“... limited license that allows physicians to use the medical and clinical knowledge, skill, and judgment of a fully licensed physician in ways which may affect the health and safety of the public or any person.
It does not include the authority to
pract ... ”
“Welcome to the Texas Medical Board’s (TMB) Employment Opportunities page. TMB is housed in the George H.W. Bush State Office Building at 1801 Congress Avenue, Suite 9.200, just north of the Texas State Capitol in the Capitol Complex.
We employ over 200 people in a wide variety of professional, ... ”
“... particular area.
To protect the public, the Texas Medical Board (TMB) has taken steps to standardize what “board certified” means under TMB advertising rules. In October 2010 the TMB amended its Physician Advertising rules.
According to the new rules, a physician may use the term "board ... ”
“Texas State Board of Acupuncture Examiners
Continuing Acupuncture Education:
Guidelines for Approval/Recognition of Courses for Credit
May 4, 2007
The following guidelines are used by staff to determine course approval/recognition.
Course Approval
CAE courses are recogni ... ”
“... istration, practitioners are required to complete continuing acupuncture education.
As of September 2018 Acupuncturist Registration/Renewal began the process of renewing biennially (every 2 years).
In order to stagger the roll out of the biennial renewals, all licensed Acupuncturists were se ... ”
“... ganization is interested in applying to have your continuing acupuncture education course approved by the Texas State Board of Acupuncture Examiners, please download and submit the current application.
Application For Continuing Acupuncture Education Course Approval
If you have at least thre ... ”
“Continuing Acupuncture Education Approved Provider Application Instructions
The Texas State Board of Acupuncture Examiners (TSBAE) requires a license holder to complete continuing acupuncture education (CAE) approved by the board each year in order to maintain licensure.
Courses ... ”
“... istration, practitioners are required to complete continuing medical education. Current requirements for physicians are summarized below. If you would like to review the current rule, these requirements are currently listed Board rule 166.2 available on our website at: http://www.tmb.stat ... ”
“... ensee becomes board certified or recertified in a medical specialty and the medical specialty program meets the standards of the American Board of Medical Specialties, the American Medical Association, the Advisory Board for Osteopathic Specialists and Boards of Certification, or the American Osteop ... ”
“... provision does not exempt the physician from the requirement for two credits involving pain management and the prescription of opioids, or the required course in the prevention of human trafficking, as outlined on the page above. ”
“... onger than one year's duration outside the state;
medical practice and residence of longer than one year's duration outside the United States; or
good cause shown on written application of the licensee that gives satisfactory evidence to the board that the licensee is unable to comply with the requi ... ”
“... istration, practitioners are required to complete continuing medical education.
As of December 2018 Physician Assistant Registrations/Renewals are on a biennial cycle (every 2 years). Even license numbers renew in even years, and odd license numbers renew in odd years.
&n ... ”
“Many practitioners are required to obtain continuing education to maintain active licensure.
For information on specific continuing education requirements per license type, please select the proper link above.
”
“... prescriptive authority required to order durable medical equipment (DME)?
Do I have to produce my prescriptive authority agreement or facility-based protocol if a licensing board asks to see it?
What is the difference between medication orders and prescriptions?
How many miles from my delegat ... ”
“... ptive authority agreement?
Do I have to let the Medical Board know about my delegates/supervising physicians?
”
“... levant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on feder ... ”
Are physicians potentially subject to discipline for violations of the standard of care by CRNAs to whom they have delegated the selection or administration of anesthesia or the care of an anesthetized patient?
Yes, potentially. Although physicians are not required to supervise CRNA’s for delegated tasks, they nonetheless remain subject to potential liability for violations of the standard of care by CRNAs, depending on federal and state statutes and regulations. The degree to which a physician is required to supervise a CRNA during the performance of a task in anesthesia services is left to the “physician’s professional judgment in light of other relevant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on federal and state statutes and regulations.
Additionally, Texas Attorney General Opinion No. KP-0353 found “In authorizing physicians to delegate the administration of anesthesia to CRNAs, the Legislature did not expressly limit the liability of the delegating physician. See TEX. OCC. CODE § 157.058; cf. id. § 157.004(c) (providing that in specified circumstances a physician who issues a standing delegation under chapter 203 generally “is not liable in connection with an act performed under that standing delegation order”). Thus, we cannot conclude that the liability of a physician delegating the administration of anesthesia to a CRNA is limited solely to the determination of competency. Questions of physician liability in any specific context are highly factual and not an appropriate determination for the opinion process. See Tex. Att’y Gen. Op. No. GA-0446 (2006) at 18 (“Questions of fact are not appropriate to the opinion process.”) (Page 4 with emphasis added.)
