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Search Term: 'affidavit for medical records form'

LMRT Exam FAQs

“... has completed the education components necessary for qualifying the individual to pass the appropriate limited scope examination, signed by the program director or registrar; or        a copy of a certificate of completion or official transcript showing completion ... ”

This content is located on the following page(s): Renewal - LMRT Exams

Gold Designated Practice Status

“... nd rule as a publicly or privately-owned facility for which a majority of patients are issued, on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.   A pain management clinic may not operate in Texas without obtaining a cert ... ”

This content is located on the following page(s): Gold Designated Practice

Continuing ED Tracking

“... uing Education Tracking with CE Broker. The Texas Medical Board has partnered with CE Broker, an online continuing education compliance platform, to provide our licensees with an additional tool to help them more easily find, track, and report continuing education coursework. All PHYSICIAN, RESPIRAT ... ”

This content is located on the following page(s): Continuing ED Tracking

Title: Press Release August 14, 2018

Description: TMB restricts Deer Park physician (Brown)

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE August 14 , 2018 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB restricts Deer Park physician On August 13 , 2018 , a disciplinary panel of the Te ...

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Title: COMPLAINT FORM

Description: Texas Medical Board - Complaint Form: The Board investigates complaints against physicians, physician assistants, acupuncturists, surgical assistants, respiratory care practitioners, medical radiologic technologists, medical physicists, and perfusionists. If you wish to complain to the Board, please ...

Document: FORM TMB - EN - 001 - A Licensee Complaint Form Page 1 of 5 Texas Medical Board Licensee Complaint Form NOTICE IF IT IS DETERMINED THE INDIVIDUAL OR PRACTICE IDENTIFIED IN YOUR COMPLAINT IS NOT REGULATED BY THE TEXAS MEDICAL BOARD THAT INFORMATION, INCLUDING YOUR IDENTITY, MUST B ...

Click to view in browser - TMB-EN-001-A_Licensee Complaint Form.pdf
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Title: TMB Consumer Brochure

Description: TMB Consumer Brochure (2022)

Document: What is the Texas Medical Board? The Texas Medical Board consists of 19 members: nine MDs, three DOs and seven public members. The Texas Physician Assistant Board is made up of nine members: three physicians, three physician assistants and three public members. The Texas State Board of Acupunctu ...

Click to view in browser - TMBConsumerBrochure.pdf
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Title: Pre-Licensure Criminal History Evaluation Request Form

Description: Pre-Licensure Criminal History Evaluation Request 

Document: ... icensure Criminal History E valuation Request Form 01. 2025 Staple Check Here APPLICATION TO REQUEST PRE - LICENSURE CRIMINAL HISTORY EVALUATION Mailing Address: P . O . Box 2029, Austin, TX 78768 - 2029 o Submit PRIOR to applying for licensure. Established ...

Click to view in browser - Criminal History Eval Letter_01.2025.pdf
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Title: NCT Program Application

Description:

Document: ... ICAL R ADIOLOGIC T ECHNOLOGY Application for Non - Certified Technician (NCT) Programs in Medical Radiologic Technology Statute requires that a P rogram present documentation satisfactory to the Board that their curriculum and program requirements meets the minimum standards as ...

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Title: NCT Instructor Application

Description:

Document: ... OLOGIC T ECHNOLOGY Instructor Application for Non - Certified Programs in Medical Radiologic Technology Statute requires that a n Instructor present documentation satisfactory to the Board that they meet the minimum standards as determined by Board Rule, Texas Administrative Cod ...

Click to view in browser - NCT Instructor Application 01.2025.pdf
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Title: Medical Physicist Licensure Advisory Committee Agenda

Description: Medical Physicist Licensure Advisory Committee Agenda

Document: ... sideration and approval of the December 9, 2015 Medical Physicist Licensure Advisory Committee meeting minutes . 8 . Adjourn. Committee members (7) Charles W. Beasley , Ph.D., Chair Dianna D. Cody, PhD Douglas A. Johnson Nikolaos Papanikolaou, PhD Alvin L. Schlichte meier, ...

Click to view in browser - MedPhy-2016-Jan-Agenda.pdf
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Title: Out of State Telemedicine Affidavit

Description: An Out-of-State Telemedicine License to practice medicine across state lines is limited exclusively to: (1) the interpretation of diagnostic testing and reporting of those results to a physician fully licensed and located in Texas, or (2) the follow-up of patients where the majority of patient care ...

Document: ... _________________ Out of State Telemedicine Affidavit Tex. Admin. Code, Sec. 172.12(c) imposes limits on the Out - of - State Telemedicine License for which you have applied. An Out - of - State Telemedicine License to practice medicine across state lines is limited exclusively to: (1) the ...

Click to view in browser - Telemed_affidavit_FORMS.pdf
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Title: EMS Off-line Medical Director

Description: EMS off-line medical director hard copy registration form

Document: 7 H[DV 0HGLFDO %oDUG 0DLOLQJ $GGUHVV 32 %o[  $XVWLQ 7H[DV  3KoQH  � ...

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Title: List of CMO Designations - Direct Hire

Description: ... ure that employed physicians maintain independent medical judgment.  The chief medical officer must notify the Texas Medical Board (TMB) that the hospital is employing physicians and that the chief medical officer will be the hospital's designated contact with TMB. ...

