No. The TMB no longer checks for compliance with Texas Higher Education Coordinating Board (THECB) requirements at the PIT permit application level. However, THECB requirements must be met when applying for a physician license.

Personal statements can be sent by e-mail, fax, regular or overnight mail. Documents and third party information can be sent by regular or overnight mail, or fax, if the documents are less than 10 pages.

• E-mail to pit.applications@tmb.state.tx.us.

Fax to (888) 550-7516 Attn: PIT Permits

• Overnight and Regular mail - We recommend using one of the private overnight delivery services that allow tracking to submit all required items. These services require delivery to a physical address and a phone number. Delivery by a private overnight service to our physical address usually allows you to obtain immediate online confirmation of delivery from the carrier.

Items mailed through the US Postal Service (regular, certified, express, or overnight), must be addressed to our mailing address, or they will be returned to the sender. A vendor signs for and delivers these items to our agency. Even if a tracking mechanism is used, the signature confirming receipt of items delivered to the mailing address will be that of a vendor employee, making confirmation of delivery more difficult.

Delivery Physical Address and Phone

• Texas Medical Board, 1801 Congress Avenue, Suite 9-200, Austin, TX 78701
Phone – (512) 305-7030

Mailing address

• Texas Medical Board, P.O. Box 2029, Austin, TX 78768

Be sure to make at least two copies of the Receipt page when you complete your online application. The amount you paid will be reflected on the receipt. You can keep one copy for your records and use the other copy to request reimbursement from your residency program or medical school.

Yes. They must register with the TMB for bulk payment processing. Your program will receive a third party identification number which they should make available to you, if they wish to pay your application fee. On the payment page of the online application, select "Pay by Third Party Payment". Enter the third party identification number you were given in the "Third Party ID" field. Note: This number should not be confused with the TMB personal identification number, or your ACGME, AOA, or TMB Program Identification number. Be sure to enter a valid email address. You will receive an email if the application fee has not been paid within seven days. Your application will not be submitted to the Texas Medical Board until the fee has been paid. Entering an incorrect third party identification number will mean that your program, or other third party payer, is prevented from paying for your application, and you will have to submit a new application with the correct third party identification number or choose another form of payment.

No. Our Board Rules at this time specify that you have to have graduated from a CAAHEP accredited Surgical Assistant program.

No, but you can use any experience working as a surgical assistant within the last three years towards the requirement for 2000 hours.

No. If you are unable to obtain a certified copy of your transcript directly from the school you will have to prove that you have made "exhaustive attempts" to obtain it. Your file will have to be reviewed by our Executive Review Group before a determination of acceptability can be made. Please consult your licensing analyst AFTER you submit your application for details on proving "exhaustive attempts."

No. The Texas Occupations Code concerning Surgical Assistants does not require that you have a license to practice as a Surgical Assistant so long as you are supervised by a physician. Please review the Occupations Code Section 206.002 for full details on applicability. Also: We are aware that many entities require that a Surgical Assistant working for them be licensed in Texas. Please be aware that this is not required by the State of Texas but instead may be the result of billing or institutional policies. Whatever the reason for applying for a license at this time, your application will be given due attention upon submission of all required documents.

If you are not able to locate your username and password, please submit a written request on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information.You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018

Please submit a written request for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018

All entities in which a physician assistant has an ownership interest, in which the physician assistant performs a professional service that falls within the scope of physician assistant practice, must register annually, regardless of percent of ownership or when they were formed.

The annual reporting for physician assistant or jointly owned entities is April 30th of each year.

For entities formed on or after June 17, 2011 there is a reporting fee of $18.00. There is no reporting fee for entities formed before June 17, 2011.

Yes. All entities in which a physician assistant has an ownership interest, in which the physician assistant performs a professional service that falls within the scope of physician assistant practice, must register annually, regardless of percent of ownership or when they were formed.

The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:

1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.

It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”

Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.

One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.

As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.

Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.

While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.

Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.