Chapter IV, pp. 32 & 33 – Physician Direction of MH Clinics: The last paragraph on page 32 indicates that there must be direct personal supervision of a physician present whereas the second paragraph on p. 33 indicates that the physician does not have to be on the premises. These two paragraphs needs to be reconciled.  However, if page 32 stands then CMCSB will be faced with reducing and/or eliminating our clinic services due to only having a part-time psychiatrist and full time Nurse Practitioners.  This would have a major adverse effect on the individuals we serve.  Plus the Virginia General Assembly increased the scope of practice for Nurse Practitioners this year and I recommend that these regulations reflect that so we (CMCSB) can continue providing our current level of clinic services.