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The hypertension medications lasix continues to negatively impact population health by indirect can you buy lasix without a prescription effects on patient and healthcare systems, in addition to the direct effects of hypertension medications itself. Accurate and quantitative information about the indirect effects of the hypertension medications lasix on cardiovascular disease (CVD) services and outcomes will allow better public health planning. Ball and colleagues1 aim to ‘design and implement a simple tool for monitoring can you buy lasix without a prescription and visualising trends in CVD hospital services in the UK’ and towards that end they present pilot data from a preliminary cohort of nine UK hospitals in this issue of Heart.

Comparing 6 months in 2019–2020 (that include the hypertension medications lockdown in the UK) to the same time period in 2018–2019, there was a 57.9% decrease in total hospital admissions and a 52.9% decrease in emergency department visits (figure 1). In addition, there was a 31%–88% decline during lockdown in procedures for treatment of cardiac, cerebrovascular and other vascular conditions.Overall hospital activity (admissions, ED attendances and hypertension medications admissions) between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019. Lines describe can you buy lasix without a prescription the mean hospital activities in 2019–2020 (solid) and 2018–2019 (dotted).

Shading represents 95% CI of the respective hospital activity. The first case of hypertension medications was on 31 January 2020 and lockdown started on 23 March 2020. ED, emergency department." data-icon-position data-hide-link-title="0">Figure 1 Overall hospital activity (admissions, ED attendances and hypertension medications admissions) can you buy lasix without a prescription between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019.

Lines describe the mean hospital activities in 2019–2020 (solid) and 2018–2019 (dotted). Shading represents 95% CI of the respective hospital activity. The first case can you buy lasix without a prescription of hypertension medications was on 31 January 2020 and lockdown started on 23 March 2020.

ED, emergency department.From the other side of the world, Brant and colleagues2 report the number of cardiovascular deaths in the six Brazilian cities with the greatest number of hypertension medications deaths. They conclude. €˜Excess cardiovascular mortality was greater in the less developed cities, possibly can you buy lasix without a prescription associated with healthcare collapse.

Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse’ (figure 2).Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities." data-icon-position data-hide-link-title="0">Figure 2 Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities.In the accompanying editorial, Watkins3 notes that ‘Taken together, these two studies quantify what many readers of this journal have experienced firsthand. The restructuring of hospital services to cope with an influx of hypertension medications cases, combined with social distancing measures, has severely can you buy lasix without a prescription limited access to cardiovascular care, adversely impacting patient outcomes.’ He then goes on to propose policy responses to reduce all-cause death among patients with CVD including deaths due to hypertension medications or to disruptions to healthcare delivery associated with the lasix (figure 3).

His two key messages are. (1) ‘the global and national lasix responses cannot be separated from the cardiovascular health agenda’ and (2) ‘priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasix’.Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified can you buy lasix without a prescription to fit the resource levels and epidemiological contexts of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 3 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts can you buy lasix without a prescription of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Other interesting papers in this issue of Heart include a study by Doris and colleagues4 showing that in adults with aortic stenosis CT quantitation of valve calcification is reproducible and demonstrates a greater rate of change in disease severity, compared with echocardiography. Guzzetti and Clavel5 point out that more precise measures of aortic stenosis (AS) severity will allow smaller sample sizes can you buy lasix without a prescription in clinical trials of potential medical therapies, in addition to providing insights into the pathophysiology of disease progression (figure 4).Model of AS progression.

Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1South Korean PCSK9 inhibitors (NCT03051360). 2EAVaLL.

Early aortic valve lipoprotein(a) lowering (NCT02109614). 3SALTIRE II. Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026).

4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525). 5EvoLVeD.

Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143). 6Early TAVR. Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104).

18F-FDG, 18-fluorodeoxyglucose. 18F-NaF, 18-sodium fluoride. AS, aortic stenosis.

AVC, aortic valve calcification. PET, positron emission tomography. PCSK9, proprotein convertase subtilisin/kexin type 9.

TAVR, transcatheter aortic valve replacement." data-icon-position data-hide-link-title="0">Figure 4 Model of AS progression. Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1South Korean PCSK9 inhibitors (NCT03051360).

2EAVaLL. Early aortic valve lipoprotein(a) lowering (NCT02109614). 3SALTIRE II.

Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026). 4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525).

5EvoLVeD. Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143). 6Early TAVR.

Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose. 18F-NaF, 18-sodium fluoride.

AS, aortic stenosis. AVC, aortic valve calcification. PET, positron emission tomography.

PCSK9, proprotein convertase subtilisin/kexin type 9. TAVR, transcatheter aortic valve replacement.In a study of patients undergoing atrial fibrillation (AF) ablation, Piccini and colleagues6 found that almost 30% experienced recurrent atrial tachycardiac (AT) or AF within 3 months. However, although those without recurrent AT/AF had greater improvement in functional status, overall quality of life was similar in those with and without AT/AF recurrence.

Sridhar and Colbert7 discuss the importance of patient-reported outcomes (PROs), not just ‘hard’ clinical endpoints in clinical trials. €˜As researchers and clinicians, our goals must align with those of the patients and what they value. It is heartening to see that more and more clinical trials in cardiology and electrophysiology are incorporating PROs as important endpoints.

