As of 1/1/2019 the fee for fingerprinting is $38.25.  This fee includes the fingerprint vendor processing fee, DPS processing fee and FBI processing fee.  There may be an additional fingerprint vendor processing fee if using an approved out-of-state live scan location. IdentoGo will inform you if the location selected is subject to this additional fee.

As of 01/01/2025, the fee for fingerprinting is $39.50.  This fee includes the fingerprint vendor processing fee, DPS processing fee and FBI processing fee. There may be an additional fingerprint vendor processing fee of $39.95 if using an approved out-of-state live scan location. IdentoGo will inform you if the location selected is subject to this additional fee.

No. Multiple methods of submission will delay the fingerprinting process, as the fee paid to IdentoGo allows for either a live scan or a mailed submission of fingerprint cards. An applicant or Texas licensee should complete their fingerprints by arranging an appointment at an approved IdentoGo location or mail to Identogo one completed fingerprint card with the completed IdentoGo confirmation document containing a bar code. If fingerprints are submitted using multiple methods or if an applicant completes their fingerprints at a different IdentoGo location than the one they set up their appointment with, the applicant will be responsible for contacting IdentoGo directly to identify the correct submission method. TMB does not have access to the IdentoGo system and is not able to amend or verify an applicant’s submission method.  Applicants should not mail fingerprint cards to the TMB.

At this time, only physician applicants can use the Form Y to expedite an application. Should this change, notification will be posted.

Texas requires physicians to professionally use the name under which they are licensed by the Texas Medical Board. Using any other name may confuse or mislead the public and could be considered by the Board to be unprofessional conduct. A physician who wishes to change his or her professional name must use the Application for Name Change.

You must provide us with a statement that gives an explanation of your request, a completed Name Change Application form and a notarized copy of the legal document(s) that granted your name change, i.e. marriage license, divorce decree etc.

No.  However, changes in mailing or practice addresses can now be updated online in most situations.  For those license types that cannot use the online system, a Change of Address form is available, but not required.  Information on the new Change of Address system is available at: http://www.tmb.state.tx.us/page/change-address

The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:

1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.

It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”

Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.

One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.

As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.

While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.

Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.

While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.

Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient. 

You can register a new supervising physician through the Online Supervisions and Prescriptive Delegation Registration System. Please note that this is a 2 step process and that the supervising physician must complete the registration.

The addition of a new supervising physician does not terminate any other supervision that is currently in place. Any current supervising physician relationship can be terminated using the Online Supervisions and Prescriptive Delegation Registration System.

Effective 1/31/2010, registration by physicians of delegated prescriptive authority to PAs or APNs is required.

There is no limitation to the number of PAs or APNs a physician may supervise. However, a physician may only delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent.  The only exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice.

A physician may delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. There are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 169.

Within 30 days of the change or addition. This can be done through the Online Supervisions and Prescriptive Delegation Registration System.

Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.