4 CCR 749-1.16 - Treatment of Children Under Eight Years of Age

The purpose of this Rule is to clarify the requirements for the treatment of children under eight years of age by a naturopathic doctor as set forth in sections 12-250-106(2)(e) and (f), C.R.S., and the reporting requirements associated with the treatment of children under two years of age set forth in section 12-250-121, C.R.S.

A. Children Under the Age of Two
1. Provision of Immunization Schedule
a. The naturopathic doctor shall provide to the parent or legal guardian of the child a copy of the most recent immunizations schedule recommended by the ACIP and recommend that the parent or legal guardian follow the immunizations schedule.
2. Education Requirements
a. As set forth in section 12-250-106(2)(e)(II)(A), C.R.S., a naturopathic doctor treating patients under two years of age must complete education and practicum training specific to pediatrics in accordance with continued professional competency requirements.
b. The continued professional competency requirements specific to treating children under two years of age are set forth in Rule 1.13 (1)(b)(ii)(2) for deemed status.
3. Collaborative Agreement Requirements
a. The Collaborative Agreement must:
(1) Be made in writing and signed by both the naturopathic doctor and the licensed physician identifying their respective license numbers, place of business, and phone numbers;
(2) Contain the responsibilities and duties of each party;
(3) Contain the process for the naturopathic doctor to consult with the licensed physician;
(a) The Collaborative Agreement must specify the anticipated means of communication and the expected frequency of consultation between the practitioners.
(i) Examples of "means" of communication include, but are not limited to, telephone, telehealth, or in person.
(ii) Examples of the expected "frequency" of the consultation include, but are not limited to, consultation for each child patient visit, consultation on an "as needed" basis, or regularly scheduled consultations on a weekly, monthly or quarterly basis.
b) The Collaborative Agreement must specify an emergency protocol to be followed by the naturopathic doctor in the event a child's condition warrants emergency treatment.
(4) Contain the process for the naturopathic doctor to refer a patient to a licensed physician to facilitate the patient's effective treatment;
(5) Be kept on file by both the naturopathic doctor and the licensed physician for seven years following the termination of the Collaborative Agreement or seven years from the date the youngest child treated pursuant to the agreement reaches the age of majority, whichever occurs later.
b. Within thirty days of the execution of the Collaborative Agreement, the naturopathic doctor shall provide, in writing, the licensed physician's name and license number to the Director. The naturopathic doctor shall inform the Director, in writing, of any change to the licensed physician's information within fifteen days of any such change.
c. A sample collaborative agreement is provided in Appendix B. Use of the sample form is not mandatory but any form must comply with statutory and rule requirements.
4. Informed Consent
a. The naturopathic doctor shall have each child's parent or legal guardian sign an informed consent form that:
(1) Discloses that the naturopathic doctor is registered with the State of Colorado;
(2) Discloses that the naturopathic doctor is not a physician licensed pursuant to Article 240 of Title 12;
(3) Recommends that the child have a relationship with a licensed pediatric health care provider; and
(4) If the child has a relationship with a licensed pediatric health care provider, the naturopathic doctor shall request permission from the parent or legal guardian to attempt to develop and maintain a Collaborative Relationship with the licensed pediatric health care provider. If the child does not have a relationship with such a provider, the naturopathic doctor shall make a referral to at least one such provider on the child's first visit.
b. In conjunction with Rule 1.11 , a sample consent form is provided in Appendix A. Use of the sample form is not mandatory but any form must comply with statutory and rule requirements.
5. Reporting Requirements
a. The naturopathic doctor shall provide the Collaborative Agreement to the Director upon request.
b. The naturopathic doctor shall collect, maintain and report the following data to the Director upon renewal:
(1) The number of children under the age of two years treated by the naturopathic doctor;
(2) The conditions for which the children under the age of two years were treated by the naturopathic doctor; and,
(3) The number and description of adverse events that occurred in connection with treatment of children under the age of two.
(a) "Adverse event" is defined as any harm to a child under two years of age that the treating naturopathic doctor is aware of and that resulted or likely resulted from the naturopathic doctor's care of the child. Reporting an adverse event to the Department does not, alone, constitute grounds for discipline under section 12-250-113, C.R.S.
c. Collaborative Agreement submissions; updates required to be reported under these rules; and, any adverse events shall be sent to the Director at dora_naturopathic_doctor@state.co.us.
B. Children from Two Years of Age to Eight Years of Age
1. Provision of the Immunization Schedule
a. The naturopathic doctor shall provide to the parent or legal guardian of the child a copy of the most recent immunizations schedule recommended by the ACIP and recommend that the parent or legal guardian follow the immunizations schedule.
2. Education Requirements
a. As set forth in section 12-250-106(2)(e)(II)(B), C.R.S., a naturopathic doctor treating patients from two years of age to eight years of age must complete education and practicum training specific to pediatrics in accordance with continued professional competency requirements.
b. The continued professional competency requirements specific to treating children under eight years of age are set forth in Rule 1.13 (1)(b)(ii)(1) for deemed status.
3. Informed Consent
a. The naturopathic doctor shall have each child's parent or legal guardian sign an informed consent form that:
(1) Discloses that the naturopathic doctor is registered with the State of Colorado;
(2) Discloses that the naturopathic doctor is not a physician licensed pursuant to Article 240 of Title 12;
(3) Recommends that the child have a relationship with a licensed pediatric health care provider; and
(4) If the child has a relationship with a licensed pediatric health care provider, the naturopathic doctor shall request permission from the parent or legal guardian to attempt to develop and maintain a Collaborative Relationship with the licensed pediatric health care provider.
b. In conjunction with Rule 1.11 , a sample consent form is provided in Appendix A.Use of the sample form is not mandatory but any form must comply with statutory and rule requirements.

Notes

4 CCR 749-1.16
37 CR 15, August 10, 2014, effective 8/30/2014 38 CR 11, June 10, 2015, effective 7/1/2015 39 CR 11, June 10, 2016, effective 6/30/2016 43 CR 03, February 10, 2020, effective 1/1/2020 43 CR 07, April 10, 2020, effective 4/30/2020 43 CR 22, November 25, 2020, effective 12/15/2020 44 CR 09, May 10, 2021, effective 5/30/2021 45 CR 17, September 10, 2022, effective 8/15/2022 45 CR 16, August 25, 2022, effective 9/14/2022 45 CR 21, November 10, 2022, effective 11/30/2022

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