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“... tions@tmb.state.tx.us for a hard copy supervision/delegation form.
Eligibility requirements for advanced practice nurses:
A full, active, and unrestricted Texas nursing license is required for online registration (this includes licenses ... ”
“... ontrolled substances and to register prescriptive delegation for Physician Assistants and Advanced Practice Nurses with the Texas Medical Board.
Physician Assistants with Temporary Licenses pending Medical Board approval will still be required to file a Prescriptive Delegation Form with the Registra ... ”
“... of the clinic.
Clinic protocols and standing delegation orders – A copy of any protocols and standing delegation orders issued by licensed physicians to healthcare providers.
Attestation regarding clinic ownership - A separate attestation page is required to be signed by each physician ow ... ”
“... orwarded by the Investigations Department and may request that an additional investigation be conducted on a case, refer the case to the Litigation Department for a possible informal settlement conference (hearing before a disciplinary panel), refer the case to the board’s disciplinary process ... ”
“... n permit and have a license in good standing.
To request a change to the Inactive status for a Texas Respiratory Care Practitioner certificate, complete and return the inactive request form (link below) to the Board for approval before the expiration date of the current certificate. Refunds o ... ”
“... ; Disciplinary Action Hotline: 800-248-4062• Request Form to File a Complaint Against a Licensee: 800-201-9353
Mailing Address:
P.O. Box 2029Austin, TX 78768
Website: www.tmb.state.tx.us
Complaint Handling Process
Our agency is committed to listen to your requests, understand your concerns, to ... ”
“... ety of Anesthesiologists, and a member of the TMA delegation to the American Medical Association. Zaafran studied biochemistry at The University of Texas at Austin and finished medical school and residency at The University of Texas McGovern Medical School in Houston. He is the current chair of the ... ”
“... eft and selecting the Licensing Forms Acupuncture.Request that each acupuncture school you attended submit both of these forms to you in a sealed envelope with the signature of an acupuncture school official across the outside envelope flap. Do not open this envelope. Send the unopened envelope to t ... ”
“... f the item has previously been submitted, the new request will include an explanation regarding why the submitted document failed to meet standards. Sometimes more items will be required based on information obtained from the new documentation.The length of time it will take to complete y ... ”
“... rtificate.
Certified Acudetox training transcript request that the provider of the acudetox training course you attended submit this to you in an unopened envelope with the signature of the provider across the outside envelope flap.
State Board Licensure Verifications - contact each state, province ... ”
“... ification has been canceled for non-payment or by request, you are required to meet current statutory requirements and board rules. Submit documentation of anything that is new or has changed since you were originally certified, as well as documentation that is non-static, such as state board verifi ... ”
“... the subject line: Acudetox Training Program Request. ”
“... ncy program coordinator and they can initiate the request for the waiver on your behalf.
”
“... icense number. This will help us route your request appropriately for a faster response.
”
“... that can be easily transmitted to the board upon request.
For physician assistants who are engaged in direct patient care; who prescribe, order, or administer opioids or controlled substances; or who have a Drug Enforcement Agency (DEA) number for prescribing or ordering opioids or controlled s ... ”
Description: TMB Bulletin Spring 2000
Document: ... orms to be mailed September 1. Renewal forms will request new profile information in addition to the mandatory information now required. Provision of the additional data will be optional until September, 2001, when the program becomes fully operational
and compliance is mandatory. After that date, ...
Description: TMB Bulletin Spring 2005
Document: ... stent with Senate Bill 104. Chapter 193, Standing Delegation OrdersAmendment to 193.6 regarding delegation of carrying out or signing of prescription drug orders to Physician Assistants and Advanced Nurse Practitioners Chapter 196, Voluntary Surrender of a Medical License. Amendments to 196.1-196. ...
Description: TMB Bulletin Spring 2006
Document: ... to 179.2 Definitions 179.3 Confidentiality, 179.4 Request for Information and Records from Physicians, and 179.6 Time Limits, regarding clarification on response time for requests for medical records and time limits for completion of an investigation of a complaint. Chapter 180, Rehabilitation Order ...
Description: TMB Bulletin Spring 2007
Document: ... a chaperone in the room and to document that the request was made and how it was answered; that any time he performs a full body skin examination or examination of potentially sensitive areas for female patients he must explain the patient's right to decline the examination, and if the patient does ...
Description: TMB Bulletin Spring 2004
Document: ... either switch the patient to a preferred drug or request prior authorization. All prior authorization requests must be called in to the Texas Prior Authorization Call Center Hotline Monday-Friday, 7:30 a.m.6:30 p.m. (CST) at (877) PA-TEXAS. Approved requests for prior authorization will be good for ...
Description: TMB Bulletin Spring 2010
Document: ... n of his practice; failure to release patient
or request for information; and failure to update his
days of the change.
Gunn, John Christian, M.D., Lic. No. L9039, San Anto-
On June 4, 2010, the Board and John Christian Gunn,
M.D., entered into a Voluntary Revocation Order to
avoid further inve ...
Description: TMB Bulletin Spring 2002
Document: ... g only the practice address. This was done at the request of physicians who use their home address as the mailing address. Physicians should be aware that mailing addresses will continue t o be subject to open records requests and cannot be withheld from the public . The Board proposed additional ru ...
Description: TMB Bulletin Spring 1997
Document: ... icient. If the physician does not comply with the request for documentation within 60 days, or if the physician is unable to provide proof of the hours stated on the annual renewal form, the physician will be investigated by the Board. If the investigation shows that the requirement was not met, the ...
