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Supervision and Prescriptive Delegation Registration

 

Senate Bill 532, effective 1/31/2010, requires physicians to register with the TMB if the physicians delegate prescriptive authority to PAs or APNs.

Senate Bill 406, effective 11/1/2013, requires a prescriptive authority agreement be in place between a physician and a PA or APN that has been delegated prescriptive authority.  Senate Bill 406 changes (including the new prescriptive authority agreements) to the online registration system will be available in January 2014.

 

Eligibility requirements for physicians and physician assistants:

  • Full, active, and unrestricted licenses are required for online registration.
  • You are not eligible to register online if:
    • your license is under a current board order, or if you have notified the TMB that you are not actively practicing medicine, or
    • you hold a temporary physician, temporary PA, or Faculty Temporary License.
  • You are not eligible to delegate prescriptive authority if:
    • you are a physician licensed under Voluntary Charity Care Status, or
    • you hold a Telemedicine, Public Health or Conceded Eminence license.

 

If you are eligible to delegate prescriptive authority and you are not eligible to register online, please contact the Registration Department at  Registrations@tmb.state.tx.us for a hard copy supervision/delegation form.

 

Eligibility requirements for advanced practice nurses:

  •           A full, active, and unrestricted Texas nursing license is required for online registration (this includes licenses that are recognized by reciprocity).
  •           If your Texas nursing license cannot be validated for prescriptive delegation through the Texas Board of Nursing, you are not eligible to use the Supervision and Prescriptive Delegation Registration System.

 

 

  • How does a PA register a supervising physician with the Board?

    You can register a new supervising physician through the Online Supervisions and Prescriptive Delegation Registration System. Please note that this is a 2 step process and that the supervising physician must complete the registration.

    How does a PA terminate a supervising physician relationship?

    The addition of a new supervising physician does not terminate any other supervision that is currently in place. Any current supervising physician relationship can be terminated using the Online Supervisions and Prescriptive Delegation Registration System.

    What are the laws or rules concerning a PA's scope of practice?

    Board Rule 185.10 covers Physician Assistant Scope of Practice.

    Does delegation of prescriptive authority to a PA or APN have to be registered with the TMB as well?

    Effective 1/31/2010, registration by physicians of delegated prescriptive authority to PAs or APNs is required.

    Can a PA sign a prescription for controlled substances?

    Yes, the PAs supervising physician must delegate prescriptive authority allowing a PA to sign prescriptions for controlled substances, also called scheduled drugs, as well as Dangerous Drugs. However, PA's are generally limited to Schedules III – V (Schedule IIs are allowed in very limited circumstances). All prescription drugs that are not controlled substances fall into the category of "dangerous drugs." Physician assistants with prescriptive authority must have their own DEA numbers to prescribe controlled substances. In addition, physician assistants must have the name of their current delegating physician authorizing prescriptive authority on file with DEA.

    Please note: Under Senate Bill 195, the requirement for controlled substances registration (CSR) with the Texas Department of Public Safety (DPS) was eliminated as of September 1, 2016.

    How many physician assistants can a physician supervise?

    There is no limitation to the number of PAs or APNs a physician may supervise. However, a physician may only delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent to seven full-time equivalent PAs for a maximum of 350 clinic hours per week. A full-time equivalent is considered to be 50 hours per week. The only exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice.

    How many supervising physicians can a PA have?

    There is no limit to the number of supervising physicians a PA may have.

    How many PAs can a physician delegate prescriptive authority to?

    A physician may delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent, for a maximum of 350 clinic hours per week. A full-time equivalent is considered to be 50 hours per week. There are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 193.

    How soon does a PA need to update the Board about a change in supervising physicians? What about an addition?

    Within 30 days of the change or addition. This can be done through the Online Supervisions and Prescriptive Delegation Registration System.

    How does a PA register an alternate supervising physician?

    This is done through a log kept at the facility.

    Can a PA call in a prescription to a pharmacy?

    Yes, a PA can call in a prescription to a pharmacy. However, the PA can only do so at the direction of a physician.