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“As a prerequisite for acudetox registration, practitioners are required to complete continuing auricular acupuncture education (CAAE).
Documentation of continuing educaiton courses shall be made available to the Board upon request but should not be submitted with the registration. Random audi ... ”
“... ation coursework.
All PHYSICIAN, RESPIRATORY CARE PRACTITIONERS, ACUPUNCTURE, MEDICAL RADIOLOGIC TECHNOLOGISTS, ACUDETOX SPECIALISTS, MEDICAL PHYSICISTS AND SURGICAL ASSISTANTS licensees have access to establish a free, basic account with CE Broker. Beginning June 2, 2025, licensed physici ... ”
Description: PA Board 2007 November, Licensure Committee
Document: ... include disciplinary action by the Texas Board of Nurse Examiners; and administrative removal from Goodfellow AFB. Mr. Reyna seconded the motion. All voted in favor. The motion passed.
Applicant #582 appeared before the Committee in executive session after referral by the Executive Director. In ope ...
Description: Medical Board 2006 April, Ad Hoc Study
Document: ... thesiologiststo hysicians or certified registered nurse anesthetist;and 192.3 (a) and 192.4 (a) delete urgicalbefore procedure; and 192.1(13) add and/or tumescent anesthesia greater than 1 liter of solution. Agenda item #4, Adjourn. The meeting was adjourned at 11:37 a.m.
...
Description: Acupuncture 2002 April, Educ Min
Document: ... ll Board to deny the course Disaster Relief: What Practitioners Need to Know for continuing acupuncture education.
Agenda item #3, regarding carry-over of continuing education hours, was considered. Following discussion, Dr. Heinze moved, Dr. Voris seconded, and the motion passed to recommend to t ...
Description: Acupuncture 2005 October, Disc Ethic
Document: ... hackelford, General Counsel; Pam Crocker, Central Nurse Investigator in the Investigation Department; and various other staff. Agenda item #2, the August 2005 Enforcement Report, was considered. Ms. Shackelford and Ms. Crocker presented the report. This was an informational item only and no vote was ...
Description: Acupuncture 2005 October, Disc Ethic
Document: ... hackelford, General Counsel; Pam Crocker, Central Nurse Investigator in the Investigation Department; and various other staff. Agenda item #2, the August 2005 Enforcement Report, was considered. Ms. Shackelford and Ms. Crocker presented the report. This was an informational item only and no vote was ...
Description: Acupuncture 2006 May, Full Board
Document: ... ertaining to registration fees for licensed Texas practitioners.
Robert Simpson, Assistant General Counsel, gave a report on a case at the State of Office of Administrative Hearings concerning Sheryl Roe.
Agenda item #4, Discussion regarding development of rules pursuant to Sunset change in Acupu ...
Description: Acupuncture 2007 May, AI 345 CAE Action Taken
Document: ... w.gfcherbs.com Expanded Medical Ethics for Ethics Practitioners of Acupuncture & Oriental Medicine 4
Ethics Treating Patients with Chinese Herbal Medicine Who are Taking Western Meds 2
Herbal
Master Tungs Magic Points Advanced Series
General
36 General
Master Tungs Magic Points Beginning Serie ...
Description: Acupuncture 2009 October, Staff CAE Approvals
Document: ... thics
1
Ethic
The Ethical Relationship between Practitioners
Distance Learning
Ethics
1
Ethic
Treating Acid Reflux and Distance Learning GERD with 5 Element Patterns
General
14
Gene
Treating Alcohol Addiction with Distance Learning 5 Elemental Patterns
General
14
Gene
Treating Anxiet ...
Description: Acupuncture 2011 January, CPT Coding
Document: ... nformation to be used in the newsletter to enable practitioners to be in compliance with current CPT coding practices. The committee will meet at the next scheduled board meeting to discuss a draft statement for release regarding CPT coding for acupuncturists. Agenda item #3, Adjourn. There being no ...