Description: TMB Bulletin Spring 2008
Document: ... 167 amend the process for the application for the request for reissuance of a revoked license, and add the requirement that a physician who wishes to have an active medical license after his license has been revoked or suspended must also demonstrate that his service would benefit the citizens of Te ...
Description: TMB Bulletin Spring 1999
Document: ... for inst itutional permits. Chapter 193, Standing Delegation Orders, amendment to section 193.2 relating to definitions. Chapter 197, Emergency Medical Service, repeal of sections 197.2-197.5 and new sections 197.2-197.5, that will update rules to current practices. For copies of these rules, write ...
Description: TMB Bulletin Spring 1998
Document: ... rvision of a qualified anesthesiologist under the delegation provisions of the Medical Practice Act, Section 3.06(d)(1). The responsibility for maintaining these standards is that of the supervising anesthesiologist who, ultimately, remains responsible for all delegated functions. For a copy of the ...
Description: TMB Bulletin May 2011
Document: ... r his or her services to indigent populations can request to be placed on voluntary charity care status. The physician must not receive direct or indirect compensation which has monetary value of any kind for medical services rendered. A physician on voluntary charity care status must still obtain a ...
Description: TMB Bulletin Spring 2009
Document: Medical Board Bulletin Spring 2009
Medical Board Bulletin Spring 09 (1.5Mb pdf)
Texas Medical Board Bulletin The newsletter of the Texas Medical Board Spring 2009 Volume 6, No. 2
Governor Appoints, Reappoints Board Members
Governor Rick Perry has made the following appointments and reappointment ...
Description: TMB Bulletin July 2012
Document: ... et standard of care, failure to comply with Board request. Failure to meet standard of care, negligence in performing medical services, resigning medical privileges while under investigation.
G8483 F8724 K8596
4/27/12 6/4/12 6/4/12
4
Board Rule Changes
The following Rule Changes were adopted at ...
Description: TMB Bulletin March 2012
Document: ... ducted by the Food and Drug Administration at the request of the military, according to the Harvard Medical School Family Health Guide. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90 percent ...
“Please submit a written request for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE R ... ”
How do I update the contact name for my registered HCE for the verification system?
Please submit a written request for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018
“... 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 M ... ”
What are the general rules related to AAs/CRNAs?
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.
“... 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. ”
How does a PA register a supervising physician with the Board?
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.
“... ed using the Online Supervisions and Prescriptive Delegation Registration System. ”
How does a PA terminate a supervising physician relationship?
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. ”
Does delegation of prescriptive authority to a PA or APN have to be registered with the TMB as well?
Effective 1/31/2010, registration by physicians of delegated prescriptive authority to PAs or APNs is required.
“... exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice. ”
How many physician assistants can a physician supervise?
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.
“... re are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 193. ”
How many PAs can a physician delegate prescriptive authority to?
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 193.
“... through the Online Supervisions and Prescriptive Delegation Registration System. ”
How soon does a PA need to update the Board about a change in supervising physicians? What about an addition?
Within 30 days of the change or addition. This can be done through the Online Supervisions and Prescriptive Delegation Registration System.
“... e registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us. ”
How much does OBA registration cost?
The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.
For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.
“... erifications of OBA registration are available on request. Please submit a written request by mail, fax or email to: Texas Medical BoardAttn: Registration DepartmentP.O. Box 2029 MC 240Austin, TX 78768 fax - (888) 512-2581 ”
How do I verify what level of OBA services an individual is registered for?
Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to:
Texas Medical Board
Attn: Registration Department
P.O. Box 2029 MC 240
Austin, TX 78768
fax - (888) 512-2581
“Yes. At any time a physician may request to cancel his or her license. However, once a license is cancelled, in order to reactivate it, a physician will be required to apply for relicensure and meet all requirements for licensure in effect at the time of application. ... ”
Can a physician request the cancellation of a license?
Yes. At any time a physician may request to cancel his or her license. However, once a license is cancelled, in order to reactivate it, a physician will be required to apply for relicensure and meet all requirements for licensure in effect at the time of application.
“... profile information will be provided to you upon request. ”
Is there a way to check the Profile and/or correct errors?
Profile changes/corrections/updates must be submitted in writing, with a signature. Written changes can be sent to: TMB P.O. Box 2029 MC-906 Austin, TX 78768-2029 (f) 512-463-9416 or (888) 790-0621 Profile information is available on our website, or if you prefer, a copy of your profile information will be provided to you upon request.
“A request for evaluation of your criminal history and potential eligibility for licensure prior to application for licensure as a physician, physician assistant, PA, or acupuncturist. Do not apply for a "Criminal History Evaluation Letter" if you are already a licensure applicant. Licensure ap ... ”
What is a "Criminal History Evaluation Letter"?
A request for evaluation of your criminal history and potential eligibility for licensure prior to application for licensure as a physician, physician assistant, PA, or acupuncturist. Do not apply for a "Criminal History Evaluation Letter" if you are already a licensure applicant. Licensure applicants will have criminal history evaluated as part of the licensure application.
“... ourse shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requ ... ”
What are the continuing education requirements for pain management clinics?
Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain management. This CME requirement applies to all personnel providing medical services to the patients (including, but not limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that clinic. Documentation of the completed CME course shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requirements and regulations pertaining to registered pain clinics, including audits of CME training as required.
“... courses shall be made available to the Board upon request but should not be mailed with the registration. CME audits will be conducted to assure compliance. ”
Does my continuing education documentation need to be sent in with my pain management registration forms?
Documentation of CME courses shall be made available to the Board upon request but should not be mailed with the registration. CME audits will be conducted to assure compliance.