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Fifth Substitute S.B. 40

This document includes House Floor Amendments incorporated into the bill on Thu, Mar 8, 2012 at 11:26 AM by lerror. -->

Representative Stewart Barlow proposes the following substitute bill:


             1     
COSMETIC MEDICAL PROCEDURES

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Peter C. Knudson

             5     
House Sponsor: Stewart Barlow

             6     

             7      LONG TITLE
             8      General Description:
             9          This bill amends the Utah Medical Practice Act and the Utah Osteopathic Practice Act.
             10      Highlighted Provisions:
             11          This bill:
             12          .    defines:
             13              .    ablative procedure;
             14              .    cosmetic medical facility;
             15              .    cosmetic medical procedure;
             16              .    nonablative procedure;
             17              .    superficial procedure; and
             18              .    supervisor;
             19          .    prohibits the use of the term "medical" under certain circumstances;
             20          .    exempts certain licensees from the definition of cosmetic medical procedures;
             21          .    establishes standards for the supervision of cosmetic medical procedures;
             22          .    amends the definition of the practice of medicine; and
             23          .    amends provisions of unprofessional conduct for physicians and other licensees
             24      whose scope of practice includes cosmetic medical procedures.
             25      Money Appropriated in this Bill:



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             26
         None
             27      Other Special Clauses:
             28          None
             29      Utah Code Sections Affected:
             30      AMENDS:
             31          58-1-102, as renumbered and amended by Laws of Utah 1993, Chapter 297
             32          58-11a-102, as last amended by Laws of Utah 2010, Chapter 145
             33          58-11a-502, as last amended by Laws of Utah 2009, Chapter 130
             34          58-16a-102, as last amended by Laws of Utah 2004, Chapters 48 and 280
             35          58-67-102, as last amended by Laws of Utah 2011, Chapter 214
             36          58-68-102, as last amended by Laws of Utah 2011, Chapter 214
             37      ENACTS:
             38          58-1-505, Utah Code Annotated 1953
             39          58-1-506, Utah Code Annotated 1953
             40          58-1-507, Utah Code Annotated 1953
             41          58-67-805, Utah Code Annotated 1953
             42          58-68-805, Utah Code Annotated 1953
             43     

             44      Be it enacted by the Legislature of the state of Utah:
             45          Section 1. Section 58-1-102 is amended to read:
             46           58-1-102. Definitions.
             47          For purposes of this title:
             48          (1) "Ablative procedure" is as defined in Section 58-67-102 .
             49          (2) "Cosmetic medical procedure":
             50          (a) is as defined in Section 58-67-102 ; and
             51          (b) except for Chapter 67, Utah Medical Practice Act, and Chapter 68, Utah
             52      Osteopathic Medical Practice Act, does not apply to the scope of practice of an individual
             53      licensed under this title if the individual's scope of practice includes the authority to operate or
             54      perform surgical procedures.
             55          [(1)] (3) "Department" means the Department of Commerce.
             56          [(2)] (4) "Director" means the director of the Division of Occupational and



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             57
     Professional Licensing.
             58          [(3)] (5) "Division" means the Division of Occupational and Professional Licensing
             59      created in Section 58-1-103 .
             60          [(4)] (6) "Executive director" means the executive director of the Department of
             61      Commerce.
             62          [(5)] (7) "Licensee" includes any holder of a license, certificate, registration, permit,
             63      student card, or apprentice card authorized under this title.
             64          (8) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             65      alter living tissue, but not intended or expected to excise, vaporize, disintegrate, or remove
             66      living tissue.
             67          (ii) Notwithstanding Subsection (8)(a)(i), nonablative procedure includes hair removal.
             68          (b) "Nonablative procedure" does not include:
             69          (i) a superficial procedure;
             70          (ii) the application of permanent make-up; or
             71          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
             72      performed by an individual licensed under this title who is acting within their scope of practice.
             73          (9) "Superficial procedure" means a procedure that is expected or intended to
             74      temporarily alter living skin tissue and may excise or remove stratum corneum but have no
             75      appreciable risk of damage to any tissue below the stratum corneum.
             76          [(6)] (10) "Unlawful conduct" has the meaning given in Subsection 58-1-501 (1).
             77          [(7)] (11) "Unprofessional conduct" has the meaning given in Subsection 58-1-501 (2).
             78          Section 2. Section 58-1-505 is enacted to read:
             79          58-1-505. Cosmetic medical procedure supervisor.
             80          (1) For purposes of this section and Section 58-1-506 :
             81          (a) "Cosmetic medical facility" means a physician's office or a facility that has a
             82      supervisor who performs the supervision required in Section 58-1-506 .
             83          (b) "Supervisor" means:
             84          (i) a physician with an unrestricted license under Chapter 67, Utah Medical Practice
             85      Act, or Chapter 68, Utah Osteopathic Medical Practice Act, who is acting within the scope of
             86      the practice of medicine, as defined in Section 58-67-102 ; and
             87          (ii) an advanced practice registered nurse with an unrestricted license under Chapter