A slow but definite paradigm shift is occurring to incorporate therapies with a focus on improving patients’ lives, not just their hearts.’The Education in Heart article in this issue discusses the diagnosis and management of familial hypercholesterolemia.8 Our Cardiology in Focus article ‘What to do when things go wrong’ provides a thoughtful discussion of the key steps in dealing with medical error.9 The Image Challenge in this issue10 provides a concise review of a sophisticated set of possible diagnoses to consider in a patient with a new murmur and classic echocardiographic images. Be sure to look at our online Image Challenge archive with over 150 image-based multiple choice questions and answers (https://heart.bmj.com/pages/collections/image_challenges/).Global trends in cardiovascular health have reached a worrisome inflection point. Decades of innovation led to a slew of drugs, devices and programmes that translated into reduced mortality from cardiovascular diseases in many countries.

Unfortunately, progress on cardiovascular mortality since 2010 has slowed. In some countries, it has even reversed.1 Compounding the problem, political actions on cardiovascular health have been inadequate, and health systems across many low-income and middle-income countries are woefully under-resourced to scale up basic cardiovascular services. These factors could increase global health inequalities in coming decades.2hypertension medications threatens to derail progress on cardiovascular health even furtherCardiovascular practitioners are now under greater pressure to deliver the same or better care in the context of a lasix.

hypertension medications has hit cardiovascular care particularly hard. WHO surveys recently found that cardiovascular services have been partially or completely disrupted in nearly half of countries with community spread of hypertension medications, raising the chance of increased cardiovascular mortality in these locations.3Two studies published in this issue of Heart shed more light on the specific effects of hypertension medications on health systems in Brazil and the UK. Brant et al looked at cardiovascular mortality in six Brazilian capital cities.4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals.5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand.

The restructuring of hospital services to cope with an influx of hypertension medications cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during hypertension medications.5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home).4 They also found that healthcare system collapse in more socioeconomically deprived states was associated with increased acute coronary syndrome and stroke deaths in these states, independent of the uptick in deaths at home.A comprehensive responseWhat can be done about these disruptions?. The relationship between hypertension medications and cardiovascular health can be separated into two issues that require different responses. First, persons living with cardiovascular diseases have worse outcomes when they acquire hypertension medications.

On the other hand, persons living with cardiovascular disease or major risk factors are also at increased risk of death from cardiovascular mechanisms (eg, thrombotic events or heart failure) when their access to acute care services is interrupted. Health systems, patients and patient-system interactions are implicated in both of these issues.Figure 1 illustrates how an appropriate policy response should consider all of the elements mentioned above, with the overarching goal being to reduce deaths from any cause (hypertension medications or otherwise) among persons living with cardiovascular diseases or major risk factors. Importantly, the actions specified in the figure 1 can be adapted to all populations and countries, regardless of health system resource levels.

With such a framework in mind, practitioners and researchers could then structure their work and advocacy around two key messages.Message 1. The global and national lasix responses cannot be separated from the cardiovascular health agendaCritical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 1 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Outcomes from infectious diseases are usually worse among patients with multimorbidity, and hypertension medications is no different. As cardiovascular practitioners, scientists and advocates, we need to articulate the substantial benefits of lasix mitigation efforts to persons living with cardiovascular diseases or risk factors.

In parallel, accelerated investment in population-level prevention efforts would reduce the future burden of cardiovascular disease on health systems and reduce the number of persons at high risk of complications from future lasixs or outbreaks.In much of the global health community, investments in acute care and in cardiovascular diseases are often perceived to be non-essential—or even anti-equity—and are almost never given serious consideration within health and development programmes. We need to forcefully push back on such short-sighted thinking. Collaborators on the Disease Control Priorities Project recently released guidance for low-income and middle-income and humanitarian settings, including a list of 120 essential health services to protect during the lasix.

On value-for-money grounds, basic cardiovascular disease prevention and care are just as ‘essential’ as immunisation programmes, maternal healthcare and screening and treatment of HIV .6At the same time, locations with advanced cardiovascular care systems need guidance on how to balance the need to treat severe cardiovascular disease against the need to adapt quickly to increased hypertension medications caseloads. Ball et al found that emergency department visits and percutaneous coronary intervention procedure rates in UK hospitals had partially rebounded by the end of May 2020.5 Assuming the top objective is to maximise health, emergency cardiac care and interventional services should be brought back online before phasing in other semi-elective vascular procedures (even if the latter provide substantial revenues to hospitals). Critically, more must be done to encourage patients with acute cardiac or neurological symptoms to seek care even in the face of potential hypertension medications exposure.

Initiatives like the American Heart Association’s ‘Don’t Die of Doubt’ campaign7 should be examined, adapted and disseminated widely to complement supply-side efforts to improve access.Message 2. Priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasixIt is increasingly clear that lasixs and emerging s, driven by globalisation and climate change, will continue to threaten health systems in the coming decades. Cardiovascular research and development priorities must adapt to this emerging reality.

We need new technologies, programmes and care systems that protect what is working during hypertension medications and transform what is not. In addition, the lasix has illuminated—and in many cases magnified—inequalities in cardiovascular health. Cardiovascular research funders should prioritise development of truly ‘global’ public goods that can immediately benefit the health of the world’s poorest as well as vulnerable populations in the global North.2How could the cardiovascular research community make this pivot?.

