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Profissional Documentos
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BOARD RULES
Texas Administrative Code, Title 22, Part 9
Revised 06/24/2009
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§167.4. Best Interests of Public.
§167.5. Best Interests of the Physician.
§167.6. Final Action.
§167.7. Judicial Review.
§167.8. Certain Persons Ineligible for Reinstatement or Reissuance of License.
Chapter 169. Authority of Physicians to Supply Drugs ..........................................................................................44
§169.1. Purpose.
§169.2. Definitions.
§169.3. Administration of Drugs.
§169.4. Providing, Dispensing, or Distributing Drugs.
§169.5. Exceptions.
§169.6. Administration or Provision of Drugs in Licensed Facilities.
§169.7. Record Keeping.
§169.8. Policy.
Chapter 170. Pain Management ...............................................................................................................................47
§170.1. Purpose.
§170.2. Definitions.
§170.3. Guidelines.
Chapter 171. Postgraduate Training Permits .........................................................................................................51
§171.1. Purpose.
§171.2. Construction.
§171.3. Physician-in-Training Permits.
§171.4. Board-Approved Fellowships.
§171.5. Duties of PIT Holders to Report.
§171.6. Duties of Program Directors to Report.
Chapter 172. Temporary and Limited Licenses......................................................................................................57
Subchapter A. General Provisions and Definitions ............................................................................................................ 57
§172.1. Purpose.
§172.2. Construction and Definitions.
Subchapter B. Temporary Licenses .................................................................................................................................... 59
§172.3. Distinguished Professors Temporary License.
§172.4. State Health Agency Temporary License.
§172.5. Visiting Physician Temporary Permit.
§172.6. Visiting Professor Temporary License.
§172.7. National Health Service Corps Temporary License.
§172.8. Faculty Temporary License.
§172.9. Postgraduate Research Temporary License.
§172.10. Department of State Health Services Medically Underserved Area (DSHS-MUA) Temporary License.
§172.11. Temporary Licensure—Regular.
Subchapter C. Limited Licenses .......................................................................................................................................... 64
§172.12. Telemedicine License.
§172.13. Conceded Eminence.
§172.15. Public Health License.
Chapter 173. Physician Profiles ................................................................................................................................67
§173.1. Profile Contents.
§173.2. Profile Update and Correction Form.
§173.3. Physician-Initiated Updates.
§173.4. Updates to the Physician's Profile Due to Board Action.
§173.5. Updates to the Physician's Profile Due to Information Received by a Third Party.
§173.7. Corrections and the Dispute Process.
Chapter 174. Telemedicine ........................................................................................................................................70
§174.1. Purpose.
§174.2. Definitions.
§174.3. Telemedicine Medical Services.
§174.4. Use of the Internet in Medical Practice.
§174.5. Notice of Privacy Practices.
§174.6. Delegation to and Supervision of Telepresenters.
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Chapter 175. Fees, Penalties, and Forms .................................................................................................................73
§175.1. Application Fees.
§175.2. Registration and Renewal Fees.
§175.3. Penalties.
§175.4. Application Forms.
§175.5. Payment of Fees or Penalties.
Chapter 176. Health Care Liability Lawsuits and Settlements .............................................................................76
§176.1. Definitions.
§176.2. Reporting Responsibilities,
§176.3. Separate Reports Required and Identifying Information.
§176.4. Timeframes and Attachments.
§176.5. Alternate Reporting Formats.
§176.6. Penalty.
§176.7. Claims not Required to be Reported.
§176.8. Board Review of Health Care Liability Lawsuits and Settlements.
§176.9. Reporting Form.
Chapter 177. Certification of Non-Profit Organizations ........................................................................................80
§177.1. Definitions.
§177.2. Initial Certification of 162.001(b) Health Organizations.
§177.3. Qualifications for Certification as a 162.001(b) Health Organization.
§177.4. Applications for Certification as a 162.001(b) Health Organization.
§177.5. Special Requirements for 162.001(b) Health Organizations.
§177.6. Biennial Reports for 162.001(b) Health Organizations.
§177.7. Establishment of Fees.
§177.8. Failure to Submit Reports or Fees for 162.001(b) Health Organizations.
§177.9. Migrant, Community or Homeless Health Centers.
§177.10. Review of Applications and Reports.
§177.11. Denial of Certification.
§177.12. Revocation of Certification.
§177.13. Complaint Procedure Notification.
Chapter 178. Complaints ..........................................................................................................................................87
§178.1. Purpose and Scope.
§178.2. Definitions.
§178.3. Complaint Procedure Notification.
§178.4. Complaint Initiation.
§178.5. Preliminary Investigation of a Complaint.
§178.6. Complaint Filing.
§178.7. Complaint Resolution.
§178.8. Appeals.
Chapter 179. Investigations ......................................................................................................................................92
§179.1. Purpose and Scope.
§179.2. Definitions.
§179.3. Confidentiality.
§179.4. Request for Information and Records from Physicians.
§179.5. Investigation of Professional Review Actions.
§179.6. Time Limits.
§179.7. Past Complaints.
§179.8. Alcohol and Drug Screening During Investigation for Substance Abuse.
Chapter 180. Rehabilitation Orders .........................................................................................................................96
§180.1. Rehabilitation Orders.
Chapter 181. Contact Lens Prescriptions ................................................................................................................99
§181.1. Purpose.
§181.2. Definitions.
§181.3. Release of Contact Lens Prescription.
§181.4. Delegation of Fitting of Contact Lenses.
§181.5. Contact Lens Dispensing Permit Not Required of Physician or Physician's Employees.
§181.6. Physician's Prescriptions: Delegation.
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§181.7. Liability.
Chapter 182. Use of Experts ...................................................................................................................................102
§182.1. Purpose.
§182.2. Board's Role.
§182.3. Definitions.
§182.4. Use of Consultants.
§182.5. Expert Panel.
§182.6. Use of expert witnesses.
§182.7. Interim Appointment.
§182.8. Expert Physician Reviewers.
Chapter 183. Acupuncture ......................................................................................................................................104
§183.1. Purpose.
§183.2. Definitions.
§183.3. Meetings.
§183.4. Licensure.
e circumstances of the outpatient treatment;
§183.5. Annual Renewal of License.
§183.6. Denial of License; Discipline of Licensee.
§183.7. Scope of Practice.
§183.8. Investigations.
§183.9. Impaired Acupuncturists.
§183.10. Patient Records.
§183.11. Complaint Procedure Notification.
§183.12. Medical Board Review and Approval.
§183.13. Construction.
§183.14. Acudetox Specialist.
§183.15. Use of Professional Titles.
§183.16. Texas Acupuncture Schools.
§183.17. Compliance.
§183.18. Administrative Penalties.
§183.19. Acupuncture Advertising.
§183.20. Continuing Acupuncture Education.
§183.21. Continuing Auricular Acupuncture Education for Acudetox Specialists.
§183.22. Language Requirements.
§183.23. Voluntary Surrender of Acupuncture License.
Chapter 184. Surgical Assistants ............................................................................................................................131
§184.1. Purpose.
§184.2. Definitions.
§184.3. Meetings.
§184.4. Qualifications for Licensure.
§184.5. Procedural Rules for Licensure Applicants.
§184.6. Licensure Documentation.
§184.7. Temporary Licensure.
§184.8. License Renewal.
§184.9. Relicensure.
§184.12. Surgical Assistant Scope of Practice.
§184.13. Physician Supervision.
§184.14. Supervising Physician.
§184.15. Grounds for Denial of Licensure and for Disciplinary Action.
§184.16. Discipline of Surgical Assistants.
§184.17. Disciplinary Guidelines.
§184.18. Administrative Penalties.
§184.19. Complaint Procedure Notification.
§184.20. Investigations.
§184.21. Impaired Surgical Assistants.
§184.22. Procedure.
§184.23. Compliance.
§184.24. Construction.
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§184.25. Continuing Education.
§184.26. Voluntary Relinquishment or Surrender of a License.
Chapter 185. Physician Assistants ..........................................................................................................................142
§185.1. Purpose.
§185.2. Definitions.
§185.3. Meetings and Committees.
§185.4. Procedural Rules for Licensure Applicants.
§185.5. Relicensure.
§185.6. Annual Renewal of License.
§185.7. Temporary License.
§185.8. Inactive License.
§185.9. Reissuance of License Following Revocation.
§185.10. Physician Assistant Scope of Practice.
§185.11. Tasks Not Permitted to be Delegated to a Physician Assistant.
§185.12. Identification Requirements.
§185.13. Notification of Intent to Practice and Supervise.
§185.14. Physician Supervision.
§185.15. Supervising Physician.
§185.16. Employment Guidelines.
§185.17. Grounds for Denial of Licensure and for Disciplinary Action.
§185.18. Discipline of Physician Assistants.
§185.19. Administrative Penalties.
§185.20. Complaints.
§185.21. Investigations.
§185.22. Impaired Physician Assistants.
§185.23. Third Party Reports to the Board.
§185.24. Procedure.
§185.25. Compliance.
§185.26. Voluntary Surrender of Physician Assistant License.
Chapter 187. Procedural Rules ...............................................................................................................................160
Subchapter A. General Provisions and Definitions .......................................................................................................... 160
§187.1. Purpose and Scope.
§187.2. Definitions.
§187.3. Computation of Time.
§187.4. Agreement to be in Writing.
§187.5. National Practitioner Data Bank (NPDB).
§187.6. Appearances Personally or by Representative.
§187.7. Conduct and Decorum.
§187.8. Subpoenas.
§187.9. Board Actions.
Subchapter B. Informal Board Proceedings ..................................................................................................................... 164
§187.10. Purpose.
§187.11. Transfer to Legal Division.
§187.13. Informal Board Proceedings Relating to Licensure Eligibility.
§187.14. Informal Resolution of Disciplinary Issues Against a Licensee.
§187.15. Investigation and Collection of Information.
§187.16. Informal Show Compliance Proceedings (ISCs).
§187.18. Informal Show Compliance Proceeding and Settlement Conference Based on Personal Appearance.
§187.19. Resolution by Agreed Order.
§187.20. Board Action.
§187.21. Board and District Review Committee Members Participation.
Subchapter C. Formal Board Proceedings at SOAH ....................................................................................................... 170
§187.22. Purpose.
§187.23. General Provisions.
§187.24. Pleadings.
§187.25. Notice of Adjudicative Hearing.
§187.26. Service in SOAH Proceedings.
§187.27. Written Answers in SOAH Proceedings and Default Orders.
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§187.28. Discovery.
§187.29. Mediated Settlement Conferences.
§187.30. Reporter and Transcripts.
§187.31. Evidence.
§187.33. Proposals for Decision.
Subchapter D. Formal Board Proceedings ....................................................................................................................... 175
§187.35. Presentation of Proposal for Decision.
§187.36. Interlocutory Appeals and Certification of Questions.
§187.37. Final Decisions and Orders.
§187.38. Motions for Rehearing.
§187.39. Costs of Administrative Hearings.
§187.42. Recusals.
Subchapter E. Proceedings Relating to Probationers ...................................................................................................... 178
§187.43. Proceedings for the Modification/Termination of Agreed Orders and Disciplinary Orders.
§187.44. Probationer Show Compliance Proceedings.
§187.45. Probationer Appearances.
Subchapter F. Temporary Suspension Proceedings......................................................................................................... 180
§187.55. Purpose.
§187.56. Convening a Disciplinary Panel.
§187.57. Charge of the Disciplinary Panel.
§187.58. Procedures before the Disciplinary Panel.
§187.59. Evidence.
§187.60. Temporary Suspension or Restriction Without Notice or Hearing.
§187.61. Ancillary Proceeding.
§187.62. Continuing Threat Constitutes A Danger to the Public.
Subchapter G. Suspension by Operation of Law ............................................................................................................. 182
§187.70. Purposes and Construction.
§187.71. Hearing before a Panel of Board Representatives.
§187.72. Decision of the Panel.
§187.73. Termination of Suspension
Subchapter H. Imposition of Administrative Penalty ...................................................................................................... 183
§187.75. Purposes and Construction.
§187.76. Notice of Intention to Impose Administrative Penalty, Response
§187.77. Notice of Intention to Impose Administrative Penalty, Response
§187.78. Written Response
§187.79. Personal Appearance at an Informal Meeting
§187.80. Imposition of Administrative Penalty
§187.81. Reports of Imposition of Administrative Penalty
§187.82. Unpaid Administrative Penalties
Chapter 189. Compliance Program........................................................................................................................185
§189.1. Purpose and Scope.
§189.2. Definitions.
§189.3. Responsibilities of Probationers.
§189.4. Limitations on Physician Probationer's Practice.
189.5. Compliance Visits and Communications.
§189.6. Probation Appearances.
§189.7. Modification/Termination Hearings.
§189.8. Procedures Concerning Non-compliance.
§189.9. Grounds for Temporary Suspension or Automatic Suspension of Probationers.
§189.10. Drug Screens.
§189.11. Process for Approval of Physicians, Other Professionals, Group Practices and Institutional Settings.
§189.12. Suspended licenses.
§189.13. Investigative Reports.
§189.14. Receipt of Probationer's Address of Record and Contact Information.
Chapter 190. Disciplinary Guidelines ....................................................................................................................190
Subchapter A. General Provisions .................................................................................................................................... 190
§190.1. Purpose.
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§190.2. Board's Role.
Subchapter B. Violation Guidelines .................................................................................................................................. 191
§190.8. Violation Guidelines.
Subchapter C. Sanction Guidelines ................................................................................................................................... 194
§190.14. Disciplinary Sanction Guidelines.
§190.15. Aggravating and Mitigating Factors.
Subchapter D. Administrative Penalties ........................................................................................................................... 199
§190.16. Administrative Penalties.
Chapter 191. District Review Committees .............................................................................................................200
§191.1. Purpose.
§191.2. Districts.
§191.3. Committee Meetings.
§191.4. Activities and Scope of Authority.
§191.5. Per Diem and Expenses.
Chapter 192. Office Based Anesthesia Services ....................................................................................................202
§192.1. Definitions.
§192.2. Provision of Anesthesia Services in Outpatient Settings.
§192.3. Compliance with Office-Based Anesthesia Rules.
§192.4. Registration.
§192.5. Inspections.
§192.6. Requests for Inspection and Advisory Opinion.
Chapter 193. Standing Delegation Orders .............................................................................................................207
§193.1. Purpose.
§193.2. Definitions.
§193.3. Exclusion from the Provisions of this Chapter.
§193.4. Scope of Standing Delegation Orders.
§193.5. Enforcement.
§193.6. Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and
Advanced Practice Nurses.
§193.7. Delegated Drug Therapy Management.
§193.8. Delegated Administration of Immunizations or Vaccinations by a Pharmacist under Written Protocol.
§193.9. Pronouncement of Death.
§193.10. Collaborative Management of Glaucoma.
§193.12. Immunization of Persons Over 65 by Physician's Offices.
Chapter 194. Non-Certified Radiologic Technicians ............................................................................................220
§194.1. Purpose.
§194.2. Definitions.
§194.3. Registration.
§194.4. Annual Renewal.
§194.5. Non-Certified Technician's Scope of Practice.
§194.6. Suspension, Revocation or Nonrenewal of Registration.
§194.7. Disciplinary Guidelines.
§194.8. Procedure.
§194.9. Compliance.
§194.11. Construction.
Chapter 196. Voluntary Relinquishment or Surrender of A Medical License ...................................................223
§196.1. Relinquishment of License.
§196.2. Surrender Associated with Disciplinary Action.
§196.3. Surrender Associated with Impairment.
§196.4. Relicensure after Relinquishment or Surrender of License.
§196.5. Competence to Resume Practice.
Chapter 197. Emergency Medical Service .............................................................................................................225
§197.1. Purpose.
§197.2. Definitions.
§197.3. Off-line Medical Director.
§197.4. On-Line Medical Direction.
§197.5. Authority for Control of Medical Services at the scene of a Medical Emergency.
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§197.6. Authority To Conduct Research and/or Educational Studies.
Chapter 198. Unlicensed Practice ...........................................................................................................................229
§198.1. Purpose.
§198.2. Complaints.
§198.3. Investigation of Complaints.
§198.4. Agreed Cease and Desist Order.
§198.5. Contested Cease and Desist Proceeding.
§198.6. Violation of Cease and Desist Order.
Chapter 199. Public Information............................................................................................................................231
§199.1. Public Information Committee.
§199.2. Requests to Speak.
§199.3. Requests for Information.
§199.4. Charges for Copies of Public Records.
§199.5. Notice of Ownership Interest in a Niche Hospital.
Chapter 200. Standards for Physicians Practicing Complementary and Alternative Medicine .......................233
§200.1. Purpose.
§200.2. Definitions.
§200.3. Practice Guidelines for the Provision of Complementary and Alternative Medicine.
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
Revised 06/24/2009
1
TEXAS MEDICAL BOARD RULES
Chapter 161, General Provisions
(d) Each board member shall meet and maintain member is not on behalf of or approved by the board
the qualifications for board membership as set by law. and should not claim special expertise
(e) A board member should strive to achieve and because of board membership.
project the highest standards of professional conduct. (12) A board member should refrain from
Such standards include: making any statement that implies that the board
(1) A board member should not accept or member is speaking for the board if the board has not
solicit any benefit that might influence the board voted on an issue or unless the board has given the
member in the discharge of official duties or that the board member such authority.
board member knows or should know is being offered (f) One ground for removal from the board occurs
with the intent to influence official conduct. if a board member is absent from more than half of the
(2) A board member should not accept regularly scheduled board meetings that the member is
employment or engage in any business or professional eligible to attend during a calendar year without an
activity that would involve the disclosure of excuse approved by a majority vote of the board. If the
confidential information acquired by reason of the executive director of the board has knowledge that a
official position as a board member. potential ground for removal exists due to a member's
(3) A board member should not accept failure to attend an adequate number of regularly
employment that could impair independence of scheduled board meetings, the executive director shall
judgment in the performance of the board member's notify the president of the board of the ground. The
official duties. president of the board shall then notify the governor's
(4) A board member should not make personal office that a potential ground for removal exists. A
investments that could reasonably be expected to create board member shall be considered to have been
a conflict between the board member's private interest absent from a regularly scheduled board meeting if the
and the public interest. member fails to attend at least a portion of either a full
(5) A board member should not intentionally board session or a portion of a regularly scheduled
or knowingly solicit, accept, or agree to accept any committee meeting to which a member is assigned
benefit for having exercised the board member's official during such board meeting. Any dispute or controversy
powers or performed the board member's official duties as to whether or not an absence has occurred shall be
in favor of another. submitted to the full board for resolution by a majority
(6) A board member should be fair and vote after giving the purported absentee the opportunity
impartial in the conduct of the business of the board. A to present information concerning the alleged absences
board member should project such fairness and and after allowing discussion by other members of the
impartiality in any meeting or hearing. board.
(7) A board member should be diligent in (g) Each member of the board shall receive per
preparing for meetings and hearings. diem as provided by law for each day that the member
(8) A board member should avoid conflicts of engages in the business of the board and will be
interests. If a conflict of interest should unintentionally reimbursed for travel expenses incurred in accordance
occur, the board member should recuse himself or with the state of Texas and board's travel policies.
herself from participating in any matter before the
board that could be affected by the conflict.
(9) A board member should avoid the use the
board member's official position to imply professional
superiority or competence.
(10) A board member should avoid the use of
the board member's official position as an endorsement
in any health care related matter. §161.4. Officers of the Board.
