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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: Medical Board 2012 - November - Licensure Committee - Agenda Item 8b: Proposed Changes to Board Rule 195
Document: ... ts of which relate to the distribution of illegal prescription drugs or a controlled substance as defined by Texas Occupations Code 551.003(11). (3) As a requirement for eligibility, a physician applying for a pain management certificate must meet the active practice of medicine definition as define ...
Description: Medical Board 2012 - November - Standing Orders Committee Meeting Minutes
Document: ... le action on requests for waivers of prescriptive delegation requirements. The committee reviewed a request for waiver of prescriptive delegation requirements from Bharat B. Latthe, MD for a site serving a medically underserved population in Houston, Texas that functions primarily as a walk-in clini ...
Description: Medical Board 2012 - November - Disciplinary Process Review Committee - Agenda Item 02 - TX PHP Report
Document: ... ine was from a cough syrup that she took and that prescription would be provided. 11/15/2012: Tested positive for 7-Aminoclonazepam (133 ng/mL).
REMAIN WITH PHP
X
TMB ACCEPTED
CONTINUE
9. 12-0292
Background:
Referral Type: Self Agreement Term: 7/11/2012 7/10/2015 Referral Reason: Substance ...
Description: Medical Board 2013 - April - Disciplinary Process Review Committee - Agenda Item 02 - TX PHP Report
Document: ... P Medical Director as the participant had a valid prescription on file. 5/25/2012: Test resulted in "low creatinine" (19.6 mg/dL; SG: 1.005). 5/29/2012: Tested "positive" (expected) for Alprazolam metabolite (153 ng/mL).
Page 1 of 13
5/30/2012: Tested "positive" (expected) for Alprazolam metaboli ...
Description: Medical Board 2013 - February - Full board Committee Meeting Minutes
Document: ... obinson reviewed the ongoing audits. Prescriptive Delegation. Deferred to later in the meeting.
Federation of State Medical Boards Update. Ms. Robinson gave a brief update on the Federation meeting that she and Dr. Arambula attended in January related to National licensure. Dr. Arambula welcomed i ...
Description: Medical Board 2013 - February - Licensure Committee - Agenda Item 6a: Proposed Changes to Board Rule 197
Document: ... , implement, and revise protocols and/or standing delegation orders, if appropriate, governing prehospital care and medical aspects of patient triage, transport, transfer, dispatch, extrication, rescue, and radio-telephone-telemetry communication by the EMS; (5) direct an effective system audit and ...
Description: Medical Board 2013 - February - Standing Orders Committee Meeting Minutes
Document: ... le action on requests for waivers of prescriptive delegation requirements. The committee reviewed a request for a modification or waiver of prescriptive delegation requirements from Jonathan Sheinberg, MD, who appeared with counsel, Adam Aseron. Dr Sheinberg would like his midlevels to provide home ...
Description: Medical Board 2013 - February - Disciplinary Process Review Committee - Agenda Item 02 - TX PHP Report
Document: ... L) and hydromorphone (334 ng/mL). Participant had prescription on file for right shoulder sprain/strain. 11/13/2012: Missed Call: Participant's account was suspended due to a credit card issue and he was unable to check in. Did not go and test. 12/27/2012: Missed Test: Participant went to Europe wit ...
Description: TMB disciplines 14 physicians at October meeting, adopts rule changes
Document: ... cal recordkeeping, twelve hours in supervision or delegation, eight hours in
medical ethics and eight hours in risk management; and within 60 days pay an administrative penalty of $2,000. Th
e
Board found Dr. Snook enabled a non
-
physician, at a clinic in which he was the medical director, to mak ...
Description: TMB disciplines 18 physicians at December meeting
Document: ... are defined as stimulants, in Texas other than a prescription written to Dr. Zeitlin for personal use; shall not use his Texas medical license in any jurisdiction to
diagnose, treat, or prescribe controlled substances to patients in Texas for chronic or postsurgical, postprocedure, persistent nonc ...
Description: To apply for the pain management clinic certification, please download and fill out the form below.
Document: ... s
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
Medi ...
Description: Legislative Update – 85th Legislature (2017, Regular & 1st Called Sessions)
Document: ... icensure & Enforcement
HB 2561
(Thompson)
Prescription
Monitoring
Program
(PMP),
Prescription Drug
Donation
, &
Pharmacy Board
Sunset
Adds new sections to TX Controlled Substances Act (Chpt 481, Health & Safety Code) re:
PMP requirements for all licensed prescribers and di ...
Description: Waiver for Chronic Pain Patients Extended by Governor Abbott
Document: ... ues to allow for
telephone refill(s) of a valid prescription for
treatment of chronic pain by a physician with an established chronic pain patient
.
The
physician(s) remains responsible
for meeting the standard of care and
all other
laws and rules
relat
ed to the practice o
f medicine.
...
Description: TMB disciplines 16 physicians at October meeting
Document: ... tilize telemedicine to continue
issuing previous prescription(s) for scheduled medications to established chronic pain patients, if the physician has,
within the past 90 days, seen a patient in
-
person or via a telemedici
ne visit using two
-
way audio and video
communication.
DISCIPLINARY ...
Description: Texas Physician Assistant Board suspends Houston physician assistant
Document: ... nt Administration (DEA), Board staff
found blank prescription forms
in the possession of an unlicensed
health care provider
that
included Ms. Behm’s name and the name of her supervising physician which were all pre
-
stamped with Ms. Behm’s signature stamp.
Furthermore
,
the Board pan ...
“... 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.