No. The TMB no longer checks for compliance with Texas Higher Education Coordinating Board (THECB) requirements at the PIT permit application level. However, THECB requirements must be met when applying for a physician license.

Personal statements can be sent by e-mail, fax, regular or overnight mail. Documents and third party information can be sent by regular or overnight mail, or fax, if the documents are less than 10 pages.

• E-mail to pit.applications@tmb.state.tx.us.

Fax to (888) 550-7516 Attn: PIT Permits

• Overnight and Regular mail - We recommend using one of the private overnight delivery services that allow tracking to submit all required items. These services require delivery to a physical address and a phone number. Delivery by a private overnight service to our physical address usually allows you to obtain immediate online confirmation of delivery from the carrier.

Items mailed through the US Postal Service (regular, certified, express, or overnight), must be addressed to our mailing address, or they will be returned to the sender. A vendor signs for and delivers these items to our agency. Even if a tracking mechanism is used, the signature confirming receipt of items delivered to the mailing address will be that of a vendor employee, making confirmation of delivery more difficult.

Delivery Physical Address and Phone

• Texas Medical Board, 1801 Congress Avenue, Suite 9-200, Austin, TX 78701
Phone – (512) 305-7030

Mailing address

• Texas Medical Board, P.O. Box 2029, Austin, TX 78768

Be sure to make at least two copies of the Receipt page when you complete your online application. The amount you paid will be reflected on the receipt. You can keep one copy for your records and use the other copy to request reimbursement from your residency program or medical school.

Yes. They must register with the TMB for bulk payment processing. Your program will receive a third party identification number which they should make available to you, if they wish to pay your application fee. On the payment page of the online application, select "Pay by Third Party Payment". Enter the third party identification number you were given in the "Third Party ID" field. Note: This number should not be confused with the TMB personal identification number, or your ACGME, AOA, or TMB Program Identification number. Be sure to enter a valid email address. You will receive an email if the application fee has not been paid within seven days. Your application will not be submitted to the Texas Medical Board until the fee has been paid. Entering an incorrect third party identification number will mean that your program, or other third party payer, is prevented from paying for your application, and you will have to submit a new application with the correct third party identification number or choose another form of payment.

No. If you are unable to obtain a certified copy of your transcript directly from the school you will have to prove that you have made "exhaustive attempts" to obtain it. Your file will have to be reviewed by our Executive Review Group before a determination of acceptability can be made. Please consult your licensing analyst AFTER you submit your application for details on proving "exhaustive attempts."

No. The Texas Occupations Code concerning Surgical Assistants does not require that you have a license to practice as a Surgical Assistant so long as you are supervised by a physician. Please review the Occupations Code Section 206.002 for full details on applicability. Also: We are aware that many entities require that a Surgical Assistant working for them be licensed in Texas. Please be aware that this is not required by the State of Texas but instead may be the result of billing or institutional policies. Whatever the reason for applying for a license at this time, your application will be given due attention upon submission of all required documents.

If you are not able to locate your username and password, please submit a written request 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

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

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. 

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. Physicians need to complete at least 24 hours of continuing medical education each year, at least half of which must be in formal courses. One hour of formal CME must be in medical ethics and/or professional responsibility. A physician must report on the registration form if she or he has completed the required CME. However, newly licensed physicians are exempt from the CME requirements the first time they register.

Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct or indirect compensation which has monetary value of any kind and the physician's practice is limited to voluntary charity care to indigent populations and receives no direct or indirect compensation of any kind for medical services rendered. Also, the physician's practice cannot include the provision of medical services to family members or the self-prescribing of controlled substances or dangerous drugs. A physician who violates the provisions of this exemption may be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes controlled substances or dangerous drugs. Additionally, a physician who attempts to obtain this exemption by submitting false or misleading statements shall be subject to disciplinary action pursuant to the Medical Practice Act, in addition to any civil or criminal actions provided for by the state or federal law.

Regulations regarding the registration and operation of pain management clinics do not apply to the following settings:

• a medical or dental school or an outpatient clinics associated with a medical or dental school;
• a hospital, including any outpatient facility or clinic of a hospital;
• a hospice established under 40 TAC §97.403 (relating to Standards Specific to Agencies Licensed to Provide Hospice Services) or defined by 42 CFR §418.3;
• a facility maintained or operated by this state;
• a clinic maintained or operated by the United States;
• a nonprofit health organization certified by the board under Chapter 177 of this title (relating to Certification of Non-Profit Health Organizations);
• a clinic owned or operated by a physician who treats patients within the physician's area of specialty who personally uses other forms of treatment, including surgery, with the issuance of a prescription for a majority of the patients.

Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your clinic meets one of the exemptions listed above. However, the Board does have inspection authority, and owners of clinics that have not been properly registered can be investigated.

A pain management clinic may not operate in Texas unless the clinic is owned and operated by a medical director who: • is a physician who practices in Texas • has an unrestricted medical license • holds a certificate of registration for that pain management clinic   In addition, the owner/operator of a pain management clinic, an employee of the clinic, or a person with whom a clinic contracts for services may not: • have been denied, by any jurisdiction, a license issued by the Drug Enforcement Agency or a state public safety agency under which the person may prescribe, dispense, administer, supply, or sell a controlled substance; • have held a license issued by the Drug Enforcement Agency or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, supply, or sell a controlled substance, that has been restricted; or • have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance   A pain management clinic may not be owned wholly or partly by a person who has been convicted of, pled nolo contendere to, or received deferred adjudication for: • an offense that constitutes a felony; or • an offense that constitutes a misdemeanor, the facts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code Annotated §551.003(11)   The medical director of a pain management clinic must operate the clinic in compliance with Drug Prevention and Control Act, 21 U.S.C.A. 801 et.seq. and the Texas Controlled Substances Act, Chapter 481 of the Texas Health and Safety Code, relating to the prescribing and dispensing of controlled substances. The medical director of a pain management clinic must, on an annual basis, ensure that all personnel: • are properly licensed, if applicable, • are trained including 10 hours of continuing medical education related to pain management, and • are qualified for employment.

Per Board Rule 172.3(d), 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.