Table 1 proposes several principles for cardiovascular research and development priorities amid and beyond the hypertension medications lasix. Not every concept in table 1 will be directly applicable to every research initiative, but they could be used by funders as benchmarks for developing or revising their strategies and scoring proposals.View this table:Table 1 Proposed principles to guide cardiovascular research and development prioritiesManagement of acute coronary syndromes exemplifies the need for a research and development pivot. Our ability to reduce case fatality from acute coronary syndromes is based on prompt delivery of interventions or fibrinolysis.

Researchers and planners have worked for years to improve referral and triage systems to increase access to these life-saving technologies. Yet when viewed through the lens of hypertension medications, it is problematic that the cornerstone of acute coronary syndrome management is early access to a referral hospital. We need new technologies, like home-based diagnostics and smartphone-based triage and referral processes, that can circumvent time and distance bottlenecks.

We also need new drugs (available at home) that bridge to interventions or replace them entirely. Such technologies are especially needed in low-income and middle-income countries, where systems are less advanced and timely access is more difficult to achieve (eg, in majority-rural countries).More generally, new technologies should ‘disrupt’ care systems in a way that makes cardiovascular care more patient-centred, community-facing and responsive to population needs. The notion that healthcare by default requires a physical building (separate from one’s home or work) should quickly become antiquated.

The greater use of telemedicine during the lasix is a big step in this direction, but we have yet to hardness the full potential of mobile devices and wearables—technologies that are already widely available and will become ubiquitous in low-income and middle-income countries much more quickly than new clinics or hospitals. Innovators and health planners in resource-limited countries could collaborate to develop ‘leapfrog’ cardiovascular health programmes that do not rely on the inefficient, slow-to-adapt and labour-intensive models used in the global North.The future of cardiovascular health and researchIn the midst of the debate over the future of cardiovascular care, we should not to lose sight of the ‘endgame’.8 In the long term, it would be far better to live in a world where the prevalence of ideal cardiovascular health is high and the lifetime disease risk is low. In such a world, the impact of another lasix on cardiovascular services and patients would be lessened greatly.

Aggressive action is needed to fully implement policies and health services that we know can help achieve this goal in a cost-effective manner. Still, in order to accomplish the endgame, we need better evidence on how to design policy instruments that can minimise dietary risks and barriers to optimal physical activity—the most challenging of the risk factors to tackle.2hypertension medications has left an indelible mark on human health. At the end of 2019, many of us in the cardiovascular health community were probably quite comfortable with business as usual and with incremental improvements in science and clinical practice.

The events of 2020 have raised the stakes, forcing us to become more accepting of disruptions (creative or otherwise). We must use this opportunity to think more boldly..

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CDT WHERE antidote for lasix. Register for events here The Wage and Hour Division will discuss federal laws covering expressing breast milk in the workplace and related workplace accommodations, while state health officials will review the process for becoming a breastfeeding-friendly organization and how doing so can help an employer’s bottom line. The state’s Department of Labor and Industry will discuss provisions of state law regarding pregnant employee accommodations, nursing in the workplace and the state’s Women's Economic Security Act.

The events coincide with the August’s National Breastfeeding Month commemoration and World Breastfeeding Week antidote for lasix from Aug. 1-7, 2021. Learn more about the Wage and Hour Division.BOSTON – Um funcionário que trabalhava para duas empreiteiras de construção em Massachusetts estava dentro de seus direitos quando reclamou com seu supervisor sobre o não recebimento de horas extras e solicitou ser pago como devido.

As duas empresas responderam com uma campanha de retaliação, pressionando o antidote for lasix trabalhador a retirar a reclamação de horas extras. Eles convenceram outros indivíduos a fazer o mesmo, ameaçaram a família do trabalhador, e disseram find more information a outros funcionários que eles poderiam perder seus empregos porque o trabalhador solicitou o pagamento de horas extras legalmente devidas.Uma investigação da Divisão de Salários e Horas do Departamento do Trabalho dos EUA concluiu que as ações dos empregadores violaram as disposições antirretaliação da Lei de Padrões Justos de Trabalho (Fair Labor Standards Act). O gabinete antidote for lasix do procurador do departamento entrou com uma ação contra os réus e obteve uma medida liminar temporária no Tribunal Distrital dos EUA para o Distrito de Massachusetts em outubro de 2020.

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Ameaçar fechar a empresa. Demitir ou ameaçar demitir funcionários ou dizer-los que antidote for lasix perderão seus empregos. €œEste caso deixa claro que o Departamento do Trabalho dos EUA não tolerará retaliações ilegais de qualquer forma, incluindo empregadores ameaçando trabalhadores ou suas famílias por fazerem valer seus direitos sob a Lei de Padrões Justos de Trabalho (Fair Labor Standards Act)”, disse a procuradora regional do trabalho Maia Fisher em Boston.

