1. Except as otherwise provided in subsections 7 and 9, every: (a) Physician, physician assistant or advanced practice registered nurse attending a pregnant woman during gestation for conditions relating to her pregnancy shall make an examination, including a standard serological test, for the discovery of syphilis. The physician, physician assistant or advanced practice registered nurse shall take or cause to be taken a sample of blood of the woman at the times prescribed by subsection 2, if applicable, and shall submit the sample to a laboratory licensed pursuant to chapter 652 of NRS for a standard serological test for syphilis. (b) Person permitted by law to attend upon pregnant women, but not permitted by law to make blood tests in Nevada, shall cause a sample of the blood of the pregnant woman to be taken at the times prescribed by subsection 2, if applicable, by a duly licensed physician, physician assistant or advanced practice registered nurse and submitted to a laboratory licensed pursuant to chapter 652 of NRS for a standard serological test for syphilis. (c) Non-hospital medical facility or emergency department or labor and delivery unit in a hospital that evaluates or treats a woman of childbearing age for any reason shall ensure that: (1) The woman is asked if she is pregnant and, if she responds in the affirmative, whether she has received any prenatal care, including, without limitation, any prenatal screenings and tests; and (2) An examination is made, including the performance of: (I) A test for the discovery of syphilis in accordance with subsection 3 if the woman indicates that she is pregnant, has no history of syphilis and has not been tested for syphilis within the immediately preceding 3 months; or (II) A serological test or a referral for the performance of a serological test if the woman indicates that she has a history of syphilis. 2. An examination for the discovery of syphilis pursuant to paragraphs (a) and (b) of subsection 1 must be performed: (a) At the first visit to a physician, physician assistant or advanced practice registered nurse or other person permitted by law to attend upon pregnant women, a non-hospital medical facility or an emergency department or labor and delivery unit of a hospital during a pregnancy or as soon thereafter as practicable; (b) During the third trimester of pregnancy between the 27th and 36th week of gestation or as soon thereafter as practicable; and (c) At delivery for a pregnant woman who: (1) Should be routinely tested for infection with syphilis, as recommended by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services; (2) Lives in an area designated by the Division as having high syphilis morbidity; (3) Did not receive prenatal care; or (4) Delivers a stillborn infant after 20 weeks of gestation. 3. For the purposes of sub-subparagraph (I) of subparagraph (2) of paragraph (c) of subsection 1, a non-hospital medical facility or emergency department or labor and delivery unit of a hospital may use: (a) A rapid or point-of-care test; or (b) A serological test only if the facility performing the test reasonably believes it is able to obtain the results of the serological test before the woman is discharged from or otherwise leaves the facility. 4. A qualified serological, rapid or point-of-care test for syphilis is one recognized as such by the State Board of Health. 5. If the test is made in a state laboratory, it must be made without charge. 6. If a serological, rapid, point-of-care or physical examination test performed pursuant to subsection 1 shows that a pregnant woman is infected with syphilis, the physician, physician assistant, advanced practice registered nurse, other person, non-hospital medical facility, emergency department or labor and delivery unit shall: (a) If the physician, physician assistant, advanced practice registered nurse, other person, non-hospital medical facility, emergency department or labor and delivery unit is capable of providing treatment for syphilis, seek the consent of the pregnant woman to begin such treatment and, if such consent is obtained, commence treatment; or (b) If the physician, physician assistant, advanced practice registered nurse, other person, non-hospital medical facility, emergency department or labor and delivery unit is not capable of providing treatment for syphilis, seek the consent of the pregnant woman to refer her for such treatment and, if such consent is obtained, issue the referral. 7. If the pregnant woman objects to the taking of the sample of blood or the serological, rapid or point-of-care test: (a) The sample must not be taken and the test must not be performed; and (b) The provider of health care attending to the woman shall ensure that any refusal is documented in her medical records. 8. Except as otherwise provided in subsection 9, a non-hospital medical facility and a hospital with an emergency department or labor and delivery unit shall develop a policy to ensure compliance with this section and recommendations of the American College of Obstetricians and Gynecologists, or its successor organization, to the extent that those recommendations do not conflict with this section, concerning best practices for prenatal screenings and tests. The policy must include, without limitation, procedures: (a) For documenting refusals to any service or testing offered by the non-hospital medical facility, emergency department or labor and delivery unit; and (b) To ensure compliance with NRS 441A.150 . 9. A rural clinic that is owned, operated or administered by the Department or any political subdivision of this State, including, without limitation, a city, county, city board of health, county board of health or district board of health, is exempt from the requirements of paragraph (c) of subsection 1 and subsection 8. 10. As used in this section, non-hospital medical facility means: (a) A freestanding birthing center; (b) An independent center for emergency medical care, as defined in NRS 449.013 ; (c) A psychiatric hospital, as defined in NRS 449.0165 ; (d) A rural clinic, as defined in NRS 449.0175 ; (e) A facility for modified medical detoxification, as defined in NRS 449.00385 ; (f) A mobile unit, as defined in NRS 449.01515 ; and (g) A community triage center, as defined in NRS 449.0031 .
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