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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 February 11, 2004 (PDF File)
Document: ... n was based on Dr. Hamilton's drug abuse and self-prescription of Phenobarbital. HOWARD, ANNETTE M, M.D., HOUSTON, TX, Lic. #J5161 On 2-6-04 the Board and Dr. Howard entered into an Agreed Order publicly reprimanding Dr. Howard, ordering her to perform 200 hours of community service, and assessing a ...
Description: Press Release February 11, 1999 (PDF File)
Document: ... ition of the word "Submit." Chapter 193, Standing Delegation Orders, section 193.2 concerning the definition of the word "Submit." The Board also adopted an amendment to Chapter 163, Section 163.1 of the licensure rules regarding acceptable combinations of examination for licensure. For copies of th ...
Description: Press Release February 13, 2003 (PDF File)
Document: ... ral cleanup of the chapter. Chapter 193, Standing Delegation Orders: Amendments to §193.6 regarding supervision waiver requests.
Proposed Rule Changes
The Board proposed the following rule changes for publication in the Texas Register and comment: Chapter 163, Licensure. Proposed amendments to §§16 ...
Description: Press Release February 15, 2007 A (PDF File)
Document: ... h codeine for no fewer than nine persons, using a prescription pad from a former employer. In August, 2006, Dr. Salmond received "field release citations" from Austin police for possession of drug paraphernalia, which later tested positive for traces of cocaine. He was reported missing during this t ...
Description: Press Release February 15, 2008 A (PDF File)
Document: ... nces registrations eliminating his Schedule II-IV prescription authorizations; that his practice be monitored by another physician for five years; that he pass the Medical Jurisprudence Examination; that he perform 100 hours of community service a year for five years; and prohibiting him from superv ...
Description: Press Release February 16, 2011 (PDF File)
Document: ... herself or any member of her immediate family any prescription drugs for 10 years; must take within one year and pass within three attempts the Medical Jurisprudence Examination; complete within one year five hours of CME in ethics; and pay an administrative penalty of $4,500 within 180 days. The Bo ...
Description: Press Release February 17, 2010 (PDF File)
Document: ... he lived and was romantically involved and on her prescription of controlled substances to the same individual, even though Dr. Dipprey knew or should have known this individual had a drug addiction, and on Dr. Dipprey's failure to maintain adequate medical records for these transactions. Miller, Je ...
Description: Press Release February 18, 2005 (PDF File)
Document: ... abuser who was found in possession of cocaine and prescription drugs. He was arrested for possession of cocaine on December 12, 2004. The length of a temporary suspension is indefinite and remains in effect until the board takes further ac tion.
The Texas State Board of Medical Examiners, the state ...
Description: Press Release February 18, 1998 (PDF File)
Document: ... a patient may request and receive a contact lens prescription and under which a physician shall provide such prescription, as mandated by the 75th Legislature through the Texas Contact Lens Prescription Act; Chapter 183, Acupuncture, repeal of current 183.17 and new sections 183.17 and 183.23, to i ...
Description: Press Release February 21, 2007 A (PDF File)
Document: ... r failing to abstain from alcohol and ingesting a prescription drug in violation of the terms and conditions of his probation. KILPATRICK, HAMILTON WRIGHT, M.D., UVALDE, TX, Lic. #C3109 On February 16, 2007, the Board and Dr. Kilpatrick entered into an Agreed Order accepting the voluntary surrender ...
Description: Press Release February 22, 2011 (PDF File)
Medical Board suspends license of doctor in Forney
Document: ... She saw all patients in her home, where she kept prescription pads unsecured and charged patients $20 per prescription given. The Temporary Suspension Hearing Without Notice took place under the Board's authority granted by the Medical Practice Act. The physician has the opportunity to have a Tempo ...
Description: Press Release March 09, 2011 (PDF File)
Document: ... rmometer found on the premises. Blank, pre-signed prescription pads were found in Dr. Stafford's office. The Temporary Suspension Hearing Without Notice took place under the Board's authority granted by the Medical Practice Act. The physician has the opportunity to have a Temporary Suspension Hearin ...
Description: Press Release April 07, 2004 (PDF File)
Document: ... primary field of practice. Chapter 193, Standing Delegation Orders: Amendment to §193.6 concerning Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses necessary for general cleanup of the section relating to controlled substance ...
Description: Press Release April 07, 2005 (PDF File)
Document: ... ations that he diverted an associate's triplicate prescription pad to prescribe medications to himself and family members; he wrote false and fictitiou s prescriptions; and his hospital staff privileges were summarily suspended and that he presented a real danger to the health of his patients or to ...
Description: Press Release April 09, 2002 (PDF File)
Document: ... a probationers compliance. Chapter 193, Standing Delegation Orders: amendment to section 193.6 regarding the delegation of prescriptive authority to alternate practice sites as specified in SB1166.
Proposed Rule Changes The Board proposed the following rule changes for publication in the Texas Reg ...
“... 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.