€œComo o Departamento do Trabalho fez neste caso, litigaremos ativamente para garantir que os empregadores não pratiquem retaliações e que os funcionários estejam protegidos quando reivindicarem seus direitos. Os empregadores devem estar cientes de que retaliar contra trabalhadores pode sair muito caro, porque podemos e iremos buscar indenizações punitivas em casos como este.” “Todo trabalhador deve se sentir livre para reclamar quando o empregador lhe negar o salário pelo qual trabalhou. A lei proíbe retaliação ou intimidação por reclamações desse tipo”, disse o diretor distrital da Divisão de Salários e Horas, Carlos Matos, em Boston.

€œPara evitar esse tipo de violação, encorajamos empregadores e trabalhadores a nos contatar para saber mais sobre seus direitos e responsabilidades. A divisão tem investigadores multilíngues que podem comunicar-se por telefone com pessoas em mais de 200 idiomas e oferece orientação on-line em uma ampla variedade de idiomas.” JKA recorreu à sentença proferida pelo tribunal. Para obter mais informações sobre a FLSA e outras leis aplicadas pela divisão, entre em contato com a linha de ajuda gratuita da agência em 866-4US-WAGE (487-9243).

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E Luiz Mauro Vilela, Jr. Ação Civil n.º 1. 20-cv-11944-RGS Leia o Aviso em Espanhol e Inglês.

MINNEAPOLIS –As more working mothers return to can you buy lasix without a prescription the workplace, federal and state agencies are coming together in August to underscore how accommodations for breastfeeding mothers can aid them in that return, in pursing their careers, and in bolstering the workforce. The U.S. Department of Labor’s Wage and Hour Division in Minnesota is promoting National Breastfeeding Month in August can you buy lasix without a prescription by educating employers and workers about federal guidelines to accommodate breastfeeding in the workplace. For the second year, the division will partner with the Minnesota Department of Labor and Industry and the Minnesota Department of Health to present two educational webinars to discuss required workplace requirements for breastfeeding families under the Fair Labor Standards Act’s Break Time for Nursing Mothers provision. “Protections that help balance work and family life have never been more important than they are today, as we emerge from a lasix and more women return to the workforce,” said Wage and Hour Assistant District Director Kristin Tout, in Minneapolis.

€œWorking with our state partners, we are proud to can you buy lasix without a prescription advance equity in the workplace for working women, who were disproportionately impacted by hypertension medications. These webinars help essential workers understand their rights, and help employers understand their responsibilities. We encourage everyone to attend, to learn, and to help us can you buy lasix without a prescription improve compliance with these crucial requirements.” WHO. U.S. Department of Labor Minnesota Department of Labor and Industry Minnesota Department of Health WHAT.

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CDT WHERE. Register for events here The Wage and Hour Division will discuss federal laws covering expressing breast milk in the workplace and related workplace accommodations, while state health officials will review the process for becoming a breastfeeding-friendly organization and how doing so can help an employer’s bottom line. The state’s Department of Labor and Industry will discuss provisions of state law regarding pregnant employee accommodations, nursing in the workplace and the state’s Women's Economic Security Act. The events coincide with the August’s National Breastfeeding Month commemoration and World Breastfeeding Week from Aug. 1-7, 2021.

Learn more about the Wage and Hour Division.BOSTON – Um funcionário que trabalhava para duas empreiteiras de construção em Massachusetts estava dentro de seus direitos quando reclamou com seu supervisor sobre o não recebimento de horas extras e solicitou ser pago como devido. As duas empresas responderam com uma campanha de retaliação, pressionando o trabalhador a retirar a reclamação de horas extras. Eles convenceram outros indivíduos a fazer o mesmo, ameaçaram a família do trabalhador, e disseram a outros funcionários que eles poderiam perder seus empregos porque o trabalhador solicitou o pagamento de horas extras legalmente devidas.Uma investigação da Divisão de Salários e Horas do Departamento do Trabalho dos EUA concluiu que as ações dos empregadores violaram as disposições antirretaliação da Lei de Padrões Justos de Trabalho (Fair Labor Standards Act). O gabinete do procurador do departamento entrou com uma ação contra os réus e obteve uma medida liminar temporária no Tribunal Distrital dos EUA para o Distrito de Massachusetts em outubro de 2020. Agora, o tribunal emitiu sentenças proibindo permanentemente à JKA Construction Inc.

De Watertown e à Mendes Candido Framers Corp. De Hudson de praticarem retaliações contra os funcionários e ordenou-lhes que paguem ao ex-funcionário um total combinado de US$ 100.000 em danos punitivos. As sentenças proíbem expressamente JKA e Mendes Candido de inibir qualquer funcionário de exercer seus direitos sob a FLSA nas seguintes formas. Assediar ou intimidar qualquer funcionário ou seus familiares. Fazer ameaças de danos aos funcionários e seus familiares.

Ameaçar fechar a empresa. Demitir ou ameaçar demitir funcionários ou dizer-los que perderão seus empregos. €œEste caso deixa claro que o Departamento do Trabalho dos EUA não tolerará retaliações ilegais de qualquer forma, incluindo empregadores ameaçando trabalhadores ou suas famílias por fazerem valer seus direitos sob a Lei de Padrões Justos de Trabalho (Fair Labor Standards Act)”, disse a procuradora regional do trabalho Maia Fisher em Boston. €œComo o Departamento do Trabalho fez neste caso, litigaremos ativamente para garantir que os empregadores não pratiquem retaliações e que os funcionários estejam protegidos quando reivindicarem seus direitos. Os empregadores devem estar cientes de que retaliar contra trabalhadores pode sair muito caro, porque podemos e iremos buscar indenizações punitivas em casos como este.” “Todo trabalhador deve se sentir livre para reclamar quando o empregador lhe negar o salário pelo qual trabalhou.