(11) A board member should not appear as an (a) The Governor shall designate a member of the
expert witness in any case in which a licensee of the board to serve as the president of the board.
board is a party and in which the expert testimony (b) The board shall elect officers from among its
relates to standard of care or professional malpractice. members to serve as the vice president and the
A board member may provide expert testimony if the secretary-treasurer for a term not to extend longer than
board member has been called primarily as a fact two years. The election of officers shall be held at least
witness. A board member should disclose any potential every other year at a regular meeting of the board.
employment as an expert witness to and seek prior (c) All elections and any other issues requiring a
approval of the board's executive committee. When vote of the board shall be decided by a simple majority
providing expert testimony in any matter, a board of the members present and voting.
member should state that any opinion of the board
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TEXAS MEDICAL BOARD RULES
Chapter 161, General Provisions
(d) If more than two candidates are nominated for Source Note: The provisions of this §161.4 adopted to
an office, and no candidate receives a majority on the be effective March 7, 2002, 27 TexReg 1486.
first ballot, a second ballot will be conducted between
the two candidates receiving the highest number of §161.5. Meetings.
votes. (a) The board shall meet at least four times a year.
(e) Duties of the officers. It shall consider such matters as may be necessary.
(1) The duties of the president shall include the (b) Special meetings shall be called by the
following: president or by resolution of the board or upon written
(A) approve the agenda for each board request signed by five members of the board.
meeting; (c) An agenda for each board meeting and
(B) preside at all meetings of the board; committee meeting shall be posted in accordance with
(C) represent the board in legislative law and copies shall be sent to the board members.
matters and in meetings with related groups; (d) Board and committee meetings shall be
(D) appoint the members to serve on the conducted pursuant to the provisions of Robert's Rules
standing, ad hoc, and advisory committees of the board; of Order Newly Revised unless the board by rule adopts
(E) appoint the chair of each board a different procedure.
committee; (e) A quorum for transaction of business by the
(F) perform or designate a member or board shall be one more than half the board's
members of the board to coordinate the annual membership at the time of the meeting.
performance review of the executive director. (f) The board may act only by majority vote of its
(G) perform such other duties as pertain to members present and voting, with each member entitled
the office of the president and to one vote. No proxy vote shall be allowed.
(2) The duties of the vice president shall (g) Meetings of the board and of the committees
include the following: are open to the public unless such meetings are
(A) function as president in the absence or conducted in executive session pursuant to state law.
incapacity of the president; (h) In order that board and committee meetings
(B) serve as president if the office of may be conducted safely, efficiently, and with decorum,
president becomes vacant until another member is attendees may not engage in disruptive activity that
named by the Governor; and interferes with board proceedings.
(C) perform such other duties that are (i) Members of the public shall remain within those
from time to time assigned by the board. areas of the board offices and board meeting room
(3) The duties of the secretary-treasurer shall designated as open to the public.
include the following: (j) Members of the public shall not address or
(A) function as president in the absence or question board members during meetings unless
incapacity of both the president and vice president; recognized by the board's presiding officer pursuant to
(B) serve as president if both the offices a published agenda item.
of president and vice president becomes vacant until (k) Journalists have the same right of access to
another member is elected by the board or named by the board meetings conducted in open session as other
Governor; and members of the public and are subject to the same
(C) perform such other duties as set out by requirements.
law or such other duties that are from time to time (l) The board's presiding officer may exclude from
assigned by the board. a meeting any person who, after being duly warned,
(f) In the event of the absence or incapacity of the persists in disruptive activity that interferes with board
president, vice president, and secretary-treasurer, the proceedings.
board may elect another person to act as presiding (m) Any person may record all or any part of the
officer of a board meeting or may elect an interim proceedings of a public board meeting in attendance by
acting president for the duration of the absence or means of a tape recorder, video camera, or any other
incapacity of the officers. means of sonic or visual reproduction.
(g) After the death, resignation, or permanent (1) The executive director shall direct any
incapacity of any elected officer, the board shall hold an individual wishing to record or videotape as to
election to fill the vacant officer position. If any elected equipment location, placement, and the manner in
officer is elected to another position at these elections, which the recording is conducted.
that officer's vacant position shall be filled by election (2) The decision will be made so as not to
to be held following the creation of the new vacancy. disrupt the normal order and business of the board.
(n) Executive Session.
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TEXAS MEDICAL BOARD RULES
Chapter 161, General Provisions
(1) The board may meet in executive session (C) take action on matters of urgency that
pursuant to law. may arise between board meetings;
(2) An executive session of the board shall not (D) assist in the presentation of
be held unless a quorum of the board has first been information concerning the board and the regulation of
convened in open meeting. If during such open the practice of medicine to the Legislature and other
meeting, a motion is passed by the board to hold an state officials;
executive session, the presiding officer shall publicly (E) review staff reports regarding finances
announce that an executive session will be held. and the budget;
(3) The presiding officer of the board shall (F) formulate and make recommendations
announce the date and time at the beginning and end of to the board concerning future board goals and
the executive session. objectives and the establishment of priorities and
methods for their accomplishment;
(G) study and make recommendations to
the board regarding the roles and responsibilities of the
board offices and committees;
(H) study and make recommendations to
the board regarding ways to improve the efficiency and
§161.6. Committees of the Board. effectiveness of the administration of the board;
(a) Each board committee shall be composed of (I) study and make recommendations to
board members appointed by the president of the board the board regarding board rules or any area of a board
and shall include at least one physician member who function that, in the judgment of the committee, needs
holds the degree of doctor of osteopathic medicine and consideration; and
one public member. (J) make recommendations to the board
(b) The following are standing and permanent regarding matters brought to the attention of the
committees of the board. The responsibilities and executive committee.
authority of these committees shall include the (3) Finance Committee:
following duties and powers, and other responsibilities (A) review staff reports regarding finances
and charges that the board may from time to time and the budget;
delegate to these committees. (B) assist in the presentation of budget
(1) Disciplinary Process Review Committee: needs to the Legislature and other state officials;
(A) oversee the disciplinary process and (C) recommend proper fees for the agency
give guidance to the board and board staff regarding to charge; and
means to improve the disciplinary process and more (D) consider and make recommendations
effectively enforce the Medical Practice Act and board to the board regarding any aspect of board finances.
rules; (4) Legislative Committee:
(B) monitor the effectiveness, (A) review and make recommendations to
appropriateness and timeliness of the disciplinary the board regarding proposed legislative changes
process and enforcement of the Medical Practice Act concerning the Medical Practice Act and the regulation
and board rules; of medicine;
(C) make recommendations regarding (B) establish communication with
resolution and disposition of specific cases and members of the Legislature, trade associations,
approve, adopt, modify, or reject recommendations consumer groups, and related groups;
from board staff or board representatives regarding (C) assist in the organization, preparation,
actions to be taken on pending cases; and delivery of information and testimony to members
(D) approve dismissals of complaints and and committees of the Legislature; and
closure of investigations; and (D) make recommendations to the board
(E) make recommendations to the board regarding matters brought to the attention of the
staff and the board regarding policies, priorities, budget, legislative committee.
and any other matters related to the disciplinary process (5) Licensure Committee:
and enforcement of the Medical Practice Act and board (A) review applications for licensure and
rules. permits, make determinations of eligibility and report to
(2) Executive Committee: the board its recommendations as provided by the
(A) ensure records are maintained of all Medical Practice Act and board rules;
committee actions; (B) review board rules regarding licensure
(B) delegate tasks to other committees; and make recommendations to the board regarding
changes or implementation of such rules;
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(C) evaluate each examination accepted (C) study and make recommendations to
by the board and develop each examination the board regarding all aspects of public information
administered by the board; and public relations;
(D) investigate and report to the board any (D) receive information from the public
problems in the administration of examinations and concerning the regulation of medicine pursuant to a
recommend and implement ways of correcting published agenda item and board rules;
identified problems; (E) study and make recommendation to
(E) make recommendations to the board the board regarding all aspects of physician profiles;
regarding postgraduate training permits and issues and
concerning physicians in training; (F) make recommendations to the board
(F) maintain communication with Texas regarding matters brought to the attention of the public
medical schools; information/physician profile committee.
(G) develop rules with regard to (7) Standing Orders Committee:
international medical schools in the areas of curriculum, (A) review and make recommendations to
faculty, facilities, academic resources, and performance the board regarding board rules pertaining to standing
of graduates; orders;
(H) study and make recommendations (B) study and make recommendations to
regarding documentation and verification of records the board regarding issues concerning or referred by the
from all applicants for licensure or permits; Texas State Board of Acupuncture Examiners or other
(I) review applications for acudetox acupuncture issues;
specialist certification, make determinations of (C) study and make recommendations to
eligibility, and report to the board its recommendations the board regarding issues concerning or referred by the
as provided by Texas Occupations Code Annotated, Texas Physician Assistant Board;
205.303; (D) study and make recommendations to
(J) review applications for acupuncture the board concerning ethical issues related to the
licensure recommended by the Texas State Board of practice of medicine; and
Acupuncture Examiners and for applicants that hold (E) make recommendations to the board
licenses in other states that have licensure requirements regarding matters brought to the attention of the
that are substantially equivalent to those of this state, standing orders committee.
make determinations of eligibility, and report to the (8) Telemedicine Committee:
board its recommendations; (A) review, study, and make
(K) review applications and make initial recommendations to the board concerning the practice
determinations and recommendations to the board of telemedicine, including but not limited to licensure,
regarding approval, denial, revocation, decertification, regulation, and/or discipline of telemedicine license
or continued approval and certification of non-profit holders or applicants;
health organizations pursuant to the Medical Practice (B) review, study, and make
Act; recommendations to the board concerning interstate and
(L) develop and review board rules intrastate telemedicine issues;
regarding all persons and entities subject to the Board's (C) review, study, and make
jurisdiction, and make recommendations to the board recommendations to the board concerning board rules
regarding changes or implementation of such rules; regarding or affecting the practice of telemedicine; and
(M) review applications for surgical (D) review, study, and make
assistant licensure, make determinations, of eligibility, recommendations to the board concerning any other
and report to the board its recommendations; and issue brought to the attention of the committee. (c)
(N) make recommendations to the board With statutory or board authorization, the president may
regarding matters brought to the attention of the appoint, disband, or reconvene standing, ad hoc, or
licensure committee. advisory committees as deemed necessary. Such
(6) Public Information/Physician Profile committees shall have and exercise such authority as
Committee: may be granted by the board.
(A) develop information for distribution to
the public; Source Note: The provisions of this §161.6 adopted to
(B) review and make recommendations to be effective March 7, 2002, 27 TexReg 1486; amended
the board in regard to press releases, newsletters, web- to be effective September 19, 2002, 27 TexReg 8768;
sites and other publications; amended to be effective January 25, 2006, 31 TexReg
382; amended to be effective August 10, 2008, 33
TexReg 6132.
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Texas Administrative Code, Title 22, Part 9
§162.1. Supervision of Medical Students. (3) hold a valid written agreement with an
(a) In order to supervise a medical student who is accredited physician assistant program to supervise its
enrolled at a Texas medical school as a full-time students, if the supervision is to occur at a site other
student or visiting student the physician must have an than that of the program itself. A copy of the agreement
active and unrestricted Texas license. must be available for inspection by the board upon
(b) In order to supervise a medical student who request.
does not meet the criteria in subsection (a) of this
section the physician must: Source Note: The provisions of this §162.2 adopted to
(1) have an active and unrestricted Texas be effective January 9, 2005, 29 TexReg 12187.
license;
(2) hold a faculty position in the graduate
medical education program in the same specialty in
which the student will receive undergraduate medical
education;
(3) supervise the student during the
educational period; and
(4) supervise the student's medical education
in either a Texas hospital or teaching institution, which
sponsors or participates in a program of graduate
medical education accredited by the Accrediting
Council for Graduate Medical Education, the American
Osteopathic Association, or the Texas Medical Board in
the same subject as the medical or osteopathic medical
education in which the hospital or teaching institution
has an agreement with the applicant's school.
(c) If the physician is not licensed in Texas as
required in subsection (a) or (b) of this section, the
physician must be employed by the federal government
and maintain an active and unrestricted license.
(d) Physician applicants who receive medical
education in the United States in settings that do not
comply with statutory requirements set forth in Texas
Occupations Code §155.003(b) - (c) may be ineligible
for licensure.
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(v) the College of Family Physicians characteristics necessary for them to become effective
of Canada; or physicians.
(C) a postresidency program, usually (iii) The curriculum shall meet the
called a fellowship, performed in the U.S. or Canada requirements for an unapproved medical school as set
and approved by the board for additional training in a forth in the "Curriculum Definitions for Course Areas
medical specialty or subspecialty. Prescribed by the Texas Higher Education Coordinating
(11) Sixty (60) semester hours of college Board for Determining Eligibility of International
courses--60 semester hours of college courses other Medical Graduates for Texas Medical Licensure," as
than in medical school that are acceptable to The adopted by the Texas Higher Education Coordinating
University of Texas at Austin for credit on a bachelor of Board, as follows:
arts degree or a bachelor of science degree; the entire (I) The basic sciences curriculum
primary, secondary, and premedical education required shall include the contemporary content of those
in the country of medical school graduation, if the expanded disciplines that have been traditionally titled
medical school is located outside the United States or gross anatomy, biochemistry, biology, physiology,
Canada; or substantially equivalent courses as microbiology, immunology, pathology, pharmacology,
determined by the board. and neuroscience.
(12) Substantially equivalent to a Texas (II) The fundamental clinical
medical school--A medical school or college shall be subjects, which shall be offered in the form of required
considered to be substantially equivalent to a Texas patient-related clerkships, are internal medicine,
medical school under the following conditions: obstetrics and gynecology, pediatrics, psychiatry,
(A) An acceptable approved medical family practice, and surgery.
school shall be considered to be substantially equivalent (iv) The curriculum shall be of at
to a Texas medical school. A medical school operating least 130 weeks in duration.
within the United States or Canada that is not an (v) There must be integrated
acceptable approved medical school shall not be institutional responsibility for the overall design,
considered to be substantially equivalent to a Texas management and evaluation of a coherent and
medical school. coordinated curriculum.
(B) A medical school operating outside (vi) For schools that have
the United States or Canada may be determined to be geographically separated programs, the principal
substantially equivalent to a Texas medical school if the academic officer of each geographically remote site
medical school is designed to select and educate must coordinate the curriculum with an academic
medical students and provide students with the officer of the medical school responsible for organizing
opportunity to acquire a sound basic medical education the educational program.
through training in basic sciences and clinical sciences. (13) Texas Medical Jurisprudence
The school should provide information about the Examination (JP exam): the ethics examination
school's program of advancement of knowledge developed by the board.
through research; the school's development of programs (14) Three-year training program--three
of graduate medical education to produce practitioners, continuous years of postgraduate training in the United
teachers, and researchers; and, the school's program to States or Canada, progressive in nature and acceptable
provide opportunity for postgraduate and continuing for specialty board certification in one specialty area
medical education, for the board's consideration. In that is:
addition, to be determined substantially equivalent to a (A) accredited by one of the following:
Texas medical school, the medical school's (i) the Accreditation Council for
characteristics shall include, but not be limited to, the Graduate Medical Education;
following: (ii) the American Osteopathic
(i) The facilities for basic sciences Association;
and clinical training (i.e., laboratories, hospitals, library, (iii) the Committee on Accreditation
etc.) shall be adequate to ensure opportunity for proper of Preregistration Physician Training Programs,
education. Federation of Provincial Medical Licensing Authorities
(ii) The admissions standards shall of Canada;
ensure that the medical school has a pool of applicants (iv) the Royal College of Physicians
sufficiently large and possessing United States national and Surgeons of Canada;
level qualifications to fill its entering class. Medical (v) the College of Family Physicians
schools must select students who possess the of Canada; or
intelligence, integrity, and personal and emotional (vi) all programs approved by the
board after August 25, 1984; or
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(4) have completed all of the didactic work, (11) have attained a satisfactory score on a
but not graduated from a foreign medical school and qualifying examination and have completed one
meet the requirements subparagraph A or B of this academic year of supervised clinical training for foreign
subsection. medical students as defined by the American Medical
(A) The medical school's curriculum Association Council on Medical Education (Fifth
meets the requirements for an acceptable unapproved Pathway Program) in a United States medical school;
medical school as determined by a committee of experts and
selected by the Texas Higher Education Coordinating (12) have supplied all additional information
Board; or that the board may require, concerning the applicant's
(B) Either: medical school, before approving the applicant.
(i) the medical school's curriculum is
substantially equivalent to a Texas medical school as Source Note: The provisions of this §163.2 adopted to
defined under §163.1(13) of this title and has not been be effective November 10, 1999, 24 TexReg 9835;
disapproved by another state physician licensing agency amended to be effective March 7, 2002, 27 TexReg
unless the applicant can provide evidence that the 1487; amended to be effective May 2, 2004, 29 TexReg
disapproval was unfounded, or: 3961; amended to be effective November 7, 2004, 29
(ii) the applicant must: TexReg 10104; amended to be effective January 25,
(I) have passed the basic sciences 2006, 31 TexReg 382; amended to be effective June 28,
portion of an acceptable examination listed in §163.6(a) 2006, 31 TexReg 5098; amended to be effective
of this title within two attempts; January 4, 2007, 31 TexReg 10797; amended to be
(II) have not been the subject of effective July 3, 2007, 32 TexReg 3991.
disciplinary action by any other state, the uniformed
services of the United States, or the applicant's peers in §163.4. Procedural Rules for Licensure Applicants.
a local, regional, state, or national professional medical (a) All applicants for licensure:
association or staff of a hospital; (1) if appropriate, are encouraged to use the
(III) have, on a full-time basis, Federation Credentials Verification Service (FCVS)
actively diagnosed or treated persons or have been on offered by the Federation of State Medical Boards of
the active teaching faculty of an acceptable approved the United States (FSMB) to verify medical education,
medical school for three of the last fours years postgraduate training, licensure examination history,
preceding receipt of an Application for licensure, which board action history and identity;
may include post-graduate training (The term "full-time (2) whose applications have been filed with
basis" shall have the same meaning provided in the board in excess of one year will be considered
§163.11(b) of this title); and expired. Any fee previously submitted with that
(IV) hold a certificate from a application shall be forfeited. Any further request for
specialty board that is a member of the American Board licensure will require submission of a new application
of Medical Specialties or the Bureau of Osteopathic and inclusion of the current licensure fee;
Specialists or have passed a monitored examination (3) who in any way submit a false or
leading to such certification by the specialty board. misleading statement, document, or certificate in an
(5) have successfully completed a three-year application may be required to appear before the board.
training program of graduate medical education in the It will be at the discretion of the board whether or not
United States or Canada that was approved by the board the applicant will be issued a Texas license;
on the date the training was completed; (4) on whom adverse information is received
(6) submit evidence of passing an by the board may be required to appear before the
examination, that is acceptable to the board for board. It will be at the discretion of the board whether
licensure; or not the applicant will be issued a Texas license;
(7) pass the Texas Medical Jurisprudence (5) shall be required to comply with the
Examination; board's rules and regulations which are in effect at the
(8) submit a sworn affidavit that no time the application form and fee are filed with the
proceedings, past or current, have been instituted board;
against the applicant before any state medical board, (6) may be required to sit for additional oral,
provincial medical board, in any military jurisdiction or written, mental or physical examinations that, in the
federal facility; opinion of the board, are necessary to determine
(9) have attained a passing score on the competency and ability of the applicant;
ECFMG examination; (7) must have the application for licensure
(10) have the ability to communicate in the complete in every detail 20 days prior to the board
English language; meeting in which they are considered for licensure.