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             88
     31b, Nurse Practice Act, who is acting within the scope of practice of advanced practice
             89      registered nursing, as defined in Section 58-31b-102 .
             90          (2) (a) An individual authorized by this title to perform a cosmetic medical procedure
             91      shall be supervised by a supervisor when performing a medical procedure.
             92          (b) Cosmetic medical procedures may only be performed in a cosmetic medical
             93      facility.
             94          (c) A supervisor may delegate the supervisory role only to another individual who is
             95      qualified as a supervisor.
             96          Section 3. Section 58-1-506 is enacted to read:
             97          58-1-506. Supervision of cosmetic medical procedures.
             98          (1) For purposes of this section:
             99          (a) "Delegation group A" means the following who are licensed under this title, acting
             100      within their respective scope of practice, and qualified under Subsections (2)(f)(i) and (iii):
             101          (i) a physician assistant, if acting under the supervision of a physician and the
             102      procedure is included in the delegation of services agreement as defined in Section 58-70a-102 ;
             103          (ii) a registered nurse;
             104          (iii) a master esthetician; and
             105          (iv) an electrologist, if evaluating for or performing laser hair removal.
             106          (b) "Delegation group B" means:
             107          (i) a practical nurse or an esthetician who is licensed under this title, acting within their
             108      respective scope of practice, and qualified under Subsections (2)(f)(i) and (iii); and
             109          (ii) a medical assistant who is qualified under Subsections (2)(f)(i) and (iii).
             110          (c) "Direct cosmetic medical procedure supervision" means the supervisor:
             111          (i) has authorized the procedure to be done on the patient by the supervisee; and
             112          (ii) is present and available for a face-to-face communication with the supervisee when
             113      and where a cosmetic medical procedure is performed.
             114          (d) "General cosmetic medical procedure supervision" means the supervisor:
             115          (i) has authorized the procedure to be done on the patient by the supervisee;
             116          (ii) is available in a timely and appropriate manner in person to evaluate and initiate
             117      care for a patient with a suspected adverse reaction or complication; and
             118          (iii) is located within 60 minutes or 60 miles of the cosmetic medical facility.



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             119
         (e) "Indirect cosmetic medical procedure supervision" means the supervisor:
             120          (i) has authorized the procedure to be done on the patient by the supervisee;
             121          (ii) has given written instructions to the person being supervised;
             122          (iii) is present within the cosmetic medical facility in which the person being
             123      supervised is providing services; and
             124          (iv) is available to:
             125          (A) provide immediate face-to-face communication with the person being supervised;
             126      and
             127          (B) evaluate the patient, as necessary.
             128          (f) "Hair removal review" means:
             129          (i) conducting an in-person, face-to-face interview of a patient based on the responses
             130      provided by the patient to a detailed medical history assessment that was prepared by the
             131      supervisor;
             132          (ii) evaluating for contraindications and conditions that are part of the treatment plan;
             133      and
             134          (iii) if the patient history or patient presentation deviates in any way from the treatment
             135      plan, referring the patient to the supervisor and receiving clearance from the supervisor before
             136      starting the treatment.
             137          (2) A supervisor supervising a nonablative cosmetic medical procedure for hair
             138      removal shall:
             139          (a) have an unrestricted license to practice medicine or advanced practice registered
             140      nursing in the state;
             141          (b) develop the medical treatment plan for the procedure;
             142          (c) conduct a hair removal review, or delegate the hair removal review to a member of
             143      delegation group A, of the patient prior to initiating treatment or a series of treatments;
             144          (d) personally perform the nonablative cosmetic medical procedure for hair removal, or
             145      authorize and delegate the procedure to a member of delegation group A or B;
             146          (e) during the nonablative cosmetic medical procedure for hair removal provide general
             147      cosmetic medical procedure supervision to individuals in delegation group A performing the
             148      procedure, except physician assistants, who shall be supervised as provided in Chapter 70a,
             149      Physician Assistant Act, and indirect cosmetic medical procedure supervision to individuals in



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             150
     delegation group B performing the procedure; and
             151          (f) verify that a person to whom the supervisor delegates an evaluation under
             152      Subsection (2)(c) or delegates a procedure under Subsection (2)(d) or (3)(b)(ii):
             153          (i) has received appropriate training regarding the medical procedures developed under
             154      Subsection (2)(b);
             155          (ii) has an unrestricted license under this title or is performing under the license of the
             156      supervising physician and surgeon; and
             157          (iii) has maintained competence to perform the nonablative cosmetic medical
             158      procedure through documented education and experience of at least 80 hours, as further
             159      defined by rule, regarding:
             160          (A) the appropriate standard of care for performing nonablative cosmetic medical
             161      procedures;
             162          (B) physiology of the skin;
             163          (C) skin typing and analysis;
             164          (D) skin conditions, disorders, and diseases;
             165          (E) pre and post procedure care;
             166          (F) infection control;
             167          (G) laser and light physics training;
             168          (H) laser technologies and applications;
             169          (I) safety and maintenance of lasers;
             170          (J) cosmetic medical procedures an individual is permitted to perform under this title;
             171          (K) recognition and appropriate management of complications from a procedure; and
             172          (L) cardio-pulmonary resuscitation (CPR).
             173          (3) For a nonablative cosmetic medical procedure other than hair removal under
             174      Subsection (2):
             175          (a) (i) except as provided in Subsection (3)(a)(ii) and (iii), a physician who has an
             176      unrestricted license to practice medicine shall:
             177          (A) develop a treatment plan for the nonablative cosmetic medical procedure; and
             178          (B) conduct an in-person face-to-face evaluation of the patient prior to the initiation of
             179      a treatment protocol or series of treatments;
             180          (ii) a nurse practitioner who has an unrestricted license for advanced practice registered