A lei proíbe retaliação ou intimidação por reclamações desse tipo”, disse o diretor distrital da Divisão de Salários e Horas, Carlos Matos, em Boston. €œPara evitar esse tipo de violação, encorajamos empregadores e trabalhadores a nos contatar para saber mais sobre seus direitos e responsabilidades. A divisão tem investigadores multilíngues que podem comunicar-se por telefone com pessoas em mais de 200 idiomas e oferece orientação on-line em uma ampla variedade de idiomas.” JKA recorreu à sentença proferida pelo tribunal. Para obter mais informações sobre a FLSA e outras leis aplicadas pela divisão, entre em contato com a linha de ajuda gratuita da agência em 866-4US-WAGE (487-9243). Saiba mais sobre a Divisão de Salários e Horas, incluindo uma ferramenta de pesquisa para usar se você achar que pode ter direito a salários cobrados pela divisão.

Secretário do Trabalho vs. JKA Construction Inc., Mendes Candido Framers Corp. E Luiz Mauro Vilela, Jr. Ação Civil n.º 1. 20-cv-11944-RGS Leia o Aviso em Espanhol e Inglês.

What should I tell my health care provider before I take Lasix?

They need to know if you have any of these conditions:

  • abnormal blood electrolytes
  • diarrhea or vomiting
  • gout
  • heart disease
  • kidney disease, small amounts of urine, or difficulty passing urine
  • liver disease
  • an unusual or allergic reaction to furosemide, sulfa drugs, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

How much water to drink when taking lasix

€˜None of us will be safe Going Here until how much water to drink when taking lasix everyone is safe. Global access to hypertension treatments, tests and treatments how much water to drink when taking lasix for everyone who needs them, anywhere, is the only way out’. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for hypertension medications vaccination. The success of a safe and efficacious hypertension medications treatment depends just not only on production and availability but also crucially on uptake.In countries such as the UK where hypertension medications treatment prioritisation and how much water to drink when taking lasix rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite availability of treatment services’)3 is not a single entity.

Reasons vary and there is a continuum from complete acceptance to refusal of all treatments, with treatment hesitancy how much water to drink when taking lasix lying between the two poles. Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the hypertension medications treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply. There are genuine knowledge voids (eg, long-term safety data), which in some cases have been filled with misinformation.7 Recent studies have assessed potential acceptance how much water to drink when taking lasix rates specifically for the hypertension medications treatment. A UK study of more than 5000 adults using a validated scale found 71.7% were willing to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of the collective importance of this decision as well as beliefs about the likelihood of hypertension medications , the efficacy, speed of development and side how much water to drink when taking lasix effects of the treatment.

This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness. As mental health clinicians, we assessed the impact of mental health conditions on hypertension medications treatment hesitancy and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in those with mental health difficulties,10 although it is recognised that this is a high-risk group how much water to drink when taking lasix who should be monitored. People with mental health issues, particularly with severe mental illness (SMI), are at particular risk both for with hypertension medications and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment in those with SMI can be how much water to drink when taking lasix as low as 25%,12 and so, similar to other low uptake groups, focused efforts are needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems.

In the example of the UK, monitoring of treatment coverage of how much water to drink when taking lasix most routine immunisation programmes relies on data extracted from primary care systems. To monitor vulnerable groups, the data need to be specifically recorded how much water to drink when taking lasix. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules. In addition, the how much water to drink when taking lasix extent of a particular inequality varies when it intersects with one or more other factors.

In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive.11 However, how much water to drink when taking lasix treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline absolute risk is so high.15 Therefore, in the context of a hypertension medications treatment programme, even if treatment uptake falls short in some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input. At the moment there is little formal guidance on how to support those with mental health issues to access clear and reliable information, and practical and easy access to vaccination for those how much water to drink when taking lasix who are willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

€˜None of us will be safe until everyone is http://mchtranslations.com/buy-real-viagra-online/ safe can you buy lasix without a prescription. Global access to hypertension treatments, tests and treatments for can you buy lasix without a prescription everyone who needs them, anywhere, is the only way out’. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for hypertension medications vaccination.

The success of a safe and efficacious hypertension medications treatment depends just not can you buy lasix without a prescription only on production and availability but also crucially on uptake.In countries such as the UK where hypertension medications treatment prioritisation and rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite availability of treatment services’)3 is not a single entity. Reasons vary and there is a continuum can you buy lasix without a prescription from complete acceptance to refusal of all treatments, with treatment hesitancy lying between the two poles. Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the hypertension medications treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply.

There are genuine knowledge voids (eg, long-term safety data), which can you buy lasix without a prescription in some cases have been filled with misinformation.7 Recent studies have assessed potential acceptance rates specifically for the hypertension medications treatment. A UK study of more than 5000 adults using a validated scale can you buy lasix without a prescription found 71.7% were willing to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of the collective importance of this decision as well as beliefs about the likelihood of hypertension medications , the efficacy, speed of development and side effects of the treatment. This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness.

