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“... specific information.
About the Agency
The Texas Medical Board is a state regulatory agency. We serve and protect the public's welfare by ensuring our licensed healthcare professionals are competent and provide quality patient health care, and by educating consumers regarding their rights in seekin ... ”
“... , M.D., of Houston, is the President of the Texas Medical Board. He is a Board Certified Anesthesiologist and is the Vice-Chair of the Clinical Governance Board for US Anesthesia Partners for the Gulf Coast region as well as a member of the Clinical Governance Board for US Anesthesia Partners Texas. ... ”
“... IDGE UNIVERSITY, HONOLULU, HI
0523
ORIENTAL MEDICAL INST OF HAWAII, HONOLULU, HI
0524
UNIV. OF HEALTH SCIENCE, HONOLULU, HI
0525
UNIVERSITY OF SCIENCES, BATON ROUGE, LA
0526
NEW ENGLAND SCHOOL OF ACUP, WATERTOWN, MA
0527
MINSHEW ACUP SCH, COLUMBIA FALLS, MT
0528
I ... ”
“... quo; answers to questions on the Professionalism, Medical Liability section of the application.
Once all items have been received, and have been reviewed and approved by the appropriate members of Board staff, your application will be considered complete and your name will be added to ... ”
“... at the verification be sent directly to the Texas Medical Board.
Verification of CCAOM Clean Needle Technique course contact the entity where you took this course and examination and request that they furnish you a verification in a sealed envelope with the providers signature across the outside of ... ”
“... hich:
o is approved by the Medical Board
o is 70 hours in length
o includes a clean needle technique course or equivalent universal infection control precaution procedures course approved by the Medical Board
· &n ... ”
“
Basic PIT permit for out of state rotators only .................... $131.00 Issued for length of the rotation in Texas only
Basic PIT permit for physicians changing institutions.......... $141.00 For physicians changing institutions before current permit expires.
Basic PIT permit for the len ... ”
“... PDF
Sample PIT application - New
PIT Application Fees
Apply
PIT Application
Supplemental Forms
Change Address
Reporting Requirements
Duties of Permit Holders to Report Form
Duties of Program Director to Report Form
FAQs ”
“
Full Texas Medical License
Physician in Training Permit
Faculty Temporary License
Out-of-State Telemedicine License
Administrative Medicine License
Provisional License
Medical License Limited to Underserved Areas
Visiting Physician Temporary Permit
Visiting Professor Temporary License
Conceded Emin ... ”
“... r chemical dependency, which:
is approved by the Medical Board
is 70 hours in length
includes a clean needle technique course or equivalent universal infection control precaution procedures course approved by the Medical Board
Hold an unrestricted and current license, registration, or certificatio ... ”
“Application Fees
Application Fee: The fee for acupuncturist licensure in Texas is $320.00. An additional non-refundable surcharge related to the Texas Physician Health Program ($5.25) will be assessed with the application fee. The entire fee must be submitted before your application ... ”
“... eed to complete at least 40 credits of continuing medical education every 24 months. (24 month timeline is in relation to the biennial registration period, not the calendar year).
Physician Assistant CME Requirements (biennial)
Of the 40 credit hours required:
At least 20 credit ... ”
“... IN THESE SECTIONS HAVE BEEN VERIFIED BY THE TEXAS MEDICAL BOARD
Verified Information
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 meet a ... ”
“... ation process, and the required documentation and fees before submitting their applications. The TSBAE meets and grants permanent licenses three times per year. A temporary license may be issued, if requested by the applicant, to allow the applicant to practice after the application has been a ... ”
Description: Rule Changes March 18, 2013
Document: ... §163.2 clarifies that applicants from unapproved medical schools in the United States and Canada may still qualify for licensure through appropriate board certification. Chapter 187. PROCEDURAL RULES 22 TAC §187.44 The amendment to §187.44 provides for a five calendar day deadline prior to a schedu ...
Description: Rule Changes March 05, 2000
Document: ... The amendment will clarify the provisions of the Medical Practice Act under which physicians holding training permits may be disciplined. Chapter 173, Physician Profiles - proposed new 173.1-173.7, concerning information to be collected by the board as mandated by House Bill 110, 76th Legislature. ...
Description: Rule Changes March 09, 2009
Document: ... complete board rules. Chapter 162, Supervision of Medical School and Physician Assistant Student, with amendments to §162.1, Supervision of Medical Students, provides for the supervision of a medical student who is not enrolled at a Texas medical school as a full-time student or visiting student. Ch ...
Description: Rule Changes March 08, 2001
Document: ... ing advertising board certification. Chapter 175, Fees, Penalties, and Applications - proposed amendment to 175.1 regarding fees for biennial non-profit health organization applications and fees for filing late applications. Chapter 177, Certification of Non-Profit Health Organizations - proposed am ...
