  to obtain maternity care; or
                      (iii) limiting reimbursement for maternity expenses and benefits in accordance with the terms
                  and conditions of the insurance contract so long as such terms do not conflict with Subsection (5)(a).
                      (6) An insurer may only represent that a policy:
                      (a) offers a vision benefit if the policy:
                      (i) charges a premium for the benefit; and
                      (ii) provides reimbursement for materials or services provided under the policy; and
                      (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted in-situ
                  keratomelusis, or related procedure, if the policy:
                      (i) charges a premium for the benefit; and
                      (ii) the procedure is at least a partially covered benefit.
                      Section 2. Section 58-13-2 is amended to read:
                       58-13-2. Emergency care rendered by licensee.
                      A person licensed under Title 58, Occupations and Professions, to practice as any of the
                  following health care professionals, who is under no legal duty to respond, and who in good faith
                  renders emergency care at the scene of an emergency gratuitously and in good faith, is not liable for
                  any civil damages as a result of any acts or omissions by the person in rendering the emergency care:
                      (1) osteopathic physician;
                      (2) physician and surgeon;
                      (3) naturopath;
                      (4) dentist or dental hygienist;
                      (5) chiropractic physician;
                      (6) physician assistant; [or]
                      (7) optometrist; or

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                      [(7)] (8) nurse licensed under Section 58-31b-301 .
                      Section 3. Section 58-13-3 is amended to read:
                       58-13-3. Qualified immunity -- Health professionals -- Charity care.
                      (1) (a) The Legislature finds many residents of this state do not receive medical care and
                  preventive health care because they lack health insurance or because of financial difficulties or cost.
                  The Legislature also finds that many physicians, charity health care facilities, and other health care
                  professionals in this state would be willing to volunteer medical and allied services without
                  compensation if they were not subject to the high exposure of liability connected with providing these
                  services.
                      (b) The Legislature therefore declares that its intention in enacting this section is to
                  encourage the provision of uncompensated volunteer health care in charity care settings in exchange
                  for a limitation on liability for the health care facilities and health care professionals who provide
                  those volunteer services.
                      (2) As used in this section:
                      (a) "Health care facility" means any clinic or hospital, church, or organization whose primary
                  purpose is to sponsor, promote, or organize uncompensated health care services for people unable
                  to pay for health care services.
                      (b) "Health care professional" means individuals licensed under Title 58, Occupations and
                  Professions, as physicians and surgeons, osteopaths, podiatrists, optometrists, chiropractors, dentists,
                  dental hygienists, registered nurses, certified nurse midwives, and other nurses licensed under Section
                  58-31b-301 .
                      (c) "Remuneration or compensation":
                      (i) (A) means direct or indirect receipt of any payment by the physician and surgeon, health
                  care facility, other health care professional, or organization, on behalf of the patient, including
                  payment or reimbursement under medicare or medicaid, or under the state program for the medically
                  indigent on behalf of the patient; and
                      (B) compensation, salary, or reimbursement to the health care professional from any source
                  for the health care professional's services or time in volunteering to provide uncompensated health

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                  care; and
                      (ii) does not mean any grant or donation to the health care facility used to offset direct costs
                  associated with providing the uncompensated health care such as medical supplies or drugs.
                      (3) A health care professional who provides health care treatment at a health care facility is
                  not liable in a medical malpractice action if:
                      (a) the treatment was within the scope of the health care professional's license under this title;
                      (b) neither the health care professional nor the health care facility received compensation or
                  remuneration for the treatment;
                      (c) the acts or omissions of the health care professional were not grossly negligent or willful
                  and wanton; and
                      (d) prior to rendering services, the health care professional disclosed in writing to the patient,
                  or if a minor, to the patient's parent or legal guardian, that the health care professional is providing
                  the services without receiving remuneration or compensation and that in exchange for receiving
                  uncompensated health care, the patient consents to waive any right to sue for professional negligence
                  except for acts or omissions which are grossly negligent or are willful and wanton.
                      (4) A health care facility which sponsors, promotes, or organizes the uncompensated care
                  is not liable in a medical malpractice action for acts and omissions if:
                      (a) the health care facility meets the requirements in Subsection (3)(b);
                      (b) the acts and omissions of the health care facility were not grossly negligent or willful and
                  wanton; and
                      (c) the health care facility has posted, in a conspicuous place, a notice that in accordance with
                  this section the health care facility is not liable for any civil damages for acts or omissions except for
                  those acts or omissions that are grossly negligent or are willful and wanton.
                      (5) Immunity from liability under this section does not extend to the use of general anesthesia
                  or care that requires an overnight stay in a general acute or specialty hospital licensed under Title 26,
                  Chapter 21, Health Care Facility Licensing and Inspection Act.
                      Section 4. Section 58-16a-102 is amended to read:
                       58-16a-102. Definitions.