Document: ... L7305 Barker Bruce Alan Palacios Community Medical Center 311 Green Ave Palacios TX 77465 AC- Active 18/04/2017 L1525 Bates Jeffrey Charles Coryell County Memorial Hospital Authority dba Coryell Memorial Hospital & Coryell Health 1507 West Main Street Gatesville TX 76528 AC- Ac ...

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Title: Form U - Actions and Investigations Section

Description: Yes response to any of the questions in the Actions and Investigations Section

Document: FORM U ______________________________________ ______________________ Applicant’s Signature Date _____________________________________________ Printed name LICENSURE APPLICATION FORM U ACTIONS/INVESTIGATIONS ...

Click to view in browser - Form U Professional Issues 01.2025.pdf
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Title: Form V - Medical Malpractice History

Description: Yes response to any of the questions in the Malpractice History Section.

Document: FORM V LICENSURE APPLICATION FORM V MALPRACTICE HISTORY Version 01.2025 “Yes” Response to Questions in Malpractice History /Professionalism Section You must complete a separa ...

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Title: Form W – Impairment Section

Description: Yes response to any of the questions in the Mental and Physical Health Section

Document: FORM W ______________________________________ ______________________ Applicant’s Signature Date _____________________________________________ Printed name LICENSURE APPLICATION FORM W IMPAIRMENT Version 0 4 .2020 “Yes” Response to ...

Click to view in browser - FORM W 04.2020.pdf
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Title: Form Y - Affidavit for Expedited Handling

Description: Form Y - Affidavit for Expedited Handling

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Click to view in browser - FORM Y 2022.08.pdf
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Title: Medical Board 2025 - March - DPRC Committee Minutes

Description: Medical Board 2025 - March - DPRC Committee Minutes

Document: TEXAS MEDICAL BOARDMINUTES OF THEDISCIPLINARY PROCESS REVIEW COMMITTEEMarch 20, 2025 9:48Manuel Quinones, Jr., M.D., Committee Chair, called the meeting to order at a.m.Other members present wereSharon Barnes, Devinder S. Bhatia, M.D., RecommendationsThis item was tabled. Agenda Item #4.Consideratio ...

Click to view in browser - MB-2025-March-DPRC-Committee-Minutes.pdf
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How do I change my address with the Texas Medical Board?

“... y to update mailing and practice addresses online for the majority of our licensees. To update your mailing or practice address online click the “My TMB” link in the upper right hand corner of our website (near the “search” box), and create an account if you do not have ... ”

What is the penalty for renewing past the expiration date?

“There is no grace period for the expiration date of a Medical Radiologist Technologist permit (general or limited). Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration ... ”

Why do I have to be fingerprinted for my first renewal with the Texas Medical Board?

“The fingerprint background check is required prior to the completion of your initial TMB registration/renewal,per the new statutory requirement set out in Texas Occupations Code, Sec 601.1111. ”

Why do I have to be fingerprinted for my first renewal with the Texas Medical Board?

“The fingerprint background check will be required prior to the completion of your initial TMB registration/renewal,per the new statutory requirement set out in Texas Occupations Code, Sec 604.1523. ”

Will I continue to renew my license in my birth month?

“... ermit holder’s birth month). Moving forward medical physicist licensees will expire once a year, on May 31st.As part of the transition from DSHS to TMB, existing medical physicist licenses will have their first registration with TMB per the existing permit expiration date. The renewal fee char ... ”

What is the penalty for renewing past the expiration date?

“There is no grace period for the expiration date of a Medical Physicist permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has been expired f ... ”

Why do I have to be fingerprinted for my first renewal with the Texas Medical Board?

“The fingerprint background check is required prior to the completion of your initial TMB registration/renewal, per the new statutory requirement set out in Texas Occupations Code, Sec 602.2101. ”

Are CRNA’s authorized to practice independent of physician supervision and delegation?

“No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA.  Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without del ... ”

Do I have to let the Medical Board know about my delegates/supervising physicians?

“... upervise 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 ... ”

What amount of detail must be in the documentation of the PMP check?

“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. ... ”

How do I qualify for the waiver?

“There are three different ways you can qualify for a waiver. If you or your practice is experiencing any of the following, you may qualify for a waiver: By experiencing economic hardship. When evaluating whether you are experiencing economic hardship, consider: special situational factors which affe ... ”

Does everyone at my practice have to apply for a waiver or just the medical director?

“... l 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.       ”

Can I get my fingerprints done anywhere?

“... y IDEMIA (formerly known as MorphoTrust USA, LLC) for a fee, payable directly to IdentoGo. Results of the fingerprinting will be sent directly to TMB from both the Texas Department of Public Safety Criminal Records and the Federal Bureau of Investigation. ... ”

Why does the application ask about my mental and physical health status?

“The Board understands that medical or mental health treatment is a normal part of many people's lives and receiving treatment such as counseling or therapy does not alone disqualify a licensee.  However, the Board is obligated to determine whether a licensee is physically and mentally fit to pr ... ”

Why am I asked about my mental and physical health status during renewal?

“The Board understands that medical or mental health treatment is a normal part of many people's lives and receiving treatment such as counseling or therapy does not alone disqualify a licensee.  However, the Board is obligated to determine whether a licensee is physically and mentally fit to pr ... ”