Description: Rule Changes March 07, 2012
Document: ... HYSICIAN PROFILES 22 TAC §173.1, §173.3 The Texas Medical Board adopted amendments to §173.1, concerning Profile Contents; and §173.3, concerning Physician-Initiated Updates. The amendment to §173.1 clarifies what utilization review services are subject to reporting on a physician's profile and spec ...
Description: Rule Changes March 07, 2002
Document: ... 163.10 regarding the performance and delivery of medical education, examinations, education and documentation requirements, relicensure requirements, and the use of the Federation of State Medical Board's Credentials Verification Service (FCVS). Chapter 171, Postgraduate Training Permits (new title ...
Description: Rule Changes April 16, 2008
Document: ... ent 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 Texas, amending 167.1 Reinstatement and Reissuance of Medical License Following Suspension or Revocation and 167.3 Ap ...
Description: Rule Changes April 27, 2003
Document: ... new '174.17 regarding the use of the Internet in medical practice. Chapter 184, Surgical Assistants. Amendments to §184.25 regarding continuing education for surgical assistants. Chapter 187, Procedural Rules. Amendments to §§187.10, .12, and .13 which will formalize the procedure whereby the Execu ...
Description: Rule Changes May 01, 2006
Document: ... k here for the complete board rules. Chapter 175, Fees, Penalties, and Forms. Increased registration fees for Physician Assistants. Chapter 183, Acupuncture. Amendments adds a more extensive list of functions of the Acupuncture board; update the citation to the board rule regarding licensure; delete ...
Description: Rule Changes February 28, 1999
Document: ... acceptable for licensure. Chapter 197, Emergenc y Medical Service, sections 197.2-197.5 are repealed and replaced with new language
Description: Rule Changes January 25, 2006
Document: ... ovisions. Amendments change "Texas State Board of Medical Examiners" to "Texas Medical Board" and "Texas State Board of Physician Assistant Examiners" to "Texas Physician Assistant Board;" the number of members of the Texas Medical Board to 19 and the number of public members to 7. Chapter 163, Lice ...
Description: Rule Changes January 22, 2009
Document: ... re recognized for the purpose of an international medical school graduate to prove that the medical school was substantially equivalent to a Texas medical school at the time of attendance. Chapter 165 Medical Records, amending 165.1, Medical Records, clarifies that a physician must destroy medical r ...
Description: Rule Changes January 17, 2011
Document: ... ial Surgery, or is a member the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (BOS) or b) if their certifying board can meet specific standards outlined in the rule. Physicians whose certifying boards are not specifically named ...
Description: Rule Changes January 09, 2005
Document: ... complete board rules. Chapter 162, Supervision of Medical Students: Amendments to §162.1 repealing requirement that supervising physician hold clinical faculty appointment and new §162.2 adding provisions of Chapter 186, Supervision of Physician Assistant Students. Chapter 166, Physician Registratio ...
Description: Rule Changes January 09, 2003
Document: ... nt procedure notification. Chapter 197, Emergency Medical Service. Rule review and amendments to §§197.2 and 197.3 regarding definitions and responsibilities of the off -line medical director. Chapter 199, Public Information. Amendment to §199.2 regarding clarification of the deadline for members of ...
“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 manag ... ”
What are the continuing education requirements for pain management clinics?
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.
“Yes. SB 406 clarified that it is necessary to have prescriptive authority to order these devices. In the past, it was not clear to DME suppliers that APRNs and PAs had this authority. The changes to the law as a result of the passage of SB 406 clearly indicate that APRNs and PAs ma ... ”
Is prescriptive authority required to order durable medical equipment (DME)?
Yes. SB 406 clarified that it is necessary to have prescriptive authority to order these devices. In the past, it was not clear to DME suppliers that APRNs and PAs had this authority. The changes to the law as a result of the passage of SB 406 clearly indicate that APRNs and PAs may order or prescribe this equipment provided all requirements for delegation of prescriptive authority are met.
“... at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision. ”
How many miles from my delegating physician can my practice site be?
SB 406 eliminated site based prescriptive authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision.
“... 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.
“... are facility based practice, delegation is by the medical director. ”
Who may delegate prescriptive authority in a long term care facility based practice?
In a long term care facility based practice, delegation is by the medical director.
“... 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 ... ”
When is Physician supervision of a CRNA required?
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.
“... ltation must be documented in the patient’s medical record. ”
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 ... ”
How do I get a copy of my examination scores sent to another state?
For physicians only:
If another state board requires your examination grades, please be advised that most physicians 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) 868-4000
A small percentage of physicians can obtain verification of examination scores from TMB.
please call the Pre-Licensure, Registration and Consumer Services at (512) 305-7030 to confirm the location of your scores.
There is no fee for this verification.
“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:
“... 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.