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Applicants with complete applications may qualify for by the board following a recommendation by the
a Temporary License prior to being considered by the Licensure Committee, in accordance with §155.007 of
board for licensure, as required by §172.11 of this title the Act (relating to Application Process) and §187.13 of
(relating to Temporary Licensure--Regular); and this title (relating to Informal Board Proceedings
(8) that receive any medical or osteopathic Relating to Licensure Eligibility).
medical education in the United States must have (f) If the Executive Director determines that the
obtained such education while enrolled as a full-time or applicant is ineligible for licensure based on one or
visiting student at a medical school that is accredited by more of the statutory or regulatory provisions listed in
an accrediting body officially recognized by the United paragraphs (1) - (5) of this subsection, the applicant
States Department of Education as the accrediting body may appeal that decision to the Licensure Committee
for medical education leading to the doctor of medicine before completing other licensure requirements for a
degree or the doctor of osteopathy degree in the United determination by the Committee solely regarding issues
States. This subsection does not apply to postgraduate raised by the determination of ineligibility. If the
medical education or training. An applicant who is Committee overrules the determination of the Executive
unable to comply with this requirement must Director, the applicant may then provide additional
demonstrate that the applicant either: information to complete the application, which must be
(A) received such medical education in a analyzed by board staff and approved before a license
hospital or teaching institution sponsoring or may be issued. Grounds for ineligibility under this
participating in a program of graduate medical subsection include noncompliance with the following:
education accredited by the Accreditation Council for (1) Section 155.003(a)(1) of the Act that
Graduate Medical Education, the American Osteopathic requires the applicant to be 21 years of age;
Association, or the board in the same subject as the (2) Section 155.003(b) and (c) of the Act that
medical or osteopathic medical education if the hospital require that medical or osteopathic medical education
or teaching institution has an agreement with the received by an applicant must be accredited by an
applicant's school; or accrediting body officially recognized by the United
(B) is specialty board certified by a board States Department of Education, or meet certain other
approved by the Bureau of Osteopathic Specialists or requirements, as more fully set forth in §§163.4(a)(8),
the American Board of Medical Specialties. 163.5(b)(11), 163.5(c)(2)(C), 163.5(c)(2)(D), and
(b) Applicants for a license must subscribe to an 163.1(12)(B)(iii) and (iv) of this chapter;
oath in writing. The written oath is part of the (3) Sections 155.051 - 155.0511, and 155.056
application. of the Act that relates to required licensure
(c) An applicant is not eligible for a license if: examinations and examination attempts;
(1) the applicant holds a medical license that is (4) Section 163.7 of this chapter relating to the
currently restricted for cause, canceled for cause, Ten Year Rule; and
suspended for cause, or revoked by a state of the United (5) Section 163.6(e) of this chapter that
States, a province of Canada, or a uniformed service of requires passage of the Jurisprudence Examination
the United States; within three attempts,
(2) an investigation or a proceeding is
instituted against the applicant for the restriction, Source Note: The provisions of this §163.4 adopted to
cancellation, suspension, or revocation of the be effective November 10, 1999, 24 TexReg 9835;
applicant's medical license in a state of the United amended to be effective May 21, 2000, 25 TexReg
States, a province of Canada, or a uniformed service of 4348; amended to be effective March 7, 2002, 27
the United States; or TexReg 1487; amended to be effective January 9, 2003,
(3) a prosecution is pending against the 28 TexReg 67; amended to be effective May 2, 2004, 29
applicant in any state, federal, or Canadian court for TexReg 3961; amended to be effective January 25,
any offense that under the laws of this state is a felony 2006, 31 TexReg 382; amended to be effective June 28,
or a misdemeanor that involves moral turpitude. 2006, 31 TexReg 5098; amended to be effective July 3,
(d) If the Executive Director determines that the 2007, 32 TexReg 3991; amended to be effective August
applicant clearly meets all licensing requirements, the 10, 2008, 33 TexReg 6133.
Executive Director or a person designated by the
Executive Director, may issue a license to the applicant, §163.5. Licensure Documentation.
to be effective on the date issued without formal board (a) On request of board staff, an applicant must
approval, as authorized by §155.002(b) of the Act. appear for a personal interview at the board offices and
(e) If the Executive Director determines that the present original documents to a representative of the
applicant does not clearly meet all licensing board for inspection. Original documents may include,
requirements, a license may be issued only upon action
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Chapter 163, Licensure
but are not limited to, those listed in subsections (b) - (9) Specialty Board Certification. Each
(e) of this section. applicant who has obtained certification by a board that
(b) Documentation required of all applicants for is a member of the American Board of Medical
licensure. Specialties or the Bureau of Osteopathic Specialists
(1) Birth Certificate/Proof of Age. Each must submit a copy of the certificate issued by the
applicant for licensure must provide a copy of a valid member showing board certification.
passport or birth certificate and translation if necessary (10) Medical License Verifications. On request
to prove that the applicant is at least 21 years of age. In of board staff, an applicant must have any state in
instances where such documentation is not available, which he or she has ever been licensed, regardless of
the applicant must provide copies of other suitable the current status of the license, submit directly to this
alternate documentation. board a letter verifying the status of the license and a
(2) Name Change. Any applicant who submits description of any sanctions or pending disciplinary
documentation showing a name other than the name matters.
under which the applicant has applied must present (11) U.S. medical education. Applicants must
copies of marriage licenses, divorce decrees, or court demonstrate that any medical school education that was
orders stating the name change. In cases where the completed in the United States in satisfaction of their
applicant's name has been changed by naturalization, core basic and clinical science courses as established by
the applicant should send the original naturalization the Texas Higher Education Coordinating Board, the
certificate by certified mail to the board office for Liaison Council on Medical Education, and/or the
inspection. American Osteopathic Association, and in satisfaction
(3) Examination Scores. Each applicant for of the 130 weeks of required medical education was
licensure must have a certified transcript of grades accredited by an accrediting body officially recognized
submitted directly from the appropriate testing service by the United States Department of Education as the
to the board for all examinations accepted by the board accrediting body for medical education leading to the
for licensure. doctor of medicine degree or the doctor of osteopathy
(4) Dean's Certification. Each applicant for degree. An applicant who is unable to comply with
licensure must have a certificate of graduation these requirements may in the alternative demonstrate
submitted directly from the medical school on a form that the applicant:
provided to the applicant by the board. The applicant (A) received such medical education in a
shall attach a recent photograph, meeting United States hospital or teaching institution sponsoring or
Government passport standards, to the form before participating in a program of graduate medical
submitting to the medical school. The school shall have education accredited by the Accrediting Council for
the Dean of the medical school or designated appointee Graduate Medical Education, the American Osteopathic
sign the form attesting to the information on the form Association, or approved by the board under Section
and placing the school seal over the photograph. 171.4 of this title (relating to Board-Approved
(5) Evaluations. All applicants must provide Postgraduate Fellowship Training Programs) in the
evaluations completed by an appropriate supervisor, on same subject as the medical or osteopathic medical
a form provided by the board, of their professional education if the hospital or teaching institution has an
affiliations for the past five years or since graduation agreement with the applicant's school; or
from medical school, whichever is the shorter period. (B) is specialty board certified by a board
(6) Medical School Transcript. On request of approved by the Bureau of Osteopathic Specialists or
board staff, an applicant must have his or her medical the American Board of Medical Specialties.
school submit a transcript of courses taken and grades (c) Applicants for licensure who are graduates of
obtained. medical schools outside the United States or Canada
(7) National Practitioner Data Bank/Health must furnish all appropriate documentation listed in this
Integrity and Protection Data Bank (NPDB-HIPDB). subsection, as well as that listed in subsections (a) and
Each applicant must contact the NPDB-HIPDB and (b) of this section.
have a report of action submitted directly to the board (1) Educational Commission for Foreign
on the applicant's behalf. Medical Graduates (ECFMG) Status Report. Each
(8) Graduate Training Verification. On request applicant must submit an ECFMG status report.
of board staff, an applicant must have any of the (2) Unique Documentation. The board may
training programs in which they have participated in request documentation unique to an individual
submit verification on a form provided by the board. unapproved medical school and additional
The evaluation must show the beginning and ending documentation as needed to verify completion of
dates of the program and state that the program was medical education that is substantially equivalent to a
successfully completed.
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TEXAS MEDICAL BOARD RULES
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Texas medical school education. This may include but (G) proof that the medical education
is not limited to: courses taught in the United States complied with the
(A) a copy of the applicant's ECFMG file; higher education laws of the state in which the courses
(B) a copy of other states' licensing files; were taught;
(C) copies of the applicant's clinical (H) proof that the faculty members of the
clerkship evaluations; and medical school who taught courses in the United States
(D) a copy of the applicant's medical were on the faculty of the program of graduate medical
school file. education when the courses were taught; and
(3) Certificate of Registration. Each applicant (I) proof that all education completed in
must provide a copy of his or her certificate to practice the United States or Canada was while the applicant
in the country in which his or her medical school is was enrolled as a visiting student as evidenced by a
located. If a certificate is unavailable, a letter submitted letter of verification from the U.S. or Canadian medical
directly to this board from the body governing licensure school.
of physicians in the country in which the school is (6) Medical Diploma. On request of board
located, will be accepted. The letter must state that the staff, an applicant must submit a copy of his or her
applicant has met all the requirements for licensure in medical diploma, and translation if necessary.
the country in which the school is located. If an (d) Applicants may be required to submit other
applicant is not licensed in the country of graduation documentation, which may include the following:
due to a citizenship requirement, a letter attesting to (1) Translations. Any document that is in a
this, submitted directly to this board, will be required. language other than the English language will need to
(4) Clinical Clerkship Affidavit. A form, have a certified translation prepared and a copy of the
supplied by the board, to be completed by the applicant, translation will have to be submitted along with the
is required listing each clinical clerkship that was translated document.
completed as part of an applicant's medical education. (A) An official translation from the
The form will require the name of the clerkship, where medical school (or appropriate agency) attached to the
the clerkship was located (name and location of foreign language transcript or other document is
hospital) and dates of the clerkship. acceptable.
(5) "Substantially equivalent" documentation. (B) If a foreign document is received
An applicant who is a graduate of a medical school that without a translation, the board will send the applicant a
is located outside the United States and Canada must copy of the document to be translated and returned to
present satisfactory proof to the board that each medical the board.
school attended was substantially equivalent to a Texas (C) Documents must be translated by a
medical school at the time of attendance as defined translation agency that is a member of the American
under §163.1(12) of this title. This may include but is Translations Association or a United States college or
not limited to: university official.
(A) a Foreign Educational Credentials (D) The translation must be on the
Evaluation from the Office of International Education translator's letterhead, and the translator must verify
Services of the American Association of Collegiate that it is a "true word for word translation" to the best of
Registrars and Admissions Officers (AACRAO) or an his/her knowledge, and that he/she is fluent in the
International Credential Evaluation from the Foreign language translated, and is qualified to translate the
Credential Service of America (FCSA), or another document.
similar entity as approved by the board; (E) The translation must be signed in the
(B) a board questionnaire, to be completed presence of a notary public and then notarized. The
by the medical school and returned directly to board; translator's name must be printed below his/her
(C) a copy of the medical school's catalog; signature. The notary public must use this phrase:
(D) verification from the country's "Subscribed and Sworn to this ________ day of
educational agency confirming the validity of school ________, 20___." The notary must then sign and date
and licensure of applicant; the translation, and affix his/her Notary Seal to the
(E) proof of written agreements between document.
the medical school and all hospitals that are not located (2) Arrest Records. If an applicant has ever
in the same country as the medical school, where been arrested, a copy of the arrest and arrest disposition
medical education was obtained; need to be requested from the arresting authority and
(F) proof that the faculty members of the said authority must submit copies directly to this board.
medical school had written contracts with the school if (3) Malpractice. If an applicant has ever been
they taught a course outside the country where the named in a malpractice claim filed with any medical
medical school was located; liability carrier or if an applicant has ever been named
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in a malpractice suit, the applicant must do the (B) a statement from the applicant's
following: treating physician/psychotherapist as to diagnosis,
(A) have each medical liability carrier prognosis, medications prescribed, and follow-up
complete a form furnished by the board regarding each treatment recommended; and
claim filed against the applicant's insurance; (C) a copy of any contracts signed with
(B) for each claim that becomes a any licensing authority or medical society or impaired
malpractice suit, have the attorney representing the physician's committee.
applicant in each suit submit a letter directly to the (6) DD214. A copy of the DD214, indicating
board explaining the allegation, dates of the allegation, separation from any branch of the United States
and current status of the suit. If the suit has been closed, military.
the attorney must state the disposition of the suit, and if (7) Premedical School Transcript. Applicants,
any money was paid, the amount of the settlement. The upon request, may be required to submit a copy of the
letter should include supporting court records. If such record of their undergraduate education. Transcripts
letter is not available, the applicant will be required to must show courses taken and grades obtained. If
furnish a notarized affidavit explaining why this letter determined that the documentation submitted by the
cannot be provided; and applicant is not sufficient to show proof of the
(C) provide a statement, composed by the completion of 60 semester hours of college courses
applicant, explaining the circumstances pertaining to other than in medical school or education required for
patient care in defense of the allegations. country of graduation, the applicant may be requested
(4) Inpatient Treatment for Alcohol/Substance to contact the Office of Admissions at The University
Disorder or Physical or Mental Illness. Each applicant of Texas at Austin for course work verification.
who has been admitted to an inpatient facility within (8) Fingerprint Card. Upon request, applicants
the last five years for the treatment of alcohol/substance must complete a fingerprint card and return to the board
disorder or mental illness (recurrent or severe major as part of the application.
depressive disorder, bipolar disorder, schizophrenia, (9) Additional Documentation. Additional
schizoaffective disorder, or any severe personality documentation as is deemed necessary to facilitate the
disorder), or a physical illness that did or could have investigation of any application for medical licensure.
impaired the applicant's ability to practice medicine, (e) The board may, in unusual circumstances, allow
shall submit documentation to include items listed in substitute documents where proof of exhaustive efforts
subparagraphs (A) - (D) of this paragraph. An inpatient on the applicant's part to secure the required documents
facility shall include a hospital, ambulatory surgical is presented. These exceptions are reviewed by the
center, nursing home, and rehabilitation facility. board's executive director on a case-by-case basis.
(A) an applicant's statement explaining the
circumstances of the hospitalization; Source Note: The provisions of this §163.5 adopted to
(B) all records, submitted directly from be effective November 10, 1999, 24 TexReg 9835;
the inpatient facility; amended to be effective March 5, 2000, 25 TexReg
(C) a statement from the applicant's 1623; amended to be effective July 2, 2000, 25 TexReg
treating physician/psychotherapist as to diagnosis, 6133; amended to be effective March 7, 2002, 27
prognosis, medications prescribed, and follow-up TexReg 1487; amended to be effective September 19,
treatment recommended; and 2002, 27 TexReg 8769; amended to be effective
(D) a copy of any contracts signed with January 9, 2003, 28 TexReg 67; amended to be
any licensing authority or medical society or impaired effective November 30, 2003, 28 TexReg 10480;
physician's committee. amended to be effective May 2, 2004, 29 TexReg 3961;
(5) Outpatient Treatment for amended to be effective November 7, 2004, 29 TexReg
Alcohol/Substance Disorder or Mental Illness. Each 10104; amended to be effective January 25, 2006, 31
applicant who has been treated on an outpatient basis TexReg 382; amended to be effective January 4, 2007,
within the last five years for alcohol/substance disorder 31 TexReg 10797; amended to be effective August 10,
or mental illness (recurrent or severe major depressive 2008, 33 TexReg6133; amended to be effective January
disorder, bipolar disorder, schizophrenia, 20, 2009, 34 TexReg 336.
schizoaffective disorder, or any severe personality
disorder), or a physical illness that did or could have §163.6. Examinations Accepted for Licensure.
impaired the applicant's ability to practice medicine, (a) Licensing Examinations Accepted by the Board
shall submit documentation to include, but not limited for Licensure. The following examinations are
to: acceptable for licensure:
(A) an applicant's statement explaining the (1) United States Medical Licensing
circumstances of the outpatient treatment; Examination (USMLE), or its successor, with a score of
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TEXAS MEDICAL BOARD RULES
Chapter 163, Licensure
75 or better, or a passing grade if applicable, on each examination within three attempts, the applicant may
step; take the remaining part of the examination one
(2) COMLEX-USA, or its successor, with a additional time. However, an applicant is considered to
score of 75 or better, or a passing grade if applicable, have satisfied the requirements of this subsection if the
on each step; applicant:
(3) Federation Licensing Examination (A) passed all but one part of the
(FLEX), on or after July 1, 1985, passage of both examination approved by the board within three
components with a score of 75 or better on each attempts and passed the remaining part of the
component; examination within six attempts;
(4) Federation Licensing Examination (B) is specialty board certified by a
(FLEX), before July 1, 1985, with a FLEX weighted specialty board that:
average of 75 or better in one sitting; (i) is a member of the American
(5) National Board of Medical Examiners Board of Medical Specialties; or
Examination (NBME) or its successor; (ii) is approved by the American
(6) National Board of Osteopathic Medical Osteopathic Association; and
Examiners Examination (NBOME) or its successor; (iii) has completed in this state an
(7) Medical Council of Canada Examination additional two years of postgraduate medical training
(LMCC) or its successor; approved by the board.
(8) State board licensing examination, passed (3) The limitation on examination attempts by
before January 1, 1977, (with the exception of Virgin an applicant under paragraph (1) of this subsection does
Islands, Guam, Tennessee Osteopathic Board or Puerto not apply to an applicant who:
Rico then the exams must be passed before July 1, (A) is licensed and in good standing as a
1963); or physician in another state;
(9) One of the following examination (B) has been licensed for at least five
combinations with a score of 75 or better on each part, years;
level, component, or step; (C) does not hold a medical license in the
(A) FLEX I plus USMLE 3; other state that has any restrictions, disciplinary orders,
(B) USMLE 1 and USMLE 2 (including or probation; and
passage of the clinical skills component if applicable), (D) passed all but one part of the
plus FLEX II; examination approved by the board within three
(C) NBME I or USMLE 1, plus NBME II attempts and:
or USMLE 2 (including passage of the clinical skills (i) passed the remaining part of the
component if applicable), plus NBME III or USMLE 3; examination within one additional attempt; or
(D) NBME I or USMLE 1, plus NBME II (ii) passed the remaining part of the
or USMLE 2 (including passage of the clinical skills examination within six attempts if the applicant:
component if applicable), plus FLEX II; (I) is specialty board certified by
(E) The NBOME Part I or COMLEX a specialty board that:
Level I and NBOME Part II or COMLEX Level II and (-a-) is a member of the
NBOME Part III or COMLEX Level III. American Board of Medical Specialties; or
(b) Examination Attempt Limit. (-b-) is approved by the
(1) An applicant must pass each part of an American Osteopathic Association; and
examination listed in subsection (a) of this section (II) has completed in this state an
within three attempts. An applicant who attempts more additional two years of postgraduate medical training
than one type of examination must pass each part of at approved by the board.
least one examination and shall not be allowed to (c) Limit on Time to Complete Examination.
combine parts of different types of examination. (1) An applicant must pass all parts of an
Attempts at a comparable part of a different type of examination listed in subsections (a)(1), (a)(2), (a)(4),
examination shall be counted against the three-attempt (a)(5), or (a)(6) of this section within seven years; or,
limit. (2) If the applicant is a graduate of a program
(2) Notwithstanding paragraph (1) of this designed to lead to both a doctor of philosophy degree
subsection, an applicant who, on September 1, 2005, and a doctor of medicine degree or doctor of osteopathy
held a Texas physician-in-training permit issued under degree, the applicant may qualify by passing each part
§155.105 of the Act or had an application for that of an examination listed in subsections (a)(1), (a)(2),
permit pending before the board must pass each part of (a)(4), (a)(5), or (a)(6) of this section not later than the
the examination within three attempts, except that, if second anniversary of the date the applicant completed
the applicant has passed all but one part of the the required graduate medical training.
