Texas Occupations Code 157.0511 requires physicians to register with the TMB if the physicians delegate prescriptive authority to PAs or APNs.
Texas Occupations Code 157.0512 requires a prescriptive authority agreement be in place between a physician and a PA or APN that has been delegated prescriptive authority.
Eligibility requirements for physicians and physician assistants:
- Full, active, and unrestricted licenses are required for online registration.
- You are not eligible to register online if:
- Your license is under a current board order, or if you have notified the TMB that you are not actively practicing medicine, or
- You hold a temporary physician, temporary PA, or Faculty Temporary License.
- You are not eligible to delegate prescriptive authority if:
- You are a physician licensed under Voluntary Charity Care Status, or
- You hold a Telemedicine, Public Health or Conceded Eminence license.
If you are eligible to delegate prescriptive authority and you are not eligible to register online, please contact the Registration Department for a hard copy supervision/delegation form.
Eligibility requirements for advanced practice nurses:
- A full, active, and unrestricted Texas nursing license is required for online registration (this includes licenses that are recognized by reciprocity).
- If your Texas nursing license cannot be validated for prescriptive delegation through the Texas Board of Nursing, you are not eligible to use the Supervision and Prescriptive Delegation Registration System.
Use the Online Supervision and Prescriptive Delegation Registration System to register prescriptive authority AND to file the notice of intent to practice/supervise as required of PAs and physicians. Hard copy supervision and delegation forms are no longer accepted (except as required).
Review the eligibility requirements for system usage then click on the link above to use the system.
Supervision/delegation approval or termination changes should be updated in our system within 30 days. Please note that for any current or future investigations, updates submitted more than 30 days after a change does not affect any liability you may have incurred for not properly registering supervision or delegation information.
The Supervision and Prescriptive Delegation Registration System - Step by Step Instructions will assist you with the process once you have entered the system.
Within this system, the following definitions apply:
- Controlled Substances - medications that require prescriptions and are on the list of scheduled drugs
- Dangerous Drugs - medications that require prescriptions and ARE NOT on the list of scheduled drugs
For a current list of scheduled drugs (controlled substances): Diversion Control Division | Controlled Substance Schedules
For more information, please contact the Registration Department.
Out of state addresses - not able to register delegation online
At this time, the Online Supervision and Prescriptive Delegation Registration system is not set up to accept delegation locations outside of Texas.
Any physician, PA or APRN who does not have a TX practice address and needs to register prescriptive delegation, please contact the Registration Department.
A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement.
Note that if a licensee’s authority to supervise, delegate, or prescribe devices is limited under a board order, the licensee may enter into a prescriptive authority agreement and practice under the agreement only to the extent permitted by the board order.
Prior to signing a prescriptive authority agreement, a licensee must disclose to the other party/parties to the prescriptive authority agreement if they have been disciplined in the past. This includes disciplinary action taken by licensing boards in other states. Once you are a party to a prescriptive authority agreement, you are required to immediately notify the other party/parties to the agreement if you receive notice that you are the subject of an investigation.
For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:
- Be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;
- State the name, address, and all professional license numbers of the parties to the agreement;
- State the nature of the practice, practice locations, or practice settings;
- Identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;
- Provide a general plan for addressing consultation and referral;
- Provide a plan for addressing patient emergencies;
- State the general process for communication and the sharing of information related to the care and treatment of patients;
- If alternate physician supervision is to be utilized, designate one or more alternate physicians; and
- Describe a prescriptive authority quality assurance and improvement plan and how it will be implemented. The plan must require chart reviews and periodic meetings.
For a prescriptive authority agreement executed on or after September 1, 2019, periodic meetings must at a minimum:
- Involve discussion of patient care improvement;
- Include the sharing of information relating to patient treatment and care, needed changes in patient care plans, and issues relating to referrals;
- Be documented; and
- Take place at least once a month.
No. Periodic meetings are required, regardless of the distance between or locations at which the physician and delegate(s) practice.
It depends upon when the agreement was executed. Note that there have been several changes to the law affecting this area in recent legislative sessions. To understand how the law might apply to your specific agreement, you may want to seek the advice of private legal counsel.
For agreements entered into on or after September 1, 2019, face-to-face meetings are no longer strictly required, and the manner in which the meetings may be conducted is to be determined by the parties to the agreement. This may include requiring participants’ physical presence in the same room, or remote methods, including meeting by telephone or video-conferencing.
It depends upon when the agreement was executed. For prescriptive authority agreements entered into prior to September 1, 2019, factors such as the type of delegate licensure and amount of time spent practicing under an agreement determined the required frequency and manner of meetings. If your agreement was entered into prior to September 1, 2019, you may want to seek the advice of private legal counsel to better understand the law’s requirements.
For prescriptive authority agreements entered on or after September 1, 2019, the law changed so that all prescriptive authority agreements must be conducted on at least a monthly basis, no matter the length of time that the physicians have been practicing with the delegates under the agreement.
Yes, as agreed to by the parties to the prescriptive authority agreement. You may meet more frequently than required by law. You may not meet less frequently than what is required by law.