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                      In addition to the definitions in Section 58-1-102 , as used in this chapter:
                      (1) "Board" means the Optometrist Licensing Board created in Section 58-16a-201 .
                      (2) "Contact lens" means any lens that:
                      (a) has a spherical, cylindrical, or prismatic power or curvature;
                      (b) is made pursuant to a current prescription; and
                      (c) is intended to be worn on the surface of the eye.
                      (3) (a) "Contact lens prescription" means a written or verbal order for contact lenses that
                  includes:
                      [(a)] (i) the commencement date [written] of the prescription;
                      [(b)] (ii) the base curve, power, diameter, material or brand name, and expiration date;
                      [(c) the quantity of lenses if other than one per eye; and]
                      [(d) the signature of the licensed optometrist or physician prescribing the contact lenses.]
                      (iii) for a written order, the signature of the prescribing optometrist or physician; and
                      (iv) for a verbal order, a record maintained by the recipient of:
                      (A) the name of the prescribing optometrist or physician; and
                      (B) the date when the prescription was issued or ordered.
                      (b) A prescription may include:
                      (i) a limit on the quantity of lenses that may be ordered under the prescription if:
                      (A) the prescription is for more than one contact per eye; or
                      (B) required for medical reasons documented in the patient's files; and
                      (ii) the expiration date of the prescription, which may not be less than one year from the
                  commencement date, unless documented medical reasons require continuous monitoring, nor more
                  than two years.
                      (c) A prescription shall be valid for two years if the prescription does not include an
                  expiration date.
                      (4) "Contact lens prescription verification" means a written request from a person who sells
                  contact lenses that:
                      (a) is sent to the prescribing optometrist or physician; and

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                      (b) seeks the confirmation of the accuracy of a patient's prescription.
                      [(4)] (5) "Eye and its adnexa" means the human eye and all structures situated within the
                  orbit, including the conjunctiva, lids, lashes, and lacrimal system.
                      [(5)] (6) "Fitting of a contact lens" means:
                      (a) the using of a keratometer to measure the human eye;
                      (b) utilizing refractive data provided by a licensed optometrist or ophthalmologist; and
                      (c) trial fitting of contact lenses, which includes a period of time for evaluation for fit and
                  performance, to determine a tentative contact lens prescription for a patient if the patient:
                      (i) has not worn contact lenses before; or
                      (ii) has changed to a different type or base curve.
                      [(6)] (7) "Laser surgery" means surgery in which human tissue is cut, burned, or vaporized
                  by means of laser or ionizing radiation.
                      [(7)] (8) "Ophthalmic lens" means any lens used to treat the eye and that:
                      (a) has a spherical, cylindrical, or prismatic power;
                      (b) is made pursuant to an unexpired prescription; and
                      (c) is intended to be used in eyeglasses or spectacles.
                      [(8)] (9) "Optometric assistant" means an unlicensed individual:
                      (a) working under the direct and immediate supervision of a licensed optometrist; and
                      (b) engaged in specific tasks assigned by the licensed optometrist in accordance with the
                  standards and ethics of the profession.
                      [(9)] (10) "Optometrist" or "optometric physician" means an individual licensed under this
                  chapter.
                      [(10)] (11) "Optometry" and "practice of optometry" mean any one or any combination of
                  the following practices:
                      (a) examination of the human eye and its adnexa to detect and diagnose defects or abnormal
                  conditions;
                      (b) determination or modification of the accommodative or refractive state of the human eye
                  or its range or power of vision by administration and prescription of pharmaceutical agents or the use