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TEXAS MEDICAL BOARD RULES
Chapter 163, Licensure
(d) The time frame to pass each part of the amended to be effective August 10, 2008, 33 TexReg
examination described by subsection (c)(1) of this 6133.
section is extended to 10 years and the anniversary date
to pass each part of the examination described by §163.7. Ten Year Rule.
subsection (c)(2) of this section is extended to the 10th An applicant who has not passed an examination listed
anniversary if the applicant: in §163.6(a) of this title (relating to Examinations
(1) is specialty board certified by a specialty Accepted for Licensure) for licensure within the ten-
board that: year period prior to the filing date of the application
(A) is a member of the American Board of must:
Medical Specialties; or (1) pass a monitored specialty certification
(B) is a member of the Bureau of examination or formal evaluation, a monitored
Osteopathic Specialists; or recertification examination or formal evaluation, or a
(2) has been issued a faculty temporary monitored examination of continued demonstration of
license, as prescribed by board rule, and has practiced qualifications by a board that is a member of the
under such a license for a minimum of 12 months and, American Board of Medical Specialties or the Bureau
at the conclusion of the 12-month period, has been of Osteopathic Specialists within the preceding ten
recommended to the board by the chief administrative years;
officer and the president of the institution in which the (2) obtain through extraordinary
applicant practiced under the faculty temporary license. circumstances, unique training equal to the training
(e) Texas Medical Jurisprudence Examination (JP required for specialty certification as determined by a
Exam). committee of the board and approved by the board,
(1) In this chapter, when applicants are including but not limited to participation for at least six
required to pass the JP exam, applicants must pass the months in a training program approved by the board
JP exam with a score of 75 or better within three within twelve months prior to the application for
attempts. licensure; or
(2) An examinee shall not be permitted to (3) pass the Special Purpose Examination
bring medical books, compendia, notes, medical (SPEX) within the preceding ten years. The applicant
journals, calculators or other help into the examination must score 75 or better within three attempts.
room, nor be allowed to communicate by word or sign
with another examinee while the examination is in Source Note: The provisions of this §163.7 adopted to
progress without permission of the presiding examiner, be July 3, 2007, 32 TexReg 3991
nor be allowed to leave the examination room except
when so permitted by the presiding examiner. §163.8. Authorization to Take Professional
(3) Irregularities during an examination such Licensing Examination.
as giving or obtaining unauthorized information or aid (a) The purpose of this section is to set forth the
as evidenced by observation or subsequent statistical requirements of a medical school institution or degree
analysis of answer sheets, shall be sufficient cause to program that will authorize its graduates to take the
terminate an applicant's participation in an examination, United State Medical Licensing Examination
invalidate the applicant's examination results, or take ("USMLE"), Jurisprudence Examination, or other
other appropriate action. professional licensing examination required for
(4) A person who has passed the JP Exam licensure by the board. By agreement entered into by
shall not be required to retake the Exam for another or the board (Agreement Regarding USMLE Step 3), the
similar license, except as a specific requirement of the board has authorized the Federation of State Medical
board. Boards ("FSMB") to verify eligibility of applicants,
register approved applicants, and assure that the
Source Note: The provisions of this §163.6 adopted to USMLE is administered according to stated guidelines.
be effective November 10, 1999, 24 TexReg 9835; The Agreement provides that the board may set
amended to be effective November 30, 2003, 28 TexReg requirements for eligibility for applicants to take the
10480; amended to be effective May 2, 2004, 29 USMLE that may be in addition to USMLE
TexReg 3961; amended to be effective November 7, requirements.
2004, 29 TexReg 10104; amended to be effective (b) A medical school institution or degree program
January 25, 2006, 31 TexReg 382; amended to be shall be approved by the board for purposes of
effective June 28, 2006, 31 TexReg 5098; amended to authorizing graduates of the medical school institution
be effective January 4, 2007, 31 TexReg 10797; or degree program to take a professional licensing
amended to be effective July 3, 2007, 32 TexReg 3991; examination required by this title if the medical school
institution or degree program:
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TEXAS MEDICAL BOARD RULES
Chapter 163, Licensure
(1) is accredited by the Liaison Committee on (4) The board retains the discretion to add or
Medical Education or the American Osteopathic delete terms and conditions of the tolled order upon the
Association Bureau of Professional Education; or granting of relicensure.
(2) meets the requirements of the Educational
Commission for Foreign Medical Graduates (ECFMG) Source Note: The provisions of this §163.10 adopted to
for purposes of certification of foreign medical be effective November 10, 1999, 24 TexReg 9835;
graduates. amended to be effective October 17, 2001, 26 TexReg
(c) Nothing in this subsection shall be construed to 8069; amended to be effective March 7, 2002, 27
limit the provisions of §155.0031(d), Occupations TexReg 1487; amended to be effective April 27, 2003,
Code, requiring an applicant to provide information 28 TexReg 3324; amended to be effective November 30,
showing that each medical school attended is 2003, 28 TexReg 10480; amended to be effective
substantially equivalent to a Texas medical school. August 10, 2008, 33 TexReg 6133.
Source Note: The provisions of this §163.8 adopted to §163.11. Active Practice of Medicine.
be July 3, 2007, 32 TexReg 3991 (a) All applicants for licensure shall provide
sufficient documentation to the board that the applicant
§163.9. Only One License. has, on a full-time basis, actively diagnosed or treated
Upon the issuance of any license or permit, all persons or has been on the active teaching faculty of an
previously issued licenses and permits, including acceptable approved medical school, within either of
postgraduate training permits, shall be considered to be the last two years preceding receipt of an Application
terminated. A person may not have more than one for licensure.
license or permit at the same time, except that a license (b) The term "full-time basis," for purposes of this
holder who is required to register periodically may hold section, shall mean at least 20 hours per week for 40
the license and the registration permit at the same time. weeks duration during a given year.
(c) Applicants who do not meet the requirements of
Source Note: The provisions of this §163.9 adopted to subsections (a) and (b) of this section may, in the
be July 3, 2007, 32 TexReg 3991 discretion of the executive director or board, be eligible
for an unrestricted license or a restricted license subject
§163.10. Relicensure. to one or more of the following conditions or
(a) Application for Relicensure. If a physician's restrictions:
license has been automatically cancelled due to failure (1) current certification or recertification by
to submit a complete registration application and the American Board of Medical Specialties or Bureau
registration fee, the physician must apply for of Osteopathic Specialists obtained by passing a
relicensure and may obtain a new license by submitting monitored specialty certification or recertification
to reexamination and complying with the requirements examination or formal evaluation;
and procedures for obtaining an original license. (2) limitation of the practice of the applicant to
(b) Existing Board Orders at Time of Cancellation. specified activities of medicine and/or exclusion of
(1) A physician who allows his or her license specified activities of medicine;
to be canceled following nonpayment while under an (3) remedial education, including but not
order of the board may apply for relicensure. Unless limited to a mini-residency, fellowship or other
otherwise provided, the terms of the order shall be structured program;
tolled for the period following cancellation. (4) such other remedial or restrictive
(2) The licensee shall be required to comply conditions or requirements that, in the discretion of the
with the terms of the order for either the period of time board are necessary to ensure protection of the public
remaining on the order when the licensee had his or her and minimal competency of the applicant to safely
license canceled for nonpayment of licensure fees or for practice medicine.
an extended period of time as established by the board
at the time of relicensure. Source Note: The provisions of this §163.11 adopted to
(3) A physician who allows his or her license be effective November 10, 1999, 24 TexReg 9835;
to be canceled following nonpayment while under a amended to be effective May 2, 2004, 29 TexReg 3961;
suspension order of the board must also demonstrate amended to be effective August 10, 2008, 33 TexReg
that his or her return to the practice of medicine is in the 6133.
physician's and the public's best interest as defined
under Chapter 167 of this title (relating to
Reinstatement and Reissuance).
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TEXAS MEDICAL BOARD RULES
Chapter 163, Licensure
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
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TEXAS MEDICAL BOARD RULES
Chapter 164, Physician Advertising
(14) makes a representation that is designed to (4) the organization has at least 100 duly
take advantage of the fears or emotions of a particularly licensed members, fellows, diplomates, or certificate
susceptible type of patient; holders from at least one-third of the states; and
(15) advertises or represents in the use of a (5) the organization requires all physicians
professional name, a title or professional identification who are seeking certification to have satisfactorily
that is expressly or commonly reserved to or used by completed identifiable and substantial training in the
another profession or professional; specialty or subspecialty area of medicine in which the
(16) claims that a physician has a unique or physician is seeking certification, and the organization
exclusive skill without substantiation of such claim; utilizes appropriate peer review. This identifiable
(17) involves uninvited solicitation such as training shall be deemed acceptable unless determined
"drumming" patients or conduct considered an offense by the Texas Medical Board to be inadequate in scope,
under Texas Occupations Code §102.001(a) relating to content, and duration in that specialty or subspecialty
the solicitation of patients; or area of medicine in order to protect the public health
(18) fails to disclose the fact of giving and safety.
compensation or anything of value to representatives of (c) A physician may not authorize the use of or use
the press, radio, television or other communicative the term "board certified" if the claimed board
medium in anticipation of or in return for any certification has expired and has not been renewed at
advertisement, article, or infomercial, unless the nature, the time the advertising in question was ordered.
format or medium of such advertisement makes the fact (d) The terms "board eligible," "board qualified,"
of compensation apparent. or any similar words or phrase calculated to convey the
same meaning may not be used in physician
Source Note: The provisions of this §164.3 adopted to advertising.
be effective May 21, 2000, 25 TexReg 4348; amended (e) A physician's authorization of or use of the term
to be effective September 19, 2002, 27 TexReg 8769; "board certified", or any similar words or phrase
amended to be effective May 12, 2008, 33 TexReg 3741. calculated to convey the same meaning in any
advertising for his or her practice shall constitute
§164.4. Board Certification. misleading or deceptive advertising unless the specialty
(a) A physician is authorized to use the term "board board which conferred the certification and the
certified" in any advertising for his or her practice only certifying organization meet the requirements in
if the specialty board that conferred the certification and subsection (a) of this section.
the certifying organization is a member board of the (f) A physician may advertise a field of interest if
American Board of Medical Specialties, or the Bureau the physician is certified by, or a member, fellow, or
of Osteopathic Specialists, or is the American Board of diplomate of an organization that meets the
Oral and Maxillofacial Surgery. requirements of subsection (a) or (b) of this section.
(b) A physician is authorized to advertise that the (g) A board certified physician who advertises
physician is a member, fellow, diplomate, or certified board certification may advertise a field of interest that
by a named organization or other designation calculated is different from the certified specialty only if the
to convey a similar meaning, if such designation is physician identifies the specialty for which the
accurate, only if the organization meets the following physician is board certified in an equal size of type or
requirements: emphasis.
(1) the organization requires all physicians (h) A physician who is not board certified by, or a
who are seeking certification to successfully pass a member, fellow, or diplomate of an organization that
written or an oral examination or both, which tests the meets either the requirements of subsection (a) or (b) of
applicant's knowledge and skills in the specialty or this section may not advertise a field of interest, except
subspecialty area of medicine. All or part of the that the physician may advertise that his or her practice
examination may be delegated to a testing organization. is "limited to" a certain practice area.
All examinations require a psychometric evaluation for
validation; Source Note: The provisions of this §164.4 adopted to
(2) the organization has written proof of a be effective March 8, 2001, 26 TexReg 1863; amended
determination by the Internal Revenue Service that the to be effective May 2, 2004, 29 TexReg 3962; amended
certifying board is tax exempt under the Internal to be effective July 3, 2007, 32 TexReg 3992.
Revenue Code pursuant to Section 501(c);
(3) the organization has a permanent §164.5. Advertising Records and Responsibility.
headquarters and staff; (a) Any and all advertisements are presumed to
have been approved by the licensee named therein.
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TEXAS MEDICAL BOARD RULES
Chapter 164, Physician Advertising
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§165.1. Medical Records. of the patient shall be maintained as part of the patient's
(a) Contents of Medical Record. Each licensed medical records.
physician of the board shall maintain an adequate (11) The board acknowledges that the nature
medical record for each patient that is complete, and amount of physician work and documentation
contemporaneous and legible. For purposes of this varies by type of services, place of service and the
section, an "adequate medical record" should meet the patient's status. Paragraphs (1) - (11) of this subsection
following standards: may be modified to account for these variable
(1) The documentation of each patient circumstances in providing medical care.
encounter should include: (b) Maintenance of Medical Records.
(A) reason for the encounter and relevant (1) A licensed physician shall maintain
history, physical examination findings and prior adequate medical records of a patient for a minimum of
diagnostic test results; seven years from the anniversary date of the date of last
(B) an assessment, clinical impression, or treatment by the physician.
diagnosis; (2) If a patient was younger than 18 years of
(C) plan for care (including discharge plan age when last treated by the physician, the medical
if appropriate); and records of the patient shall be maintained by the
(D) the date and legible identity of the physician until the patient reaches age 21 or for seven
observer. years from the date of last treatment, whichever is
(2) Past and present diagnoses should be longer.
accessible to the treating and/or consulting physician. (3) A physician may destroy medical records
(3) The rationale for and results of diagnostic that relate to any civil, criminal or administrative
and other ancillary services should be included in the proceeding only if the physician knows the proceeding
medical record. has been finally resolved.
(4) The patient's progress, including response (4) Physicians shall retain medical records for
to treatment, change in diagnosis, and patient's non- such longer length of time than that imposed herein
compliance should be documented. when mandated by other federal or state statute or
(5) Relevant risk factors should be identified. regulation.
(6) The written plan for care should include (5) Physicians may transfer ownership of
when appropriate: records to another licensed physician or group of
(A) treatments and medications physicians only if the physician provides notice
(prescriptions and samples) specifying amount, consistent with §165.5 of this chapter and the physician
frequency, number of refills, and dosage; who assumes ownership of the records maintains the
(B) any referrals and consultations; records consistent with this chapter.
(C) patient/family education; and, (6) Medical records may be owned by a
(D) specific instructions for follow up. physician's employer, to include group practices,
(7) any written consents for treatment or professional associations, and non-profit health
surgery requested from the patient/family by the organizations, provided records are maintained by these
physician. entities consistent with this chapter.
(8) Billing codes, including CPT and ICD-9- (7) Destruction of medical records shall be
CM codes, reported on health insurance claim forms or done in a manner that ensures continued confidentiality.
billing statements should be supported by the
documentation in the medical record. Source Note: The provisions of this §165.1 adopted to
(9) Any amendment, supplementation, change, be effective December 29, 1997, 22 TexReg 12490;
or correction in a medical record not made amended to be effective September 14, 2003, 28 TexReg
contemporaneously with the act or observation shall be 7703; amended to be effective March 4, 2004, 29
noted by indicating the time and date of the TexReg 1946; amended to be effective September 28,
amendment, supplementation, change, or correction, 2006, 31 TexReg 8090; amended to be effective
and clearly indicating that there has been an January 20, 2009, 34 TexReg 337.
amendment, supplementation, change, or correction.
(10) Records received from another physician §165.2. Medical Record Release and Charges.
or health care provider involved in the care or treatment (a) Release of Records Pursuant to Written
Request. As required by the Medical Practice Act,
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TEXAS MEDICAL BOARD RULES
Chapter 165, Medical Records
§159.006, a physician shall furnish copies of medical billing records requested. The fee may not include costs
and/or billing records requested or a summary or associated with searching for and retrieving the
narrative of the records pursuant to a written release of requested information.
the information as provided by the Medical Practice (2) A reasonable fee, shall include only the
Act, §159.005, except if the physician determines that cost of:
access to the information would be harmful to the (A) copying, including the labor and cost
physical, mental, or emotional health of the patient. The of supplies for copying;
physician may delete confidential information about (B) postage, when the individual has
another patient or family member of the patient who requested the copy or summary be mailed; and
has not consented to the release. If by the nature of the (C) preparing a summary of the records
physician's practice, the physician transmits health when appropriate.
information in electronic form, the physician may be (f) Emergency Requests. The physician providing
subject to the Health Insurance Portability and copies of requested medical and/or billing records or a
Accountability Act (HIPAA) 45 C.F.R. Parts 160-164. summary or a narrative of such records shall be entitled
Unless otherwise provided under HIPAA, physicians to payment of a reasonable fee prior to release of the
subject to HIPAA must permit the patient or an information unless the information is requested by a
authorized representative access to inspect medical licensed Texas health care provider or a physician
and/or billing records and may not provide summaries licensed by any state, territory, or insular possession of
in lieu of actual copies unless the patient authorizes the the United States or any State or province of Canada if
summary and related charges. requested for purposes of emergency or acute medical
(b) Deadline for Release of Records. The requested care.
copies of medical and/or billing records or a summary (g) Non-emergent Requests. In the event the
or narrative of the records shall be furnished by the physician receives a proper request for copies of
physician within 15 business days after the date of medical and/or billing records or a summary or
receipt of the request and reasonable fees for furnishing narrative of the records for purposes other than for
the information. emergency or acute medical care, the physician may
(c) Denial of Requests for Records. If the physician retain the requested information until payment is
denies the request for copies of medical and/or billing received. If payment is not routed with such a request,
records or a summary or narrative of the records, either within ten calendar days from receiving a request for
in whole or in part, the physician shall furnish the the release of such records, the physician shall notify
patient a written statement, signed and dated, within 15 the requesting party in writing of the need for payment
business days of receipt of the request stating the reason and may withhold the information until payment of a
for the denial and how the patient can file a compliant reasonable fee is received. A copy of the letter
with the federal Department of Health and Human regarding the need for payment shall be made part of
Services (if the physician is subject to HIPAA) and the the patient's medical and/or billing record as
Texas State Board of Medical Examiners. A copy of the appropriate.
statement denying the request shall be placed in the (h) Improper Withholding for Past Due Accounts.
patient's medical and/or billing records as appropriate. Medical and/or billing records requested pursuant to a
(d) Contents of Records. For purposes of this proper request for release may not be withheld from the
section, "medical records" shall include those records as patient, the patient's authorized agent, or the patient's
defined in §165.1(a) of this title (relating to Medical designated recipient for such records based on a past
Records) and shall include copies of medical records of due account for medical care or treatment previously
other health care practitioners contained in the records rendered to the patient.
of the physician to whom a request for release of (i) Subpoena Not Required. A subpoena shall not
records has been made. be required for the release of medical and/or billing
(e) Allowable Charges. records requested pursuant to a proper release for
(1) The physician responding to a request for records under this section and the Medical Practice Act,
such information shall be entitled to receive a §159.006, made by a patient or by the patient's guardian
reasonable, cost-based fee for providing the requested or other representative duly authorized to obtain such
information. A reasonable fee shall be a charge of no records.
more than $25 for the first twenty pages and $.50 per (j) Billing Record Requests. In response to a proper
page for every copy thereafter. If an affidavit is request for release of medical records, a physician shall
requested, certifying that the information is a true and not be required to provide copies of billing records
correct copy of the records, a reasonable fee of up to pertaining to medical treatment of a patient unless
$15 may be charged for executing the affidavit. A specifically requested pursuant to the request for release
physician may charge separate fees for medical and of medical records.
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TEXAS MEDICAL BOARD RULES
Chapter 165, Medical Records
(k) Prohibited Fees for Records Released Related from a patient or recipient of the original imaging
to Disability Claims. The allowable charges as set forth studies, or from their authorized representative,
in this chapter shall be maximum amounts, and this acknowledging receipt of and responsibility for the
chapter shall be construed and applied so as to be original imaging studies.
consistent with lower fees or the prohibition or absence (c) Exceptions. As provided for under §159.005 of
of such fees as required by state statute or prevailing the Act, a physician is not required to release imaging
federal law. In particular, under §161.202 of the Texas studies directly to a patient if the physician determines
Health and Safety Code, a physician may not charge a that access to the imaging studies would be harmful to
fee for a medical or mental health record requested by a the physical, mental, or emotional health of the patient.
patient, former patient or authorized representative of If a physician makes a determination that access would
the patient if the request is related to a benefits or be harmful to the physical, mental, or emotional health
assistance claim based on the patient's disability. of the patient, the physician shall, within the time
(l) Applicable Federal Law. Whenever federal law allowed after receipt of a proper request, provide access
or applicable federal regulations affecting the release of to the requested imaging studies to an authorized
patient information are inconsistent with provisions of representative of the patient as provided for in
this section, the provisions of federal law or federal subsection (b) of this section.
regulations shall be controlling, unless the state law is (d) Time for release and denial. The requested
more restrictive/stringent. Physicians are responsible copies or access to imaging studies shall be provided by
for ensuring that they are in compliance with federal the physician within 15 business days after the date of
law and regulations including the Health Insurance receipt of the request. If the physician denies the
Portability and Accountability Act (HIPAA) 45 C.F.R. request, in whole or in part, the physician shall furnish
Parts 160-164. the patient or recipient a written statement, signed and
dated, within 15 business days of receipt of the request
Source Note: The provisions of this §165.2 adopted to stating the reason for the denial and how the patient or
be effective December 29, 1997, 22 TexReg 12490; recipient can file a complaint with federal Department
amended to be effective May 21, 2000, 25 TexReg of Health and Human Services and the Texas Medical
4349; amended to be effective November 19, 2000, 25 Board. A copy of the statement denying the request
TexReg 11282; amended to be effective September 19, shall be placed in the patient's medical records.