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             181
     nursing may perform the evaluation and develop the treatment plan under Subsection (3)(a)(i)
             182      for nonablative medical procedures other than tattoo removal; or
             183          (iii) a physician assistant acting under the supervision of a physician, with the
             184      procedure included in the delegation of service agreement as defined in Section 58-70a-102 ,
             185      may perform the evaluation under Subsection (3)(a)(i)(B) for nonablative medical procedures
             186      other than tattoo removal; and
             187          (b) the supervisor supervising the procedure shall:
             188          (i) have an unrestricted license to practice medicine or advanced practice registered
             189      nursing;
             190          (ii) personally perform the nonablative cosmetic medical procedure or:
             191          (A) authorize and provide general cosmetic medical procedure supervision for the
             192      nonablative cosmetic medical procedure that is performed by a registered nurse or a master
             193      esthetician;
             194          (B) authorize and provide supervision as provided in Chapter 70a, Physician Assistant
             195      Act, for the nonablative cosmetic medical procedure that is performed by a physician assistant,
             196      if the procedure is included in the delegation of services agreement; or
             197          (C) authorize and provide direct cosmetic medical procedure supervision for the
             198      nonablative cosmetic medical procedure that is performed by an esthetician; and
             199          (iii) verify that a person to whom the supervisor delegates a procedure under
             200      Subsection (3)(b):
             201          (A) has received appropriate training regarding the medical procedures to be
             202      performed;
             203          (B) has an unrestricted license and is acting within their scope of practice under this
             204      title; and
             205          (C) is qualified under Subsection (2)(f)(iii).
             206          (4) A supervisor performing or supervising a cosmetic medical procedure under
             207      Subsection (2) or (3) shall ensure that:
             208          (a) the supervisor's name is prominently posted at the cosmetic medical facility
             209      identifying the supervisor;
             210          (b) a copy of the supervisor's license is displayed on the wall of the cosmetic medical
             211      facility;



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             212
         (c) the patient receives written information with the name and licensing information of
             213      the supervisor who is supervising the nonablative cosmetic medical procedure and the person
             214      who is performing the nonablative cosmetic medical procedure;
             215          (d) the patient is provided with a telephone number that is answered within 24 hours
             216      for follow-up communication; and
             217          (e) the cosmetic medical facility's contract with a master esthetician who performs a
             218      nonablative cosmetic medical procedure at the facility is kept on the premises of the facility.
             219          (5) Failure to comply with the provisions of this section is unprofessional conduct.
             220          (6) A chiropractic physician licensed under Chapter 73, Chiropractic Physician Practice
             221      Act is not subject to the supervision requirements in this section for a nonablative cosmetic
             222      medical procedure for hair removal if the chiropractic physician is acting within the scope of
             223      practice of a chiropractic physician and with training specific to nonablative hair removal.
             224          Section 4. Section 58-1-507 is enacted to read:
             225          58-1-507. Cosmetic medical procedure -- Truth in advertising.
             226           H. [ A ] Beginning July 1, 2013, a .H facility that performs a cosmetic medical procedure
             226a      as defined in Section 58-67-102
             227      may not advertise or hold itself out to the public as a "medical spa", "medical facility" or
             228      "medical clinic" unless the facility has an individual on the premises while a cosmetic medical
             229      procedure is performed who is licensed under:
             230          (1) Chapter 31b, Nurse Practices Act, as an advanced practice registered nurse,
             231      practicing as a nurse practitioner;
             232          (2) Chapter 67, Utah Medical Practice Act; or
             233          (3) Chapter 68, Utah Osteopathic Medical Practice Act.
             234          Section 5. Section 58-11a-102 is amended to read:
             235           58-11a-102. Definitions.
             236          As used in this chapter:
             237          (1) "Approved barber or cosmetologist/barber apprenticeship" means an apprenticeship
             238      that meets the requirements of Subsection 58-11a-306 (1) for barbers or Subsection
             239      58-11a-306 (2) for cosmetologist/barbers and the requirements established by rule by the
             240      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             241      Administrative Rulemaking Act.
             242          (2) "Approved esthetician apprenticeship" means an apprenticeship that meets the



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             243
     requirements of Subsection 58-11a-306 (3) and the requirements established by rule by the
             244      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             245      Administrative Rulemaking Act.
             246          (3) "Approved master esthetician apprenticeship" means an apprenticeship that meets
             247      the requirements of Subsection 58-11a-306 (4) and the requirements established by rule by the
             248      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             249      Administrative Rulemaking Act.
             250          (4) "Approved nail technician apprenticeship" means an apprenticeship that meets the
             251      requirements of Subsection 58-11a-306 (5) and the requirements established by rule by the
             252      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             253      Administrative Rulemaking Act.
             254          (5) "Barber" means a person who is licensed under this chapter to engage in the
             255      practice of barbering.
             256          (6) "Barber instructor" means a barber who is licensed under this chapter to teach
             257      barbering at a licensed barber school or in an apprenticeship program as defined in Section
             258      58-11a-306 .
             259          (7) "Board" means the Barber, Cosmetology/Barbering, Esthetics, Electrology, and
             260      Nail Technology Licensing Board created in Section 58-11a-201 .
             261          (8) "Cosmetic laser procedure" includes a nonablative procedure as defined in Section
             262      58-67-102 .
             263          (9) "Cosmetic supervisor" means a supervisor as defined in Section 58-1-505 .
             264          [(8)] (10) "Cosmetologist/barber" means a person who is licensed under this chapter to
             265      engage in the practice of cosmetology/barbering.
             266          [(9)] (11) "Cosmetologist/barber instructor" means a cosmetologist/barber who is
             267      licensed under this chapter to teach cosmetology/barbering at a licensed cosmetology/barber
             268      school, licensed barber school, licensed nail technology school, or in an apprenticeship
             269      program as defined in Subsection 58-11a-306 (2).
             270          [(10)] (12) "Direct supervision" means that the supervisor of an apprentice or the
             271      instructor of a student is immediately available for consultation, advice, instruction, and
             272      evaluation.
             273          [(11)] (13) "Electrologist" means a person who is licensed under this chapter to engage