As mental health clinicians, we assessed the impact of mental health conditions on hypertension medications treatment hesitancy and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in those with mental health difficulties,10 although it is recognised that this is a high-risk group who should can you buy lasix without a prescription be monitored. People with mental health issues, particularly with severe mental illness (SMI), are at particular risk both for with hypertension medications can you buy lasix without a prescription and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment in those with SMI can be as low as 25%,12 and so, similar to other low uptake groups, focused efforts are needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems.

In the example of the can you buy lasix without a prescription UK, monitoring of treatment coverage of most routine immunisation programmes relies on data extracted from primary care systems. To monitor vulnerable groups, the data need to be specifically recorded can you buy lasix without a prescription. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules.

In addition, the extent of a particular inequality varies when it intersects with one or more other can you buy lasix without a prescription factors. In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive.11 However, treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline absolute risk is so high.15 Therefore, in the context of a can you buy lasix without a prescription hypertension medications treatment programme, even if treatment uptake falls short in some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input.

At the moment there is little formal guidance on how to support those with mental health issues to access clear and reliable information, and practical and easy access to vaccination for those who are can you buy lasix without a prescription willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

Lasix for fluid overload

The PREP Act was enacted on December 30, 2005, as http://interiorsnoop.com/buy-propecia-australia/ Public Law 109-148, Division C, lasix for fluid overload § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C.

247d-6d and 42 lasix for fluid overload U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the lasix and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013, and the hypertension Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, 2020, to expand Covered Countermeasures under the PREP Act.

On January 31, lasix for fluid overload 2020, the former Secretary, Alex M. Azar II, declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the hypertension medications outbreak.

Pursuant to section 319 of the lasix for fluid overload PHS Act, the Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021. On March 10, 2020, former Secretary Azar issued a Declaration under the PREP Act for medical countermeasures against hypertension medications (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the former Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the lasix for fluid overload CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm hypertension medications might otherwise cause.

(85 FR lasix for fluid overload 35100, June 8, 2020). On August 19, the former Secretary amended the declaration to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures. (85 FR 52136, August 24, 2020).

On December 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP lasix for fluid overload Act and the Secretary's Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond. Added an additional category of qualified persons under Section V of the Declaration. Made explicit that the Declaration covers all qualified lasix and epidemic products as defined under the PREP Act.

Added a third method of distribution to provide liability protections for, among other things, private lasix for fluid overload distribution channels. Made explicit that there can be Start Printed Page 41978situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests in having a unified whole-of-nation response to the hypertension medications lasix among federal, state, local, and private-sector entities.

Revised the effective lasix for fluid overload time period of the Declaration. And republished the declaration in full. (85 FR 79190, December 9, 2020).

On February lasix for fluid overload 2, 2021, the Acting Secretary Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 7872, February 2, 2021). On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 9516, February 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and correcting the description of qualified persons added by the February 16, 2021 amendment. (86 FR 10588, February 22, 2021).

On March 11, 2021, the Acting Secretary amended the Declaration to add additional Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration lasix for fluid overload. (86 FR 14462 March 16, 2021). Secretary Xavier Becerra now amends section V of the Declaration to revise subsections (d) and (f) to clarify that qualified pharmacy technicians are Qualified Persons covered by the Declaration, and to expand the scope of authority for qualified pharmacy technicians to administer seasonal influenza treatments to adults within the state where they are authorized to practice and for interns to administer seasonal influenza treatments to adults consistent with other terms and conditions of the Declaration.

Accordingly, subsection V(d) authorizes lasix for fluid overload. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older.

Such State-licensed pharmacists and the State-licensed lasix for fluid overload or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii.

In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi.

The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments. If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), Start Printed Page 41979complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi.

The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate. And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s).

Further, the initial phrase of subsection V(f) is revised to state authorize “Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration. . .

.” Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under the PREP Act has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed.

Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8) By this amendment to the Declaration, the Secretary clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B).

First, the amendment clarifies that qualified pharmacy technicians are authorized to administer Childhood vaccinations and hypertension medications vaccinations that are Covered Countermeasures under section VI of this Declaration. The Department has authorized qualified pharmacy technicians to administer these treatments under section V(a) of the Declaration through Guidance issued by the Assistant Secretary for Health.[] This amendment adds qualified pharmacy technicians to section V(d) of the Declaration, to clarify that these healthcare professionals are authorized subject to the conditions stated in that subsection. In addition, the amendment expands the authorization for qualified pharmacy technicians and interns to administer seasonal influenza treatments under the supervision of a pharmacist to persons aged 19 and older consistent with ACIP recommendations.

The Secretary anticipates that there will be a need for the adult population to receive both hypertension medications and seasonal influenza treatments throughout the 2021-2022 influenza season. Health risks may increase for individuals who contract seasonal influenza concurrently with hypertension medications, thus expanding the scope of authorized vaccinators for seasonal influenza lessens the harm otherwise caused by hypertension medications. While influenza incidence was lower than anticipated last fall and winter, the same cannot be assumed for the 2021-2022 flu season, as states have largely lifted the community mitigation measures previously in place at the height of the hypertension medications lasix.