2002, 27 TexReg 8769; amended to be effective March (e) Fees. The physician responding to a request by
4, 2004, 29 TexReg 1946. providing copies of imaging studies shall be entitled to
a reasonable fee for providing the copies. A reasonable
§165.3. Patient Access to Diagnostic Imaging Studies fee shall be no more than $8 per copy of an imaging
in Physician's Office. study. In addition, a reasonable fee may include actual
(a) Purpose. This section is promulgated to ensure costs for mailing, shipping, or delivery.
that patients have reasonable access to diagnostic (f) Emergency Request. The physician providing
imaging studies maintained in the physician's office and copies of requested imaging studies shall be entitled to
that the practice of medicine by individual licensees and a reasonable fee prior to release of the copies unless the
the delivery of health care to the public shall not be copies are requested by a licensed Texas health care
unduly hindered or interrupted by allowing for such provider or a physician licensed by any state, territory,
access. As used in this section, "diagnostic imaging or insular possession of the United States or any state or
studies" or "imaging studies" includes static and non- province of Canada if requested for purposes of
static films and imaging studies in electronic format. emergency or acute medical care.
(b) Request and release. (g) Non-emergent Requests. In the event that the
(1) Upon receiving a written request and physician receives a proper request for access to
release of information that complies with §159.005 of imaging studies for purposes other than for emergency
the Act, a physician in possession or control of or acute medical care, the physician may retain copies
diagnostic imaging studies of a patient shall allow of the requested information until payment is received.
access to the imaging studies through one or more of If payment is not routed with such a request, within ten
the following means: calendar days from receiving the request, the physician
(A) providing copies of the imaging shall notify the requesting party in writing of the need
studies to the patient or recipient as designated in the for payment and may withhold the copies until payment
request; or of a reasonable fee is received. A copy of the letter
(B) releasing the original imaging studies regarding the need for payment shall be made part of
to the patient or recipient as designated in the request. the patient's medical record.
(2) Release and transfer of original imaging (h) Improper Withholding for Past Due Accounts.
studies may be evidenced by a signed and dated receipt Access to or copies of imaging studies requested
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TEXAS MEDICAL BOARD RULES
Chapter 165, Medical Records
pursuant to a proper request for release may not be contractor is not selected, the board may publish a
withheld from the patient, the patient's authorized Request for Bids for entities to function as regional
agent, or the patient's designated recipient for such appointed record custodian or a custodian may be
copies based on a past due account for medical care or appointed on a case by case basis.
treatment previously rendered to the patient.
(i) Subpoena. A subpoena shall not be required for Source Note: The provisions of this §165.4 adopted to
access to or the release of originals or copies of imaging be effective May 21, 2000, 25 TexReg 4349; amended
studies requested pursuant to the provisions of this to be effective September 19, 2002, 27 TexReg 8769;
section. amended to be effective September 14, 2003, 28 TexReg
(j) Maximum charges. The allowable charges set 7703.
forth in this section shall be maximum amounts, and
this section shall be construed and applied so as to be §165.5. Transfer and Disposal of Medical Records.
consistent with lower fees or the prohibition or absence (a) Required Notification of Discontinuance of
of such fees as required by prevailing state or federal Practice. When a physician retires, terminates
law. employment or otherwise leaves a medical practice, he
or she is responsible for:
Source Note: The provisions of this §165.3 adopted to (1) ensuring that patients receive reasonable
be effective December 29, 1997, 22 TexReg 12490; notification and are given the opportunity to obtain
amended to be effective September 19, 2002, 27 TexReg copies of their records or arrange for the transfer of
8769; amended to be effective September 14, 2003, 28 their medical records to another physician; and
TexReg 7703; amended to be effective June 24, 2009, (2) notifying the board when they are
34 TexReg 4124. terminating practice, retiring, or relocating, and
therefore no longer available to patients, specifying
§165.4. Appointment of Record Custodian of a who has custodianship of the records, and how the
Physician's Records. medical records may be obtained.
(a) The board may appoint a temporary or (3) Employers of the departing physician as
permanent custodian for medical records abandoned by described in §165.1(b)(6) of this chapter are not
a physician when a person or entity applies with the required to provide notification, however, the departing
board to be appointed record custodian. physician remains responsible, for providing
(b) The records will be considered abandoned if notification consistent with this section.
they are without custodial care for a minimum of two (b) Method of Notification.
weeks without alternative arrangements being made by (1) When a physician retires, terminates
the physician, the physician's legal guardian, or by the employment, or otherwise leaves a medical practice, he
executor of the physician's estate. or she shall provide notice to patients of when the
(c) The record custodian appointed by the board physician intends to terminate the practice, retire or
shall take custody of and maintain the confidentiality of relocate, and will no longer be available to patients, and
the physician's records, to include available medical offer patients the opportunity to obtain a copy of their
records and billing records, according to the provisions medical records or have their records transferred.
of board rules and state statutes. (2) Notification shall be accomplished by:
(d) The appointed record custodian shall provide (A) publishing notice in the newspaper of
the records, or copies of the records, to the patient or to greatest general circulation in each county in which the
the patient's designee according to board rules and state physician practices or practiced and in a local
statutes. In addition to the reasonable copying fee newspaper that serves the immediate practice area;
defined in board rules, the appointed record custodian (B) placing written notice in the
may charge an additional fee of $25.00 per patient physician's office; and
record. (C) sending letters to patients seen in the
(e) The appointed record custodian shall retain care last two years notifying them of discontinuance of
of the records for no less than 90 days and shall publish practice.
appropriate notice of pending destruction of the records (3) A copy of the notice shall be submitted to
for no less than 30 days prior to destruction of the the Board within 30 days from the date of termination,
records. sale, or relocation of the practice.
(f) Destruction of medical records shall be done in (4) Notices placed in the physician's office
a manner that ensures continued confidentiality. shall be placed in a conspicuous location in or on the
(g) The board may publish a Request for Bids for facade of the physician's office, a sign, announcing the
§one entity to function as the appointed record termination, sale, or relocation of the practice. The sign
custodian for all areas of the state. If a sole statewide shall be placed at least thirty days prior to the
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TEXAS MEDICAL BOARD RULES
Chapter 165, Medical Records
termination, sale or relocation of practice and shall accordance with §164.052(a)(19), Medical Practice
remain until the date of termination, sale or relocation. Act;
(c) Prohibition Against Interference. (2) a court order authorizing the minor to
(1) Other licensed physicians remaining in the consent to the abortion, in accordance with §33.003 or
practice may not prevent the departing physician from §33.004, Texas Family Code;
posting notice and the sign. (3) an affidavit of the physician authorizing
(2) A physician or physician group should not the physician to perform the abortion as if the court had
withhold information from a departing physician that is issued an order granting the application or appeal, in
necessary for notification of patients. accordance with §33.005, Texas Family Code; or
(d) Voluntary Surrender or Revocation of (4) indications supporting the physician's
Physician's License. judgment, if the physician concludes, on the basis of
(1) Physicians who have voluntarily good faith clinical judgment, that a condition exists that
surrendered their licenses or have had their licenses complicates the medical condition of the pregnant
revoked by the board must notify their patients, minor and necessitates the immediate abortion of her
consistent with subsection (b) of this section, within 30 pregnancy to avert her death or to avoid a serious risk
days of the effective date of the voluntary surrender or of substantial impairment of a major bodily function
revocation. and that there is insufficient time to obtain the consent
(2) Physicians who have voluntarily of the patient's parent, managing conservator, or legal
surrendered their licenses or have had their licenses guardian, in accordance with §164.052(a)(19), Medical
revoked by the board must obtain a custodian for their Practice Act. The physician shall also maintain in the
records to be approved by the board within 30 days of medical records a copy of the certification to the
the effective date of the voluntary surrender or Department of State Health Services, as required by
revocation. §33.002, Texas Family Code.
(e) Criminal Violation. A person who violates any (c) Except in the case of a medical emergency, the
provision of this chapter is subject to criminal penalties physician shall obtain and maintain in the medical
pursuant to §165.151 of the Act. records a written consent signed by the patient that
includes the requirements set forth in §171.011 and
Source Note: The provisions of this §165.5 adopted to §171.012, Texas Health and Safety Code.
be effective March 4, 2004, 29 TexReg 1946; amended (d) The physician must use due diligence in
to be effective January 20, 2009, 34 TexReg 337. determining that any person signing a written consent
for an abortion on an unemancipated minor is, in fact,
§165.6. Medical Records Regarding an Abortion on who the person purports to be. The physician may not
an Unemancipated Minor. perform the abortion unless the written consent is
(a) As used in this section: notarized. The physician must use due diligence to
(1) "Abortion" means the use of any means to determine that any woman on which he or she performs
terminate the pregnancy of a female known by the an abortion who claims to have reached the age of
attending physician to be pregnant with the intention majority or to have had the disabilities of minority
that the termination of the pregnancy by those means removed has, in fact, reached the age of majority or has
will, with reasonable likelihood, cause the death of the had the disabilities of minority removed.
fetus (as defined at §33.001, Texas Family Code). (e) The physician shall maintain the medical
(2) "Unemancipated minor" means a minor records required by this section until the later of the
who is not 18 years, unmarried and has not had the fifth anniversary of the date of the patient's majority or
disabilities of minority removed under Chapter 31, the seventh anniversary of the date the physician
Texas Family Code (as defined at §33.001, Texas received or created the documentation for the record.
Family Code). (f) Pursuant to §164.052(c), Medical Practice Act,
(b) In the case of an unemancipated minor patient the board adopts the following form for physicians to
on whom a physician plans to perform an abortion, the obtain the consent required for an abortion to be
physician shall obtain and maintain in the medical performed on an unemancipated minor:
records one of the following:
(1) the written consent of one of the patient's
parents, managing conservator, or legal guardian, in
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33
Source Note: The provisions of this §165.6 adopted to
be effective September 28, 2006, 31 TexReg 8090.
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
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TEXAS MEDICAL BOARD RULES
Chapter 166, Physician Registration
(2) A maximum of 48 total excess credits may (k) Unless exempted under the terms of this
be carried forward and shall be reported according to section, a licensee's apparent failure to obtain and
the categories set out in subsection (a) of this section. timely report the completion of the required number of
(3) Excess CME credits of any type may not credits of CME on his or her registration application as
be carried forward or applied to a report of CME more provided for in this section may result in the denial of
than two years beyond the date of the registration the registration permit until such time as the physician
following the period during which the credits were obtains and reports the required CME credits. The
earned. executive director of the board may issue to the licensee
(c) A licensee shall be presumed to have complied a temporary CME license numbered so as to correspond
with this section if in the preceding 36 months the to the nonrenewed license. Such a temporary CME
licensee becomes board certified or recertified by a license shall be issued upon receipt of a written request
specialty board approved by the American Board of and fee for the license made prior to the expiration of
Medical Specialties or the American Osteopathic the 30-day grace period for registration at the direction
Association Bureau of Osteopathic Specialists. This of the executive director for a period of no longer than
provision exempts the physician from all CME 60 days. A temporary CME license issued pursuant to
requirements, including the requirement for one credit this subsection may be issued to allow the physician
involving the study of medical ethics and/or who has not obtained or timely reported the required
professional responsibility, as outlined in subsection number of credits an opportunity to correct any
(a)(2) of this section. This exemption is valid for one deficiency so as not to require termination of ongoing
registration period only. patient care.
(d) A physician may request in writing an (l) The fee for issuance of a temporary CME
exemption for the following reasons: license pursuant to the provisions of this section shall
(1) catastrophic illness; be in the amount specified for temporary licenses under
(2) military service of longer than one year's §175.1 of this title (relating to Fees).
duration outside the state; (m) CME credits which are obtained during the 30
(3) medical practice and residence of longer day grace period after the expiration of the licensee's
than one year's duration outside the United States; or permit or while under a CME temporary license to
(4) good cause shown submitted in writing by comply with the CME requirements for the preceding
the licensee, that gives satisfactory evidence to the two years as a prerequisite for obtaining a registration
board that the licensee is unable to comply with the permit, shall first be credited to meet the CME
requirement for CME. requirements for the previous registration period and
(e) Exemptions are subject to the approval of the then any additional credits obtained shall be credited to
executive director or medical director and must be meet the CME requirements for the current registration
requested in writing at least 30 days prior to the period.
expiration date of the permit. (n) A false report or false statement to the board by
(f) A temporary exemption under subsection (d) of a licensee regarding CME credits reportedly obtained
this section may not exceed one year but may be shall be a basis for disciplinary action by the board
renewed, subject to the approval of the board. pursuant to the Medical Practice Act (the "Act"), Tex.
(g) Subsection (a) of this section does not apply to Occ. Code Ann. §§164.051 - 164.053. A licensee who
a licensee who is retired and has been exempted from is disciplined by the board for such a violation may be
paying the registration fee under §166.3 of this title subject to the full range of actions authorized by the Act
(relating to Retired Physician Exception). including suspension or revocation of the physician's
(h) This section does not prevent the board from medical license, but in no event shall such action be
taking board action with respect to a licensee or an less than an administrative penalty of $500.
applicant for a license by requiring additional credits of (o) Administrative penalties for failure to timely
CME or of specific course subjects. obtain and report required CME credits may be
(i) The board may require written verification of assessed in accordance with §§187.75 - 187.82 of this
both formal and informal credits from any licensee title (relating to Imposition of Administrative Penalty)
within 30 days of request. Failure to provide such and §190.14 (relating to Disciplinary Sanction
verification may result in disciplinary action by the Guidelines).
board. (p) Unless exempted under the terms of this
(j) Physicians in residency/fellowship training or section, failure to obtain and timely report the CME
who have completed such training within six months credits on a registration permit application shall subject
prior to the registration expiration date, will satisfy the the licensee to a monetary penalty for late registration
requirements of subsection (a)(1) and (2) of this section in the amount set forth in §175.2 of this title (relating to
by their residency or fellowship program. Penalties). Any temporary CME licensure fee and any
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TEXAS MEDICAL BOARD RULES
Chapter 166, Physician Registration
administrative penalty imposed for failure to obtain and (A) the physician's Texas medical license
timely report the 48 credits of CME required for a number;
registration permit application shall be in addition to the (B) current mailing address;
applicable penalties for late registration as set forth in (C) proposed practice location;
§175.2 of this title. (D) intended type of medical practice;
(E) length of retired status;
Source Note: The provisions of this §166.2 adopted to (F) any other medical licenses held;
be effective December 24, 1993, 18 TexReg 9189; (G) any condition which adversely affects
amended to be effective August 2, 1995, 20 TexReg the physician's ability to practice medicine with
5240; amended to be effective January 12, 1996, 21 reasonable skill and safety;
TexReg 106; amended to be effective December 12, (H) any current specialty board
1996, 21 TexReg 11785; amended to be effective certifications; and,
December 23, 1997, 22 TexReg 12490; amended to be (I) any formal or informal continuing
effective March 4, 1998, 23 TexReg 1949; amended to medical education obtained during the period of retired
be effective May 9, 1999, 24 TexReg 3346; amended to status.
be effective May 21, 2000, 25 TexReg 4349; amended (4) The request of a physician seeking a return
to be effective September 21, 2000, 25 TexReg 9217; to active status whose license has been placed on
amended to be effective October 17, 2001, 26 TexReg official retired status for two years or longer shall be
8069; amended to be effective January 6, 2002, 26 submitted to the Licensure Committee of the board for
TexReg 10865; amended to be effective September19, consideration and a recommendation to the full board
2002, 27 TexReg 8769; amended to be effective for approval or denial of the request. After
November 30, 2003, 28 TexReg 10483; amended to be consideration of the request and the recommendation of
effective June 29, 2006, 31 TexReg 5099; amended to the Licensure Committee, the board shall grant or deny
be effective August 10, 2008, 33 TexReg 6133; amended the request subject to such conditions which the board
to be effective January 20, 2009, 34 TexReg 337; determines are necessary to adequately protect the
amended to be effective May 6, 2009, 34 TexReg 2675. public including but not limited to passage of the
Special Purpose Examination (SPEX), passage of the
§166.3. Retired Physician Exception. Medical Jurisprudence Examination, and/or passage of
The registration fee shall apply to all physicians a specialty board certification examination.
licensed by the board, whether or not they are (5) The request of a physician seeking a return
practicing within the borders of this state, except retired to active status whose license has been placed on
physicians. official retired status for less than two years may be
(1) To become exempt from the registration approved by the executive director of the board or
fee due to retirement: submitted by the executive director to the Licensure
(A) the physician's current license must be Committee for consideration and a recommendation to
active and not under an order with the board or the full board for approval or denial of the request. In
otherwise have a restricted license; and those instances in which the executive director submits
(B) the physician must request in writing the request to the Licensure Committee of the board,
on a form prescribed by the board for his or her license the Licensure Committee shall make a recommendation
to be placed on official retired status. to the full board for approval or denial. After
(2) The following restrictions shall apply to consideration of the request and the recommendation of
physicians whose licenses are on official retired status. the Licensure Committee, the board shall grant or deny
(A) the physician must not engage in the request subject to such conditions which the board
clinical activities or practice medicine in any state; determines are necessary to adequately protect the
(B) the physician may not prescribe or public including but not limited to passage of the
administer drugs to anyone, nor may the physician Special Purpose Examination (SPEX), passage of the
possess a Drug Enforcement Agency or Texas Medical Jurisprudence Examination, and/or passage of
controlled substances registration; and a specialty board certification examination.
(C) the physician's license may not be (6) In evaluating a request to return to active
endorsed to any other state. status, the Licensure Committee or the full board may
(3) A physician whose license has been placed require a personal appearance by the requesting
on official retired status must obtain the approval of the physician at the offices of the board, and may also
board before returning to active status by submitting a require a physical or mental examination by one or
written request to the attention of the Permits more physicians or other health care providers
Department of the board which indicates the following: approved in advance in writing by the executive
director, the secretary-treasurer, the Licensure
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TEXAS MEDICAL BOARD RULES
Chapter 166, Physician Registration
committee, or other designee(s) determined by majority registration fee, a physician must submit to
vote of the board. reexamination and qualify under §164.151 of the Act
and §163.10 of this title (relating to Relicensure).
Source Note: The provisions of this §166.3 adopted to (b) To be relicensed following voluntary
be effective December 24, 1993, 18 TexReg 9189; relinquishment or surrender of a medical license, a
amended to be effective January 12, 1996, 21 TexReg physician must reapply and qualify under §164.151 of
107; amended to be effective October 17, 2001, 26 the Act and §196.4 of this title (relating to Relicensure
TexReg 8069; amended to be effective January 6, 2002, After Relinquishment or Surrender of a Medical
26 TexReg 10865; amended to be effective November License).
30, 2003, 28 TexReg 10483.
