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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: PA Board 2013 November - Full Board Minutes

Description: PA Board 2013 November - Full Board Minutes

Document: ... C; Teralea Jones, PA - C; R. Blayne Rush; and Stanley Wang, M.D, liaison from the Medical Board . Felix Koo, M.D.; Anna Chapman ; and Michael Reis, M.D , were not present . Staff members present were Mari Robinson, J.D., Executive Director; Robert Bredt , M.D., Medical ...

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Title: Out-of-State Telemedicine License Eligibility Checklist

Description: Out-of-State Telemedicine License Eligibility Checklist

Document: ... ded for cause, revoked or subject to another form of discipline in a state or territory of the United States, Canada, or a uniformed service of United States. an investigation or proceeding pending for the restriction, cancellation, suspens ion, revocation, or other discipline of the ...

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Title: Press Release April 4, 2014

Description: TMB suspends Marble Falls psychiatrist

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE April 4 , 2014 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB suspends Marble Falls psychiatrist On April 3 , 2014, a disciplinary panel of the Texas M ...

Click to view in browser - pr-20140404.pdf
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Title: Physician Emeritus 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 ...

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Title: Pain Management Clinic - Change of Address Form

Description: ... ble or transferrable. In order to change the name and/or address of a registered clinic, please complete this form and submit with the required materials.   *If the business is owned by more than one physician, the primary physician owner listed on the certificate must be the one to complete an ...

Document: 7 H[DV 0HGLFDO %RDUG 0 $,/,1* $ ''5(66  32 % 2;  ‡ $ 867,1 7;  3 +21(   ...

Click to view in browser - PMC_Change_of_Address 10-2022 update.pdf
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Title: Press Release April 22, 2014 - 1

Description: TMB suspends San Antonio physician

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE April 22 , 2014 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB su spends San Antonio physician On April 22 , 2014, a disciplinary panel of the Texas Medic ...

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Title: Press Release April 22, 2014 - 2

Description: TMB suspends Tahoka physician

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE April 22 , 2014 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB su spends Tahoka physician On April 22 , 2014, a disciplinary panel of the Texas Medical ...

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Title: NCT Supervision Form

Description: Any person performing radiologic procedures under the supervision of a licensed Texas physician must be registered with the Texas Medical Board as required under Chapter 194 of the board rules. The physician must also be registered with the board to supervise the non-certified technician. ...

Document: ... \n \r      I am submitting this form to notify the Board that my relationship with the NCT named above has been or will be terminated. Yes No _________________________ Termination Date  I hereby certify that I am the per ...

Click to view in browser - NCT Supervision Form - 2017.pdf
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Title: Medical Board 2014 - May - Licensure Committee

Description: Medical Board 2014 - May - Licensure Committee Minutes

Document: ... ; Carlos Gallardo; Robert B. S imonson, D.O.; and Wynne M. Snoots, M.D. Mr. Ellis moved , s econded , that the Committee close the meeting to the public and continue in Executive Session for deliberations concerning Agenda items 2 , 3a and 3b . The motion passed. Dr. Arambu ...

Click to view in browser - MB-2014-May-Licensure-Minutes.pdf
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Title: Form L - Acupuncture Professional Evaluation

Description: Form L - Acupuncture Professional Evaluation  

Document: Form L - Acupun c ture LICENSURE APPLICATION FORM L AC EVALUATION Version 02.2025 Acupuncture Licensure Evaluation Texas State Board of Acupuncture Examiners APPLICANT: Complete the information in this b ...

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Title: Medical Board 2014 - May - DPRC - Agenda Item 02 - TX PHP Report

Description: Medical Board 2014 - May - DPRC - Agenda Item 02 - TX PHP Report

Document: ... e(s) : Non - compliance due to unacceptable and insufficient monitor reporting. The Board was notified that the participant was relieved of her shift after not responding right away to the ER to see patients. The participant was in the ER claiming she had low blood sugar reading ( ...

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Title: Press Release December 12, 2014

Description: TMB suspends Houston physician

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE December 12 , 2014 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB suspends Houston physician On December 12 , 2014, a disciplinary panel of the Texas M ...

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Title: Press Release May 15, 2014

Description: TMB disciplines 61 physicians at May meeting, adopts rule changes

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE May 15, 2014 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 TMB disciplines 6 1 physicians at May meeting , adopts rule changes At its May 1 - 2 , 201 ...

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Title: Press Release July 23, 2018

Description: Texas Board of Respiratory Care suspends Livingston respiratory care practitioner (Walsh)

Document: Texas Medical Board Press Release FOR IMMEDIATE RELEASE July 23 , 2018 Media contact: Jarrett Schneider , 512 - 305 - 7018 Customer service: 512 - 305 - 7030 or 800 - 248 - 4062 Texas Board of Respiratory Care suspends Livingston respiratory care practitioner On July 19 , ...

Click to view in browser - pr-20180723.pdf
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Title: Form L - PA Professional Evaluation

Description: Form L - PA Professional Evaluation

Document: Form L - PA LICENSURE APPLICATION FORM L PA LICENSURE EVALUATION Version 02.2025 Physician Assistant Licensure Evaluation Texas Physician Assistant Board APPLICANT: Complete the information in this box ...

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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 ... ”