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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 October 21, 2005 (PDF File)
Document: ... administrative violations. Chapter 193 , Standing Delegation Orders 193.2 Definitions and 193.6 Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses, to include elimination of registration of prescriptive delegation with the board ...
Description: Press Release October 30, 2000 (PDF File)
Document: ... ing sitebased registration. Chapter 193, Standing Delegation Orders, rule review and amendments regarding cites to Texas Occupations Code Annotated. Chapter 194, Non-Certified Radiologic Technicians, rule review and amendments regarding cites to Texas Occupations Code Annotated. Proposed amendments ...
Description: Press Release November 05, 2010 (PDF File)
Document: ... tion was based on Dr. Dannemiller's inappropriate prescription of dangerous drugs to himself and failure to maintain adequate medical records. Davis, Nora J., M.D., Lic. No. J4071, Houston On October 29, 2010, the Board and Nora J. Davis, M.D., entered into an Agreed Order requiring Dr. Davis to com ...
Description: Press Release November 06, 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 November 13, 2009 (PDF File)
Document: ... of Pain Management Clinics. Chapter 193, Standing Delegation Orders: amendments to§193.6, relating to Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses; and §193.7, relating to Delegated Drug Therapy Management. Chapter 194, No ...
Description: Press Release November 17, 2011 (PDF File)
Document: ... d controlled substances for himself by altering a prescription so he could obtain multiple refills. Dr. Kim was charged with a felony and is currently participating in a pre-trial diversion program; charges will be dropped upon Dr. Kim's successful completion of the program. Paige, Robert Warren, M. ...
Description: Press Release February 02, 2012 (PDF File)
Document: ... Enforcement Agency inspected the clinic and found prescription logs that showed Dr. Evans continued to devote 85-90% of his practice to pain management, prescribing opoids and other controlled substances including Oxycontin, Hyrdocodone, Dilaudid and Fentanyl. Previously, Dr. Evans entered into an A ...
Description: Press Release December 19, 2002 (PDF File)
Document: ... al cleanup and rule review. Chapter 193, Standing Delegation Orders, proposed change to §193.6(i)(2)(C) to include Physician Assistants in the language regarding supervision waiver requests. Proposed amendments to Chapter 174, Telemedicine, were sent back to staff for changes. Proposed amendment to ...
Description: Press Release December 28, 2010 (PDF File)
Document: ... that Dr. Atlas's record-keeping had not improved. Prescription activity records from the Texas Department of Public Safety for a 12-month period showed that the majority of Dr. Atlas's prescriptions were for opiates and in high doses. The temporary restriction is in effect until the Board takes furt ...
Description: Press Release February 23, 2012 (PDF File)
Document: ... . Billue failed to document justification for the prescription of controlled substances. Campbell, Odette Louise, M.D., Lic. No. H9609, Duncanville On February 10, 2012, the Board and Odette Louise Campbell, M.D., entered into a Mediated Agreed Order resolving a matter at the State Office of Adminis ...
Description: Press Release February 24, 2002 (PDF File)
Document: ... y found from the study is many of the drugs, both prescription and over-the-counter, were good to use years after the expiration date. But the key was proper storage. The U.S. Food and Drug Administration maintains an extensive website devoted to the issue. For more information, visit http://www.fda ...
Description: TEXAS STATE BOARD OF PHYSICIAN ASSISTANT EXAMINERS BOARD MEETING MINUTES AUGUST 1, 2002
Document: ... enda item #5, a report regarding the Prescriptive Delegation Waiver Advisory Committee, was next. Ms. Jaime Garanflo, Director of Customer Affairs, updated the board members regarding the work of the Prescriptive Delegation Waiver Advisory Committee, stating that there had been no recent waiver requ ...
Description: TEXAS STATE BOARD OF PHYSICIAN ASSISTANT EXAMINERS BOARD MEETING MINUTES AUGUST 1, 2003
Document: ... enda item #5, a report regarding the Prescriptive Delegation Waiver Advisory Committee, was next. Ms. Jaime Garanflo, Director of Customer Affairs, updated the board members regarding the work of the Prescriptive Delegation Waiver Advisory Committee, stating that there had been no recent waiver requ ...
Description: Press Release April 25, 2012 (PDF File)
Document: ... mit within 60 days written protocols for standing delegation orders for her pain management clinic. The Board found Dr. Cruz engaged in a pattern of nontherapeutic prescribing of controlled substances to two patients who resided in Louisiana. Hoover, Samuel Clark, M.D., Lic. No. E8569, Euless On Apr ...
Description: Press Release May 07, 2012 (PDF File)
Document: ... n or Restriction hearing. In addition, Dr. Evans' prescription of Schedule III-IV controlled substances is restricted to acute care/crisis patients. The Board found that Dr. Evans illegally operated two pain clinics, CPR Medical Group Clinic in Houston and Holland Medical Group Clinic in Jacinto Cit ...
“... 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.