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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 August 30, 2007 A (PDF File)
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 ...
Description: Press Release August 31, 2005 (PDF File)
Document: ... Board rules relating to requirements for standing delegation orders. ASHLEY, IAN MARCUS, M.D., WACO, TX, Lic. #K6528 On August 26, 2005, the Board and Dr. Ashley entered into an Agreed Order assessing an administrative penalty of $500. The action was based on allegations that Dr. Ashley violated the ...
Description: Press Release August 31, 2006 (PDF File)
Document: ... of care in the management of pain and appropriate prescription of narcotic pain medications in treating a patient with multiple medical problems, including excessive use of pain medications. CANTU, PHILIP MARTINEZ, M.D., FORT WORTH, TX, Lic. #K 2865 On August 25, 2006, the Board and Dr. Cantu entere ...
Description: Press Release August 31, 1998 (PDF File)
Document: ... an, and Other Information." Chapter 193, Standing Delegation Orders, new section 193.8, regarding delegated administration of immunizations or vaccinations by a pharmacist under written protocol.
Proposed Rules The Board proposed the following new rules for publication in the Texas Register and com ...
Description: Press Release September 02, 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. New §174.7, concerning Telemedicine Medical Services Provided at ...
Description: Press Release September 06, 2000 (PDF File)
Document: ... ing proposals for decision. Chapter 193, Standing Delegation Orders: new 193.10 regarding collaborative management of glaucoma. Proposed Rules The Board proposed the following rule changes for publication in the Texas Register and comment: Chapter 162, Supervision of Medical Students: amendment to 1 ...
Description: Press Release September 08, 2011 (PDF File)
Document: ... iods of on-call time and refrain from designating prescription writing authority to physician extenders. The action was based on Dr. Basped's failure to practice medicine in an acceptable professional manner consistent with public health and welfare. Bishop, Donald Wayne, D.O., Lic. No. E3649, Plano ...
Description: Press Release September 10, 2008 A (PDF File)
Document: ... on Dr. Skie s failure to adequately document his prescription and treatment decisions for the care he provided these patients.
SURAPANENI, VEENA, M.D., Lic. #K6938, Cedar Park, TX On August 29, 2008, the Board and Dr. Surapaneni entered into an Agreed Order requiring that Dr. Surapaneni have her m ...
Description: Press Release September 17, 2001 (PDF File)
Document: ... nformal board proceedings . Chapter 193, Standing Delegation Orders: proposed revision to 193.6 pursuant to SB 1166, relating to delegation of prescriptive authority at alternate practice sites and procedures for waiver from site and supervision requirements . For copies of proposed rules, write the ...
Description: Press Release September 24, 2010 (PDF File)
Document: ... bson suffered in a 2002, and his current abuse of prescription narcotics, make him a danger to the public. Both Temporary Suspension Hearings Without Notice took place under the Board's authority, granted by the Medical Practice Act, to suspend or restrict a physician's license without notice when i ...
Description: Press Release October 09, 2006 A (PDF File)
Document: ... ation; he was arrested and indicted for issuing a prescription for a controlled substance without proper registration; his car was searched by the Palestine Police Department, which found controlled substances and other drugs and a triplicate prescription pad in another doctor's name; and other find ...
Description: Press Release October 12, 2005 (PDF File)
Document: ... without charting any clinical indication for the prescription. HORAN, JOHN W. P., M.D., NEW BRAUNFELS, TX, Lic. #J1097 On October 7, 2005, the Board and Dr. Horan entered into an Agreed Order assessing an administrative penalty of $1,000. The action was based on allegations that Dr. Horan failed to ...
Description: Press Release October 13, 2004 (PDF File)
Document: ... sed repeal of this chapter. Chapter 193, Standing Delegation Orders: Proposed amendments to §193.6 on d elegation of the carrying out or signing of prescription drug orders to physician assistants and advanced practice
nurses to make the procedure for registering alternate delegating physicians co ...
Description: Press Release October 16, 2008 A (PDF File)
Document: ... rd-keeping. The action was based on his writing a prescription for hydrocodone for a patient without a physical examination after the patient's four-month absence from a treatment program. Launius, John A., M.D., Lic. #H2149, Lewisville, TX On October 10, 2008, the Board and Dr. Launius entered into ...
Description: Press Release October 21, 2003 (PDF File)
Document: ... le review with no c hanges. Chapter 193, Standing Delegation Orders. Proposed changes to §193.6 concerning applications for waiver and meetings of the Prescriptive Delegation Waiver Advisory Committee. Chapter 194, Non-Certified Radiologic Technicians. Proposed rule review of Chapter 194 and changes ...
“... 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.