“... IN THESE SECTIONS HAVE BEEN VERIFIED BY THE TEXAS MEDICAL BOARD
Current Board Action
Medical Malpractice Investigations
THE INFORMATION IN THESE SECTIONS WAS REPORTED BY THE LICENSEE AND MAY HAVE NOT BEEN VERIFIED BY THE TEXAS MEDICAL BOARD
Self-Reported Informat ... ”
“... ysician, physician assistant, acupuncturist, medical radiologic technologist, non-certified radiological technician, respiratory care practitioner, medical physicist, or perfusionist.
Please note that this evaluation is not a guarantee of eligibility for licensure. Applicants must m ... ”
“... mation is seen, processed, or stored by the Texas Medical Board.
The payment portion of the online registration system is handled by Texas.gov, the official website of Texas. The price of this service includes funds that support the ongoing operations and enhancements of Texas.gov, w ... ”
“... gical assistants, respiratory care practitioners, medical radiologic technologists, medical physicists, and perfusionists.
If you wish to complain to the Board, please do so in writing. Provide full name and practice address of practitioner. Also, provide dates and details of any incident, being as ... ”
“... physicians, physician assistants, acupuncturists, medical radiological technologists, non-certified radiologic technicians, respiratory care practitioners, medical physicists, and perfusionists licensed by the State of Texas. (This includes Physician Profiles and verifications for oth ... ”
“... rgical Physician Assistant program or a
4) a full medical school (and receipt of a physician's degree).
Worked 2000 hours within the last 3 years as a Surgical Assistant.
Taken and passed one of the three national certifying exams.
Have a current national Board Certification.
Have never been ... ”
“... rsquo;s check or money order payable to the Texas Medical Board.
Surgical Assistant applications are not currently avaliable online. Please download and submit the Surgical Assistant License Application. ”
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 ma ... ”
Provides helpful information about the Texas Medical Board, its disciplinary process, how to research a licensee, and how to file a complaint.
TMB Consumer Brochure
Consumer Guide to Health Care
This guide for consumers on the quality of healthcare and healthcare billing and pri ... ”
“TEXAS MEDICAL BOARD RESOURCE EFFICIENCY PLAN
The Texas Medical Board is committed to energy conservation by ensuring our facilities are operating in an efficient and effective manner.
Regarding energy management, the TMB’s original Resource Efficiency Plan (REP), submitted October 2002, ... ”
“... limited license that allows physicians to use the medical and clinical knowledge, skill, and judgment of a fully licensed physician in ways which may affect the health and safety of the public or any person.
It does not include the authority to
pract ... ”
“Welcome to the Texas Medical Board’s (TMB) Employment Opportunities page. TMB is housed in the William P. Hobby State Office Building in Tower Three, Suite 610 on 3rd and Guadalupe Streets in Austin's downtown "warehouse" district, two blocks from Town Lake and its natural environment of ... ”
This content is located on the following page(s): Employment
Advertisement of Board Certification
“... particular area.
To protect the public, the Texas Medical Board (TMB) has taken steps to standardize what “board certified” means under TMB advertising rules. In October 2010 the TMB amended its Physician Advertising rules.
According to the new rules, a physician may use the term "board ... ”
Document: ... onflict with other provisions of the rule and the Medical Practice Act. The amendment to §187.83 deletes language requiring a panel member to sign cease and desist order, as rule already provides for executive director to sign order. Chapter 189 COMPLIANCE PROGRAM 22 TAC §§189.1, 189.3, 189.5, 189.7 ...
Document: ... dor used by the PHP must be approved by the Texas Medical Board, and establishes standards for processing referrals, requiring evaluations, settings terms for agreements with participants, and facilitating interventions. http://www.sos.state.tx.us/texreg/archive/September102010/adopted/22.EXAMINING% ...
Document: ... 3.1 and 163.5 that will update the definitions of medical school curriculum and substantially equivalent; and supervision of medical school students. Chapter 164, Physician Advertising. Amendment to '164.3 concerning testimonials used in advertising. Chapter 165, Medical Records. Amendments to ''165 ...
