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State of California—Health and Human Services Agency
California Department of Public Health

AFL 12-47
December 14, 2012

General Acute Care Hospitals

Use of Medical Assistants in Hospital Outpatient Clinics

AUTHORITY:     Health & Safety Code Section 1275; Business and Professions Code (BPC) Sections 2069-2071; Title 22 California Code of Regulations (CCR), Section 70217 (m),CCR, Title 16, Chapter 3, Article 2 (Sections 1366-1366.4)

This All Facilities Letter (AFL) is being issued to provide information related to the use of medical assistants in an approved outpatient clinic supplemental service of a licensed General Acute Care Hospital (GACH). Medical assistants may be used in GACH outpatient clinics as long as they are: Only provide services and tasks as allowed in the Business and Professions Code and in Title 16 of the California Code of Regulations (current citations above); and Under the supervision of either: A licensed physician or podiatrist, or A physician assistant, nurse practitioner, or nurse midwife, under the physician's or podiatrist's written instructions. A registered nurse is not authorized to supervise a medical assistant. This, however, should not be construed to affect the clinic's ability to provide nursing services. Please review AFL 12-30 (dated September 11, 2012) addressing "Nurse Staffing in Outpatient Supplemental Service and Licensed Primary Care Clinics," for more information regarding the requirements related to the provision of nursing services within a hospital outpatient clinic, as well as within primary care clinics.

The information in this letter is intended to be an aid in developing policies and procedures which are compliant with existing state laws and regulations. Facilities are responsible for following all applicable laws. CDPH's failure to expressly notify facilities of state or federal requirements does not relieve them of this responsibility.

Additional questions related to the medical assistant scope of practice may be directed to the Medical Board of California (MBC) at (916) 263-2382. The MBC also provides a page of answers to frequently asked questions:


Questions about the staffing requirements of GACH outpatient clinics may be directed to your local District Office.



Original signed by Debby Rogers

Debby Rogers, RN, MS, FAEN
Deputy Director
Center for Health Care Quality

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