TEMPORARY, LIMITED, AND SUPERVISED PRACTICE OF OPTOMETRY.
Optometrist seeking North Carolina licensure, never licensed previously in North Carolina
An optometrist wishing to practice optometry in North Carolina prior to taking and passing the Board’s clinical/practicum examination and who has never been licensed previously by the Board must obtain a provisional license. An applicant for a provisional license must hold a doctor of optometry degree from a school or college of optometry accredited by the Accreditation Council on Optometric Education (ACOE). Such an applicant will be referred to as an “academically qualified optometrist.” Once granted a provisional license, the optometrist is considered to be an “intern” and should be introduced to patients as an “optometrist or doctor of optometry awaiting licensure.”
An optometrist who has been previously licensed by the Board should refer to the Board’s Policy on Reinstatement or Restoration of License
The following criteria must be met before an optometrist can apply for a provisional license to practice optometry in North Carolina.
The applicant must be an academically qualified optometrist.
The applicant must have an active application to take or retake the North Carolina clinical/practicum examination at its next administration. Failure to take the Board’s Exam would make the applicant ineligible to renew the provisional license. In situations of good cause or excusable neglect, the Board at it's discretion may reconsider the application.
The applicant must meet the following National Board of Examiners in Optometry (NBEO) criteria:
The applicant has successfully passed NBEO examination Part I, Part II with TMOD, and Part III with ISE, or
The applicant has successfully passed Part I and Part II with TMOD, but whose taking Part III and ISE of the NBEO examinations has been delayed due to circumstances which in the Board’s discretion constitute good cause or excusable neglect.
An applicant holding a valid and active license in another state or jurisdiction who wishes to practice optometry in North Carolina before taking and passing the Board’s clinical/practicum examination must also meet criteria 1. and 2. above and have successfully passed all parts of the NBEO examinations that were available at the time the applicant graduated from an accredited school or college of optometry. Such applicant must also provide evidence or otherwise satisfy the Board that he is in good standing with each other state or jurisdiction in which he currently is licensed. He also must provide evidence to the Board regarding (i) any restriction of his license or any discipline to which he has been subjected in any state or jurisdiction in which he previously has been licensed; (ii) any surrender of a license by him in any state or jurisdiction; and (iii) any pending disciplinary matter or investigation by any state or federal agency or authority.
Provisional license authority:
Pursuant to section 90-115.1(5) of the General Statutes of North Carolina, the Board may issue a provisional license allowing an optometrist to render services and perform procedures that a duly licensed North Carolina optometrist may perform in accordance with Article 6 of Chapter 90 of the General Statutes of North Carolina, provided that such are performed “at the direction and under the direct supervision” of a North Carolina licensed optometrist. Ordinarily, such approval will be given by the Board only to persons who have an opportunity to work under the supervision of a North Carolina licensed optometrist in order to gain additional clinical experience prior to taking the licensing examinations or while awaiting the results of such examination.
“At the direction and under the supervision of” shall be applied to the facts of each particular situation in which a provisionally licensed optometrist, hereinafter referred to as an “intern,” performs optometric procedures which otherwise may be performed only by a regularly licensed optometrist. The optometrist supervising the intern assumes the responsibility for the intern and therefore can and should control and direct the services and procedures performed by the intern.
Responsibilities of the supervising optometrist and provisionally licensed optometrist:
Both the supervising and provisionally licensed optometrist must register by completing an application with the Board, and the optometrist seeking a provisional license must pay the applicable registration fee.
The supervising optometrist must have been licensed for a minimum of five years in North Carolina and her license must be in good standing as outlined in criteria 4. above.
Direct supervision required: the supervising optometrist must be physically present within the practice location when the intern is examining patients or providing optometric services. The practice location must be registered as a primary or branch office and must be located in North Carolina. Being absent from the practice location but being “available by phone” or “by computer” does not constitute direct supervision.
Identification of the intern to the patient:
The supervising optometrist must have a formal written procedure in place by which patients are informed that an intern will be performing their examination. Further, the patient will be provided information regarding the status of the intern and the intern’s background. Additionally, the patient will be informed that the intern will have a supervising optometrist and that supervising optometrist will be identified to the patient. The patient will be advised that the supervising optometrist will review the intern’s finding in person with the patient and when necessary will confirm the intern’s findings. A written notice to this effect and expressing the patient’s consent to this process must be presented to and signed by the patient prior to the intern’s examination taking place.
The intern will likewise inform the patient of his status and introduce himself as an “optometrist or doctor of optometry awaiting licensure.” An intern shall also wear appropriate identification at all times when involved in patient care that will identify himself to patients by his name followed by his degree, “O.D.,” and the word “INTERN”.
Prior to the patient’s departure from the practice after being examined by an intern, the supervising optometrist must personally review the chart of that patient and confirm that (i) the examination was thorough and complete under the circumstances; (ii) the intern’s findings and diagnosis are accurate; and (iii) the treatment plan proposed by the intern is reasonable and appropriate. The supervising optometrist shall make a notation of his agreement or disagreement with the findings of the intern in the patient’s chart and likewise note any change(s) made in the treatment suggested by the intern. The supervising optometrist will meet with the patient face to face before the patient is discharged to review the findings and repeat any aspect of the exam as she deems appropriate.
Glasses or contact lens
In the event that the intern generates a glasses and/or contact lens prescription, the supervising optometrist can authorize the intern to sign such prescriptions if the intern has passed Part III of the NBEO examination. The decision to authorize the intern to sign a glasses and/or contact lens prescription should be based on the supervising optometrist establishing an appropriate clinical comfort level with the intern.
In all cases in which a prescription pharmaceutical agent is recommended by the intern in the treatment of a patient, the supervising optometrist shall physically examine the patient prior to any prescription being written to determine the agent’s appropriateness for the patient’s condition. The supervising optometrist will sign all such prescriptions; this responsibility cannot be delegated to the intern.
Limitations of authority:
The intern will not participate in any form of telemedicine.
If the intern has passed the NBEO’s ISE examination and the supervising optometrist is certified by this Board to perform injections, the intern may perform injections under the personal supervision (in the same room) of the supervising optometrist. An appropriate informed consent must be used and must note the specifics of the procedure.
Acknowledging responsibilities of the internship:
Both the supervising optometrist and the intern must apply to the Board for approval of the internship and each must acknowledge her respective responsibilities.
Term of a provisional license:
The initial provisional license is issued either for a six-month period or until the results of the intern’s clinical/practicum examination are announced, whichever occurs first. All renewals are for the same period of time and must be consecutive and require the intern to register and take the next regularly scheduled Board Exam. The license is forfeited if not renewed and cannot be renewed if the intern fails to take the Board's Exam. The maximum number of times that any one applicant can renew a provisional license is two.
Provisional license subject to discipline:
Both the holder of a provisional license and the licensed supervising optometrist are subject to discipline under the provisions of, inter alia, G.S. 90-121.2 and relevant Board rules.
Provisional license fee:
The fee for an initial provisional License is $300 and $100 for each extension.