Health providers: medical chaperones.

The bill was assigned Chapter 442 and the Governor's approval date of October 7, 2025 was added, replacing the blank signature block from the enrolled version.

Page headers changed from 'AB 849' to 'Ch. 442' and page numbers shifted from 92 to 91, reflecting the new pagination of the chaptered document.

The constitutional article reference in Section 4 was reformatted from 'Article XIIIB' to 'Article XIII B' (same article, different spacing convention).

New Section 1234.1 extends medical chaperone requirements to clinics (as defined in Health and Safety Code Section 1200), which were not covered in the prior version.

Section 1264.1 now specifically applies to general acute care hospitals (as defined in Section 1250) rather than using the broader 'provider' definition from Section 127500.2, making the hospital coverage more precise.

New Section 124441 extends requirements to providers with the meaning of Section 127500.2 that are NOT licensed by the State Department of Public Health and not owned by DOCR, capturing independent or non-licensed sonography practices.

Senator Rubio is added as a coauthor, indicating Senate sponsorship of the expanded version.

The chaperone's role is changed from 'observe' to 'assist or observe' throughout all three sections, broadening what a chaperone may do during a sensitive examination.

New paragraph (b)(4) in all three sections requires that if a medical chaperone is unavailable at the time of the sensitive examination, the provider must coordinate with the patient to find an acceptable alternative, which may include waiting without undue delay for a chaperone to become available.

Electronic transmission notice may now be sent 'prior to or during the visit' rather than only 'prior to the visit,' giving providers more flexibility in timing.

The definition of 'sensitive examination' for groin-area ultrasounds is broadened: the prior version limited it to DVT diagnosis ('lower extremities or groin for the purposes of diagnosing a deep vein thrombosis'), while the new version covers any ultrasound of the 'pubic or groin region.'

In all three sections (1234.1, 1264.1, and 124441), the provision about what to do when a medical chaperone is unavailable was moved from subsection (b)(4) to subsection (c)(3). This reorganizes the bill so that operational provisions about providing and documenting chaperones are grouped together in subsection (c), while subsection (b) focuses on notice requirements.

Drafting artifacts were cleaned up, including removal of a duplicate word ('visit. visit' changed to 'visit') in the notice provision and removal of amendment markup remnants ('If Except as provided' cleaned to 'Except as provided').

Standard enrolled bill formatting changes: removal of all prior amendment dates and coauthor information, addition of Assembly passage date (September 12, 2025) and Senate passage date (September 11, 2025), and addition of the Governor's approval line.

In all three sections (1234.1 for clinics, 1264.1 for hospitals, and 124441 for other providers), the hard copy notice option was expanded to allow the document to be provided 'prior to a visit in a separate single document,' not just in person at a visit. This gives providers more flexibility in how they deliver chaperone availability notices.

A new paragraph (c)(3) was added in all three sections creating an exception to the mandatory chaperone requirement. When a medical chaperone is unavailable at the time of the sensitive examination, the provider must coordinate with the patient to find an acceptable alternative, which may include waiting without undue delay for a chaperone to become available. The existing chaperone provision in (c)(2) was modified to reference this new exception.

Minor formatting corrections throughout: added 'and' before the last section number in the bill title, removed a redundant 'SECTION 1.' line, and adjusted page numbering from 94 to 93.

The term 'pelvis' was removed from the list of body areas that constitute a sensitive examination. The remaining covered areas are genitalia, breast, and rectum.

The phrase 'pubic or groin region' was added to the deep vein thrombosis diagnostic exception, expanding what is considered a sensitive examination when performed for DVT diagnosis purposes.

The explicit statement that 'a patient reserves the right to decline the inclusion of a medical chaperone during the sensitive examination' was removed. The provider's right to decline performing without a chaperone remains, but the patient's right to refuse one is no longer stated in the bill text.

The notice provision language was cleaned up from the awkward 'shall include either of the following: be provided in any of the following methods' to simply 'shall be provided in any of the following methods.'

The medical chaperone definition was corrected from 'assists and or observes' to 'assists or observes,' removing an erroneous conjunction.

Medical chaperones are no longer automatically present during sensitive examinations. They are now made available only upon patient request, shifting from a mandatory presence model to an opt-in model.

Notice requirement changed from requiring both a hard copy and electronic transmission to requiring either a hard copy or an electronic transmission, reducing the burden on providers.

Training requirements are restructured: instead of training all clinical and nonclinical hospital staff to identify nonstandard behavior, providers must now educate sonographers and staff who may serve as chaperones on observational techniques, draping, neutrality, and reporting procedures.

If a patient requests a medical chaperone, the provider must document the chaperone's presence in the patient's health record.

Responsibility shifts from licensed health facilities to individual providers (defined by reference to Health and Safety Code Section 127500.2), broadening which entities are covered while changing the unit of accountability.

An emergency services exception is added: when performing a sensitive examination on a patient receiving emergency care, the provider must inform the patient that a chaperone is available upon request only when feasible.

The definition of sensitive examination is narrowed from any examination that requires ultrasound performed by a sonographer to specifically an ultrasound examination performed by a sonographer of the pelvis, genitalia, breast, or rectum.

Providers now have the right to decline performing a sensitive examination if the patient does not request a chaperone but the provider determines one must be present for any reason.

A specific operative date of January 1, 2027 is added, giving providers and facilities time to comply before requirements take effect.

The obligation to provide chaperone notice and training shifted from 'licensed health facility' to 'provider' as defined in Section 127500.2, expanding applicability beyond licensed facilities to a broader class of providers.

The fiscal note changed from 'By creating new requirements for health facilities, providers' to 'By creating new requirements for providers,' reflecting the narrowed and clarified scope of obligated entities.

A new exclusion was added: 'provider' does not include any facility owned or operated by the Department of Corrections and Rehabilitation, exempting prison and jail medical settings from the chaperone requirements.

The definition of 'medical chaperone' changed from 'a trained medical employee of a provider' to 'a trained employee of a provider,' removing the requirement that the chaperone be a medical employee and allowing non-medical staff to serve in that role.

Training requirements were restructured: the old version required health facilities to provide general chaperone training and prepare a 'medical chaperone competency report outlining chaperone assignment and procedure.' The new version requires providers to educate staff on specific topics (observational and intervention techniques, draping, neutrality, and reporting inappropriate behaviors) but removes the competency report requirement.

The notice language changed from 'a medical chaperone will be provided' to 'a medical chaperone will be made available upon a patient's request,' shifting from an affirmative provision obligation to an availability standard.

The definition of 'sensitive examination' now includes ultrasound examinations of the lower extremities or groin performed to diagnose deep vein thrombosis, expanding which exams require chaperone availability notice.

The definition of 'sonographer' was narrowed to require that the person be a sonography technician whose primary duties consist of performing diagnostic medical ultrasounds, rather than any nonphysician qualified to perform them.

The definition of 'medical chaperone' was changed from 'assists and observes' to 'assists and or observes,' clarifying that a chaperone need not perform both functions simultaneously.

A new notice method (C) allows providers to inform patients verbally about chaperone availability, either prior to or in person at a visit, provided the offer is documented in the patient's health record.

If a patient requests a medical chaperone and any portion of an ultrasound examination is a sensitive examination, the provider must now provide a chaperone for the entirety of the ultrasound exam, not just the sensitive portion.