Seasonal influenza has the potential to inflict significant burden and strain on the U.S. Healthcare system in its own right. And in conjunction with the ongoing hypertension medications lasix, a spike in influenza cases could overwhelm healthcare providers.

Like the vaccination against hypertension medications, the vaccination against influenza requires many people to be vaccinated within a short period of time, potentially creating a surge on the system. Concern also remains regarding the emergence of hypertension variants and their potential to cause disease both among vaccinated and unvaccinated populations. It is yet to be determined if hypertension medications treatment boosters will be recommended.

However, if boosters become necessary, allowing pharmacy interns and technicians to administer both hypertension medications treatments and influenza treatments would allow states maximum flexibility in limiting potential impacts of both illnesses. ACIP also recently voted unanimously in favor of hypertension medications and influenza treatment co-administration.[] Like hypertension medications treatments, influenza treatments are administered as intramuscular (IM) injections, and would require minimal, if any, additional training to administer, and would not place any undue training burden on providers. As qualified persons, these qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration.

Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering hypertension medications treatments or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized hypertension medications diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration.

Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” Start Printed Page 41980specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law. The plain language of the PREP Act makes clear that there is preemption of state law as described above.

Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by hypertension medications as it will enable States to quickly expand the vaccination workforce with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the hypertension medications countermeasure program. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against hypertension medications. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against hypertension medications, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, and as amended on February 2, 2021, and as amended March 11, 2021, is further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below.

All other sections of the Declaration remain in effect as republished at 85 FR 79190 (December 9, 2020). 1. Covered Persons, section V, delete in full and replace with.

V. Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States.

€œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an Emergency, as that term is defined in Section VII of this Declaration; [] (b) Any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act.

(c) Any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older.

Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii.

In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi.

The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments. If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the Start Printed Page 41981recognition and treatment of emergency reactions to treatments.

Vii. The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

X. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi.

The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate. And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s).

(e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice. When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice. Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services.

(f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a hypertension medications vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to. (i) Documentation of completion of the Centers for Disease Control and Prevention hypertension medications (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the hypertension medications treatment(s) to be administered. (g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure.

Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met. The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph.

1. Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. 2.

Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General. 3. Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, Start Printed Page 41982podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered.

Subject to the following requirements. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. Vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii.

The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention hypertension medications treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments. Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the hypertension medications treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments.

V. The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi. The healthcare professionals and students must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.

And vii. The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program.

Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other terms and conditions of the Declaration apply to such covered countermeasures. 2. Effective Time Period, section XII, delete in full and replace with.

Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024. Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024. Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first.

Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect. Or (b) October 1, 2024. Whichever occurs first.

Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to administer seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021.

Azar II, declared a public health http://interiorsnoop.com/buy-propecia-australia/ emergency pursuant to can you buy lasix without a prescription section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the hypertension medications outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021.

On March 10, can you buy lasix without a prescription 2020, former Secretary Azar issued a Declaration under the PREP Act for medical countermeasures against hypertension medications (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the former Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr.

15, 2020) can you buy lasix without a prescription. On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm hypertension medications might otherwise cause. (85 FR 35100, June 8, 2020).

On August can you buy lasix without a prescription 19, the former Secretary amended the declaration to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures. (85 FR 52136, August 24, 2020). On December 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP Act and the Secretary's Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond.

Added an additional category of qualified persons can you buy lasix without a prescription under Section V of the Declaration. Made explicit that the Declaration covers all qualified lasix and epidemic products as defined under the PREP Act. Added a third method of distribution to provide liability protections for, among other things, private distribution channels.

Made explicit that there can be can you buy lasix without a prescription Start Printed Page 41978situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests in having a unified whole-of-nation response to the hypertension medications lasix among federal, state, local, and private-sector entities. Revised the effective time period of the Declaration.

And republished can you buy lasix without a prescription the declaration in full. (85 FR 79190, December 9, 2020). On February 2, 2021, the Acting Secretary Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 7872, February 2, 2021).

On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of Qualified Persons authorized can you buy lasix without a prescription to prescribe, dispense, and administer hypertension medications treatments that are covered countermeasures under the Declaration (86 FR 9516, February 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and correcting the description of qualified persons added by the February 16, 2021 amendment. (86 FR 10588, February 22, 2021). On March 11, 2021, the Acting Secretary amended the Declaration to add additional Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration.

(86 FR can you buy lasix without a prescription 14462 March 16, 2021). Secretary Xavier Becerra now amends section V of the Declaration to revise subsections (d) and (f) to clarify that qualified pharmacy technicians are Qualified Persons covered by the Declaration, and to expand the scope of authority for qualified pharmacy technicians to administer seasonal influenza treatments to adults within the state where they are authorized to practice and for interns to administer seasonal influenza treatments to adults consistent with other terms and conditions of the Declaration. Accordingly, subsection V(d) authorizes.

(d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and can you buy lasix without a prescription the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii.

In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V.

In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Vii.

The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Viii.

The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), Start Printed Page 41979complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Further, the initial phrase of subsection V(f) is revised to state authorize “Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration.