The law does not provide a specific number or percentage of charts that must be reviewed. Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement. The number may vary from one practice setting to another. Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this determination. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the number or percentage of charts reviewed may be an important factor in determining the quality of the physician’s supervision.
The prescriptive authority agreement designates who may serve as an alternate physician if alternate physician supervision will be utilized. If an alternate physician(s) will participate in the quality assurance and improvement meetings with the APRN or PA, this information must be included in the prescriptive authority agreement.
APRNs and PAs are required to have delegated authority from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authority agreement. The prescriptive authority agreement need not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however.
Yes, if you are a physician or a physician assistant.
Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work for them. If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.
PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement. They are also required to notify the Board within 30 days of any change to the scope of the delegation.
APRNs should look to guidance provided by the Texas Board of Nursing for how to register their delegating physicians, as the Medical Board does not have licensing authority for nurses.
Effective January 1, 2021, Texas Health and Safety Code, §§481.0755 requires that prescriptions for controlled substances to be issued electronically, except in limited circumstances, or unless a waiver has been granted by the appropriate agency.
A prescription for a controlled substance is not required to be issued electronically and may be issued in writing if the prescription is issued:
- By a veterinarian;
- In circumstances in which electronic prescribing is not available due to temporary technological or electronic failure, as prescribed by board rule;
- By a practitioner to be dispensed by a pharmacy located outside this state, as prescribed by board rule;
- When the prescriber and dispenser are in the same location or under the same license;
- In circumstances in which necessary elements are not supported by the most recently implemented national data standard that facilitates electronic prescribing;
- For a drug for which the United States Food and Drug Administration requires additional information in the prescription that is not possible with electronic prescribing;
- For a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific prescription;
- For a drug under a research protocol;
- By a practitioner who has received a waiver from the requirement to use electronic prescribing;
- Under circumstances in which the practitioner has the present ability to submit an electronic prescription but reasonably determines that it would be impractical for the patient to obtain the drugs prescribed under the electronic prescription in a timely manner and that a delay would adversely impact the patient's medical condition; or
- Before January 1, 2021.
A physician may apply for a waiver from the electronic prescribing requirement by:
- Submitting a waiver request to the TMB and providing required information, and
- Demonstrating circumstances necessitating a waiver from the requirement, including
- Economic hardship, including:
- Any special situational factors affecting either the cost of compliance or ability to comply;
- The likely impact of compliance on profitability or viability; and
- The availability of measures that would mitigate the economic impact of compliance;
- Technological limitations not reasonably within the control of the physician; or
- Other exceptional circumstances.
- Economic hardship, including:
Request a waiver
The Electronic Prescribing Waiver form is available for submission through your MyTMB account. Once you sign in, you can click on the e-prescribing waiver icon. This will take you to the online waiver application. Verification of an approved waiver will be displayed on the physician profile once granted.
Once approved, waivers will be issued for a period of one year.
Physicians may apply for a subsequent waiver no more than 30 days before an active waiver expires. There is currently no limit to the number of waivers that may be requested.
Please email the Registration Department if you have any questions or need assistance.
At this time, all you must do is fill out the waiver application. No additional information is currently required.
Currently, each individual physician who needs a waiver will have to apply for their own individual waiver. Although this may change in the future, TMB is currently unable to track waivers by group.
No. If you are granted a waiver, it applies to all your Texas practice locations.
No, TMB is not currently notifying prescribers when their waiver expires. This may change in the future.
If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing.
The Texas Prescription Monitoring Program (PMP) is used to verify a practitioner’s own records and prescribing history as well as inquiring about patients. In addition, the program may be used to generate and disseminate information regarding prescription trends.
Effective September 1, 2019, Texas Health and Safety Code, §§481.076 requires prescribers to check a patient’s PMP history before prescribing opioids, benzodiazepines, barbiturates, and carisoprodol with some exceptions.
For patients with the following documented conditions, a PMP check is not required:
- A documented cancer diagnosis, sickle cell disease, the patient is receiving care through a licensed hospice provider, or
- If the prescriber makes and documents a good faith attempt to comply but is unable to access the PMP because of circumstances outside the control of the prescriber.
In addition, a PMP check is not required:
- Before or during an inpatient stay, such as a hospital admission, or
- During an outpatient encounter in settings such as an emergency department or ambulatory surgical center visit.
- See Texas PMP Frequently Asked Questions (FAQs) below
See the Pharmacy Board website for more information about the PMP.
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient (often referred to as a refill), then this would be considered a new prescription and would require a PMP check.
Yes. Each time the patient’s PMP history is accessed, the physician or advanced practice provider must ensure that the review is documented in the patient’s medical record.
Yes. The provider may maintain a copy of the PMP history report in the patient’s medical record. There is no specific method required for documenting that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed.
As with all medical records documentation, the notation must be contemporaneous, legible and provide complete information. In this case, complete information would include the date of the review and the identity of the provider who reviewed the information.