Document: ... html#301 CHAPTER 187, PROCEDURAL RULES: The Texas Medical Board (Board) adopts amendments to §187.83, concerning Proceedings for Cease and Desist Orders, without changes to the proposed text as published in the April 29, 2011, issue of the Texas Register (36 TexReg 2690) and will not be republished. ...
Document: ... k here for the complete board rules. Chapter 165, Medical Records: Amendments to §§165.1, 165.3, and 165.4 regarding definitions and general cleanup. Chapter 171, Postgraduate Training Permits: Amendment to §171.6 regarding faculty temporary permits that would allow active military physicians , hold ...
Document: ... g board, physician health advisory committee, and medical director of the Texas Physician Health Program. The New Rule §180.7, Rehabilitation Orders, provides that rehabilitation orders entered into on or before January 1, 2010 shall be subject to all laws that existed immediately before that date a ...
Document: ... cian assistants to obtain six hours of continuing medical education (CME) per year by serving as an expert panel reviewer for the Board and deletes language relating to a 30-day grace period after expiration of license to conform with §204.156, Texas Occupations Code; §185.13, Notification of Intent ...
Document: ... rm with biennial registration; §166.2, Continuing Medical Education, updates rule to conform with biennial registration and amends provisions related to administra tive penalties to be consistent with provisions under Chapter 190 related to disciplinary guidelines; §166.5, Relicensure, clean-up of l ...
Document: ... 5 The amendment to §163.2, relating to Full Texas Medical License, sets out medical graduation requirements for 5th pathway applicants to be consistent with rules relating to other types of applicants for full licensure. The amendment to §163.4, relating to Procedural Rules for Licensure Applicants, ...
Document: ... lating to standards for provision of telemedicine medical services and use of the Internet in transmission of information. Chapter 177, Certification of Non-Profit Health Organizations. Rule review, amendments to §§177.1-177.8, repeal of §§177.9-177.16, and new §§177.9-177.13 for general cleanup of ...
Document: ... endments to 163.1, Definitions; 163.2, Full Texas Medical License, regarding recognition of Texas Higher Education Coordinating Board authority to determine a school to be Fraudulent or Substandard and to clarify that any foreign medical school must meet the Boards substantial equivalence requiremen ...
Document: ... pter 163, Licensure , to include a limit on Texas medical jurisprudence examination attempts, delegated authority to staff to issue licenses, alternative requirements for graduates of unapproved medical schools, and general rule cleanup. Chapter 166, Physician Registration, to include the addition o ...
Document: ... n of graduate of an acceptable unapproved foreign medical school. Chapter 175, Fees, Penalties, and Applications. Amendments to §§175.1 and 175.4 relating to fees and applications required for reissuance of a physician assistant license. Chapter 179, Investigation Files. Rule review and amendments t ...
Document: ... itted unprofessional conduct as defined under the Medical Practice Act. http://www.sos.state.tx.us/texreg/archive/June242011/adopted/22.EXAMINING%20BOA RDS.html#361
Chapter 195, Pain Management Clinics: Amendment to §195.2 concerning Certification of Pain Management Clinics, establishes the proced ...
Document: ... complete board rules. Chapter 162, Supervision of Medical School Students, with amendments to §162.1 Supervision of Medical Students, which clarifies the intent of the amendment previously adopted, which became effective on March 9, 2009. The Board determined that the revised language was necessary ...
“... elegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present a ... ”
What are the Texas Medical Board’s requirements for a physician who delegates to an APRN or PA?
All prescriptive delegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.
“... ity from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authori ... ”
Do I need to have a protocol in addition to a prescriptive authority agreement?
APRNs and PAs are required to have delegated authority from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authority agreement. The prescriptive authority agreement need not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however.
“No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive au ... ”
If I work in a clinic owned by the hospital, is this considered a facility-based practice?
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
“... sed practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate. ... ”
Who may delegate prescriptive authority in a hospital facility-based practice?
In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.
“... levant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on feder ... ”
Are physicians potentially subject to discipline for violations of the standard of care by CRNAs to whom they have delegated the selection or administration of anesthesia or the care of an anesthetized patient?
