Colorado department of regulatory agencies
Division of Professions and Occupations Office of Naturopathic Doctor Registration Program
4 CCR 749-1
Rules regulating naturopathic doctors registration, practice, and discipline

Authority
Basis:  These rules are promulgated pursuant to § 12-37.3-104(1)(a) C.R.S. The registration and regulation of Naturopathic Doctors is found in Title 12 (“Professions and Occupations”), Article 37.3 (“Naturopathic Doctors”) of the Colorado Revised Statutes. 
Scope and Purpose
These rules were promulgated in order to carry out the powers and duties of the Division Director of the Division of Professions and Occupations, Department of Regulatory Agencies (“Director”) pursuant to § 12-37.3-104(1)(a), C.R.S. These rules affect every person who practices as a Naturopathic Doctor in the State of Colorado.
Rule 1 - Process and form to report adverse actions by governmental agencies, convictions, judgments, civil actions, and illness or conditions (§ 12-37.3-112(1)(n),(o),(p)(I), C.R.S.)
The purpose of this rule is to clarify the process and form for reporting adverse actions, convictions, judgments, civil actions, and illness or conditions to the Director as required in § 12-37.3-112(1)(n),(o),(p)(I), C.R.S.
A.	A registered Naturopathic Doctor shall make an initial report to the Director within 30 days of receiving a diagnosis of a physical or mental illness or condition that affects the Naturopathic Doctor’s ability to treat patients with reasonable skill and safety or that may endanger the health or safety of persons under his or her care, and shall update such report within 30 days after any significant change in the illness or condition, regardless of whether the change is positive or negative. 
B.	Report contents 
1. 	If the event is an adverse action by any governmental agency, the report to the Director must include the name of the agency, its jurisdiction, the case name, court docket, proceeding or case number by which the event is designated, and a copy of the consent decree, order, or decision. 
2.	If the event is a criminal conviction, the report to the Director must include the court, its jurisdiction, the case name, the case number, a description of the matter or a copy of the indictment or charges, and any plea or verdict entered by the court. Within 30 days of the imposition of sentence for a felony conviction, the registrant shall provide to the Director a copy of the imposition of sentence. Within 30 days of the completion of any terms of the sentence, the registrant shall provide written notice to the Director of the completion of the sentence terms, and any evidence of rehabilitation as described in § 24-5-101(4)(c), C.R.S. 
3. 	If the event concerns a civil action or arbitration proceeding, the report to the Director must include the court or arbiter, the jurisdiction, the case name, the case number, a description of the matter or a copy of the complaint, and a copy of the verdict, the court or arbitration decision, or, if settled, the settlement agreement and court’s order of dismissal.
4.	 IF THE EVENT CONCERNS A PHYSICAL OR MENTAL ILLNESS OR CONDITION:
a.	THE INITIAL REPORT SHALL CONTAIN: THE DIAGNOSIS AND A DESCRIPTION OF THE ILLNESS OR CONDITION; THE DATE THAT THE ILLNESS OR CONDITION WAS FIRST DIAGNOSED; THE NAME OF THE CURRENT TREATMENT PROVIDER AND DOCUMENTATION FROM THE CURRENT TREATMENT PROVIDER CONFIRMING THE DIAGNOSIS, DATE OF ONSET, AND TREATMENT PLAN; AND, A DESCRIPTION OF THE NATUROPATHIC DOCTOR’S PRACTICE AND ANY MODIFICATIONS, LIMITATIONS OR RESTRICTIONS TO THAT PRACTICE THAT HAVE BEEN MADE AS A RESULT OF THE ILLNESS OR CONDITION.
b.	THE REPORT OF A CHANGE IN CONDITION SHALL CONTAIN: THE DATE OF THE CHANGE IN CONDITION; THE NAME OF THE CURRENT TREATMENT PROVIDER AND DOCUMENTATION FROM THE CURRENT TREATMENT PROVIDER CONFIRMING THE CHANGE IN CONDITION, THE DATE THAT THE CONDITION CHANGED, THE NATURE OF THE CHANGE IN CONDITION, AND THE CURRENT TREATMENT PLAN; AND, A DESCRIPTION OF THE NATUROPATHIC DOCTOR’S PRACTICE AND ANY MODIFICATIONS, LIMITATIONS OR RESTRICTIONS TO THAT PRACTICE THAT HAVE BEEN MADE AS A RESULT OF THE CHANGE IN CONDITION.
