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“... SUPERVISION & PRESCRIPTIVE DELEGATION REGISTRATION
If you have questions regarding the log in for the Supervision and Prescriptive Delegation Registration System, please use the “HELP” options available in the the upper right hand corner on each screen. ... ”
“... rsquo;s emergency department, contingent upon the prescription being filled at the hospital’s facility-based pharmacy. A PA or APRN may also issue such prescriptions as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, ... ”
“... nacted)
H.B. 2561 S. Thompson (V. Taylor) — Prescription Monitoring Program
S.B. 315 Hinojosa (Burkett) — Subpoena Authority and Pain Management Regulation
S.B. 674 Schwertner (S. Davis) — Licensing Provisions and Elimination of Dual Registration
S.B. 1625 Uresti (Cortez) — P ... ”
“... spital privileges, specialty board certification, delegation information, etc.)and some of which is provided and verified by the board (e.g., license status, educational background, disciplinary actions, etc.):
(1) Full name;(2) Place of birth if the physician requests that it be included in the phy ... ”
“... spital privileges, specialty board certification, delegation information, etc.) and can be updated at any time. Many updates are provided by the physician at a time of licensure renewal/registration. An update may be provided by the licensee between renewals, while certain updates MUST b ... ”
“... tmb.state.tx.us/page/supervision-and-prescriptive-delegation
Limits on Number of Delegates: waived the delegate limit of seven PAs or APRNs that a physician could supervise and delegate to regardless of location or setting.
PITs: allowed Texas hospitals and facilities associ ... ”
“... his time, the Online Supervision and Prescriptive Delegation Registration system is not set up to accept delegation locations outside of Texas.
Any physician, PA or APRN who does not have a TX practice address and needs to register prescriptive delegation, please contact the Registration Department ... ”
“... s been granted by the appropriate agency.
A prescription for a controlled substance is not required to be issued electronically and may be issued in writing if the prescription is issued:
by a veterinarian;
in circumstances in which electronic prescribing is not available due to temporary tec ... ”
“... ity of patients are issued, on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.
A pain management clinic may not operate in Texas without obtaining a certificate from the Texas Medical Board (TMB). Certain exemption ... ”
Description: Press Release December 05, 1997 (PDF File)
Document: ... administrative penaltie s; Chapter 193, Standing Delegation Orders, repeals sections 193.1-193.5, 193.8, 193.9 and adds new sections 193.1-193.7, which will reorganize the chapter and comply with HB 2846 and SB 1566, 75th Legislature; Chapter 194, Non-Certified Radiologic Technic ians, adds new sec ...
Description: Press Release December 06, 2004 (PDF File)
Document: ... ing: Dr. Elder diverted an associate's triplicate prescription pad to prescribe medications to himself and family members; he wrote false and fictitious prescriptions; and his hospital staff privileges were summarily suspended. Based on these findings, the panel found that Dr. Elder is a real danger ...
Description: Press Release December 06, 2007 A
Document: ... chronic pain patient.
INADEQUATE SUPERVISION OR DELEGATION
JOSHI, CHANDRA M., M.D., Minden, LA, Lic. #G7832 On November 30, 2007, the Board and Dr. Joshi entered into an Agreed Order reprimanding Dr. Joshi; prohibiting him from practicing pain management; and requiring that his practice be monit ...
Description: Press Release June 15, 2012 (PDF File)
Document: ... , and non-therapeutically prescribed, after which prescription the patient died from a prescription drug overdose.
Johnson, Tone, Jr., M.D., Lic. No. G6946, Corpus Christi On June 8, 2012, the Board and Tone Johnson Jr., M.D., entered into a Mediated Agreed Order requiring Dr. Johnson to have his ...
Description: Press Release September 07, 2012 (PDF File)
Document: ... in a file for one year containing a copy of every prescription he writes for controlled substances or dangerous drugs with addictive potential, have a physician monitor his practice for four cycles, undergo an independent psychiatric evaluation and comply with all recommendations for care and treatm ...
Description: Press Release December 11, 2012 (PDF File)
Document: ... n Guidelines, provides the standard for physician delegation of the performance of nerve conduction studies by individuals who are not licensed as physicians or physical therapists. The amendment to §190.14, concerning Disciplinary Sanction Guidelines, amends the range and scope of sanctions for vio ...
Description: Press Release December 18, 2012 (PDF File)
Document: ... legal operations have been fueling an epidemic of prescription drug abuse and fraud that is killing more people than heroin and cocaine combined. We hope this sends the message that pill mills aren't welcome in Texas." The medical board staff worked closely with the Drug Enforcement Administration, ...
