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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 April 10, 2000 (PDF File)
Document: ... of physicians providing, or overseeing by proper delegation, anesthesia services in outpatient settings and outlining the minimum acceptable standards for the provision of anesthesia services in outpatient settings, as mandated by Senate Bill 1340, 76th Legislature. Proposed Rules The Board propose ...
Description: Press Release April 10, 2009 (PDF File)
Document: ... The action was based on Dr. Hamilton's writing a prescription for a co-worker in the name of someone he had never met or treated. Price, Clinton C., M.D., Lic. #L4657, Seguin TX On February 19, 2009, the board and Dr. Price entered into an Agreed Order requiring that within one year Dr. Price enrol ...
Description: Press Release April 13, 2005 (PDF File)
Document: ... ession of cocaine and the subsequent discovery of prescription drugs and syringes in his vehicle. The action was also based on findings by the Board that Dr. Sauceda is a known drug abuser who had been under two previous Board orders for substance abuse. SCALLY, MICHAEL CHARLES, M.D., HOUSTON, TX, L ...
Description: Press Release April 13, 2006 (PDF File)
Document: ... e amendments to §174.2, Definitions and to §174.6 Delegation to and Supervision of Telepresenters regarding delegation of tasks and activities by a physician to a telepresenter. Chapter 175, Fees, to include amendments to §175.2, Registration and Renewal Fees, regarding Texas Online fees for office- ...
Description: Press Release April 16, 2008 A (PDF File)
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, 193.4, Scope of Standing Delegation Orders , clean-up language; §193.6, Delega ...
Description: Press Release April 18, 2007 A (PDF File)
Document: ... from administering, prescribing or delegating the prescription of intravenous Lidocaine or intravenous Colchicine or their generic counterparts; requiring that he complete additional continuing medical education in the areas of pain management and endocrinology; and assessing an administrative penal ...
Description: Press Release April 20, 2011 (PDF File)
Document: ... ilure to meet the standard of care; inappropriate prescription of dangerous drugs to oneself, family members or others in which there is a close personal relationship; failure to follow guidelines for the prescription of pain medications; becoming financially or personally involved with a patient in ...
Description: Press Release April 21, 2005 (PDF File)
Document: ... chronic neck and back pain. Her initial two-week prescription included 30 Xanax 2 mg., 90 Xenical 120, Estradiol 1 mg. with a one-year refill, 60 Hydrocodone/APAP 10/500, and 60 Soma 350. She was seen every two weeks through May 3, 2004, and progress notes included only symptoms. She was given 15 D ...
Description: Press Release April 21, 2010 (PDF File)
Document: ... d how to file complaints with the Board; § 174.6, Delegation to and Supervision of Telepresenters. Repeals Section 174.6 and add new language for rules relating to Telemedicine Medical Services Provided at an Established Medical Site; § 174.7, Telemedicine Medical Services Provided at Sites other th ...
Description: Press Release April 28, 1998 (PDF File)
Document: ... f intent to practice forms; Chapter 193, Standing Delegation Orders, amendment to section 193.2 relating to definitions. For copies of these rules, write to the Board at MC 901, P.O. Box 2018, Austin TX 78768-2018, or email pat.wood@tmb.state.tx.us.
Proposed Rules The Board proposed the repeal of C ...
Description: Press Release May 08, 2007 A (PDF File)
Document: ... sting and abstain from consumption of alcohol and prescription drugs unless prescribed by a physician. The panel found Dr. Halbert a danger to the health of his patients or to the public through his lack of competence, impaired status or failure to care adequately for his patients.
The temporary su ...
Description: Press Release May 17, 2011 (PDF File)
Document: ... igating the son's death discovered multiple empty prescription pill bottles under the son's bed. The majority were labeled as having been prescribed by Dr. Jacoby to his son's friends and one family member. Pharmacy records showed that since the date of his son's death, Dr. Jacoby continued to presc ...
Description: Press Release May 21, 2002 (PDF File)
Document: ... al clean-up of the chapter. Chapter 193, Standing Delegation Orders. New 193.11 and 193.12 concerning the use of lasers. For copies of rule changes or proposed rules, write the Board at MC 901, P.O. Box 2018, Austin, TX 78768-2018, or e-mail jill.wiggins@t mb.state.tx.us
...
Description: Press Release May 27, 1998 (PDF File)
Document: ... ture patient records; new section 193.8 regarding delegation of pharmacist immunizations under protocol.
The Board deferred action on previously proposed amendment to Rule 165.1165.3 concerning medical records charges.
Correction A previous disciplinary action summary was published incorrec tly; ...
Description: Press Release June 03, 2009 (PDF File)
Document: ... n's inability to practice because of addiction to prescription medicine.
ACTIONS BASED ON ACTION BY ANOTHER STATE OR ENTITY
Hurley, Regina S., M.D., Lic. #L4454, Clearwater FL On May 29, 2009, the board and Dr. Hurley entered into an agreed order requiring that she pay an administrative penalty of ...
“... 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.