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             274
     in the practice of electrology.
             275          [(12)] (14) "Electrologist instructor" means an electrologist who is licensed under this
             276      chapter to teach electrology at a licensed electrology school.
             277          [(13)] (15) "Esthetician" means a person who is licensed under this chapter to engage
             278      in the practice of esthetics.
             279          [(14)] (16) "Esthetician instructor" means a master esthetician who is licensed under
             280      this chapter to teach the practice of esthetics and the practice of master-level esthetics at a
             281      licensed esthetics school, a licensed cosmetology/barber school, or in an apprenticeship
             282      program as defined in Subsection 58-11a-306 (3).
             283          [(15)] (17) "Fund" means the Barber, Cosmetologist/Barber, Esthetician, Electrologist,
             284      and Nail Technician Education and Enforcement Fund created in Section 58-11a-103 .
             285          [(16)] (18) "Licensed barber or cosmetology/barber school" means a barber or
             286      cosmetology/barber school licensed under this chapter.
             287          [(17)] (19) "Licensed electrology school" means an electrology school licensed under
             288      this chapter.
             289          [(18)] (20) "Licensed esthetics school" means an esthetics school licensed under this
             290      chapter.
             291          [(19)] (21) "Licensed nail technology school" means a nail technology school licensed
             292      under this chapter.
             293          [(20)] (22) "Master esthetician" means an individual who is licensed under this chapter
             294      to engage in the practice of master-level esthetics.
             295          [(21)] (23) "Nail technician" means an individual who is licensed under this chapter to
             296      engage in the practice of nail technology.
             297          [(22)] (24) "Nail technician instructor" means a nail technician licensed under this
             298      chapter to teach the practice of nail technology in a licensed nail technology school, a licensed
             299      cosmetology/barber school, or in an apprenticeship program as defined in Subsection
             300      58-11a-306 (5).
             301          [(23)] (25) "Practice of barbering" means:
             302          (a) cutting, clipping, or trimming the hair of the head of any person by the use of
             303      scissors, shears, clippers, or other appliances;
             304          (b) draping, shampooing, scalp treatments, basic wet styling, and blow drying; and



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             305
         (c) removing hair from the face or neck of a person by the use of shaving equipment.
             306          [(24)] (26) "Practice of barbering instruction" means instructing barbering in a licensed
             307      barber school, licensed cosmetology/barber school, or in an apprenticeship program as defined
             308      in Subsection 58-11a-306 (1).
             309          [(25)] (27) "Practice of basic esthetics" means any one of the following skin care
             310      procedures done on the head, face, neck, arms, hands, legs, feet, eyebrows, or eyelashes for
             311      cosmetic purposes and not for the treatment of medical, physical, or mental ailments:
             312          (a) cleansing, stimulating, manipulating, exercising, applying oils, antiseptics, clays, or
             313      masks, manual extraction, including a comodone extractor, depilatories, waxes, tweezing, the
             314      application of eyelash extensions, natural nail manicures or pedicures, or callous removal by
             315      buffing or filing;
             316          (b) limited chemical exfoliation as defined by rule;
             317          (c) removing superfluous hair by means other than electrolysis, except that an
             318      individual is not required to be licensed as an esthetician to engage in the practice of threading;
             319          (d) other esthetic preparations or procedures with the use of the hands, a
             320      high-frequency or galvanic electrical apparatus, or a heat lamp for cosmetic purposes and not
             321      for the treatment of medical, physical, or mental ailments; or
             322          (e) except as provided in Subsection (27)(e)(i), cosmetic laser procedures under
             323      [direct] the direct cosmetic medical procedure supervision of a [licensed health care
             324      practitioner as defined by rule,] cosmetic supervisor limited to the following:
             325          (i) superfluous hair removal which shall be under indirect supervision;
             326          (ii) anti-aging resurfacing enhancements;
             327          (iii) photo rejuvenation; or
             328          (iv) tattoo removal.
             329          [(26)] (28) (a) "Practice of cosmetology/barbering" means:
             330          (i) styling, arranging, dressing, curling, waving, permanent waving, cleansing,
             331      singeing, bleaching, dyeing, tinting, coloring, or similarly treating the hair of the head of a
             332      person;
             333          (ii) cutting, clipping, or trimming the hair by the use of scissors, shears, clippers, or
             334      other appliances;
             335          (iii) arching eyebrows, or tinting eyebrows or eyelashes, applying eyelash extensions,



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             336
     or any combination of these procedures;
             337          (iv) removing hair from the face, neck, shoulders, arms, back, torso, feet, bikini line, or
             338      legs of a person by the use of depilatories, waxing, or shaving equipment;
             339          (v) cutting, curling, styling, fitting, measuring, or forming caps for wigs or hairpieces
             340      or both on the human head; or
             341          (vi) practicing hair weaving or hair fusing or servicing previously medically implanted
             342      hair.
             343          (b) The term "practice of cosmetology/barbering" includes:
             344          (i) the practice of basic esthetics; and
             345          (ii) the practice of nail technology.
             346          (c) An individual is not required to be licensed as a cosmetologist/barber to engage in
             347      the practice of threading.
             348          [(27)] (29) "Practice of cosmetology/barbering instruction" means instructing
             349      cosmetology/barbering as defined in Subsection [(26)] (28) in a licensed cosmetology/barber
             350      school or in an apprenticeship program as defined in Subsection 58-11a-306 (2).
             351          [(28)] (30) "Practice of electrology" means:
             352          (a) the removal of superfluous hair from the body of a person by the use of electricity,
             353      waxing, shaving, or tweezing; or
             354          (b) cosmetic laser procedures under the [general] supervision of a [licensed health care
             355      practitioner as defined by rule,] cosmetic supervisor limited to superfluous hair removal.
             356          [(29)] (31) "Practice of electrology instruction" means instructing electrology in a
             357      licensed electrology school.
             358          [(30)] (32) "Practice of esthetics instruction" means instructing esthetics in a licensed
             359      esthetics school, a licensed cosmetology/barber school, or instructing master-level esthetics in a
             360      licensed esthetics school or in an apprenticeship program as defined in Subsections
             361      58-11a-306 (2), (3), and (4).
             362          [(31)] (33) (a) "Practice of master-level esthetics" means:
             363          (i) any of the following when done for cosmetic purposes on the head, face, neck,
             364      torso, abdomen, back, arms, hands, legs, feet, eyebrows, or eyelashes and not for the treatment
             365      of medical, physical, or mental ailments:
             366          (A) body wraps as defined by rule;



