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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 June 08, 2000 (PDF File)
Document: ... ng licensure documentation. Chapter 193, Standing Delegation Orders, new 193.9 regarding pronouncement of death. Proposed Rules The Board proposed the following rule changes for publication in the Texas Register and comment: Chapter 164, Advertising, proposed amendment to 164.4 regarding board certi ...
Description: Press Release June 08, 2006 (PDF File)
Document: ... clude 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 ap ...
Description: Press Release June 10, 2004 (PDF File)
Document: ... ration requirements. Chapter 193, Standing Orders Delegation. Proposed amendments to §193.11, Use of Lasers, regarding continuing education on the use of laser devices. Creation of new §193.12, Use of Prescription Medical Devices, concerning rules governing delegation and supervision of medical acts ...
Description: Press Release June 10, 2010 (PDF File)
Document: ... or purposes of intimidation Chapter 193, Standing Delegation Orders: §193.6 Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses, amendment exempts certified registered nurse anesthetists who only sign or carry out drug orders fro ...
Description: Press Release June 11, 2003 (PDF File)
Document: ... l and dishonorable conduct. Chapter 193, Standing Delegation Orders: proposed amendment to 193.6 regarding the delegation of prescriptive authority as mandated by HB1095 of the 78th Legislature. Proposed amendments to 193.11 and 193.12 regarding delegation and supervision of the use of lasers. For c ...
Description: Press Release June 14, 2007 A (PDF File)
Document: ... learning that the patient was obtaining the same prescription simultaneously from another physician. CAMPBELL, ROBERT DOUGLAS, M.D., DALLAS, TX, Lic. #C3003 On June 8, 2007, the Board and Dr. Campbell entered into an Agreed Order assessing an
administrative penalty of $1,000 and prohibit ...
Description: Press Release June 16, 2011 (PDF File)
Document: ... record, and failure to timely acknowledge a drug prescription issue and a patient monitoring issue. Rasamallu, Vijaya Kishore, M.D., Lic. No. M9598, San Antonio On June 3, 2011, the Board and Vijaya Kishore Rasamallu, M.D., entered into an Agreed Order requiring Dr. Rasamallu to complete within one ...
Description: Press Release June 28, 2011 (PDF File)
Document: ... ice, investigators found more than 100 bottles of prescription medications issued in the names of various patients in and around his office and in his personal desk drawer. Dr. Jimenez admitted to pre-signing prescriptions and 194 pre-signed prescriptions were found in the office. In addition, an em ...
Description: Press Release July 07, 2008 B (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, Scope of Standing Delegation orders, clean-up language; §193.7, Delegated Drug T ...
Description: Press Release August 19, 1997 (PDF File)
Document: ... n and renewal requirements; Chapter 193: Standing Delegation Orders, implementing physician assistant licensure and supervision requirements. Disciplinary Actions Abrantes, Anthony Clark, M.D., Sherman, TX, Lic. #F6375 An agreed order was entered on 8-9-97 suspending Dr. Abrantes' license; however, ...
Description: Press Release August 20, 2003 (PDF File)
Document: ... e changes below for detail. 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. New 193.11 regarding delegation and supervision of the use of lasers. Proposed Rule Changes Th ...
Description: Press Release August 20, 2004 (PDF File)
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.
Rule Withdrawals
The Board withdrew the following rule changes that were published in the Texas Register:
Chapter 163, Licensure, Amendme ...
Description: Press Release August 20, 2009 A (PDF File)
Document: ... ons for her patients for controlled substances on prescription forms from his former, now closed, practice, and used a handwritten, expired, DEA authorization number. In addition Dr. Lewis wrote the prescriptions with knowledge that both his federal (DEA) and state (Texas Department of Public Safety ...
Description: Press Release August 21, 2002 A (PDF File)
Document: ... al clean-up of the section. Chapter 193, Standing Delegation Orders: Proposed new §§193.11 and 193.12 regarding the use of lasers. Action was deferred until the October 3-5 Board meeting. Proposed Rule Changes The Board proposed the following rule changes for publication in the Texas Register and co ...
Description: Press Release August 28, 2009 (PDF File)
Document: ... of Pain Management Clinics. Chapter 193, Standing Delegation Orders: Proposed amendments to § 193.6, Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses; and §193.7, Delegated Drug Therapy Management. Chapter 194, Non-Certified R ...
“... 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.