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                  of diagnostic instruments;
                      (c) prescription, ordering, administration, or adaptation of ophthalmic lenses, contact lenses,
                  ophthalmic devices, pharmaceutical agents, laboratory tests, or ocular exercises to diagnose and treat
                  diseases, defects, or other abnormal conditions of the human eye and its adnexa; [or]
                      (d) display of any advertisement, circular, sign, or device offering to:
                      (i) examine the eyes;
                      (ii) fit glasses or contact lenses; or
                      (iii) adjust frames; [or]
                      [(iv) duplicate, replace, or accept for duplication or replacement any ophthalmic lens or
                  contact lens;]
                      (e) removal of a foreign body from the eye or its adnexa, that is not deeper than the anterior
                  [one-half] 1/2 of the cornea;
                      (f) consultation regarding the eye and its adnexa with other appropriate health care providers,
                  including referral to other appropriate health care providers; and
                      (g) a person, not licensed as an optometrist, directing a licensee under this chapter to
                  withhold or alter the eye care services the licensee has ordered.
                      [(11)] (12) "Pharmaceutical agent" means any diagnostic or therapeutic drug or combination
                  of drugs that has the property of assisting in the diagnosis, prevention, treatment, or mitigation of
                  abnormal conditions or symptoms of the eye and its adnexa.
                      [(12)] (13) "Prescription drug" has the same definition as in Section 58-17a-102 .
                      [(13)] (14) "Unexpired" means a prescription that was issued:
                      (a) not more than two years prior to presentation of the prescription for an ophthalmic lens
                  [or lenses]; or
                      (b) in accordance with Subsection (3) for a contact lens.
                      Section 5. Section 58-16a-305 is amended to read:
                       58-16a-305. License -- Exemptions.
                      In addition to the exemptions from licensure in Section 58-1-307 , the following persons may
                  engage in acts included in the definition of the practice of optometry subject to the stated

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                  circumstances and limitations without being licensed under this chapter:
                      (1) a person who sells [eyeglasses] contact lenses on prescription provided by a person
                  authorized under state law to practice either optometry or medicine and surgery if the person
                  complies with Section 58-16a-801 ;
                      (2) a person who sells eyeglasses or spectacles as articles of merchandise or who fabricates
                  them from a prescription if the person:
                      (a) [he] does so in the ordinary course of trade from a permanently located and established
                  place of business;
                      (b) [he] does not traffic or attempt to traffic upon assumed skill in testing the eye and
                  adapting lenses according to the test;
                      (c) [he] does not duplicate, replace, or accept for replacement any ophthalmic lens [or
                  lenses], except in the case of an emergency[, unless he is an exclusive wholesale optical
                  establishment];
                      (d) [he] does not use in the testing of the eyes any lenses or instruments other than the lenses
                  actually sold; and
                      (e) [he] does not give or offer eyeglasses or spectacles as premiums as defined in Section
                  13-26-2 ; and
                      (3) a person who [sells] fits contact lenses under the following conditions:
                      (a) he has a current certification from both the American Board of Opticianry and the
                  National Contact Lens Examiners;
                      (b) he does not give or offer contact lenses as premiums;
                      (c) he does not perform a refraction, over-refraction, or attempt to traffic upon assumed skill
                  in testing the eye;
                      (d) he operates in the ordinary course of trade from a permanently located and established
                  place of business;
                      (e) he performs the work involved in fitting contact lenses himself and does not delegate the
                  contact lens fitting to any other individual who is not qualified under this Subsection (3);
                      (f) he does not use in the testing of the eye any lenses or instruments other than the lenses