Source Note: The provisions of this §166.5 adopted to
§166.4. Expired Registration Permits. be effective December 24, 1993, 18 TexReg 9189;
(a) If a physician's registration permit has expired, amended to be effective January 6, 2002, 26 TexReg
the physician may register for a new permit without 10865; amended to be effective November 30, 2003, 28
monetary penalty during the first 30 days following TexReg 10483; amended to be effective July 3, 2007, 32
expiration. If a physician's permit has been expired for TexReg 3992; amended to be effective August 10, 2008,
longer than 30 days, but less than 91, the physician may 33 TexReg 6133.
obtain a new permit by submitting to the board a
completed permit application, the registration fee, and a §166.6. Exemption From Registration Fee for
$75 penalty fee. Retired Physician Providing Voluntary Charity
(b) If a physician's registration permit has been Care.
expired for longer than 90 days but less than one year, (a) A retired physician licensed by the board whose
the physician may obtain a new permit by submitting a only practice is the provision of voluntary charity care
completed permit application, the registration fee, and a shall be exempt from the registration fee.
$150 penalty fee. (b) As used in this section:
(c) If a physician's registration permit has been (1) "voluntary charity care" means medical
expired for one year or longer, the physician's license is care provided for no compensation to:
automatically canceled, unless an investigation is (A) indigent populations;
pending, and the physician may not obtain a new (B) in medically underserved areas; or
permit. (C) for a disaster relief organization.
(d) In accordance with §156.008(a) of the Act, (2) "compensation" means direct or indirect
practicing medicine after the expiration of the 30-day payment of anything of monetary value, except
grace period under subsection (a) of this section without payment or reimbursement of reasonable, necessary,
obtaining a new registration permit for the current and actual travel and related expenses.
registration period has the same effect as, and is subject (c) To qualify for and obtain such an exemption, a
to all penalties of, practicing medicine without a license physician must truthfully certify under oath, on a form
and may be subject to criminal penalties under approved by the board, and received by the board at
§165.152 of the Act. However, the Board interprets least 30 days prior to the expiration date of the permit,
§156.005 of the Act to provide the exclusive sanction that the following information is correct:
that may be imposed by the board for practicing (1) the physician's practice of medicine does
medicine after the 30-day grace period and within one not include the provision of medical services for either
year after expiration direct or indirect compensation which has monetary
value of any kind;
Source Note: The provisions of this §166.4 adopted to (2) the physician's practice of medicine is
be effective December 24, 1993, 18 TexReg 9189; limited to voluntary charity care for which the
amended to be effective January 12, 1996, 21 TexReg physician receives no direct or indirect compensation of
106; amended to be effective May 9, 1999, 24 TexReg any kind for medical services rendered;
3346; amended to be effective October 17, 2001, 26 (3) the physician's practice of medicine does
TexReg 8069; amended to be effective January 6, 2002, not include the provision of medical services to
26 TexReg 10865; amended to be effective November members of the physician's family; and
30, 2003, 28 TexReg 10483; amended to be effective (4) the physician's practice of medicine does
March 16, 2008, 33 TexReg 2024. not include the self-prescribing of controlled substances
or dangerous drugs.
§166.5. Relicensure. (d) A physician who qualifies for and obtains an
(a) To be relicensed following cancellation for exemption from the registration fee authorized under
failure to submit a complete registration application and this section shall obtain and report continuing medical
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TEXAS MEDICAL BOARD RULES
Chapter 166, Physician Registration
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§167.1. Reinstatement or Reissuance of Medical TexReg 3324; amended to be effective March 16, 2008,
License Following Suspension or Revocation. 33 TexReg 2024
(a) Reinstatement of Medical License Following
Suspension. §167.2. Procedure for Requests for Reinstatement.
(1) A physician whose license has been Pursuant to the Medical Practice Act, §§154.006,
suspended by order of the board must submit a written 164.003 and 164.151-.154, and the Administrative
request to the board's compliance division and appear at Procedure Act, Government Code, §2001.056, the
a probationer show compliance proceeding as described following rules shall apply to dispositions of any
in §187.44 of this title (relating to Probationer Show requests for reinstatement of a medical license
Compliance Proceedings) and in paragraph (2) of this following suspension.
subsection to request reinstatement of licensure. (1) The board may make a disposition of any
(2) A person may not apply for reinstatement request for reinstatement of a medical license following
of a license that was suspended before the first suspension by stipulation, agreed order, agreed
anniversary of the date on which the suspension became settlement, consent order, or default.
effective. (2) In the event the board makes such a
(3) A request for reinstatement following disposition of a request for reinstatement of a medical
suspension cannot be considered more often than license following suspension, the disposition shall be in
annually unless otherwise specified by order of the writing and, if appropriate, the writing shall be signed
board. by the applicant.
(4) A physician's request for reinstatement (3) To facilitate the expeditious disposition of
must include evidence that all stipulations for the requests for reinstatement following suspension, the
probation of the suspension have been completed. board may provide an applicant with an opportunity to
(5) A physician who allows his or her license attend a probationer show compliance proceeding in
to be cancelled for nonpayment while under a accordance with §187.44 of this title (relating to
suspension order may apply for relicensure in Probationer Show Compliance Proceedings).
accordance with §163.10 of this title (relating to (4) In accordance with §187.44 of this title
Relicensure). (relating to Probationer Show Compliance Proceedings)
(b) Reissuance of License Following Revocation. an applicant for reinstatement shall be provided with
(1) A physician whose license has been written notice of the time, date, and location of the
revoked must complete in every detail the application probationer show compliance proceeding and the rules
for reissuance of license, including payment of the governing the proceeding by certified mail - return
required application fee. receipt requested, overnight or express mail, or
(2) The physician whose license has been registered mail, to the last mailing address of the
revoked must appear before a committee of the board applicant or the applicant's attorney on file with the
for a determination regarding reissuance of license. board.
(3) A person may not apply for reissuance of a (5) The probationer show compliance
license that was revoked before the first anniversary of proceeding shall allow:
the date on which the revocation became effective. (A) the board staff to address whether it is
(4) An application for reissuance of a license in the best interest of the public and the physician to
following revocation cannot be considered more often return to the practice of medicine by presenting a
than annually. synopsis of the allegations and the basis of the
(5) In addition to any other requirement set out suspension of the applicant's medical license, the facts
in this chapter for reissuance of a license following which the board staff reasonably believes could be
revocation, a physician must also demonstrate proven by competent evidence at a hearing, and
compliance with current licensure eligibility whether the applicant has complied with the terms and
requirements. conditions of the order suspending his license if
applicable;
Source Note: The provisions of this §167.1 adopted to (B) the applicant to reply to the board
be effective December 24, 1993, 18 TexReg 9190; staff's presentation and present facts the applicant
amended to be effective October 17, 2001, 26 TexReg reasonably believes could be proven by competent
8069; amended to be effective April 27, 2003, 28 evidence at a hearing;
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TEXAS MEDICAL BOARD RULES
Chapter 167, Reinstatement and Reissuance
(C) presentation of evidence by the staff remedial actions in the public interest. These
and the applicant which may include medical and office recommendations may be subsequently modified by the
records, x-rays, pictures, film recordings of all kinds, board's representative(s) or staff based on new
audio and video recordings, diagrams, charts, drawings, information, a change of circumstance, or to expedite a
and any other illustrative or explanatory materials resolution in the interest of protecting the public. These
which in the discretion of the board's representative(s) recommendations may be adopted, modified, or
are relevant to the proceeding; rejected by the duly convened board or through the duly
(D) representation of the applicant by authorized actions of the board's Disciplinary Process
counsel; Review Committee.
(E) presentation of oral or written (12) The applicant may either accept or reject
statements by the applicant or the applicant's counsel; the settlement recommendations proposed by the
(F) presentation of oral or written board's representative(s). If the applicant accepts the
statements or testimony by witnesses; and, recommendations, the applicant shall execute the
(G) questioning of witnesses. settlement agreement in the form of an agreed order or
(6) The board's representative(s) shall exclude affidavit as soon thereafter as is practicable. If the
from the probationer show compliance proceeding all applicant rejects the proposed agreement, the applicant
persons except witnesses during their testimony or shall be given the option of requesting a formal hearing.
presentation of statements, the applicant, the applicant's If the applicant requests a formal hearing, the matter
attorney or representative, board members, district shall be referred to the board's staff for hearing, as
review committee members, and board staff. described in Chapter 187, Subchapter C of this title
(7) During the probationer show compliance (relating to Formal Proceedings at SOAH).
proceeding, the board's legal counsel shall be present to (13) Following acceptance and execution by
advise the board's representative(s) or the board's the applicant of the settlement agreement, the
employees. agreement shall be submitted to the board for approval.
(8) During the deliberations of an appropriate (14) The following as stated in subparagraphs
settlement, the board's representative(s) at a probationer (A)-(C) of this paragraph relate to consideration of an
show compliance proceeding shall exclude the agreed disposition by the board.
applicant, the applicant's attorney or representative, any (A) Upon an affirmative majority vote, the
witnesses, and the general public. A board legal counsel board shall enter an order approving the proposed
and board staff shall be available to assist the settlement agreement. The order shall bear the signature
representative(s) in their deliberations. of the president of the board or of the officer presiding
(9) At the probationer show compliance at such meeting and shall be referenced in the minutes
proceeding the board's representative(s) will attempt to of the board.
mediate disputed matters, and the board's (B) If the board does not approve a
representative(s) may call upon the board staff at any proposed settlement agreement, the applicant shall be
time for assistance in conducting the proceeding. so informed and the matter shall be referred to the
(10) The board's representative(s) shall board staff for appropriate action to include further
prohibit or limit access to the board's investigative file negotiation, further investigation, an additional
by the applicant, the applicant's attorney or probationer show compliance proceeding or a formal
representative, any witnesses, and the public consistent hearing.
with the Medical Practice Act, §164.007. (C) To promote the expeditious resolution
(11) At the conclusion of the probationer show of any request for reinstatement, with the approval of
compliance proceeding, the board's representative(s) the executive director, a member of the Executive
shall make recommendations for disposition of the Committee, or the Disciplinary Process Review
request for reinstatement which may include deferral Committee, board staff may present a proposed
pending receipt of additional information, denial of the settlement agreement to the board for consideration and
request, or in accordance with board rule §187.43 of acceptance without conducting a probationer show
this title (relating to Proceedings for the compliance proceeding. If the board does not approve
Modification/Termination of Agreed Orders and such a proposed settlement agreement, the applicant
Disciplinary Orders), a modification or termination of shall be so informed and the matter shall be referred to
the agreed or disciplinary order under which the the board staff for appropriate action to include further
suspension was originally granted. The board's negotiation, further investigation, a probationer show
representative(s) may make recommendations to the compliance proceeding or a hearing.
applicant for resolution of the issues. Such
recommendations may include any reasonable Source Note: The provisions of this §167.2 adopted to
restrictions authorized by the Act and any other be effective September 15, 1997, 22 TexReg 8997;
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TEXAS MEDICAL BOARD RULES
Chapter 167, Reinstatement and Reissuance
amended to be effective October 17, 2001, 26 TexReg (6) An applicant who is offered a restricted
8069; amended to be effective April 27, 2003, 28 license may either accept or reject the recommendations
TexReg 3324. proposed by the committee. If the applicant accepts the
recommendations, the applicant shall execute the
§167.3. Application for Reissuance of a Revoked agreement in the form of an agreed order. If the
License. applicant rejects the proposed agreement, the applicant
Pursuant to the Medical Practice Act, §164.151 and the shall be given the option of requesting judicial review
Administrative Procedure Act, Government Code, in the manner provided by §164.009 of the Act.
§2001.056, the following rules shall apply to the (7) Following acceptance and execution by the
dispositions of any applications for reissuance of a applicant of the agreement to restrictions on the
license to practice medicine. applicant's license, the application for reissuance and
(1) The board may make an informal the agreed order shall be submitted to the board for
disposition of any application for reissuance of a approval.
medical license following revocation by stipulation, (A) Upon an affirmative majority vote, the
agreed order, agreed settlement or default. board shall enter an order approving the proposed
(2) In the event the board makes such a reissuance of licensure subject to restrictions or
disposition of an application for reissuance of a medical conditions. The order shall bear the signature of the
license following revocation, the disposition shall be in president of the board or of the officer presiding at such
writing and, if appropriate, the writing shall be signed meeting and shall be referenced in the minutes of the
by the applicant. board.
(3) If an opportunity to appear before a (B) If the board does not approve the
committee of the board is provided to an applicant, the proposed order or otherwise denies the applicant's
applicant shall be provided with written notice of the application for reissuance, the applicant shall be so
hearing including the date and time and allegations to informed and the board's decision shall be subject to
the last mailing address of the applicant or the judicial review in the manner provided by §164.009 of
applicant's attorney on file with the board. The the Act.
applicant shall also be provided with written notice of
the time, date and location of the committee hearing Source Note: The provisions of this §167.3 adopted to
and the rules governing the proceeding. be effective October 17, 2001, 26 TexReg 8069;
(4) The committee hearing shall allow: amended to be effective March 16, 2008, 33 TexReg
(A) board staff to present a synopsis of the 2024.
allegations and the facts that supported the revocation
of the applicant's medical license, and to address §167.4. Best Interests of Public.
whether it is in the best interest of the public and the Pursuant to §164.151 of the Act, a physician may be
physician to return to the practice of medicine; reissued a medical license or reinstated to the practice
(B) the applicant the opportunity to reply of medicine only if the physician demonstrates that the
to the board staff's presentation and offer relevant reissuance or reinstatement is in the best interests of the
evidence; public. Best interests of the public may include, but not
(C) representation of the applicant by be limited to, an assessment by the Board as to whether
counsel; and the physician demonstrates:
(D) presentation of oral or written (1) remediation of any competency,
statements by the applicant or the applicant's counsel. technical, educational, training or ethical limitations as
(5) At the conclusion of the applicant's found in the order leading to revocation or suspension
presentation, the committee shall make a of a license or any competency, technical, educational,
recommendation for disposition of the application for training or ethical limitations found since the entry of
reissuance which may include: the order;
(A) deferral pending receipt of additional (2) that risk of further disciplinary
information; proceedings for the revocation or suspension of the
(B) denial of the request for reissuance; license will be minimal or minimized if the physician is
(C) reissuance of an unrestricted license; returned to the practice of medicine and the public will
or adequately be protected, whether by probationary order
(D) reissuance of a restricted license or other terms and conditions as agreed to by the
subject to any reasonable restrictions or conditions physician or authorized by §164.101 and §164.102 of
authorized by the Act and any other remedial actions the Act;
found to be in the public's best interest.
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TEXAS MEDICAL BOARD RULES
Chapter 167, Reinstatement and Reissuance
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§169.1. Purpose. according to the most recent federal census, but not
The purpose of this chapter is to provide physicians including a city or town, incorporated or
with guidelines for supplying drugs to their patients as unincorporated, whose boundaries are adjacent to an
authorized by the Medical Practice Act §§157.002, incorporated city or town with an equal or greater
158.001-.003 ("the Act") Title 3 Subtitle B Tex. Occ. population.
Code Ann. and by the Texas Pharmacy Act Title 3 (11) Sample--A prescription drug which is
Subtitle J Tex. Occ. Code Ann. prepackaged by the original manufacturer, provided to
the physician at no cost by the manufacturer, and is
Source Note: The provisions of this §169.1 adopted to either marked as a sample on the original container or is
be effective April 27, 1990, 15 TexReg 2167; amended included in the physician's records as a sample.
to be effective April 27, 2003, 28 TexReg 3325. (12) Standing delegation order--Written
instructions, orders, rules, regulations, or procedures
§169.2. Definitions. prepared by a physician and designed for a patient
The following words and terms, when used in this population with specific diseases, disorders, health
chapter, shall have the following meanings, unless the problems, or sets of symptoms. Such written
context clearly indicates otherwise. instructions, orders, rules, regulations, or procedures
(1) Act--The Medical Practice Act of Texas, shall delineate under what set of conditions and
Title 3 Subtitle B Tex. Occ. Code Ann. circumstances action should be instituted. These
(2) Administer--The direct application of a instructions, orders, rules, regulations, or procedures are
drug by injection, inhalation, ingestion, or any other to provide authority of and a plan for use with patients
means to the body of a physician's patient. presenting themselves prior to being examined or
(3) Board--The Texas Medical Board. evaluated by a physician to assure that such acts are
(4) Dispense--Preparing, packing, carried out correctly and are distinct from specific
compounding, or labeling for delivery a prescription orders written for a particular patient.
drug or device in the course of professional practice to (13) Standing medical orders--Orders, rules,
an ultimate user or his or her agent by or pursuant to the regulations, or procedures prepared by a physician or
lawful order of a physician. approved by a physician or the medical staff of an
(5) Distribute--The delivery of a prescription institution for patients who have been examined or
drug or device other than by administering or evaluated by a physician and which are used as a guide
dispensing. in preparation for and carrying out medical and/or
(6) Immediate needs--The amount of a surgical procedures. These orders, rules, regulations, or
prescription drug needed for the proper treatment of a procedures are authority and direction for the
patient until access to a pharmacy is possible. performance for certain prescribed acts for patients by
"Immediate needs" shall be considered the amount of authorized persons as distinguished from specific orders
medication deemed necessary for a 72-hour period. written for a particular patient.
(7) Physician--A licensee of the Texas Medical
Board. Source Note: The provisions of this §169.2 adopted to
(8) Provision--To supply one or more unit be effective April 27, 1990, 15 TexReg 2167; amended
doses of a dangerous drug or controlled substance. to be effective April 27, 2003, 28 TexReg 3325;
(9) Reimbursed for cost--An additional charge amended to be effective August 10, 2008, 33 TexReg
separate from that made for the physician's professional 6134.
services which includes the cost of the drug product and
all other actual costs to the physician incidental to §169.3. Administration of Drugs.
providing the dispensing service, but not including a A physician may personally administer those drugs to
separate fee for the act of dispensing the drug product his or her patients, which are, in the physician's medical
itself. judgment, therapeutically beneficial or necessary for
(10) Rural area--An area in which there is no the patient's treatment. A physician may delegate to any
pharmacy within a 15-mile radius of the physician's qualified and properly trained person the authority to
office and which is within either a county with a total administer drugs . A physician shall comply with all
population of 5,000 or less according to the most recent appropriate record keeping requirements applicable to
federal census; or a city or town, incorporated or the drugs administered, or shall assure compliance with
unincorporated, with a population of less than 2,500 said record keeping requirements by persons acting
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TEXAS MEDICAL BOARD RULES
Chapter 169, Authority of Physicians to Supply Drugs
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TEXAS MEDICAL BOARD RULES
Chapter 169, Authority of Physicians to Supply Drugs
§169.8. Policy.
It is the policy of the board to encourage physicians to
issue prescriptions for drugs and remedies, unless
supplying the drug is necessary to meet the patient's
immediate medical needs and the drug is reasonably
unavailable from licensed pharmacies in the existing
circumstances, or unless the physician determines that
the patient's prescribed treatment regimen requires that
pharmaceutical samples should be supplied to the
patient.
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§170.1. Purpose. legible, complete, accurate and current for each patient.
The treatment of pain is a vital part of the practice of (7) The extent of medical records should be
medicine. Patients look to physicians not only to cure reasonable for each case. A treatment plan for acute,
disease, but also to try to relieve their pain. Physicians episodic pain may note only the dosage and frequency
should be able to treat their patients' pain using sound of drugs prescribed and that no further treatment is
clinical judgment without fear that the board will planned.
pursue disciplinary action. This Rule sets forth the (8) Treatment of chronic pain requires a
board's policy for the proper treatment of pain. The reasonably detailed and documented plan to assure that
board's intent is to protect the public and give guidance the treatment is monitored. An explanation of the
to physicians. The principles underlying this policy physician's rationale is especially required for cases in
include: which treatment with scheduled drugs is difficult to
(1) Pain is a medical condition that every relate to the patients objective physical, radiographic, or
physician sees regularly. It is an integral part of the laboratory findings.
practice of medicine. Patients deserve to have medical (9) The intent of these guidelines is not to
treatment for their pain, whether the pain is acute or impose regulatory burdens on the practice of medicine.
chronic, mild or severe. The goal of pain management Rather, these guidelines are intended to set forth those
is to treat the patient's pain in relation to overall health, items expected to be done by any reasonable physician
including physical function, psychological, social, and involved in the treatment of pain. The use of the word
work-related factors. "shall" in these guidelines is used to identify those
(2) The regulatory atmosphere must support a items a physician is required to perform in all such
physician's ability to treat pain, no matter how difficult cases. The word "should" and the phrase "it is the
the case, using whatever tools are most appropriate. responsibility of the physician" in these guidelines are
Drugs, including opiates, are essential tools for the used to identify those actions that a prudent physician
treatment of pain. will either do and document in the treatment of pain or
(3) The board is charged by the Legislature be able to provide a thoughtful explanation as to why
with the responsibility to assure that drugs are used in a the physician did not do so.
therapeutic manner. A license to practice medicine
gives a physician legal authority to prescribe drugs for Source Note: The provisions of this §170.1 adopted to
pain. The physician has a duty to use that authority to be effective January 4, 2007, 31 TexReg 10798
help, and not to harm patients and the public.
