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Search Term: 'authorization and release form'

OBA - Unanticipated Transfer/Hospitalization or Death

“... gs under these rules resulted in an unanticipated and unplanned transport of the patient to a hospital for observation or treatment for a period in excess of 24 hours, or a patient's death intraoperatively or within the immediate postoperative period. Immediate postoperative period is defined as 72 ... ”

This content is located on the following page(s): Renewal - Office Based Anesthesia

Registration/Renewal

“... physicians, physician assistants, acupuncturists and others licensed by the TMB to practice in Texas are currently required to register regularly with the board, and pay a fee.  Registration fees and renewal periods vary according to license type.  A licensee may obtain a registration per ... ”

This content is located on the following page(s): Renewals and Registration

Private Autopsy Facility - Complaint Notice

“... lso required TMB, by rule, to adopt a sample form of the notice and post the notice on the TMB website. Penalty for non-compliance by a facility is a Class C misdemeanor.   Click on the following link to access the complaint notice: Complaint Notice Poster - Private Autopsy Facility & ... ”

This content is located on the following page(s): Autopsy Facility Complaint Notice

PA Cancellation by Request

“... ssistant must file an application for relicensure and meet all requirements for licensure in effect at that time (including current NCCPA certification, etc.).   To request cancellation of a license, complete and return the cancellation request form (link below) to the Board for approval before ... ”

This content is located on the following page(s): Renewal - Cancellation by Request

Physician Voluntary Charity Care Status

“... voluntary charity care, from the registration fee and reduces the informal CME requirement.   "Voluntary charity care" is defined as medical care provided for no compensation to indigent populations; in medically underserved areas; or for a disaster relief organization.  “Compensatio ... ”

This content is located on the following page(s): Physician Retirement Options

IMLC Biennial Renewal information

“... LC) must complete a biennial registration/renewal and pay a fee.   You must complete the IMLC portion of the renewal (including the payment of fees), and the TMB portion of the renewal before the expiration date of your license to avoid penalty fees. Physician licenses expire at one o ... ”

This content is located on the following page(s): IMLC Renewal Information

Verification Request

“... issue date, expiration date, disciplinary status, and our board seal will be affixed. There is no fee for state board verifications. Please allow 10 working days to process your verification. The verification will be mailed or emailed directly to the state board of your request.  Please no ... ”

This content is located on the following page(s): Resources - Verification Request

Practice Resources

“... any other name may confuse or mislead the public and may be considered by the Board to be unprofessional conduct as defined by the Texas Occupations Code Chapter 164.052(a)(5). Any physician who wishes to change the professional name under which he/she practices must first satisfy certain formaliti ... ”

This content is located on the following page(s): Resources - Practice Resources

Pain Management Clinic Forms

“... management clinic certification, please download and fill out the form below. At this time there is no charge for a pain management clinic certification. Pain Management Clinic Registration Form   To withdraw a pending application or cancel certification, please download and fill out the form ... ”

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

Join Our eMail List

“Join Our E-Mail List Email: ”

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

Military Limited Volunteer License

“... ch of the United States armed forces or veterans, and is limited to the practice of medicine for no compensation in clinics that serve indigent populations. The Military Limited Volunteer License: authorizes the physician to practice medicine only in a clinic that primarily treats indigent populati ... ”

This content is located on the following page(s): Licensing - Military Limited Volunteer License

Provisional License Quick Links

“... as Medical License Examination Requirements Apply Form G - Provisional License Application and Sponsorship Form Get Fingerprints Check Your Status LIST License Issue Dates FAQs ”

This content is located on the following page(s): Physician Provisional License

Physician Emeritus Retired Status

“... from the registration process, registration fee, and CME. The following restrictions apply to physicians whose licenses are on the standard or emeritus retired status: the physician cannot engage in clinical activities or practice medicine in Texas, and to be eligible for retired status, a physici ... ”

This content is located on the following page(s): Physician Retirement Options

EMS – Off-line Medical Director Registration

“... egister as such with both the Texas Medical Board and the Texas Department of State Health Services (DSHS). As of July 2014, the TMB registration is part of the physician biennial registration process. Information on registration with the DSHS as an EMS off-line medical director is available through ... ”

This content is located on the following page(s): EMS – Off-line Medical Director

EMS - Waivers

“... e Health Services has reviewed the waiver request and has determined that the waiver in the best interest of the public; the physician is in compliance with Board rule, by submitting documentation of protocols and standing orders upon request; and appropriate safeguards exist for patient care and ad ... ”

This content is located on the following page(s): EMS – Off-line Medical Director