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                  he actually will sell;
                      [(f)] (g) he provides services only to a patient who:
                      (i) presents an unexpired contact lens prescription; or
                      (ii) has had an eye examination within the prior six months by an optometrist or
                  ophthalmologist meeting the requirements under Section 58-16a-306 ; [and]
                      [(g)] (h) he maintains a copy of the patient's contact lens prescription for not less than seven
                  years[.];
                      (i) he enters into a written agreement with an optometrist or an ophthalmologist before July
                  1, 2000, to fit contact lenses prescribed by that optometrist or ophthalmologist;
                      (j) he fits contact lenses for at least two years under the direct supervision of the optometrist
                  or ophthalmologist identified in Subsection (3)(i) before July 1, 2000, as documented in the written
                  agreement; and
                      (k) the optometrist or ophthalmologist described in Subsection (3)(i):
                      (i) ensures that the final contact lens is accurate;
                      (ii) presents a written copy of the prescription to the person fitting the contact lens; and
                      (iii) ensures that a copy of the prescription is provided to the patient, except as provided in
                  Section 58-16a-306 .
                      Section 6. Section 58-16a-306 is amended to read:
                       58-16a-306. Contact lens prescription -- Qualifications.
                      (1) An optometrist or ophthalmologist issuing a contact lens prescription [that may be filled
                  by a person fitting contact lenses under Subsection 58-16a-305 (3)] shall:
                      [(1)] (a) be licensed under this title to practice in Utah;
                      [(2) have a current written agreement with the person fitting the contact lenses to fit the
                  contact lenses to be prescribed by that particular optometrist or ophthalmologist;]
                      [(3) be an optometrist or ophthalmologist for whom the person fitting the contact lenses has
                  performed not less than two years of contact lens apprenticeship which apprenticeship shall be noted
                  in the written agreement; and]
                      [(4)] (b) ensure the final contact lens prescription is accurate [and shall];

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                      (c) present a written copy of the prescription to the [person fitting the contact lens under
                  Subsection 58-16a-305 (3).] patient after fitting unless:
                      (i) there are unpaid fees associated with the examination or treatment; or
                      (ii) providing a copy is not in the best medical interests of the patient in the professional
                  judgement of the prescribing optometrist or physician; and
                      (d) provide a copy of the patient's contact lens prescription to a person who sells contact
                  lenses upon the request of the patient or the person selling the contact lenses.
                      (2) An optometrist or physician may not be held liable as a result of providing a prescription
                  to a patient as required by Subsection (1).
                      Section 7. Section 58-16a-501 is amended to read:
                       58-16a-501. Unlawful conduct.
                      "Unlawful conduct" includes, in addition to the definition in Section 58-1-501 :
                      (1) buying, selling, or fraudulently obtaining, any optometry diploma, license, certificate, or
                  registration;
                      (2) aiding or abetting the buying, selling, or fraudulently obtaining, of any optometry diploma,
                  license, certificate, or registration;
                      (3) selling contact lenses [without having received a written unexpired prescription] in a
                  manner inconsistent with Section 58-16a-801 or intentionally altering a prescription unless the person
                  selling the lenses is a licensed optometrist or ophthalmologist[, or an individual exempt from licensure
                  under Subsection 58-16a-305 (3)]; or
                      (4) representing oneself as or using the title of "optometrist," "optometric physician," "doctor
                  of optometry," or "O.D.," unless currently licensed [or exempted from licensure] under this chapter.
                      Section 8. Section 58-16a-502 is amended to read:
                       58-16a-502. Unprofessional conduct.
                      "Unprofessional conduct" includes, in addition to the definition in Section 58-1-501 :
                      (1) using or employing the services of an optometric assistant to assist a licensee in any
                  manner not in accordance with:
                      (a) the generally recognized practices and standards of ethics of the profession; or