(4) Harm can result when a physician does not §170.2. Definitions.
use sound clinical judgment in using drug therapy. If In this Chapter:
the physician fails to apply sufficient drug therapy, the (1) "Abuse" or "substance abuse"--the
patient will likely suffer continued pain and may essential feature of substance abuse is a maladaptive
demonstrate relief-seeking behavior, known as pattern of substance use manifested by recurrent and
pseudoaddiction. On the other hand, non-therapeutic significant adverse consequences related to the repeated
drug therapy may lead to or contribute to abuse, use of substances.
addiction, and/or diversion of drugs. As with everything (2) "Acute pain"--the normal, predicted,
in the practice of medicine, physicians must be well physiological response to a stimulus such as trauma,
informed of and carefully assess the risks and the disease, and operative procedures. Acute pain is time
benefits as they apply to each case. limited.
(5) Physicians should not fear board action if (3) "Addiction"--a primary, chronic,
they provide proper pain treatment. The board will not neurobiological disease characterized by craving and
look solely at the quantity or duration of drug therapy. compulsive use of drugs. Addiction is often
Proper pain treatment is not a matter of how much drug characterized by impaired control over drug use,
therapy is used, as long as that therapy is based on including taking more drugs more often than prescribed
sound clinical judgment. Sound clinical judgment by a physician. It may also be characterized by
results from evidence-based medicine and/or the use of continued use despite harm to oneself or others.
generally accepted standards. Genetic, psychosocial, and environmental factors may
(6) A physician can demonstrate sound clinical influence the development and manifestation of
judgment by recording the physician's rationale for the addiction. Physical dependence and tolerance are
treatment plan and maintaining medical records that are normal physiological consequences of extended drug
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TEXAS MEDICAL BOARD RULES
Chapter 170, Authority of Physicians to Prescribe for the Treatment of Pain
therapy for pain and, alone, do not indicate addiction. indicate addiction.
(4) "Chronic pain"--a state in which pain (15) "Withdrawal"--the physiological and
persists beyond the usual course of an acute disease or mental readjustment that accompanies discontinuation
healing of an injury. Chronic pain may be associated of a drug for which a person has established a physical
with a chronic pathological. process that causes dependence.
continuous or intermittent pain over months or years.
(5) "Dangerous drugs"--medications defined Source Note: The provisions of this §170.2 adopted to
by the Texas Dangerous Drug Act, Chapter 483, Texas be effective January 4, 2007, 31 TexReg 10798
Health and Safety Code. Dangerous drugs require a
prescription, but are not included in the list of §170.3. Guidelines.
scheduled drugs. A dangerous drug bears the legend (a) The Texas Medical Board will use these
"Caution: federal law prohibits dispensing without a guidelines to assess a physician's treatment of pain.
prescription" or "Prescription Only." (1) Evaluation of the patient.
(6) "Diversion"--the use of drugs by anyone (A) A physician is responsible for
other than the person for whom the drug was obtaining a medical history and a physical examination
prescribed. that includes a problem-focused exam specific to the
(7) "Escalation"--increasing the dosage and/or chief presenting complaint of the patient.
frequency of the use of drugs. (B) The medical record shall document
(8) "Improper pain treatment"--includes over the medical history and physical examination. In the
treatment, under treatment, no treatment, and the case of chronic pain, the medical record should
prescription of drugs for purposes other than the proper document:
treatment of pain. (i) the nature and intensity of the
(9) "Non-therapeutic"--is defined in pain,
§164.053(a)(5), Texas Occupations Code and includes (ii) current and past treatments for
improper pain treatment. pain,
(10) "Pain"--An unpleasant sensory and (iii) underlying or coexisting diseases
emotional experience associated with actual or potential and conditions,
tissue damage or described in terms of such damage. (iv) the effect of the pain on physical
(11) "Physical dependence"--A state of and psychological function,
adaptation that is manifested by drug class-specific (v) any history and potential for
signs and symptoms that can be produced by abrupt substance abuse, and
cessation, rapid dose reduction, decreasing blood level (vi) the presence of one or more
of the drug, and/or administration of an antagonist. recognized medical indications for the use of a
Physical dependence, alone, does not indicate dangerous or scheduled drug.
addiction. (2) Treatment plan for chronic pain. The
(12) "Pseudoaddiction"--the iatrogenic physician is responsible for a written treatment plan that
syndrome resulting from the misinterpretation of relief is documented in the medical records. The medical
seeking behaviors as though they are drug-seeking record should include:
behaviors that are commonly seen with addiction. The (A) How the medication relates to the
relief seeking behaviors resolve upon institution of chief presenting complaint of chronic pain;
effective analgesic therapy. (B) dosage and frequency of any drugs
(13) "Scheduled drugs" (sometimes referred to prescribed,
as "Controlled Substances")--medications defined by (C) further testing and diagnostic
the Texas Controlled Substances Act, Chapter 481, evaluations to be ordered,
Texas Health and Safety Code. This Act establishes (D) other treatments that are planned or
five categories, or schedules of drugs, based on risk of considered,
abuse and addiction. (Schedule I includes drugs that (E) periodic reviews planned, and
carry an extremely high risk of abuse and addiction and (F) objectives that will be used to
have no legitimate medical use. Schedule V includes determine treatment success, such as pain relief and
drugs that have the lowest abuse/addiction risk). improved physical and psychosocial function.
(14) "Tolerance" (tachyphylaxis)--a (3) Informed consent. It is the physician's
physiological state resulting from regular use of a drug responsibility to discuss the risks and benefits of the use
in which an increased dosage is needed to produce a of controlled substances for the treatment of chronic
specific effect, or a reduced effect is observed with a pain with the patient, persons designated by the patient,
constant dose over time. Tolerance does not necessarily or with the patient's surrogate or guardian if the patient
occur during opioid treatment and does not, alone, is without medical decision-making capacity. This
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TEXAS MEDICAL BOARD RULES
Chapter 170, Authority of Physicians to Prescribe for the Treatment of Pain
discussion should be documented by either a written the individual medical needs of the patient.
signed document maintained in the records or a (E) A physician should continue or
contemporaneous notation included in the medical modify the use of dangerous and scheduled drugs for
records. Discussion of risks and benefits should include pain management based on an evaluation of progress
an explanation of the: toward treatment objectives.
(A) diagnosis; (i) Progress or the lack of progress in
(B) treatment plan; relieving pain should be documented in the patient's
(C) anticipated therapeutic results, record.
including the realistic expectations for sustained pain (ii) Satisfactory response to treatment
relief and improved functioning and possibilities for may be indicated by the patient's decreased pain,
lack of pain relief increased level of function, and/or improved quality of
(D) therapies in addition to or instead of life.
drug therapy, including physical therapy or (iii) Objective evidence of improved
psychological techniques; or diminished function should be monitored.
(E) potential side effects and how to Information from family members or other caregivers
manage them; should be considered in determining the patient's
(F) adverse effects, including the potential response to treatment.
for dependence, addiction, tolerance, and withdrawal; (iv) If the patient's progress is
and unsatisfactory, the physician should reassess the current
(G) potential for impairment of judgment treatment plan and consider the use of other therapeutic
and motor skills. modalities.
(4) Agreement for treatment of chronic pain. A (6) Consultation and Referral. The physician
proper patient-physician relationship for treatment of should refer a patient with chronic pain for further
chronic pain requires the physician to establish and evaluation and treatment as necessary. Patients who are
inform the patient of the physician's expectations that at-risk for abuse or addiction require special attention.
are necessary for patient compliance. If the treatment Patients with chronic pain and histories of substance
plan includes extended drug therapy, the physician abuse or with co-morbid psychiatric disorders require
should consider the use of a written pain management even more care. A consult with or referral to an expert
agreement between the physician and the patient in the management of such patients should be
outlining patient responsibilities, including the considered in their treatment.
following provisions: (7) Medical records. The medical records shall
(A) the physician may require laboratory document the physician's rationale for the treatment
tests for drug levels upon request; plan and the prescription of drugs for the chief
(B) the physician may limit the number complaint of chronic pain and show that the physician
and frequency of prescription refills; has followed these guidelines. Specifically the records
(C) only one physician will prescribe should include:
dangerous and scheduled drugs; (A) the medical history and the physical
(D) only one pharmacy will be used for examination;
prescriptions, and (B) diagnostic, therapeutic and laboratory
(E) reasons for which drug therapy may results;
be discontinued (e.g. violation of agreement). (C) evaluations and consultations;
(5) Periodic review of the treatment of chronic (D) treatment objectives;
pain. (E) discussion of risks and benefits;
(A) The physician should see the patient (F) informed consent;
for periodic review at reasonable intervals in view of (G) treatments;
the individual circumstances of the patient. (H) medications (including date, type,
(B) Periodic review should assess dosage and quantity prescribed);
progress toward reaching treatment objectives, taking (I) instructions and agreements; and
into consideration the history of medication usage, as (J) periodic reviews.
well as any new information about the etiology of the (b) It is not the board's policy to take disciplinary
pain. action against a physician solely for not adhering
(C) Each periodic visit shall be strictly to these guidelines if the physician's rationale
documented in the medical records. for the treatment indicates sound clinical judgment
(D) Contemporaneous to the periodic documented in the medical records. Each case of
reviews, the physician should note in the medical prescribing for pain will be evaluated on an individual
records any adjustment in the treatment plan based on basis. The physician's conduct will be evaluated by
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TEXAS MEDICAL BOARD RULES
Chapter 170, Authority of Physicians to Prescribe for the Treatment of Pain
considering:
(1) the treatment objectives, including any
improvement in functioning,
(2) whether the drug used is pharmacologically
recognized to be appropriate for the diagnosis as
determined by a consensus of medical practitioners in
the State or by recognized experts in the field for which
the drug is being used,
(3) the patient's individual needs, and
(4) that some types of pain cannot be
completely relieved.
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
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TEXAS MEDICAL BOARD RULES
Chapter 171, Postgraduate Training Permits
permit holder must apply for a new permit for the new intends to begin postgraduate training in Texas to
program. ensure the application information is not outdated. To
(D) A physician-in-training permit holder assist in the expedited processing of the application, the
is restricted to the supervised practice of medicine that application should be submitted as early as possible
is part of and approved by the training program. The within the sixty-day window prior to the date the
permit does not allow for the practice of medicine that applicant intends to begin postgraduate training in
is outside of the approved program. Texas.
(b) Qualifications of Physician-in-Training Permit (B) The board may, in unusual
Holders. circumstances, allow substitute documents where
(1) To be eligible for a physician-in-training exhaustive efforts on the applicant's part to secure the
permit, an applicant must present satisfactory proof to required documents is presented. These exceptions shall
the board that the applicant: be reviewed by the board's executive director on a case-
(A) is at least 18 years of age; by-case basis.
(B) is of good professional character and (C) For each document presented to the
has not violated §§164.051 - 164.053 of the Medical board, which is in a foreign language, an official word-
Practice Act; for-word translation must be furnished. The board's
(C) is a graduate of a medical school or definition of an official translation is one prepared by a
has completed a Fifth Pathway Program; government official, official translation agency, or a
(D) has been accepted into an approved college or university official, on official letterhead. The
postgraduate training program, a board-approved translator must certify that it is a "true translation to the
postgraduate fellowship training program, or a best of his/her knowledge, that he/she is fluent in the
fellowship meeting the criteria set forth in subsection language, and is qualified to translate." He/she must
(a)(4) of this section; and sign the translation with his/her signature notarized by a
(E) has been credentialed by the Notary Public. The translator's name and title must be
postgraduate training program to include verification by typed/printed under the signature.
the program of: (D) The board's executive director shall
(i) the applicant's identity; and review each application for training permit and shall
(ii) the applicant's character and approve the issuance of physician-in-training permits
academic qualifications including verification of for all applicants eligible to receive a permit. The
medical school graduation. executive director shall also report to the board the
(2) To be eligible for a physician-in-training names of all applicants determined to be ineligible to
permit, an applicant must not have: receive a permit, together with the reasons for each
(A) a medical license, permit, or other recommendation. The executive director may refer any
authority to practice medicine that is currently restricted application to a committee or panel of the board for
for cause, canceled for cause, suspended for cause, review of the application for a determination of
revoked or subject to another form of discipline in a eligibility.
state or territory of the United States, a province of (E) An applicant deemed ineligible to
Canada, or a uniformed service of the United States; receive a permit by the executive director may request
(B) an investigation or proceeding review of such recommendation by a committee or
pending against the applicant for the restriction, panel of the board within 20 days of written receipt of
cancellation, suspension, revocation, or other discipline such notice from the executive director.
of the applicant's medical license, permit, or authority (F) If the committee or panel finds the
to practice medicine in a state or territory of the United applicant ineligible to receive a permit, such
States, a province of Canada, or a uniformed service of recommendation together with the reasons for the
the United States; recommendation, shall be submitted to the board unless
(C) a prosecution pending against the the applicant makes a written request for a hearing
applicant in any state, federal, or Canadian court for within 20 days of receipt of notice of the committee's or
any offense that under the laws of this state is a felony, panel's determination. The hearing shall be before an
a misdemeanor that involves the practice of medicine, administrative law judge of the State Office of
or a misdemeanor that involves a crime of moral Administrative Hearings and shall comply with the
turpitude. Administrative Procedure Act, the rules of the State
(c) Application for Physician-in-Training Permit. Office of Administrative Hearings and the board. The
(1) Application Procedures. board shall, after receiving the administrative law
(A) Applications for a physician-in- judge's proposed findings of fact and conclusions of
training permit shall be submitted to the board no law, determine the eligibility of the applicant to receive
earlier than the 120th day prior to the date the applicant a permit. A physician whose application to receive a
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TEXAS MEDICAL BOARD RULES
Chapter 171, Postgraduate Training Permits
permit is denied by the board shall receive a written the previously named positions is held by a Texas
statement containing the reasons for the board's action. licensed physician, the Texas Licensed physician
(G) All reports and investigative supervising physician of the postgraduate training
information received or gathered by the board on each program on a form provided by the board that certifies
applicant are confidential and are not subject to that:
disclosure under the Public Information Act, Gov't (I) the program meets the
Code Chapter 552 and the Medical Practice Act, Tex. definition of an approved postgraduate training program
Occ. Code §§155.007(g), 155.058, and 164.007(c). The in subsection (a)(1), (a)(2), and (a)(4) of this section;
board may disclose such reports and investigative (II) the applicant has met all
information to appropriate licensing authorities in other educational and character requirements established by
states. the program and has been accepted into the program;
(H) All applicants for physician-in- and
training permits whose applications have been filed (III) the program has received a
with the board in excess of one year will be considered letter from the dean of the applicant's medical school
expired. that states that the applicant is scheduled to graduate
(I) If the Executive Director determines from medical school before the date the applicant plans
that the applicant clearly meets all PIT requirements, to begin postgraduate training, if the applicant has not
the Executive Director or a person designated by the yet graduated from medical school.
Executive Director, may issue a permit to the applicant, (ii) if the applicant is completing
to be effective on the date of the reported first date of rotations in Texas as part of the applicant's residency
the training program without formal board approval, as out-of-state training program or with the military:
authorized by §155.002(b) of the Act. (I) a certification must be
(J) If the Executive Director determines completed by the director of medical education, the
that the applicant does not clearly meet all PIT chair of graduate medical education, the program
requirements, a PIT may be issued only upon action by director, or, if none of the previously named positions is
the board following a recommendation by the Licensure held by a physician licensed in any state, the
Committee, in accordance with §155.007 of the Act supervising physician, licensed in any state, of the
(relating to Application Process) and §187.13 of this postgraduate training program on a form provided by
title (relating to Informal Board Proceedings Relating to the board that certifies that:
Licensure Eligibility). (-a-) the program meets
(K) If the Executive Director determines the definition of an approved postgraduate training
that the applicant is ineligible for a PIT for one or more program in subsection (a)(1), (a)(2), and (a)(4) of this
reasons listed under subsection (b)(1)(A) and (C) - (E) section;
of this section, the applicant may appeal that decision to (-b-) the applicant has
the Licensure Committee before completing other met all educational and character requirements
licensure requirements for a determination by the established by the program and has been accepted into
Committee solely regarding issues raised by the the program;
determination of ineligibility. If the Committee (-c-) the program has
overrules the determination of the Executive Director, received a letter from the dean of the applicant's
the applicant may then provide additional information medical school which states that the applicant is
to complete the application, which must be analyzed by scheduled to graduate from medical school before the
board staff and approved before a license may be date the applicant plans to begin postgraduate training,
issued. if the applicant has not yet graduated from medical
(2) Physician-in-Training Permit Application. school; and
An application for a physician-in-training permit must (II) a certification by the Texas
be on forms furnished by the board and include the Licensed physician supervising the Texas rotations of
following: the postgraduate training program on a form provided
(A) the required fee as mandated in the by the board that certifies:
Medical Practice Act, §153.051 and as construed in (-a-) the facility at
board rules; which the rotations are being completed,
(B) certification by the postgraduate (-b-) the dates the
training program: rotations will be completed in Texas, and
(i) for a Texas postgraduate training (-c-) that the Texas on-
program, a certification must be completed by the site preceptor physician will supervise and be
director of medical education, the chair of graduate responsible for the applicant during the rotation in
medical education, the program director, or, if none of Texas;
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TEXAS MEDICAL BOARD RULES
Chapter 171, Postgraduate Training Permits
(C) arrest records. If an applicant has ever (1) Physician-in-Training permits shall be
been arrested, a copy of the arrest and arrest disposition issued with effective dates corresponding with the
must be requested from the arresting authority by the beginning and ending dates of the postgraduate
applicant and said authority must submit copies directly resident's training program as reported to the board by
to the board; the program director.
(D) medical records for inpatient (2) Physician-in-training permits shall expire
treatment for alcohol/substance disorder, mental illness, on any of the following, whichever occurs first:
and physical illness. Each applicant who has been (A) on the reported ending date of the
admitted to an inpatient facility within the last five postgraduate training program;
years for the treatment of alcohol/substance disorder, (B) on the date a postgraduate training
mental illness (recurrent or severe major depressive program terminates or otherwise releases a permit
disorder, bipolar disorder, schizophrenia, holder from its training program; or
schizoaffective disorder, or any severe personality (C) on the date the permit holder obtains
disorder), or a physical illness that did or could have full licensure or temporary licensure pending full
impaired the applicant's ability to practice medicine, licensure pursuant to §155.002 of the Act.
shall submit documentation to include, but not limited (3) Physician-in-training permit holders who
to: are issued permits on or after April 1, 2005, and who
(i) an applicant's statement explaining require extensions to remain in a training program after
the circumstances of the hospitalization; a program's reported ending date must submit a written
(ii) all records, submitted directly request to the board and fee, if required, along with a
from the inpatient facility; statement by the program director authorizing the
(iii) a statement from the applicant's request for the extension. Such extensions shall be
treating physician/psychotherapist as to diagnosis, granted at the discretion of the board's executive
prognosis, medications prescribed, and follow-up director and may not be for longer than 90 days unless
treatment recommended; and good cause is shown.