Yes, potentially. Although physicians are not required to supervise CRNA’s for delegated tasks, they nonetheless remain subject to potential liability for violations of the standard of care by CRNAs, depending on federal and state statutes and regulations. The degree to which a physician is required to supervise a CRNA during the performance of a task in anesthesia services is left to the “physician’s professional judgment in light of other relevant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on federal and state statutes and regulations.
Additionally, Texas Attorney General Opinion No. KP-0353 found “In authorizing physicians to delegate the administration of anesthesia to CRNAs, the Legislature did not expressly limit the liability of the delegating physician. See TEX. OCC. CODE § 157.058; cf. id. § 157.004(c) (providing that in specified circumstances a physician who issues a standing delegation under chapter 203 generally “is not liable in connection with an act performed under that standing delegation order”). Thus, we cannot conclude that the liability of a physician delegating the administration of anesthesia to a CRNA is limited solely to the determination of competency. Questions of physician liability in any specific context are highly factual and not an appropriate determination for the opinion process. See Tex. Att’y Gen. Op. No. GA-0446 (2006) at 18 (“Questions of fact are not appropriate to the opinion process.”) (Page 4 with emphasis added.)
“... nbsp; The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any ... ”
Regardless of the circumstances when supervision is or is not required, it is important to remember that the delegating physician must abide by all required federal and state statutes and regulations regarding delegation. The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any time.
The Texas Attorney General has issued three opinions on CRNA supervision. The latest opinion found that although physician supervision of a CRNA is not required in Texas Occupations Code Sec. 157.058, other federal and state statutes and regulations may require physician supervision of a CRNA, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician, and the Legislature did not expressly limit the liability of the delegating physician.
Specifically, Texas Attorney General Opinion KP-0353 found “Section 157.058 of the Occupations Code does not, by itself, require a physician who properly delegates anesthesia-related tasks to a certified registered nurse anesthetist (“CRNA”) to supervise the performance of those acts.” (Page 5)
However, KP-0353 also found “…the language of chapter 157 is not the only relevant authority to consider in addressing the question of physician supervision over acts delegated to a CRNA. Federal regulations limiting Medicare coverage and conditioning hospital participation in Medicare and Medicaid programs require physician supervision of a CRNA when administering anesthesia in certain circumstances. See, e.g., 42 C.F.R. §§ 416.42(b)(2), 482.52(a)(4), 485.639(c)(1)(v), (2) (requiring a CRNA to operate under a physician’s supervision when administering anesthesia in certain circumstances). Furthermore, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician. See TEX. HEALTH & SAFETY CODE §§ 481.002(1)(A) (defining “administer” to require agent to apply controlled substance in presence of physician), .071(a) (prohibiting physician from causing controlled substance to be administered under physician’s “direction and supervision” except for valid medical purpose and in course of medical practice). And a CRNA may not obtain an anesthetic that is a dangerous drug unless a physician has listed that CRNA as the physician’s designated agent. See id. §§ 483.001(4) (defining “designated agent”), .022(a) (requiring physician to name each designated agent in writing). (Page 3 with emphasis added.)
Finally, KP-0353 found “Whether and the extent to which physician supervision is required for an act delegated to a CRNA will depend on the specific act delegated, the type of facility in which the CRNA performs the act, and any relevant regulations of that facility. And while section 157.058 authorizes a physician to delegate to a CRNA, a physician is never required to do so. If a physician is concerned about a CRNA’s ability to perform a delegated act or desires to limit the delegation, the physician retains the authority to refrain from delegating, to limit the delegation, or to supervise the delegation to whatever extent the physician determines necessary. In sum, the authority to delegate provided by section 157.058 of the Occupations Code does not eliminate the need to comply with all other applicable statutes, regulations, bylaws, ethical standards, and a physician’s own professional judgment. See TEX. OCC. CODE § 157.007 (“An act delegated by a physician under [chapter 157] must comply with other applicable laws.”). (Page 4 with emphasis added.)
“... cordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who: (A) has been admitted to the hospital for an intended length of stay of 24 ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
How often is physician consultation required when prescribing controlled substances?
APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.
“... ians will have to contact the Federation of State Medical Boards to obtain examination scores.Federation of State Medical Boards 400 Fuller Wiser Rd. Suite 300 Euless, TX 76039-3855 Tel. (817) 868-4000A small percentage of physicians can obtain verification of examination scores from TMB.
If you wer ... ”
“The requirements are the same for International Medical School Graduates (IMGs) and U.S. or Canadian medical school graduates except that:
IMGs must demonstrate that they are either ABMS or BOS specialty board certified, have graduated from a medical ... ”
What are the requirements for an international medical school graduate to get a Full Texas Medical License?
The requirements are the same for International Medical School Graduates (IMGs) and U.S. or Canadian medical school graduates except that:
IMGs must demonstrate that they are either ABMS or BOS specialty board certified, have graduated from a medical school on our Substantial Equivalence list, or must submit Forms Z1-Z7 so that we can evaluate their medical education.
IMGs who performed their clinical clerkships in the United States will have to demonstrate that each clerkship was performed in a setting that has an accredited residency training program in the same specialty or sub-specialty.
Finally, IMGs are required to have either two years of continuous progressive accredited training, TMB Board approved training, teaching under a Faculty Temporary License in Texas, or a combination.
“... e selection and administration of anesthesia is a medical act, if such an act was validly delegated to a CNRA by a physician, the act is considered to be within the practice of nursing and governed by the Nursing Practice Act. Any discipline for a violation of the standard of care by a CRNA wo ... ”
Is a CRNA under a valid delegation order, subject to discipline by the Texas Medical Board under the Medical Practice Act for a violation of the standard of care in the selection and administration of anesthesia or the care of an anesthetized patient?
No, while the selection and administration of anesthesia is a medical act, if such an act was validly delegated to a CNRA by a physician, the act is considered to be within the practice of nursing and governed by the Nursing Practice Act. Any discipline for a violation of the standard of care by a CRNA would be carried out by the Texas Board of Nursing under the authority of the Nursing Practice Act. Ultimate responsibility and accountability for the medical management of a patient under anesthesia remains with the delegating physician who may be subject to discipline for improper delegation dependent upon the facts and circumstances of each case, and how state statutes and regulations apply in those situations.
“... lated fields, contained in a patient's electronic medical record, must contain accurate data and information pertaining to the patient based on actual findings, assessments, evaluations, diagnostics or assessments as documented by the physician."Non-biographical data/information is data that will ty ... ”
What is "non-biographical" information as it pertains to an Electronic Medical Record (EMR)?
165.1(a) (10) now requires the following:
"All non-biographical populated fields, contained in a patient's electronic medical record, must contain accurate data and information pertaining to the patient based on actual findings, assessments, evaluations, diagnostics or assessments as documented by the physician."
Non-biographical data/information is data that will typically change from visit to visit. For example, many EMR systems bring forward from the previous encounter non-biographical information such as symptoms, diagnosis, vitals, lab levels, history, previous treatments etc... However, because symptoms often resolve between encounters (as result of treatment), diagnoses may no longer be active or present (because of previous treatments), and vitals fluctuate, such data fields should not contain inaccurate, non-current, or irrelevant data that is not pertinent to the present illness/issue. Such information may be part of the patient’s history, but should not be reflected as current/present unless such symptoms/diagnoses are ongoing. Such information may become part of the patient’s historical data/information contained in the electronic medical record. Non-biographical information/data contained in a medical record for each encounter should be based on actual assessment, evaluations or other diagnostics that are documented by the physician.
“... of the PMP history report in the patient’s medical record. There is no specific method required for documenting that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review ... ”
May I maintain a copy of the PMP history report in the patient’s medical record?
Yes. The provider may maintain a copy of the PMP history report in the patient’s medical record. There is no specific method required for documenting that the PMP has been checked prior to issuing a prescription. Certain electronic medical record systems, for example, may provide other ways to document that the review has been completed.