c.	COMPLIANCE WITH SUBSECTION A OF THIS RULE IS A PREREQUISITE FOR ELIGIBILITY TO ENTER INTO A CONFIDENTIAL AGREEMENT WITH THE DIRECTOR PURSUANT TO C.R.S. § 12-37.3-116(2)(a). HOWEVER, MERE COMPLIANCE WITH THIS RULE DOES NOT REQUIRE THE DIRECTOR TO NEGOTIATE REGARDING, OR ENTER INTO, A CONFIDENTIAL AGREEMENT. RATHER, THE DIRECTOR WILL EVALUATE ALL FACTS AND CIRCUMSTANCES TO DETERMINE IF A CONFIDENTIAL AGREEMENT IS APPROPRIATE.
d.	THE FAILURE TO TIMELY NOTIFY THE DIRECTOR OF AN ILLNESS OR CONDITION AS REQUIRED UNDER THIS RULE IS A VIOLATION OF § 12-37.3-112(1)(P)(I), C.R.S., CONSTITUTING GROUNDS FOR DISCIPLINE AND DENIAL OF A CONFIDENTIAL AGREEMENT UNDER § 12-37.3-116, C.R.S.
RULE 7 – MEDICINES AND DEVICES USED IN THE PRACTICE OF NATUROPATHIC MEDICINE
PURPOSE:  THE PURPOSE OF THIS RULE IS TO CLARIFY THE USE AND ADMINISTRATION OF PRESCRIPTION AND NONPRESCRIPTION MEDICATIONS FOR REGISTERED NATUROPATHIC DOCTORS.
A.	THE DIRECTOR HAS APPROVED THE FOLLOWING FORMULARY OF PRESCRIPTION AND NONPRESCRIPTION MEDICATIONS AND DEVICES A NATUROPATHIC DOCTOR MAY USE IN THE PRACTICE OF NATUROPATHIC MEDICINE PURSUANT TO §§ 12-37.3-102(11), (12) AND 12-37.3-105(1)(c), C.R.S.
NATUROPATHIC FORMULARY	
PRESCRIPTION MEDICATIONS AND DEVICES	
EPINEPHRINE TO TREAT ANAPHYLAXIS	
BARRIER CONTRACEPTIVES (EXCLUDING INTRAUTERINE DEVICES)	
	
NONPRESCRIPTION MEDICATIONS AND DEVICES	
ANY NONPRESCRIPTION MEDICATIONS AND DEVICES APPROPRIATE WITHIN NATUROPATHIC MEDICINE FOR TREATING PATIENTS	
B.	WHEN APPROPRIATE FOR THE TREATMENT OF THE PATIENT, A NATUROPATHIC DOCTOR MAY PRESCRIBE, ORDER, PROCURE, DISPENSE, INJECT AND ADMINISTER NONPRESCRIPTION MEDICATIONS AND DEVICES, EPINEPHRINE TO TREAT ANAPHYLAXIS, AND BARRIER CONTRACEPTIVES, EXCLUDING INTRAUTERINE DEVICES.
C.	NONPRESCRIPTION HOMEOPATHIC PREPARATIONS PREPARED ACCORDING TO THE MOST CURRENT VERSION OF THE HOMOEOPATHIC PHARMACOPOEIA OF THE UNITED STATES REVISION SERVICE, ARE AUTHORIZED FOR USE IN NATUROPATHIC MEDICINE.  
D.	A NATUROPATHIC DOCTOR REGISTERED IN COLORADO SHALL NOT USE A CERTIFICATION, REGISTRATION, OR LICENSE ISSUED BY ANOTHER STATE TO:
1.	ISSUE PRESCRIPTION ORDERS FOR PRESCRIPTION MEDICATIONS OR DEVICES TO BE DISPENSED BY A PHARMACY LOCATED IN COLORADO OR IN ANY OTHER STATE FOR PATIENTS WHO THE NATUROPATHIC DOCTOR EXAMINES, DIAGNOSES, OR TREATS IN COLORADO, OR
2.	PRESCRIBE, ORDER, PROCURE, DISPENSE, OR ADMINISTER PRESCRIPTION MEDICATIONS OR DEVICES FOR GENERAL USE WITH PATIENTS SEEN IN HIS OR HER OFFICE IN COLORADO.
RULE 8 - DEFINITIONS
PURPOSE:  THE PURPOSE OF THIS RULE IS TO DEFINE TERMS USED IN THE NATUROPATHIC DOCTOR ACT.
A.	“COLLABORATIVE RELATIONSHIP” MEANS A COOPERATIVE RELATIONSHIP AMONG A PATIENT’S HEALTH CARE PROVIDERS; TO SHARE INFORMATION AND CONSULT WITH ONE ANOTHER AS APPROPRIATE TO ACHIEVE THE BEST HEALTH CARE OUTCOMES FOR THE PATIENT.