. . .” Description of This Amendment by Section Section V.

Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under the PREP Act has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act.

42 U.S.C. 247d-6d(i)(8) By this amendment to the Declaration, the Secretary clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B). First, the amendment clarifies that qualified pharmacy technicians are authorized to administer Childhood vaccinations and hypertension medications vaccinations that are Covered Countermeasures under section VI of this Declaration.

The Department has authorized qualified pharmacy technicians to administer these treatments under section V(a) of the Declaration through Guidance issued by the Assistant Secretary for Health.[] This amendment adds qualified pharmacy technicians to section V(d) of the Declaration, to clarify that these healthcare professionals are authorized subject to the conditions stated in that subsection. In addition, the amendment expands the authorization for qualified pharmacy technicians and interns to administer seasonal influenza treatments under the supervision of a pharmacist to persons aged 19 and older consistent with ACIP recommendations. The Secretary anticipates that there will be a need for the adult population to receive both hypertension medications and seasonal influenza treatments throughout the 2021-2022 influenza season.

Health risks may increase for individuals who contract seasonal influenza concurrently with hypertension medications, thus expanding the scope of authorized vaccinators for seasonal influenza lessens the harm otherwise caused by hypertension medications. While influenza incidence was lower than anticipated last fall and winter, the same cannot be assumed for the 2021-2022 flu season, as states have largely lifted the community mitigation measures previously in place at the height of the hypertension medications lasix. Seasonal influenza has the potential to inflict significant burden and strain on the U.S.

Healthcare system in its own right. And in conjunction with the ongoing hypertension medications lasix, a spike in influenza cases could overwhelm healthcare providers. Like the vaccination against hypertension medications, the vaccination against influenza requires many people to be vaccinated within a short period of time, potentially creating a surge on the system.

Concern also remains regarding the emergence of hypertension variants and their potential to cause disease both among vaccinated and unvaccinated populations. It is yet to be determined if hypertension medications treatment boosters will be recommended. However, if boosters become necessary, allowing pharmacy interns and technicians to administer both hypertension medications treatments and influenza treatments would allow states maximum flexibility in limiting potential impacts of both illnesses.

ACIP also recently voted unanimously in favor of hypertension medications and influenza treatment co-administration.[] Like hypertension medications treatments, influenza treatments are administered as intramuscular (IM) injections, and would require minimal, if any, additional training to administer, and would not place any undue training burden on providers. As qualified persons, these qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering hypertension medications treatments or other Covered Countermeasures, such law is preempted.

On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized hypertension medications diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” Start Printed Page 41980specified in this declaration from administering a covered countermeasure is likewise preempted.

In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer covered countermeasures within its jurisdiction under State law. The plain language of the PREP Act makes clear that there is preemption of state law as described above. Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by hypertension medications as it will enable States to quickly expand the vaccination workforce with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the hypertension medications countermeasure program.

Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against hypertension medications. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against hypertension medications, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, and as amended on February 2, 2021, and as amended March 11, 2021, is further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as republished at 85 FR 79190 (December 9, 2020).

1. Covered Persons, section V, delete in full and replace with. V.

Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. €œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required.

In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an Emergency, as that term is defined in Section VII of this Declaration; [] (b) Any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) Any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act.

(d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed hypertension medications -19 treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii.

In the case of a hypertension medications treatment, the vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule.

Iv. In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V.

In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE) to order and administer treatments. Such a training program must include hands on injection technique, clinical evaluation of indications and contraindications of treatments, and the Start Printed Page 41981recognition and treatment of emergency reactions to treatments. Vii.

The licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. Viii.

The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. Xi. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). (e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice.

When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice. Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services. (f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a hypertension medications vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to.

(i) Documentation of completion of the Centers for Disease Control and Prevention hypertension medications (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the hypertension medications treatment(s) to be administered. (g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure. Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met.

The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph. 1.

Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. 2. Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General.

3. Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, Start Printed Page 41982podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers hypertension medications treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a hypertension medications vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the hypertension medications treatment covered countermeasure is administered. Subject to the following requirements.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii.

Vaccination must be ordered and administered according to ACIP's hypertension medications treatment recommendation(s). Iii. The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention hypertension medications treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments.

Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the hypertension medications treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering hypertension medications treatments. V.

The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi. The healthcare professionals and students must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. And vii.

The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) hypertension medications vaccination provider agreement and any other federal requirements that apply to the administration of hypertension medications treatment(s). Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures.

2. Effective Time Period, section XII, delete in full and replace with. Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024.

Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024. Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first. Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect.

Or (b) October 1, 2024. Whichever occurs first. Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to administer seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021.

Liability protections for Qualified Persons under section V(f) of the Declaration begin on February 2, 2021, and last through October 1, 2024. Liability protections for Qualified Persons under section V(g) of the Declaration begin on February 16, 2021, and last through October 1, 2024. Liability protections for Qualified Persons who are physicians, advanced practice registered nurses, registered nurses, or practical nurses under section V(h) of the Declaration begins on February 2, 2021 and last through October 1, 2024, with additional conditions effective as of March 11, 2021and liability protections for all other Qualified persons under section V(h) begins on March 11, 2021 and last through October 1, 2024.