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                      (b) applicable state law or division rule;
                      (2) failure to refer a patient to an appropriate licensed practitioner when:
                      (a) the patient's condition does not respond to treatment; or
                      (b) the treatment is not within the scope of competence or licensure of the licensee;
                      (3) providing confidential information regarding a patient to any third party who does not
                  have a legal and professional ground for obtaining the information;
                      (4) knowingly prescribing, selling, giving away, or administering any prescription drug except
                  for a legitimate medical purpose and upon a proper diagnosis indicating the use of the drug in the
                  amount prescribed or provided;
                      (5) giving or receiving directly or indirectly any fee, commission, rebate, or other
                  compensation for professional services not actually and personally rendered, except as part of a legal
                  relationship within a lawful professional partnership, corporation, or association; [or]
                      (6) failure to transfer pertinent and necessary information from a patient's medical records
                  to another optometrist or physician when so requested by the patient or his representative, as
                  designated in writing[.]; or
                      (7) failure to provide a contact lens prescription to a person who sells contact lenses in
                  accordance with Section 58-16a-306 .
                      Section 9. Section 58-16a-503 is amended to read:
                       58-16a-503. Penalty for unlawful conduct.
                      [Any] (1) Except as provided in Subsection (2), any person who violates the unlawful
                  conduct provision defined in Section 58-16a-501 or Subsection 58-1-501 (1)(a) or (1)(c) is guilty of
                  a third degree felony.
                      (2) A person who violates Subsection 58-16a-501 (3) is guilty of a class C misdemeanor.
                      Section 10. Section 58-16a-601 is amended to read:
                       58-16a-601. Scope of practice.
                      (1) An optometrist may:
                      (a) provide any optometric services not specifically prohibited under this chapter or division
                  rules and that are within the optometrist's training, skills, and scope of competence; and

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                      (b) prescribe or administer any pharmaceutical agent for the eye and its adnexa, including all
                  oral pharmaceutical agents, except that:
                      (i) the oral antibiotics may only be prescribed for:
                      [(i)] (A) eyelid-related ocular conditions or diseases; and
                      [(ii)] (B) any other ocular disease or condition as specified by division rule[.]; and
                      (ii) Schedule III controlled substances may only be prescribed or administered to be taken
                  orally or topically for pain of the eye or adnexa in a quantity not to exceed 72 hours in duration and
                  which may not be refilled.
                      (2) An optometrist may not:
                      (a) perform surgery, including laser surgery; or
                      (b) prescribe or administer any Schedule II [or Schedule III] controlled substance as defined
                  in Title 58, Chapter 37, Controlled Substances.
                      (3) An optometrist is a health care provider for purposes of Sections 31A-22-617 and
                  31A-22-618 .
                      Section 11. Section 58-16a-801 is enacted to read:
                 
Part 8. Contact Lens Seller

                      58-16a-801. Contact lens seller.
                      (1) A person may sell contact lenses if the person:
                      (a) does so in the ordinary course of trade from a permanently located and established place
                  of business;
                      (b) does not perform refractions, over-refractions, or attempts to traffic upon assumed skill
                  in testing the eye;
                      (c) does not offer or give contact lenses as premiums, as defined in Section 13-26-2 ;
                      (d) does not fit contact lenses;
                      (e) provides a contact lens to a patient after:
                      (i) receiving an unexpired verbal or written prescription; or
                      (ii) sending a contact lens prescription verification to the prescribing optometrist or physician,
                  regardless of whether the prescribing optometrist or physician responds to or confirms the

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                  verification, provided that:
                      (A) the person has all of the information necessary to fill the prescription;
                      (B) the prescribing optometrist or physician has not informed the person that the prescription
                  has expired or is otherwise inaccurate prior to the person shipping or hand-delivering the contact lens
                  to the patient;
                      (C) the person confirms a valid, unexpired contact lens prescription for the patient if the
                  person is aware that the patient provided inaccurate prescription information in his last order; and
                      (D) the person informs the patient that the prescription has expired or that there is a medical
                  problem associated with the prescription if the information is communicated by the prescribing
                  optometrist or physician to the person within 72 hours of the contact lens prescription verification
                  being sent; and
                      (f) maintains patient information, including the method and date of any prescription
                  verification, for no less than seven years.
                      (2) Nothing in this section may be construed as requiring a person to be licensed or certified
                  in any way under this or any another chapter of this title to sell contact lenses in accordance with
                  Subsection (1).
                      Section 12. Section 58-17a-305 is amended to read:
                       58-17a-305. Exemptions from licensure.
                      In addition to the exemptions from licensure in Section 58-1-307 [,]:
                      (1) an individual who has completed all qualifications for licensure as a pharmacy technician,
                  except an experience requirement which may be established by rule under Subsection 58-17a-302 (4),
                  may practice under the direct personal supervision of a pharmacist while completing that requirement
                  for a period not to exceed six consecutive months without being licensed under this chapter[.]; and
                      (2) a person may sell contact lenses in accordance with Section 58-16a-801 without being
                  licensed under this chapter.

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