B.	“NATUROPATHIC FORMULARY” MEANS THE NON-PRESCRIPTION MEDICATIONS AUTHORIZED TO BE USED IN THE PRACTICE OF NATUROPATHIC MEDICINE, EPINEPHRINE TO TREAT ANAPHYLAXIS AND BARRIER CONTRACEPTIVES, BUT EXCLUDING INTRAUTERINE DEVICES. (§§ 12-37.3-102(11), 12-37.3-105(1)(c), C.R.S.)
RULE 9 - UNREGISTERED PRACTICE OF NATUROPATHIC MEDICINE
PURPOSE:  THE PURPOSE OF THIS RULE IS TO CLARIFY ACTS THAT MAY CONSTITUTE THE UNREGISTERED PRACTICE OF NATUROPATHIC MEDICINE.
THE DIRECTOR OF THE NATUROPATHIC DOCTOR REGISTRATION PROGRAM, OR HER DESIGNEE, MAY DISCIPLINE REGISTERED NATUROPATHIC DOCTORS FOR VIOLATIONS OF § 12-37.3-112(1), C.R.S.  PURSUANT TO §§ 12-37.3-112(10) THROUGH (13) AND 12-37.3-113, C.R.S., THE DIRECTOR MAY ISSUE CEASE AND DESIST ORDERS AND SEEK OTHER RELIEF AGAINST UNREGISTERED PERSONS WHO ENGAGE IN CONDUCT THAT REQUIRES REGISTRATION AS A NATUROPATHIC DOCTOR.  
A.	ACTS THAT MAY CONSTITUTE THE UNREGISTERED PRACTICE OF NATUROPATHIC MEDICINE INCLUDE BUT ARE NOT LIMITED TO:

1.	DISPENSING, ADMINISTERING, ORDERING, OR PRESCRIBING A MEDICINE OR DEVICE THAT REQUIRES A PRESCRIPTION;
2.	DIAGNOSING INJURY, DISEASE, AILMENT, INFIRMITY, DEFORMITY, PAIN, OR ANOTHER CONDITION OF THE HUMAN BODY;
3.	USING THE TITLE “NATUROPATHIC DOCTOR,” “DOCTOR OF NATUROPATHY,” OR THE ABBREVIATION, “N.D.”; AND
4.	PERFORMING MINOR OFFICE PROCEDURES AS DEFINED AT § 12-37.3-102(8), C.R.S.
B. 	ACTS THAT DO NOT CONSTITUTE THE UNREGISTERED PRACTICE OF NATUROPATHIC MEDICINE INCLUDE BUT ARE NOT LIMITED TO:
1. 	UTILIZING THERAPIES THAT USE NUTRITIONAL SUPPLEMENTS, HERBS, FOODS, NONPRESCRIPTIVE HOMEOPATHIC PREPARATIONS, AND PHYSICAL FORCES SUCH AS HEAT, COLD, WATER, TOUCH, AND LIGHT IN THE PRACTICE OR PROVISION OF NATURAL HEALTH CARE;
2. 	USING MIND-BODY AND ENERGETIC HEALING PRACTICES IN THE PRACTICE OR PROVISION OF NATURAL HEALTH CARE;  
3. 	PROVIDING INFORMATION ABOUT OR SELLING VITAMINS, HEALTH FOOD, DIETARY SUPPLEMENTS, HERBS, OR OTHER NATURAL PRODUCTS WHEN OTHERWISE PERMITTED BY STATE AND FEDERAL LAW;
4. 	PROVIDING TRUTHFUL AND NON-MISLEADING INFORMATION REGARDING NATURAL HEALTH CARE PRODUCTS OR SERVICES.
C.	ACTS DESCRIBED IN THIS RULE THAT DO NOT CONSTITUTE THE UNREGISTERED PRACTICE OF NATUROPATHIC MEDICINE MAY, UNDER SOME CIRCUMSTANCES, NEVERTHELESS BE PROHIBITED BY LAWS OTHER THAN THE NATUROPATHIC DOCTOR ACT. 
RULE 10 - ALTERNATIVE QUALIFICATIONS FOR REGISTRATION
PURPOSE:  THE PURPOSE OF THIS RULE IS TO CLARIFY ALTERNATIVE QUALIFICATIONS FOR REGISTRATION AS A NATUROPATHIC DOCTOR.
THE DIRECTOR MAY DETERMINE THAT COMPLETION OF A FOUR YEAR POST-GRADUATE LEVEL DIDACTIC AND SUPERVISED CLINICAL EDUCATIONAL PROGRAM AS DESCRIBED IN § 12-37.3-106(4)(a), C.R.S., CONSTITUTES DOCUMENTED EXPERIENCE PROVIDING THE SAME KIND, AMOUNT, AND LEVEL OF KNOWLEDGE AS A FOUR YEAR BACCALAUREATE DEGREE REQUIRED PURSUANT TO § 12-37.3-106(2)(b), C.R.S.
