M-9, r. 13 - Regulation respecting the activities contemplated in section 31 of the Medical Act which may be engaged in by classes of persons other than physicians

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8.5. The nurse practitioner specialized in primary care must request the intervention of the partner physician in the following cases:
(1)  his or her evaluation does not allow the clear identification of the common health problem, the criteria to initiate the medical treatment are not clear or the situation exceeds the skills of the nurse practitioner specialized in primary care, specifically in the presence of one of the following factors:
(a)  a persistent or recurrent sign or symptom to which no cause can be assigned;
(b)  a sign, a symptom or a result of medical imaging or laboratory analysis suggesting the presence of an undiagnosed chronic or systemic disease;
(c)  a symptom or an analysis result demonstrating the decline or alteration of the function of an organ or a system;
(d)  a symptom, a sign or a laboratory analysis result suggesting a recurrent or persistent infection;
(e)  an atypical manifestation of a common disease or an unusual reaction to treatment;
(f)  a sign or a symptom of change of behaviour which cannot be attributed to a specific cause.
(2)  he or she notes that the growth or development of a newborn, an infant or a child is abnormal or observes the presence of a sign or a symptom of disease in the newborn or the infant of 3 months old or less other than thrush, seborrheic dermatitis, diaper rash or tear duct obstruction;
(3)  there is a suspicion of abuse or the presence of a sign of abuse or a symptom of a sexually transmitted infection in a child;
(4)  a chronic condition becomes worse, especially in the presence of one of the following factors:
(a)  a symptom or a result of laboratory analysis indicating deterioration of a patient;
(b)  the unexpected deterioration of the condition of a patient already treated for a diagnosed disease.
(5)  a woman more than 32 weeks pregnant;
(6)  his or her evaluation allows the identification of a symptom, a sign or a result of medical imaging or laboratory analysis suggesting a risk for the pregnant woman or the unborn child.
(7)  the situation imperils the life or the physical or mental integrity of a person.
Further to the intervention of the partner physician, he or she may continue the practice of the activities stipulated in section 8.4 within the limits of the medical treatment plan determined by this physician.
O.C. 668-2007, s. 5.