A physician, their delegated midlevel provider, or any other qualified and licensed individual delegated authority to check the PMP may do so on behalf of the prescriber. Ultimately though, it is the prescriber’s responsibility to ensure that the PMP has been checked and that they have reviewed and taken into account any relevant information prior to issuing a prescription.
The TMB cannot tell providers how to use the information they obtain through the PMP check. Providers should follow the standard of care and utilize the information they gain to make educated and informed prescribing decisions.
No. You do not have to obtain patient consent. A PMP check is allowed for anyone with whom the provider has or is in the process of forming a patient/provider relationship.
However please be aware that the privacy protections of HIPAA and similar laws that protect patients’ private health information also apply to information in the PMP database. Accessing the PMP information for someone with whom you do not have patient/provider relationship would be a violation of that patient’s privacy rights. This applies to friends and family members as well as colleagues and public figures.
There is nothing that discusses how far ahead of time the PMP check can be undertaken, however the reason for the requirement is to ensure that prescribers have as much information as possible in order to make informed decisions about prescribing certain controlled substances. If the PMP check is completed too far ahead of time, then there may be new information in the PMP that the prescriber is not considering.
The PMP is updated on a 24-hour basis and therefore contains information accurate up to 24 hours prior to completion of the check.
Yes. A patient, the patient’s parent or legal guardian if the patient is a minor, or the patient’s legal guardian if the patient is an incapacitated person, may receive a copy of the patient’s PMP record, including a list of who has accessed that record.
For more information on how to submit a request, please review the Pharmacy Board’s Patient Access
Physicians and Physician Assistants (PAs) who prescribe or will be prescribing controlled substances in the State of Texas need to be aware of changes to the laws regarding prescribing and ordering these drugs.
Prescription Pad Orders -
For information on official prescription forms, and ordering information, visit the Texas State Board of Pharmacy website.
Texas Controlled Substances Registration Numbers for Physicians and PAs
Under Senate Bill 195 (2015), the requirement for controlled substances registration (CSR) with the Texas Department of Public Safety (DPS) was eliminated on September 1, 2016. DPS has stopped accepting applications for the Texas Controlled Substances Registration under Chapter 481.061 of the Health and Safety Code.
Physicians and PAs will continue to be required to hold registration from the U.S. Drug Enforcement Administration in order to prescribe controlled substances and to register prescriptive delegation for Physician Assistants and Advanced Practice Nurses with the Texas Medical Board.
Physician Assistants with Temporary Licenses pending Medical Board approval will still be required to file a Prescriptive Delegation Form with the Registrations Department of the Medical Board. To request a form, please email the Registration Department. The DEA will verify temporary licenses with assigned delegation for registration of a DEA CSR directly with board staff.
Yes, the physician’s name, address and telephone number are required to be included on the prescription drug order. If the prescription is for a controlled substance, the physician’s DEA number is also required to be included on the prescription.
The answer to the question depends on the practice setting. In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations. In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).
No, the waiver process no longer exists. A physician may only delegate prescriptive authority to more than seven full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations. In all other settings and practice scenarios, the 1:7 FTE ratios applies.
There is no limit to the number of physicians who may delegate prescriptive authority to an APRN or PA provided all requirements for such delegation are met.
Texas is one of just a few states that use the term “dangerous drugs.” The Dangerous Drug Act defines a dangerous drug as a device or drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481, Health and Safety Code (Texas Controlled Substances Act). The term includes a device or drug that bears, or is required to bear, the legend: “Caution: federal law prohibits dispensing without prescription” or “Rx only” or another legend that complies with federal law. Many other states use the term “legend drugs.”
Yes. SB 406 clarified that it is necessary to have prescriptive authority to order these devices. In the past, it was not clear to DME suppliers that APRNs and PAs had this authority. The changes to the law as a result of the passage of SB 406 clearly indicate that APRNs and PAs may order or prescribe this equipment provided all requirements for delegation of prescriptive authority are met.
Yes. You are required to provide a copy of the prescriptive authority agreement to the board that requested it within three business days. Each licensing board has the authority to request this information. Failure to provide the requested information could result in disciplinary action against the professional license.
A medication order is an order for administration of a drug or device to a patient in a hospital for administration while the patient is in the hospital or for emergency use on the patient’s release from the hospital, as defined by §551.003, Occupations Code and §481.002, Health and Safety Code. A prescription is an order to dispense a drug or device to a patient for self-administration as defined by §551.003, Occupations Code.
The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision.
All prescriptive delegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.
A physician may delegate prescriptive authority via facility based protocol at no more than one licensed hospital or no more than two long term care facilities.
In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.
In a long term care facility based practice, delegation is by the medical director.
APRNs or PAs may prescribe schedule II drugs in the following situations:
- in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
- has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
- is receiving services in the emergency department of the hospital; or
- as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
No. A free standing emergency department is not located within the hospital and does not qualify as an eligible site for delegation of schedule II authority. The physician may only delegate authority to prescribe controlled substances in schedules III through V in this setting. Authority to prescribe dangerous drugs, nonprescription drugs and devices may be delegated in any setting.
APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.