RULE 11 - MANDATORY DISCLOSURES AND FORMS
PURPOSE:  THE PURPOSE OF THIS RULE IS TO CLARIFY THE USE OF FORMS AND DISCLOSURES THE DIRECTOR HAS DETERMINED AS MANDATORY.
SECTIONS 12-37.3-105(2)(f), (3)(b) and 12-37.3-111, C.R.S., REQUIRE A NATUROPATHIC DOCTOR TO DISCLOSE CERTAIN INFORMATION  AND OBTAIN A SIGNED CONSENT FROM THE PATIENT BEFORE CONDUCTING AN INITIAL EXAMINATION.  A SAMPLE DISCLOSURE AND CONSENT FORM CONTAINING ESSENTIAL INFORMATION WHICH MUST BE PROVIDED TO THE PATIENT CAN BE ACCESSED IN APPENDIX A. WHILE USE OF THE SAMPLE FORM IS NOT MANDATORY, THE FORM USED MUST CONTAIN THE INFORMATION PROVIDED WITHIN THE SAMPLE FORM AND COMPLY WITH THE STATUTES REFERENCED IN THIS RULE AND OTHER APPLICABLE LAWS.  
RULE 12 – RECORD-KEEPING AND PATIENT RECORDS
PURPOSE:  THE PURPOSE OF THIS RULE IS TO CLARIFY ADDITIONAL RECORD-KEEPING AND PATIENT RECORD MANAGEMENT REQUIREMENTS AS DESCRIBED IN §§ 12-37.3-111 AND 12-37.3-115(1)(a), C.R.S. 
A.	DOCUMENTATION OF THE PATIENT’S HEALTH HISTORY (INCLUDING PREGNANCY STATUS, AS APPLICABLE), PRESENTING COMPLAINT(S), EXAMINATION, DIAGNOSES, PROGNOSES, TREATMENT RECOMMENDATIONS, TREATMENT, PROGRESSION OF CARE, PRESCRIPTIONS, LAB RESULTS, XRAYS, CORRESPONDENCE, REPORTS, AND ANY HEALTH INSURANCE RECORDS MUST BE MAINTAINED IN THE PATIENT RECORD .
B.	PATIENT RECORDS ARE REQUIRED TO BE CONTEMPORANEOUS, LEGIBLE, UTILIZE STANDARD MEDICAL TERMINOLOGY OR ABBREVIATIONS, IDENTIFY THE PATIENT, INDICATE ALL SERVICES RENDERED DURING EACH PATIENT ENCOUNTER, IDENTIFY THE PROVIDER OF SERVICE, AND INDICATE THE DATE THE SERVICE WAS PERFORMED. ANY ADDITION OR CORRECTION TO THE PATIENT RECORD AFTER ENTRY SHALL BE SIGNED AND DATED BY THE PERSON MAKING THE ADDITION OR CORRECTION. 
C.	PATIENT RECORDS SHALL BE MAINTAINED FOR A MINIMUM OF SEVEN (7) YEARS AFTER THE LAST DATE OF TREATMENT OR EXAMINATION, OR AT LEAST TWO YEARS AFTER THE PATIENT REACHES THE AGE OF EIGHTEEN, WHICHEVER OCCURS LATER. IF PATIENT RECORDS ARE MAINTAINED ELECTRONICALLY, THEN A BACK-UP AND DATA RECOVERY SYSTEM MUST BE IN PLACE. 
D.	WHEN THE DESTRUCTION CYCLE FOR PATIENT RECORDS IS IMMINENT, WRITTEN NOTICE TO THE PATIENT’S LAST KNOWN ADDRESS, OR NOTICE BY PUBLICATION, MUST BE MADE SIXTY (60) DAYS PRIOR TO DESTRUCTION ALLOWING A THIRTY (30) DAY PERIOD WHEREIN THE PATIENT MAY CLAIM HIS/HER RECORDS. WHEN A PATIENT CLAIMS SUCH RECORDS, THE RECORDS MUST BE PROVIDED TO THE PATIENT, OR LEGAL GUARDIAN, AT NO CHARGE; HOWEVER, RECOVERY OF APPROPRIATE POSTAGE AND HANDLING COSTS IS PERMITTED. 
E.	PATIENT RECORDS SHALL BE DESTROYED IN A MANNER THAT TOTALLY OBLITERATES ALL INFORMATION CONTAINED IN THE RECORD SUCH AS BY INCINERATING OR SHREDDING. 
F.	PATIENT RECORDS MAY NOT BE WITHHELD FOR OUTSTANDING/PAST DUE PROFESSIONAL FEES. A REASONABLE FEE FOR COPYING RECORDS MAY BE ASSESSED TO THE REQUESTING PARTY.