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             367
         (B) hydrotherapy as defined by rule;
             368          (C) chemical exfoliation as defined by rule;
             369          (D) advanced pedicures as defined by rule;
             370          (E) sanding, including microdermabrasion;
             371          (F) advanced extraction;
             372          (G) other esthetic preparations or procedures with the use of:
             373          (I) the hands; or
             374          (II) a mechanical or electrical apparatus which is approved for use by division rule for
             375      beautifying or similar work performed on the body for cosmetic purposes and not for the
             376      treatment of a medical, physical, or mental ailment; or
             377          (H) cosmetic laser procedures under the [general] supervision of a [licensed health care
             378      practitioner as defined by rule,] cosmetic supervisor with a physician's evaluation before the
             379      procedure, as needed, unless specifically required under Section 58-1-506 , and limited to the
             380      following:
             381          (I) superfluous hair removal;
             382          (II) anti-aging resurfacing enhancements;
             383          (III) photo rejuvenation; or
             384          (IV) tattoo removal with a physician's evaluation before the tattoo removal procedure;
             385      and
             386          (ii) lymphatic massage by manual or other means as defined by rule.
             387          (b) Notwithstanding the provisions of Subsection [(31)] (33)(a), a master-level
             388      esthetician may perform procedures listed in Subsection [(31)] (33)(a)(i)(H) [for noncosmetic
             389      purposes] if done under the supervision of a [licensed health care practitioner] cosmetic
             390      supervisor acting within the scope of the [licensed health care practitioner's] cosmetic
             391      supervisor license [as defined by rule].
             392          (c) The term "practice of master-level esthetics" includes the practice of esthetics, but
             393      an individual is not required to be licensed as an esthetician or master-level esthetician to
             394      engage in the practice of threading.
             395          [(32)] (34) "Practice of nail technology" means to trim, cut, clean, manicure, shape,
             396      massage, or enhance the appearance of the hands, feet, and nails of an individual by the use of
             397      hands, mechanical, or electrical preparation, antiseptic, lotions, or creams, including the



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             398
     application and removal of sculptured or artificial nails.
             399          [(33)] (35) "Practice of nail technology instruction" means instructing nail technology
             400      in a licensed nail technician school, licensed cosmetology/barber school, or in an
             401      apprenticeship program as defined in Subsection 58-11a-306 (5).
             402          [(34)] (36) "Recognized barber school" means a barber school located in a state other
             403      than Utah, whose students, upon graduation, are recognized as having completed the
             404      educational requirements for licensure in that state.
             405          [(35)] (37) "Recognized cosmetology/barber school" means a cosmetology/barber
             406      school located in a state other than Utah, whose students, upon graduation, are recognized as
             407      having completed the educational requirements for licensure in that state.
             408          [(36)] (38) "Recognized electrology school" means an electrology school located in a
             409      state other than Utah, whose students, upon graduation, are recognized as having completed the
             410      educational requirements for licensure in that state.
             411          [(37)] (39) "Recognized esthetics school" means an esthetics school located in a state
             412      other than Utah, whose students, upon graduation, are recognized as having completed the
             413      educational requirements for licensure in that state.
             414          [(38)] (40) "Recognized nail technology school" means a nail technology school
             415      located in a state other than Utah, whose students, upon graduation, are recognized as having
             416      completed the educational requirements for licensure in that state.
             417          [(39)] (41) "Salon" means a place, shop, or establishment in which
             418      cosmetology/barbering, esthetics, electrology, or nail technology is practiced.
             419          [(40)] (42) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-11a-502 .
             420          [(41)] (43) "Unprofessional conduct" is as defined in Sections 58-1-501 and
             421      58-11a-501 and as may be further defined by rule by the division in collaboration with the
             422      board in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
             423          Section 6. Section 58-11a-502 is amended to read:
             424           58-11a-502. Unlawful conduct.
             425          Unlawful conduct includes:
             426          (1) practicing or engaging in, or attempting to practice or engage in activity for which a
             427      license is required under this chapter unless:
             428          (a) the person holds the appropriate license under this chapter; or



