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Search Term: 'authorization and release form'

E-Prescribing Waiver

“... quirement 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 contro ... ”

This content is located on the following page(s): Renewal - Electronic Prescribing Waiver

Expert Consultants

“DIRECT DEPOSIT FORM 74-176 PAYEE CHANGE FORM 74-157 APPLICATION FOR TX ID NUMBER ”

This content is located on the following page(s): Expert Consultants

CE for AD Tab 2 - Exemptions

“... *Exemptions are reviewed on a case-by-case basis and must be requested in writing at least 30 days prior to the expiration date of the license.  An exemption may not exceed one registration period, but may be renewed, subject to approval.   Acudetox Continuing Education Exemption Request ... ”

This content is located on the following page(s): CAE for Acudetox Specialists

LMRT Exam FAQs

“... ication to take the LMRT Exam? In order to obtain authorization to attempt passage of the exam, an individual must provide the following documentation:        evidence of current enrollment in an approved limited program and an attestation stating that the individual h ... ”

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

Gold Designated Practice Status

“A pain management clinic is defined in statute and 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 m ... ”

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

Title: Form Y - Affidavit for Expedited Handling

Description: Form Y - Affidavit for Expedited Handling

Document: )250 < BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBB $SSOLFDQW¶V 6LJQDWXUH 'DWH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3ULQWHG QDPH /,&(1685( $33/,&$7,21 )250 < ± $)),'$9,7 )25 (;3(',7(' +$1'/,1* 9HUVLRQ  ...

Click to view in browser - FORM Y 2022.08.pdf
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Title: Press Release March 31, 2025

Description: TMB disciplines 33 physicians at March meeting

Document: ... c. No. T8668, MissouriTo view disciplinary orders and Board action history, visit the TMB website, click on "Look Up License," accept the usage terms, then type in a licensee's name. Click on the name shown in the search results to view the licensee's full profile. Within that profile is a button th ...

Click to view in browser - pr-20250331.pdf
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Title: Press Release April 22, 2025-1

Description: Texas Board of Medical Radiologic Technology suspends Sugar Land MRT (Bettsack)

Document: ... February 12, 2025, Mr. Bettsack was charged with and was arrested on two counts of Possession of Child PornographyA temporary suspension hearing with notice will be held as soon as practicable with 10 days' notice to Mr. Bettsackunless the hearing is specifically waived by Mr. BettsackThe temporary ...

Click to view in browser - pr-20250422.pdf
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Title: Press Release April 22, 2025-2

Description: TMB suspends McAllen physician (Haak)

Document: Texas Medical Board Press ReleaseFOR IMMEDIATE RELEASEApril, 202Media contact: communications@tmb.state.tx.usCustomer service: 5123057030 or 8004062 TMB suspendMcAllenphysicianOn April 17, 2025, a disciplinary panel of the Texas Medical Board temporarily suspended, without notice, the Texas medical ...

Click to view in browser - pr-20250422-2.pdf
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Title: Press Release April 22, 2025-3

Description: TMB suspends Houston physician (Adeyemo)

Document: ... t impairs his ability to safely practice medicine and is currently engaged in the practice of medicine without any oversight or monitoring.A temporary suspension hearing with notice will be held as soon as practicable with 10 days' notice to Dr. Adeyemounless the hearing is specifically waived by Dr ...

Click to view in browser - pr-20250422-3.pdf
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Title: Press Release April 3, 2015

Description: TMB suspends Sugar Land physician

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE April 3 , 2015 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB suspends Sugar Land physician On April 2 , 2015 , a disciplinary panel of the Texas ...

Click to view in browser - pr-20150403.pdf
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Title: Medical Board 2014 - November - Full Board Minutes

Description: Medical Board 2014 - November - Full Board Minutes

Document: ... ndra K. Varma, M.D .; Stanley S. Wang, M.D. ; and Timothy Webb, J.D. John D. Ellis, Jr., J.D . ; Carlos L. Gallardo ; Allan Shulkin, M.D .; Wynne Snoots, M.D.; and Karl W. Swann, M.D ., a rrived a few minutes after roll call. J ohn R. Guerra , D.O. ; and Robert B. Simonson, D. ...

Click to view in browser - MB-2014-Nov-Full-Board-Minutes.pdf
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Title: Medical Board 2015 - February - Disciplinary Process Review Committe Minutes

Description: Medical Board 2015 - February - Disciplinary Process Review Committe Minutes: Agenda Item 02 - TX PHP Report; Agenda Item 04 - TX Impaired Licensee Report; Agenda Item 08 - List of Potential Expert Panelists ; Agenda Item 12 - Legal Dismissals; Agenda Item 12 - Case List ...

Document: ... Surendra K. Varma, M.D. , Stanley Wang, M.D., and George Willeford III, M.D. Committee Member Michael Arambula, M.D., Pharm.D Staff members present were Mari Robinson, Executive Director, Robert Bredt, M.D., Medical Director, and various other staff. Agenda Item #2 . Discussion ...

Click to view in browser - MB-2015-Feb-DPRC-Minutes.pdf
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Title: Physician Retirement Request Form

Description: ... sician must submit a notarized retirement request form

Document: 7 (;$6 0 (',&$/ %2$5' ȱȱ ȱ˜ŒŠ’˜—ȱ ›ŽœœDZȱŠ’•’—ȱ ›ŽœœDZȱ˜&#x ...

Click to view in browser - Retirement_Request_Form 02-2025.pdf
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Title: Physician Voluntary Charity Care Request Form

Description: ... icensed physician must submit a notarized request form

Document: 7 (;$6 0 (',&$/ %2$5' ȱȱ ȱ˜ŒŠ’˜—ȱ ›ŽœœDZȱŠ’•’—ȱ ›ŽœœDZȱ˜&#x ...

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Title: PA Retirement Request Form

Description: ... istant must submit a notarized retirement request form.

Document: 7 (;$6 3 +

Click to view in browser - PA - TR affidavit 02-2025.pdf
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Title: Referring Physician Attestation Form

Description: For Physician applicants who report solo practice work history.

Document: ... ation Texas Medical Board IMPORTANT: This form is to be completed by applicants that are in solo practice ONLY and have not held hospital affiliations for any period of time within the five years prior to submission of their application. This form should be completed by three (3) sep ...

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Title: Press Release May 20, 2021

Description: Texas Board of Respiratory Care suspends Richmond respiratory care practitioner (Alvarado)

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE May 20 , 2021 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 Texas Board of Respiratory Care suspends Richmond respiratory care practitioner On May 18 , 2021 , ...

Click to view in browser - pr-20210520.pdf
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Title: Pain Management Clinic Registration Form

Description: ... management clinic certification, please download and fill out the form below.

Document: ... : A pain management clinic is defined in statute and 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 suboxo ...

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Title: Pain Management Clinic Withdrawal/Cancellation Form

Description: ... lication or cancel certification, please download and fill out the form below.

Document: ȱ˜ŒŠ’˜—ȱ ›ŽœœDZȱŠ’•’—ȱ ›ŽœœDZȱ˜—ŠŒȱ ...

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How do I qualify for the waiver?

“... pact of compliance on profitability or viability; and the availability of measures that would mitigate the economic impact of complying. If your practice has technological limitations not reasonably within your control.    Other exceptional circumstances that would lead to you or your pr ... ”