“... nbsp; The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any ... ”
When is Physician supervision of a CRNA required?
Regardless of the circumstances when supervision is or is not required, it is important to remember that the delegating physician must abide by all required federal and state statutes and regulations regarding delegation. The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any time.
The Texas Attorney General has issued three opinions on CRNA supervision. The latest opinion found that although physician supervision of a CRNA is not required in Texas Occupations Code Sec. 157.058, other federal and state statutes and regulations may require physician supervision of a CRNA, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician, and the Legislature did not expressly limit the liability of the delegating physician.
Specifically, Texas Attorney General Opinion KP-0353 found “Section 157.058 of the Occupations Code does not, by itself, require a physician who properly delegates anesthesia-related tasks to a certified registered nurse anesthetist (“CRNA”) to supervise the performance of those acts.” (Page 5)
However, KP-0353 also found “…the language of chapter 157 is not the only relevant authority to consider in addressing the question of physician supervision over acts delegated to a CRNA. Federal regulations limiting Medicare coverage and conditioning hospital participation in Medicare and Medicaid programs require physician supervision of a CRNA when administering anesthesia in certain circumstances. See, e.g., 42 C.F.R. §§ 416.42(b)(2), 482.52(a)(4), 485.639(c)(1)(v), (2) (requiring a CRNA to operate under a physician’s supervision when administering anesthesia in certain circumstances). Furthermore, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician. See TEX. HEALTH & SAFETY CODE §§ 481.002(1)(A) (defining “administer” to require agent to apply controlled substance in presence of physician), .071(a) (prohibiting physician from causing controlled substance to be administered under physician’s “direction and supervision” except for valid medical purpose and in course of medical practice). And a CRNA may not obtain an anesthetic that is a dangerous drug unless a physician has listed that CRNA as the physician’s designated agent. See id. §§ 483.001(4) (defining “designated agent”), .022(a) (requiring physician to name each designated agent in writing). (Page 3 with emphasis added.)
Finally, KP-0353 found “Whether and the extent to which physician supervision is required for an act delegated to a CRNA will depend on the specific act delegated, the type of facility in which the CRNA performs the act, and any relevant regulations of that facility. And while section 157.058 authorizes a physician to delegate to a CRNA, a physician is never required to do so. If a physician is concerned about a CRNA’s ability to perform a delegated act or desires to limit the delegation, the physician retains the authority to refrain from delegating, to limit the delegation, or to supervise the delegation to whatever extent the physician determines necessary. In sum, the authority to delegate provided by section 157.058 of the Occupations Code does not eliminate the need to comply with all other applicable statutes, regulations, bylaws, ethical standards, and a physician’s own professional judgment. See TEX. OCC. CODE § 157.007 (“An act delegated by a physician under [chapter 157] must comply with other applicable laws.”). (Page 4 with emphasis added.)
“... cordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who: (A) has been admitted to the hospital for an intended length of stay of 24 ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
“... ltation must be documented in the patient’s medical record. ”
How often is physician consultation required when prescribing controlled substances?
APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.
“... ians will have to contact the Federation of State Medical Boards to obtain examination scores.Federation of State Medical Boards 400 Fuller Wiser Rd. Suite 300 Euless, TX 76039-3855 Tel. (817) 868-4000A small percentage of physicians can obtain verification of examination scores from TMB. If you wer ... ”
How do I get a copy of my examination scores sent to another state?
For physicians only:
If another state board requires your examination grades, please be advised that most physicians will have to contact the Federation of State Medical Boards to obtain examination scores.
Federation of State Medical Boards
400 Fuller Wiser Rd.
Suite 300
Euless, TX 76039-3855
Tel. (817) 868-4000
A small percentage of physicians can obtain verification of examination scores from TMB.
please call the Pre-Licensure, Registration and Consumer Services at (512) 305-7030 to confirm the location of your scores.
There is no fee for this verification.
“The requirements are the same for International Medical School Graduates (IMGs) and U.S. or Canadian medical school graduates except that: IMGs must demonstrate that they are either ABMS or BOS specialty board certified, have graduated from a medical ... ”
What are the requirements for an international medical school graduate to get a Full Texas Medical License?
The requirements are the same for International Medical School Graduates (IMGs) and U.S. or Canadian medical school graduates except that:
“... e selection and administration of anesthesia is a medical act, if such an act was validly delegated to a CNRA by a physician, the act is considered to be within the practice of nursing and governed by the Nursing Practice Act. Any discipline for a violation of the standard of care by a CRNA wo ... ”
Is a CRNA under a valid delegation order, subject to discipline by the Texas Medical Board under the Medical Practice Act for a violation of the standard of care in the selection and administration of anesthesia or the care of an anesthetized patient?