Description: Medical Board 2006 April STANDING ORDERS COMMITTEE MEETING MINUTES April 6, 2006
Document: ... prescriptions written by physician assistants and nurse practitioners. The committee received a request for waiver of prescriptive delegation from Craig Gunter, M.D. Following discussion, Mr. Turner moved that the Standing Orders Committee recommend to the full board that Dr. Gunter waiver request b ...
Description: TMB restricts Houston physician (King)
Document: ... ty to a
physician assistant or advanced practice nurse or supervise a surgical assistant.
The Board panel f
ound
that
Dr.
King nontherapeutically
prescribed controlled substances to 20
chronic pain patients and violated the applicable standard of care and Board rules relating to the
tr ...
Description: Medical Board 2007 - April - Full Board Committee Meeting Minutes April 13, 2007
Document: ... amended to prohibit Dr. Pruett from supervising a nurse practitioner or physician assistant.
After discussion, Mr. Turner moved, Dr. Benavides seconded, and the motion passed to approve the Agreed Order for Benjamin V. Thurman, M.D. once the requirement of a three-year chart monitor is added. Dr. Z ...
Description: Medical Board 2007 - February - Minutes of the Disciplinary Process Review Committee
Document: ... concerning the issue of proper supervision of the Nurse Practitioner involved in the complaint. Dr. Khan moved, Ms. Blackwell seconded and the motion passed to take no further action on Log # 05-2028; Log # 06-1037; Log # 06-2075; Log # 06-2414; and Log # 06-2864. Discussion was held on Agenda Item ...
Description: Medical Board 2007 - November - Full Board Committee Meeting Minutes
Document: ... ve authority to physician assistants and advanced nurse practitioners.
After discussion, Mr. Turner moved, Dr. Anderson seconded, and the motion passed to approve the Agreed Order for Robert N. Crabtree, M.D. as written.
After discussion, Dr. Price moved, Mr. Turner seconded and the motion passed ...
Description: Medical Board 2008 - April - Standing Orders Committee Meeting Minutes
Document: ... y practice site, employment relationship with the nurse practitioner, and how hard-copy medical records can be appropriately transferred between the two sites. Dr. Zeitler seconded the motion. Ms Fredricks, Dr. Khan, Dr. McNeese, and Dr. Zeitler, voted in favor. Ms . Raggette was opposed. The motion ...
“It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician. ... ”
It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician.
“... ysician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the pr ... ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“... exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however. ”
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.
“A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement. ... ”
What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement.
Note that if a licensee’s authority to supervise, delegate, or prescribe devices is limited under a board order, the licensee may enter into a prescriptive authority agreement and practice under the agreement only to the extent permitted by the board order.
“... nesthesia-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 phys ... ”
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.)
“... n No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this ac ... ”
Are CRNA’s authorized to practice independent of physician supervision and delegation?
No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA. Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this act by a physician. A CRNA who administers anesthesia without proper delegation from a physician would be liable for the unlicensed practice of medicine.
“... rofile page will list the waiver status. For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website. ”
Do delegates who have prescribing authority have to apply for their own waiver or are they covered by the supervising physician’s waiver?
If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing.
If an individual wants to look up whether a prescribing delegate has a waver they can do so as listed below:
For physician assistants: A PA’s waiver status will not be viewable on their TMB public profile. Each PA’s public profile has a link to their supervising physician’s profile page. The physician’s profile page will list the waiver status.
For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website.
“... o; If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile. You can look up a prescriber’s public profile here: Look up a LicenseNOTE: Per the Texas State Board of Pharmacy, a “pharmaci ... ”
How can someone determine if a practitioner has a waiver?
If a physician has a waiver from e-prescribing, it is viewable on their public profile page, under the section entitled “Verified Information.” If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile. You can look up a prescriber’s public profile here: Look up a License
NOTE: Per the Texas State Board of Pharmacy, a “pharmacist is not responsible for ensuring there is a waiver. In addition, there is no requirement of the pharmacist to ensure an appropriate waiver is granted.”