Description: Press Release December 13, 2006 A (PDF File)
Document: ... that Dr. Rittenhouse refilled a patient's Lipitor prescription at the patient's first visit, but did not order adequate laboratory work or maintain adequate records for the patient. OTHER STATES' BOARD ACTIONS HEMPHILL, JOHN MICHAEL, M.D., SAVANNAH, GA, Lic. #E2606 On December 8, 2006, the Board an ...
Description: Press Release December 15, 2005 (PDF File)
Document: ... administrative violations. Chapter 193, Standing Delegation Orders 193.2 Definitions and 193.6 Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses , to include elimination of registration of prescriptive delegation with the boar ...
Description: Press Release December 16, 2004 (PDF File)
Document: ... tudents. Repeal of chapter. Chapter 193, Standing Delegation Orders. Amendment to §193.6 regarding delegation of carrying out or signing of prescription drug orders to Physician Assistants and Advanced Nurse Practitioners. Proposed Rule Changes The Board proposed the following rule changes for publi ...
Description: Press Release December 17, 2003 (PDF File)
Document: ... ule review with no changes. Chapter 193, Standing Delegation Orders: Changes to §193.6 concerning applications for waiver and meetings of the Prescriptive Delegation Waiver Advisory Committee. Chapter 194, NonCertified Radiologic Technicians: Rule review of Chapter 194 and changes to §194.1-194.11 r ...
Description: Press Release December 18, 2008 A (PDF File)
Document: ... taff who did not make a correction to a called-in prescription upon request of a patient. In addition, twelve licensees agreed to enter into administrative orders with the board for minimal statutory violations.
CEASE AND DESIST ORDER
Baughman, Liz, Austin, TX On December 12, 2008, the Board and Ms ...
Description: TEXAS PHYSICIANS ASSISTANT BOARD Physician Assistant Owned Clinics Ad Hoc Committee December 3, 2010
Document: ... uirements pertaining to physician supervision and delegation. Accordingly, a proposed amendment to Physician Assistant Board Rule 185.16 was drafted, adding Subsection 185.16(e) to permit PAs to own health clinics and contract with physicians to provide supervision under certain circumstances. A sta ...
Description: TEXAS PHYSICIAN ASSISTANT BOARD BOARD MEETING December 14, 2012
Document: ... Interim Committee report related to prescriptive delegation relationships between APN/PA's is yet to be filed. Key legislation dates were given. Staff will be tracking bills related to the board during the legislative session. Ms. Robinson gave a brief update on self direct semi independent status. ...
Description: DISCIPLINE & ETHICS REVIEW & DECISIONS Texas Physician Health Program (Probationer/Licensee Violated PHP Agreement & Cases of Concern) December 14, 2012
Document: ... ugh syrup that she took and ensured a copy of the prescription would be provided to TXPHP. On 11/26/2012, a copy of a prescription for Phenergan with Codeine cough syrup, dated 10/15/2012, was provided to TXPHP. More importantly, the prescription was written by the participants Physician Assistant, ...
“... 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. ”
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.
“Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient ... ”
What if a prescriber is just approving a refill?
Refills issued to the patient pursuant to a valid prescription and without any reauthorization from the prescriber do not require a PMP check by the prescriber. However, if a prescriber is issuing a prescription for a patient that is unchanged from a previous prescription issued to the patient (often referred to as a refill), then this would be considered a new prescription and would require a PMP check.
“... endent 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 ... ”
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.
“... m. If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement. ... ”
Do I have to let the Medical Board know about my delegates/supervising physicians?
Yes, if you are a physician or a physician assistant.
Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work for them. If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.
PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement. They are also required to notify the Board within 30 days of any change to the scope of the delegation.
APRNs should look to guidance provided by the Texas Board of Nursing for how to register their delegating physicians, as the Medical Board does not have licensing authority for nurses.
“... count any relevant information prior to issuing a prescription. ”
Is only the prescriber allowed to check the PMP, or can someone else check on behalf of the physician?
A physician, their delegated midlevel provider, or any other qualified and licensed individual delegated authority to check the PMP may do so on behalf of the prescriber. Ultimately though, it is the prescriber’s responsibility to ensure that the PMP has been checked and that they have reviewed and taken into account any relevant information prior to issuing a prescription.
“... ans. 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 ... ”
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.