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             429
         (b) an exemption in Section 58-1-307 or 58-11a-304 applies;
             430          (2) knowingly employing any other person to engage in or practice or attempt to
             431      engage in or practice any occupation or profession licensed under this chapter if the employee
             432      is not licensed to do so under this chapter or exempt from licensure;
             433          (3) touching, or applying an instrument or device to the following areas of a client's
             434      body:
             435          (a) the genitals or the anus, except in cases where the patron states to a licensee that the
             436      patron requests a hair removal procedure and signs a written consent form, which must also
             437      include the witnessed signature of a legal guardian if the patron is a minor, authorizing the
             438      licensee to perform a hair removal procedure; or
             439          (b) the breast of a female patron, except in cases in which the female patron states to a
             440      licensee that the patron requests breast skin procedures and signs a written consent form, which
             441      must also include the witnessed signature of a parent or legal guardian if the patron is a minor,
             442      authorizing the licensee to perform breast skin procedures; [and]
             443          (4) using or possessing as a nail technician a solution composed of at least 10% methyl
             444      methacrylete on a client[.]; or
             445          (5) performing an ablative procedure as defined in Section 58-67-102 .
             446          Section 7. Section 58-16a-102 is amended to read:
             447           58-16a-102. Definitions.
             448          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             449          (1) "Board" means the Optometrist Licensing Board created in Section 58-16a-201 .
             450          (2) "Contact lens" means any lens that:
             451          (a) has a spherical, cylindrical, or prismatic power or curvature;
             452          (b) is made pursuant to a current prescription; or
             453          (c) is intended to be worn on the surface of the eye.
             454          (3) (a) "Contact lens prescription" means a written or verbal order for contact lenses
             455      that includes:
             456          (i) the commencement date of the prescription;
             457          (ii) the base curve, power, diameter, material or brand name, and expiration date;
             458          (iii) for a written order, the signature of the prescribing optometrist or physician; and
             459          (iv) for a verbal order, a record maintained by the recipient of:



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             460
         (A) the name of the prescribing optometrist or physician; and
             461          (B) the date when the prescription was issued or ordered.
             462          (b) A prescription may include:
             463          (i) a limit on the quantity of lenses that may be ordered under the prescription if
             464      required for medical reasons documented in the patient's files; and
             465          (ii) the expiration date of the prescription, which shall be two years from the
             466      commencement date, unless documented medical reasons require otherwise.
             467          (c) When a provider prescribes a private label contact lens for a patient the prescription
             468      shall include:
             469          (i) the name of the manufacturer;
             470          (ii) the trade name of the private label brand; and
             471          (iii) if applicable, the trade name of the equivalent national brand.
             472          (4) "Contact lens prescription verification" means a written request from a person who
             473      sells or provides contact lenses that:
             474          (a) is sent to the prescribing optometrist or physician; and
             475          (b) seeks the confirmation of the accuracy of a patient's prescription.
             476          (5) "Eye and its adnexa" means the human eye and all structures situated within the
             477      orbit, including the conjunctiva, lids, lashes, and lacrimal system.
             478          (6) "Fitting of a contact lens" means:
             479          (a) the using of a keratometer to measure the human eye;
             480          (b) utilizing refractive data provided by a licensed optometrist or ophthalmologist; and
             481          (c) trial fitting of contact lenses, which includes a period of time for evaluation for fit
             482      and performance, to determine a tentative contact lens prescription for a patient if the patient:
             483          (i) has not worn contact lenses before; or
             484          (ii) has changed to a different type or base curve.
             485          (7) "Laser surgery" means surgery in which human tissue is cut, burned, or vaporized
             486      by means of laser or ionizing radiation.
             487          (8) "Ophthalmic lens" means any lens used to treat the eye and that:
             488          (a) has a spherical, cylindrical, or prismatic power;
             489          (b) is made pursuant to an unexpired prescription; and
             490          (c) is intended to be used in eyeglasses or spectacles.



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             491
         (9) "Optometric assistant" means an unlicensed individual:
             492          (a) working under the direct and immediate supervision of a licensed optometrist; and
             493          (b) engaged in specific tasks assigned by the licensed optometrist in accordance with
             494      the standards and ethics of the profession.
             495          (10) "Optometrist" or "optometric physician" means an individual licensed under this
             496      chapter.
             497          (11) "Optometry" and "practice of optometry" mean any one or any combination of the
             498      following practices:
             499          (a) examination of the human eye and its adnexa to detect and diagnose defects or
             500      abnormal conditions;
             501          (b) determination or modification of the accommodative or refractive state of the
             502      human eye or its range or power of vision by administration and prescription of pharmaceutical
             503      agents or the use of diagnostic instruments;
             504          (c) prescription, ordering, administration, or adaptation of ophthalmic lenses, contact
             505      lenses, ophthalmic devices, pharmaceutical agents, laboratory tests, or ocular exercises to
             506      diagnose and treat diseases, defects, or other abnormal conditions of the human eye and its
             507      adnexa;
             508          (d) display of any advertisement, circular, sign, or device offering to:
             509          (i) examine the eyes;
             510          (ii) fit glasses or contact lenses; or
             511          (iii) adjust frames;
             512          (e) removal of a foreign body from the eye or its adnexa, that is not deeper than the
             513      anterior 1/2 of the cornea;
             514          (f) consultation regarding the eye and its adnexa with other appropriate health care
             515      providers, including referral to other appropriate health care providers; and
             516          (g) a person, not licensed as an optometrist, directing a licensee under this chapter to
             517      withhold or alter the eye care services the licensee has ordered.
             518          (12) "Pharmaceutical agent" means any diagnostic or therapeutic drug or combination
             519      of drugs that has the property of assisting in the diagnosis, prevention, treatment, or mitigation
             520      of abnormal conditions or symptoms of the eye and its adnexa.
             521          (13) "Physician" has the same meaning as defined in [Subsection 58-67-102 (7)]



