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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: Rule Changes December 23, 1997
Document: ... ysician assistants. Chapter 193.1-193.7, Standing Delegation Orders reorganization of the entire chapter, incorporates several legislative changes, deletes old section 7 regarding rad techs and renumbers the sections. Chapter 194.1-194.11, Non-Certified Radiologic Technicians new sections outlining ...
Description: Rule Changes November 30, 2009
Document: ... XAMINING%20BOA RDS.html#312 Chapter 193, Standing Delegation Orders, with proposed amendments to§193.6, relating to Delegation of the Carrying Out or Signing of Prescription Drug, reflects changes passed during
the 81st Legislative Session under Senate Bill No. 532. Specifically, the amendments ch ...
Description: Rule Changes November 30, 2003
Document: ... 04 of the 78th Legislature. Chapter 193, Standing Delegation Orders. New §193.11 regarding delegation and supervision of the use of lasers. Chapter 196, Voluntary Surrender of a Medical License. Amendments to §§196.1-196.3 for general cleanup of the chapter. NOTE: Chapter 168, Persons with Criminal ...
Description: Rule Changes November14, 2000
Document: ... ng site-based registration. Chapter 193, Standing Delegation Orders - rule review and proposed amendments regarding cites to Texas Occupations Code Annotated. Chapter 194, Non-Certified Radiologic Technicians - rule review and proposed amendments regarding current registry with the Texas Department ...
Description: Rule Changes October 17, 2010
Document: ... The repeal and replacement of §174.6, concerning Delegation to and Supervision of Telepresenters, repeals §174.6 and adds new language for new §174.6, concerning Telemedicine Medical Services Provided at an Established Medical Site. The Board has determined that the new language is necessary to est ...
Description: Rule Changes October 03, 2010
Document: ... XAMINING%20BOA RDS.html#306 Chapter 193, Standing Delegation Orders: Amendments to §193.6 clarify that physicians who delegate to certified registered nurse anesthetists (CRNAs) who only sign or carry out prescription drug orders are not required to register with the Board. The Board has determined ...
Description: Rule Changes September 28, 2006
Document: ... gation for substance abuse. Chapter 193, Standing Delegation Orders, 193.12 relating to the immunization of persons over 65 by physicians' offices.
Description: Rule Changes September 27, 2007
Document: ... 181.2 Definitions; 181.3 Release of Contact Lens Prescription; and 181.6 Physician s Prescriptions: Delegation, relating to establishing that the verification of a contact lens prescription may substitute for an original signature to create a valid contact lens prescription. Chapter 191, District R ...
Description: Rule Changes September 24, 1998
Document: ... her to follow this advice." Chapter 193, Standing Delegation Orders, new section 193.8, regarding pharmacist immunizations under protocol.
Description: Rule Changes September 21, 2000
Document: ... 33 regarding oral argument. Chapter 193, Standing Delegation Orders - new §193.10, regarding collaborative management of glaucoma.
Description: Rule Changes September 14, 2003
Document: ... uing acupuncture education. Chapter 193, Standing Delegation Orders: Amendments to §§193.2 and 193.6 regarding the delegation of prescriptive authority as mandated by House Bill 1095 of the 78th Legislature.
Description: Rule Changes September 12, 2004
Document: ... es and registration. Chapter 193, Standing Orders Delegation. Amendments to §193.11, Use of Lasers, regarding continuing education on the use of laser devices.
Description: Rule Changes August 10, 2008
Document: ... pter 196 of the Board Rules. Chapter 193 Standing Delegation Orders, with amendments to §193.1, Purpose, updates name of Texas Medical Board; §193.2, Definitions, updates name of Texas Physician Assistant Board; §193.4, Scope of Standing Delegation Orders, clean-up language; §193.6, Delegation of th ...
Description: Rule Changes July 02, 2000
Document: ... ng licensure documentation. Chapter 193, Standing Delegation Orders - new §193.9, regarding pronouncement of death.
Description: Rule Changes June 29, 2006
Document: ... nclude amendments to 174.2, Definitions and 174.6 Delegation to and Supervision of Telepresenters regarding delegation of tasks and activities by a physician to a telepresenter. Chapter 178, Complaints , to include amendments to 178.8, Appeals regarding the deletion of the deadline for filing an app ...
“... 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.