No, while the selection and administration of anesthesia is a medical act, if such an act was validly delegated to a CNRA by a physician, the act is considered to be within the practice of nursing and governed by the Nursing Practice Act. Any discipline for a violation of the standard of care by a CRNA would be carried out by the Texas Board of Nursing under the authority of the Nursing Practice Act. Ultimate responsibility and accountability for the medical management of a patient under anesthesia remains with the delegating physician who may be subject to discipline for improper delegation dependent upon the facts and circumstances of each case, and how state statutes and regulations apply in those situations.
“... lated fields, contained in a patient's electronic medical record, must contain accurate data and information pertaining to the patient based on actual findings, assessments, evaluations, diagnostics or assessments as documented by the physician."Non-biographical data/information is data that will ty ... ”
What is "non-biographical" information as it pertains to an Electronic Medical Record (EMR)?
165.1(a) (10) now requires the following:
"All non-biographical populated fields, contained in a patient's electronic medical record, must contain accurate data and information pertaining to the patient based on actual findings, assessments, evaluations, diagnostics or assessments as documented by the physician."
Non-biographical data/information is data that will typically change from visit to visit. For example, many EMR systems bring forward from the previous encounter non-biographical information such as symptoms, diagnosis, vitals, lab levels, history, previous treatments etc... However, because symptoms often resolve between encounters (as result of treatment), diagnoses may no longer be active or present (because of previous treatments), and vitals fluctuate, such data fields should not contain inaccurate, non-current, or irrelevant data that is not pertinent to the present illness/issue. Such information may be part of the patient’s history, but should not be reflected as current/present unless such symptoms/diagnoses are ongoing. Such information may become part of the patient’s historical data/information contained in the electronic medical record. Non-biographical information/data contained in a medical record for each encounter should be based on actual assessment, evaluations or other diagnostics that are documented by the physician.
Also see: EMR Position Statement
“... t the review is documented in the patient’s medical record. ”
Must I document the PMP check? Each and every time?
Yes. Each time the patient’s PMP history is accessed, the physician or advanced practice provider must ensure that the review is documented in the patient’s medical record.
“... 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 ... ”
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.
“... equest a fingerprint card by contacting the Texas Medical Board at Screen-CIC@tmb.state.tx.us if they are an applicant, or at Registrations@tmb.state.tx.us if they are a licensee. When emailing the request, please include a current mailing address. ”
Will I automatically be sent fingerprint cards if I enter an out-of-state address when I apply?
No, fingerprint cards are not automatically sent out to applicants. Because not all applicants reside at the mailing address of record when they submit their online applications, it is the responsibility of the applicant to verify whether or not they can be live-scanned. If that is not an option, they must request a fingerprint card by contacting the Texas Medical Board at Screen-CIC@tmb.state.tx.us if they are an applicant, or at Registrations@tmb.state.tx.us if they are a licensee. When emailing the request, please include a current mailing address.
“Disciplinary actions for Medical Physicists are available at: http://www.tmb.state.tx.us/page/DSHS-Transferred-Licenses under the Disciplinary/Enforcement Actions tab labeled “Medial Physicist”. ”
How do I verify disciplinary action on a Medical Physicist?
Disciplinary actions for Medical Physicists are available at: http://www.tmb.state.tx.us/page/DSHS-Transferred-Licenses under the Disciplinary/Enforcement Actions tab labeled “Medial Physicist”.
“... session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians. What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting prac ... ”
Why was the NCT permit eliminated?
In the 2017 legislative session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians. What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting practice.
“... session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians. What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting prac ... ”
Why can’t I register my NCT permit and my NCT registry at the same time?
In the 2017 legislative session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians. What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting practice.
The NCT Registry and the NCT Permit were renewed separately. Under current rules and regulations, the NCT registry is on a biennial (2 year) renewal schedule. Before elimination by statutory changes, the NCT permit was an annual renewal.
You will need to continue to renew your NCT Registry listing or hardship exemption to continue to practice as an NCT in Texas.
“... l TMB registration/renewal, per the new statutory requirement set out in Texas Occupations Code, Sec 601.1111. ”
Why do I have to be fingerprinted for my first NCT Registry renewal with the Texas Medical Board?
The fingerprint background check will be required prior to the completion of your initial TMB registration/renewal, per the new statutory requirement set out in Texas Occupations Code, Sec 601.1111.