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             522
     Sections 58-67-102 and 58-68-102 .
             523          (14) "Prescription drug" has the same definition as in Section 58-17b-102 .
             524          (15) "Unexpired" means a prescription that was issued:
             525          (a) not more than two years prior to presentation of the prescription for an ophthalmic
             526      lens; or
             527          (b) in accordance with Subsection (3) for a contact lens.
             528          Section 8. Section 58-67-102 is amended to read:
             529           58-67-102. Definitions.
             530          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             531          (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,
             532      disintegrate, or remove living tissue, including the use of carbon dioxide lasers and
             533      erbium:YAG lasers, and excluding hair removal.
             534          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             535      of the American Medical Association.
             536          [(2)] (3) "Administrative penalty" means a monetary fine or citation imposed by the
             537      division for acts or omissions determined to constitute unprofessional or unlawful conduct, in
             538      accordance with a fine schedule established by the division in collaboration with the board, as a
             539      result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
             540      Administrative Procedures Act.
             541          [(3)] (4) "Board" means the Physicians Licensing Board created in Section 58-67-201 .
             542          (5) (a) "Cosmetic medical device" means tissue altering energy based devices that have
             543      the potential for altering living tissue and that are used to perform ablative or nonablative
             544      procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
             545      Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices, and
             546      excludes ANSI designated Class IIIa and lower powered devices.
             547          (b) Notwithstanding Subsection (5)(a), if an ANSI designated Class IIIa and lower
             548      powered device is being used to perform an ablative procedure, the device is included in the
             549      definition of cosmetic medical device under Subsection (5)(a).
             550          (6) "Cosmetic medical procedure":
             551          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             552      procedures; and



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             553
         (b) does not include a treatment of the ocular globe such as refractive surgery.
             554          [(4)] (7) "Diagnose" means:
             555          (a) to examine in any manner another person, parts of a person's body, substances,
             556      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             557      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             558      condition;
             559          (b) to attempt to conduct an examination or determination described under Subsection
             560      [(4)] (7)(a);
             561          (c) to hold oneself out as making or to represent that one is making an examination or
             562      determination as described in Subsection [(4)] (7)(a); or
             563          (d) to make an examination or determination as described in Subsection [(4)] (7)(a)
             564      upon or from information supplied directly or indirectly by another person, whether or not in
             565      the presence of the person making or attempting the diagnosis or examination.
             566          [(5)] (8) "LCME" means the Liaison Committee on Medical Education of the
             567      American Medical Association.
             568          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             569      and immediate supervision of a licensed physician and surgeon and engaged in specific tasks
             570      assigned by the licensed physician and surgeon in accordance with the standards and ethics of
             571      the profession.
             572          (10) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             573      alter living tissue, but is not intended or expected to excise, vaporize, disintegrate, or remove
             574      living tissue.
             575          (ii) Notwithstanding Subsection (10)(a)(i), nonablative procedure includes hair
             576      removal.
             577          (b) "Nonablative procedure" does not include:
             578          (i) a superficial procedure as defined in Section 58-1-102 ;
             579          (ii) the application of permanent make-up; or
             580          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
             581      performed by an individual licensed under this title who is acting within their scope of practice.
             582          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             583      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under



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             584
     Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             585          [(8)] (12) (a) "Practice of medicine" means:
             586          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
             587      disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
             588      or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
             589      means or instrumentality, and by an individual in Utah or outside the state upon or for any
             590      human within the state[, except that conduct described in this Subsection (8)(a) that is
             591      performed by a person legally and in accordance with a license issued under another chapter of
             592      this title does not constitute the practice of medicine];
             593          [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             594      to withhold or alter the health care services that the licensee has ordered[, but practice of
             595      medicine does not include any conduct under Subsection 58-67-501 (2)];
             596          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             597      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             598          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             599      diagnosis or treatment of human diseases or conditions in any printed material, stationery,
             600      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
             601      "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
             602      designations in any manner which might cause a reasonable person to believe the individual
             603      using the designation is a licensed physician and surgeon, and if the party using the designation
             604      is not a licensed physician and surgeon, the designation must additionally contain the
             605      description of the branch of the healing arts for which the person has a license, provided that an
             606      individual who has received an earned degree of doctor of medicine degree but is not a licensed
             607      physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
             608      Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
             609          (b) The practice of medicine does not include:
             610          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             611      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             612      under another chapter of this title;
             613          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             614      performing the ablative cosmetic medical procedure includes the authority to operate or



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             615
     perform a surgical procedure; or
             616          (iii) conduct under Subsection 58-67-501 (2).
             617          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             618      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             619      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             620      and dispensed by or through a person or entity licensed under this chapter or exempt from
             621      licensure under this chapter.
             622          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or
             623      rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             624          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             625      Medical Boards.
             626          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-67-501 .
             627          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and
             628      58-67-502 , and as may be further defined by division rule.
             629          Section 9. Section 58-67-805 is enacted to read:
             630          58-67-805. Supervision of cosmetic medical procedures.
             631          (1) Except as provided in Subsection (2), a physician may not delegate the performance
             632      of an ablative cosmetic medical procedure to an individual who is not licensed under this
             633      chapter or Chapter 68, Utah Osteopathic Medical Practice Act.
             634          (2) A physician may delegate to an advanced practice registered nurse with an
             635      unrestricted license under Chapter 31b, Nurse Practice Act, the performance of an erbium full
             636      ablation resurfacing procedure or a CO2 fractionated resurfacing procedure, if the physician:
             637          (a) prescribes that specific procedure for the patient who is to receive the procedure;
             638          (b) ensures that the advanced practice registered nurse performs the procedure under
             639      the indirect supervision of the physician; and
             640          (c) verifies that the advanced practice registered nurse is qualified to perform the
             641      procedure by having received at least 50 hours of training specific to the procedure to be
             642      performed and the laser to be used.
             643          Section 10. Section 58-68-102 is amended to read:
             644           58-68-102. Definitions.
             645          In addition to the definitions in Section 58-1-102 , as used in this chapter:



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             646
         (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,
             647      disintegrate, or remove living tissue, including the use of carbon dioxide lasers and
             648      erbium:YAG lasers, and excluding hair removal.
             649          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             650      of the American Medical Association.
             651          [(2)] (3) "Administrative penalty" means a monetary fine imposed by the division for
             652      acts or omissions determined to constitute unprofessional or unlawful conduct, as a result of an
             653      adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
             654      Procedures Act.
             655          [(3)] (4) "AOA" means the American Osteopathic Association.
             656          [(4)] (5) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
             657      created in Section 58-68-201 .
             658          (6) (a) "Cosmetic medical device" means tissue altering energy based devices that have
             659      the potential for altering living tissue and that are used to perform ablative or nonablative
             660      procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
             661      Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices and
             662      excludes ANSI designated Class IIIa and lower powered devices.
             663          (b) Notwithstanding Subsection (6)(a), if an ANSI designated Class IIIa and lower
             664      powered device is being used to perform an ablative procedure, the device is included in the
             665      definition of cosmetic medical device under Subsection (6)(a).
             666          (7) "Cosmetic medical procedure":
             667          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             668      procedures; and
             669          (b) does not include a treatment of the ocular globe such as refractive surgery.
             670          [(5)] (8) "Diagnose" means:
             671          (a) to examine in any manner another person, parts of a person's body, substances,
             672      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             673      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             674      condition;
             675          (b) to attempt to conduct an examination or determination described under Subsection
             676      [(5)] (8)(a);



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             677
         (c) to hold oneself out as making or to represent that one is making an examination or
             678      determination as described in Subsection [(5)] (8)(a); or
             679          (d) to make an examination or determination as described in Subsection [(5)] (8)(a)
             680      upon or from information supplied directly or indirectly by another person, whether or not in
             681      the presence of the person making or attempting the diagnosis or examination.
             682          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             683      and immediate supervision of a licensed osteopathic physician and surgeon and engaged in
             684      specific tasks assigned by the licensed osteopathic physician and surgeon in accordance with
             685      the standards and ethics of the profession.
             686          (10) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             687      alter living tissue, but is not expected or intended to excise, vaporize, disintegrate, or remove
             688      living tissue.
             689          (ii) Notwithstanding Subsection (10)(a)(i), nonablative procedure includes hair
             690      removal.
             691          (b) "Nonablative procedure" does not include:
             692          (i) a superficial procedure as defined in Section 58-1-102 ;
             693          (ii) the application of permanent make-up; or
             694          (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
             695      preformed by an individual licensed under this title who is acting within their scope of practice.
             696          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             697      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
             698      Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             699          [(8)] (12) (a) "Practice of osteopathic medicine" means:
             700          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
             701      disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
             702      or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
             703      is based upon emphasis of the importance of the musculoskeletal system and manipulative
             704      therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
             705      state upon or for any human within the state[, except that conduct described in this Subsection
             706      (8)(a) that is performed by a person legally and in accordance with a license issued under
             707      another chapter of this title does not constitute the practice of medicine];



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             708
         [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             709      to withhold or alter the health care services that the licensee has ordered[, but practice of
             710      medicine does not include any conduct under Subsection 58-68-501 (2)];
             711          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             712      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             713          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             714      diagnosis or treatment of human diseases or conditions, in any printed material, stationery,
             715      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic
             716      medicine," "osteopathic physician," "osteopathic surgeon," "osteopathic physician and
             717      surgeon," "Dr.," "D.O.," or any combination of these designations in any manner which might
             718      cause a reasonable person to believe the individual using the designation is a licensed
             719      osteopathic physician, and if the party using the designation is not a licensed osteopathic
             720      physician, the designation must additionally contain the description of the branch of the healing
             721      arts for which the person has a license, provided that an individual who has received an earned
             722      degree of doctor of osteopathic medicine but is not a licensed osteopathic physician and
             723      surgeon in Utah may use the designation "D.O." if it is followed by "Not Licensed" or "Not
             724      Licensed in Utah" in the same size and style of lettering.
             725          (b) The practice of osteopathic medicine does not include:
             726          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             727      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             728      under another chapter of this title;
             729          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             730      performing the ablative cosmetic medical procedure includes the authority to operate or
             731      perform a surgical procedure; or
             732          (iii) conduct under Subsection 58-68-501 (2).
             733          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             734      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             735      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             736      and dispensed by or through a person or entity licensed under this chapter or exempt from
             737      licensure under this chapter.
             738          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or



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House Floor Amendments 3-8-2012 le/cjd
             739
     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             740          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             741      Medical Boards.
             742          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-68-501 .
             743          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-68-502
             744      and as may be further defined by division rule.
             745          Section 11. Section 58-68-805 is enacted to read:
             746          58-68-805. Supervision of cosmetic medical procedures.
             747           H. [ An ] (1) Except as provided in Subsection (2), an .H osteopathic physician and
             747a      surgeon may not delegate the performance of an ablative
             748      cosmetic medical procedure to an individual who is not licensed under this chapter or Chapter
             749      67, Utah Medical Practice Act.
             749a      H. (2) A physician may delegate to an advanced practice registered nurse with an
             749b      unrestricted license under Chapter 31b, Nurse Practice Act, the performance of an erbium full
             749c      ablation resurfacing procedure or a CO2 fractionated resurfacing procedure, if the physician:
             749d          (a) prescribes that specific procedure for the patient who is to receive the procedure;
             749e          (b) ensures that the advanced practice registered nurse performs the procedure under
             749f      the indirect supervision of the physician; and
             749g          (c) verifies that the advanced practice registered nurse is qualified to perform the
             749h      procedure by having received at least 50 hours of training specific to the procedure to be
             749i      performed and the laser to be used. .H


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