(iv) a copy of any contracts signed (e) The executive director of the board may, in
with any licensing authority or medical society or his/her discretion, issue a temporary physician-in-in-
impaired physician's committee; training permit to an applicant if the applicant and the
(E) medical records for outpatient postgraduate training program have submitted written
treatment for alcohol/substance disorder, mental illness, requests. The executive director, in his/her discretion,
or physical illness. Each applicant that has been treated will determine the length of the permit and may issue
on an outpatient basis within the last five years for additional temporary physician-in-training permits to an
alcohol/substance abuse, mental illness (recurrent or applicant.
severe major depressive disorder, bipolar disorder,
schizophrenia, schizoaffective disorder, or any severe Source Note: The provisions of this §171.3 adopted to
personality disorder), or a physical illness that did or be effective November 7, 2004, 29 TexReg 10107;
could have impaired the applicant's ability to practice amended to be effective June 29, 2006, 31 TexReg
medicine, shall submit documentation to include, but 5100; amended to be effective August 10, 2008, 33
not limited to: TexReg 6134.
(i) an applicant's statement explaining
the circumstances of the outpatient treatment; §171.4. Board-Approved Fellowships.
(ii) a statement from the applicant's (a) The executive director may in his/her
treating physician/psychotherapist as to diagnosis, discretion, upon written request, approve fellowships as
prognosis, medications prescribed, and follow-up referenced in §171.3(a)(2) of this chapter. Fellowships
treatment recommended; and meeting the criteria set forth in §171.3(a)(4) of this
(iii) a copy of any contracts signed chapter do not require board approval for physician-in-
with any licensing authority or medical society or training permits to be issued to subspecialty
impaired physician's committee; postgraduate residents in the fellowship. If the
(F) an oath on a form provided by the executive director does not recommend approval, the
board attesting to the truthfulness of statements institution's designated institutional official (DIO) and
provided by the applicant; chair of the Graduate Medical Education Committee
(G) such other information or (GMEC) may appeal to the board for its discretionary
documentation the board and/or the executive director consideration of the request.
deem necessary to ensure compliance with this chapter, (b) The initial request for approval should be
the Medical Practice Act and board rules. submitted to the executive director, on a form
(d) Expiration of Physician-in-Training Permit. prescribed by the board, 90 days prior to the beginning
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TEXAS MEDICAL BOARD RULES
Chapter 171, Postgraduate Training Permits
date of the program to assist in the expedited processing continue after the expiration date. Applications for
of an application. The request must include the length subsequent approval must comply with all requirements
of the fellowship; the length of time for which the in this section for initial approval and must be
institution is requesting approval of the fellowship submitted at least three months prior to the expiration
itself, not to exceed five years; and other information as of the approved program in order to prevent a lapse in
required by the board. time of the fellowship. Permit holders shall be allowed
(c) Approval of fellowships requires certification to complete their fellowship regardless of continuing
by the DIO and the chair of the GMEC of the institution program approval.
in which the fellowship will be conducted that the (g) All board-approved fellowships that
fellowship program has been evaluated and approved subsequently become approved by the ACGME, AOA,
by the institution's graduate medical education a member board of the ABMS, or a member board of
committee. The evaluation shall include but not be the BOS, must notify the board within 30 days of their
limited to satisfactory demonstration to the committee approval. Fellowships may not be dually approved by
of the fellowship's: the board and ACGME, AOA, a member board of the
(1) goals and objectives; documented ABMS, or a member board of the BOS. A board-
curriculum; and, qualifications of the program director approved fellowship that becomes approved by the
and program faculty, including, but not limited to, ACGME, AOA, a member board of the ABMS, or a
certification by the appropriate specialty board and/or member board of the BOS immediately loses its board-
appropriate educational qualifications; approved status when its new approval becomes
(2) process by which subspecialty effective through the ACGME, AOA, a member board
postgraduate residents are selected; of the ABMS, or a member board of the BOS.
(3) prerequisite requirements of the
postgraduate residents, including whether prior Source Note: The provisions of this §171.4 adopted to
residency training in a related specialty is required; be effective November 7, 2004, 29 TexReg 10107;
(4) delineated duties and responsibilities amended to be effective June 29, 2006, 31 TexReg
required of subspecialty postgraduate residents in the 5100; amended to be effective August 10, 2008, 33
program; TexReg 6134.
(5) number of subspecialty postgraduate
residents to be enrolled each year; §171.5. Duties of PIT Holders to Report.
(6) scholarly activity to be required of (a) Failure of any PIT holder to comply with the
subspecialty postgraduate residents; provisions of this chapter or the Medical Practice Act
(7) type of supervision to be provided for §160.002 and §160.003 may be grounds for disciplinary
subspecialty postgraduate residents; action as an administrative violation against the PIT
(8) requirements for the program director or holder.
supervising physician to hold a Texas license or faculty (b) The PIT holder shall report in writing to the
temporary license issued by the board; executive director of the board the following
(9) methods for evaluation of subspecialty circumstances within thirty days of their occurrence:
postgraduate residents by the program; and (1) the opening of an investigation or
(10) progressive nature, including, but not disciplinary action taken against the PIT holder by any
limited to, the progressively greater responsibility of the licensing entity other than the TMB;
subspecialty postgraduate residents throughout the (2) an arrest, fine (over $100), charge or
course of the fellowship if the fellowship is over one conviction of a crime, indictment, imprisonment,
year in length. placement on probation, or receipt of deferred
(d) Institutions with board-approved fellowships adjudication; and
must determine whether to conduct internal reviews of (3) diagnosis or treatment of a physical, mental
the program at the mid-point of the program's most or emotional condition, which has impaired or could
recent approval period. impair the PIT holder's ability to practice medicine.
(e) Institutions with board-approved fellowships
that are eligible for accreditation as described in Source Note: The provisions of this §171.5 adopted to
§171.3(a)(4) of this chapter must determine whether the be effective August 10, 2008, 33 TexReg 6134.
fellowship should seek such accreditation rather than
board approval of the fellowship. §171.6. Duties of Program Directors to Report.
(f) The DIO and the chair of the GMEC of the (a) Failure of any postgraduate training program
institution for which a fellowship program has been director to comply with the provisions of this chapter or
previously approved by the board must apply to have the Medical Practice Act §160.002 and §160.003 may
the program approved again, if the program is to
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TEXAS MEDICAL BOARD RULES
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§§172.1-172.2
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Chapter 172, Temporary and Limited Licenses
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Chapter 172, Temporary and Limited Licenses
§§172.3-172.11
§172.3. Distinguished Professors Temporary academic officer of the institution and re-petition the
License. board for a permanent, unrestricted license to practice
(a) The executive director of the board may issue a medicine in Texas. If the petition is again denied, no
distinguished professors temporary license to an further distinguished professors temporary license shall
applicant: be issued.
(1) who has passed the Texas medical (e) If the board grants the petition for licensure, the
jurisprudence examination; distinguished professor may be issued a permanent,
(2) whose application has been filed, unrestricted license.
processed, and found to be in order. The application
shall be complete in every detail except that the Source Note: The provisions of this §172.3 adopted to
applicant will not be required to have taken and passed be effective November 7, 2004, 29 TexReg 10111;
the SPEX examination as set forth in §163.4 of this title amended to be effective August 10, 2008, 33 TexReg
(relating to Procedural Rules for Licensure Applicants); 6135.
(3) who holds an appointment as a salaried full
professor on the faculty working full-time in one of the §172.4. State Health Agency Temporary License.
following institutions: An applicant may elect to apply for a state health
(A) a school of medicine in this state agency temporary license in lieu of licensure.
accredited by the Liaison Committee on Medical (1) The executive director of the board may
Education or the American Osteopathic Association issue such a temporary license to an applicant:
Bureau of Professional Education; (A) who holds a valid license in another
(B) The University of Texas Health state or Canadian province on the basis of an
Center at Tyler; examination, that is accepted by the board for licensure;
(C) The University of Texas M.D. (B) who has passed the Texas medical
Anderson Cancer Center; or jurisprudence examination;
(D) a program of graduate medical (C) whose application has been filed,
education, accredited by the Accreditation Council for processed, and found to be in order. The application
Graduate Medical Education, that exceeds the shall be complete in every detail with the exception of
requirements for eligibility for first board certification compliance with §163.1(a)(9)(K) of this title (relating
in the discipline. to Definitions of Examinations accepted by the board
(b) The distinguished professors temporary license for licensure); and
shall be requested by the president, dean or chief (D) who holds a salaried, administrative,
academic officer of the institution as defined in or clinical position with an agency of the State of
subsection (a)(3) of this section and shall be valid only Texas.
in the institution or its affiliated hospitals. (2) The state health agency temporary license
(c) The distinguished professors temporary license shall be requested by the chief administrative officer of
shall be valid for a continuous one-year period; the employing state agency and shall be issued
however, the permit is revocable at any time the board exclusively to that agency. The chief administrative
deems necessary. The distinguished professors officer shall state whether the temporary license is for
temporary license shall automatically expire one year a:
after the date of issuance. The distinguished professors (A) clinical position. This temporary
temporary license is renewable one time, at the license will be valid for a one-year period from the date
discretion of the executive director. of issuance and will not be renewable. The temporary
(d) At the conclusion of this one-year period, the license is revocable at any time the board deems
distinguished professor shall present recommendations necessary. To practice beyond one year, the holder of
from the president, dean or chief academic officer of the temporary license must fully comply with §163.7 of
the institution, and shall petition the board for a this title (relating to Ten Year Rule). During the period
permanent, unrestricted license to practice medicine in that the state health agency clinical temporary license is
Texas. If this petition is denied, the institution may in effect, the physician will be supervised by a licensed
request a one-year extension of the distinguished staff physician who will regularly review the temporary
professors temporary license. If an extension is granted, license holder's skill and performance. This temporary
and following termination of such extension, the license will be marked "clinical"; or
distinguished professor shall again present (B) administrative non-clinical position.
recommendations from the president, dean or chief This temporary license will be valid for a one-year
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TEXAS MEDICAL BOARD RULES
Chapter 172, Temporary and Limited Licenses
period from the date of issuance; however, it is §172.6. Visiting Professor Temporary License.
revocable at any time the board deems necessary. The The board may issue a temporary license to practice
temporary license shall automatically expire one year medicine to a physician appointed as a visiting
after the date of issuance but may be re-issued annually professor by a Texas medical school or institution in
at the request of the chief administrative officer of the accordance with this section.
employing state agency and at the discretion of the (1) The visiting professor temporary license
board. The holder of a state health agency temporary may be valid for any number of 31-day increments not
license, not designated as clinical, shall not practice to exceed 24 increments. The incremental periods
medicine as that term is defined in the Medical Practice wherein the temporary license is valid need not be
Act, TEX. OCCUPATIONS CODE ANN. contiguous, but rather may be in any arrangement
§151.002(a)(13). This temporary license will be marked approved by the executive director of the board.
"administrative." (2) The visiting professor temporary license
shall state on its face the periods during which it will be
Source Note: The provisions of this §172.4 adopted to valid. If all periods of validity are not known at the time
be effective November 7, 2004, 29 TexReg 10111; of the temporary license issuance, the temporary license
amended to be effective March 9, 2009, 34 TexReg holder shall request that the executive director of the
1589. board endorse the temporary license with each
incremental period of validity as such becomes known.
§172.5. Visiting Physician Temporary Permit. No temporary license shall be valid at any time when
(a) The executive director of the board may issue a the period of validity is not stated on the temporary
permit to practice medicine to an applicant who intends license unless suitable temporary alternative
to practice under the supervision of a licensed Texas arrangements have been presented to and accepted by
physician, excluding training in postgraduate training the executive director of the board.
programs, for educational purposes or in order to (3) The visiting professor temporary license
practice charity care to underserved populations in shall be issued to the institution authorizing the named
Texas. In order to be determined eligible for a visiting visiting professor to practice medicine within the
physician permit the applicant must: teaching confines of the applying medical school as a
(1) not have any medical license that is under part of duties and responsibilities assigned by the
restriction, disciplinary order, or probation in another school to the visiting professor. The visiting professor
state, territory, or Canadian province; may participate in the full activities of the department
(2) be supervised by a physician with an in whichever hospital the appointee's department has
unrestricted license in Texas; full responsibility for clinical, patient care, and teaching
(3) present written verification from the activities.
physician who will be supervising the applicant that the (4) The visiting professor temporary license
physician will provide continuous supervision of the may be issued to one of the following institutions:
applicant. Constant physical presence of the physician (A) a school of medicine in this state
is not required but the physician must remain readily accredited by the Liaison Committee on Medical
available; and Education or the American Osteopathic Association
(4) present written verification from the Bureau of Professional Education;
supervising physician as to the purpose for the (B) The University of Texas Health
requested permit. Center at Tyler;
(b) Visiting physician permits shall be valid for no (C) The University of Texas M.D.
more than ten working days and for a specified locale Anderson Cancer Center; or
and purpose. The executive director of the board, in (D) a program of graduate medical
his/her discretion, may extend the length of the education, accredited by the Accreditation Council for
temporary permit if the applicant shows good cause for Graduate Medical Education, that exceeds the
why the extended time is needed. requirements for eligibility for first board certification
in the discipline.
Source Note: The provisions of this §172.5 adopted to (5) The visiting professor and the school shall
be effective November 7, 2004, 29 TexReg 10111; file affidavits with the board affirming acceptance of
amended to be effective January 25, 2006, 31 TexReg the terms, limitations and conditions imposed by the
387; amended to be effective July 3, 2007, 32 TexReg board on the medical activities of the visiting professor.
3992 (6) The application for visiting professor
temporary license or the renewal thereof shall be
presented to the executive director of the board at least
30 days prior to the effective date of the appointment of
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TEXAS MEDICAL BOARD RULES
Chapter 172, Temporary and Limited Licenses
the visiting professor. The application shall be made by §172.8. Faculty Temporary License.
the chairman of the department in which the visiting (a) The board may issue a faculty temporary
professor will teach and provide such information and license to practice medicine to a physician in
documentation to the board as may be requested. Such accordance with §155.104, Tex. Occ. Code.
application shall be endorsed by the dean of the medical "Physician," as used in that statute and in this section, is
school or by the president of the institution. interpreted to mean a person who holds an M.D., D.O.,
(7) All applications shall state the date when or equivalent degree and who is licensed to practice
the visiting professor shall begin performance of duties. medicine in another state or Canadian province or has
completed at least three years of postgraduate
Source Note: The provisions of this §172.6 adopted to residency, but does not hold a license to practice
be effective November 7, 2004, 29 TexReg 10111; medicine in this state.
amended to be effective August 10, 2008, 33 TexReg (1) Each medical license held in any state,
6135. territory, or Canadian province must be free of any
restrictions, disciplinary order or probation.
§172.7. National Health Service Corps Temporary (2) The physician must have passed the Texas
License. medical jurisprudence examination within three
The board may issue a temporary license to practice attempts, with a score of 75 or better.
medicine to a physician who has contracted with the (3) "Institution," as used in this section, shall
National Health Service Corps to practice medicine in mean any of the following:
Texas under the following terms and conditions. (A) a school of medicine in this state
(1) The physician must be a graduate of a accredited by the Liaison Committee on Medical
medical school approved by the board. An 8 1/2 x 11 Education or the American Osteopathic Association
notarized true copy of the original medical diploma Bureau of Professional Education;
shall be submitted to the board. (B) The University of Texas Health
(2) The physician must hold a valid, Center at Tyler;
unrestricted license in another state or territory to (C) The University of Texas M.D.
practice medicine. A notarized true copy of the license Anderson Cancer Center; or
registration certificate shall be submitted to the board. (D) a program of graduate medical
If the physician is not licensed in another state, he or education, accredited by the Accreditation Council for
she must have passed either the United States Medical Graduate Medical Education, that exceeds the
Licensing Examination (USMLE), within three requirements for eligibility for first board certification
attempts, with a score of 75 or better on each step, all in the discipline.
steps must be passed within seven years, or the National (4) The physician must:
Board of Osteopathic Medical Examiners Examination (A) hold a salaried faculty position of
(NBOME) or its successor, within three attempts, all assistant professor-level or higher working full-time in
steps must be passed within seven years, or the National one of the institutions; or
Board of Medical Examiners Examination (NBME) (B) hold a faculty position of assistant
within three attempts, all steps must be passed within professor-level or higher, work at least part-time in one
seven years. A certified transcript of the scores shall be of the institutions and;
submitted to the board by the appropriate authority. (i) be on active duty in the United
(3) The physician must have a valid contract States military; and,
with the National Health Service Corps. The temporary (ii) be engaged in a practice under the
license will expire at the termination of the contract faculty temporary license that will fulfill a critical need
with the National Health Service Corps. A notarized of the citizens of Texas.
true copy of the contract shall be submitted to the (5) The physician must sign an oath on a form
board. provided by the board swearing that the physician has
(4) The temporary license shall be issued for read and is familiar with board rules and the Medical
one year and may be renewed. Practice Act; will abide by board rules and the Medical
(5) The temporary license allows the physician Practice Act in activities permitted by this section; and
to practice medicine only within the scope of his or her will subject themselves to the disciplinary procedures
contract with the National Health Service Corps. of the board.
(b) The faculty temporary license shall be issued
Source Note: The provisions of this §172.7 adopted to for a period of one year. The holder of a faculty
be effective November 7, 2004, 29 TexReg 10111. temporary license may apply for one or more
successive faculty temporary licenses.
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TEXAS MEDICAL BOARD RULES
Chapter 172, Temporary and Limited Licenses
(c) The faculty temporary license holder's practice §172.9. Postgraduate Research Temporary License.
of medicine shall be limited to the teaching confines of The board may issue a temporary license to practice
the applying medical school as a part of duties and medicine to a medical school graduate, who holds a
responsibilities assigned by the school to the physician. research appointment at a Texas medical school, in a
(d) The physician may participate in the full program approved by the board, under the following
activities of the department of any hospital for which terms and conditions listed in paragraphs (1) - (6) of
the physician's medical school has full responsibility for this section.
clinical, patient care, and teaching activities. "Full (1) The research must be in clinical medicine
responsibility" means that the medical school has and/or the basic sciences of medicine.
agreed to provide physicians to see patients in the (2) The research must be conducted in the
hospital and that the medical school provides any Texas medical school or its affiliated institutions.
necessary supervision for such physicians. (3) The research appointment must be
(e) The physician and the school shall file approved by the Dean of the medical school or the
affidavits with the board affirming acceptance of the president of the institution.
terms, limitations, and conditions imposed by the board (4) The research appointment must be
on the medical activities of the physician. supervised by a faculty member of the Texas medical
(f) The application and fee for the faculty school who has an active unrestricted Texas medical
temporary license shall be presented to the executive license.
director of the board at least 30 days prior to the (5) The research appointment must be of good
effective date of the appointment of the physician. professional character as elaborated in the Medical
(g) The application shall be made by the chairman Practice Act.
of the department in which the physician will teach and (6) The Postgraduate Research Temporary
provide such information and documentation to the License may be issued for a maximum of one year and
board as may be requested. is not renewable.
(h) The application shall be endorsed by the dean
of the medical school or by the president of the Source Note: The provisions of this §172.9 adopted to
institution. An endorsement must include a statement be effective November 7, 2004, 29 TexReg 10111.
that the medical school or institution has investigated
and determined the physician to be of good professional §172.10. Department of State Health Services
character and fit to practice medicine. An endorsement Medically Underserved Area (DSHS-MUA)
shall also state that the medical school or institution has Temporary License.
accepted the responsibility to properly supervise the The board may issue a temporary license to practice
medical activities of the physician. medicine to a physician who is appointed by the
(i) Three years in a teaching faculty position at any Department of State Health Services (DSHS) to provide
institution listed in subsection (a)(3) of this section may free services at medically underserved areas at its
be equivalent to three years of approved postgraduate regional clinics. Medically underserved areas shall be
training if, at the conclusion of this three-year period, those areas as defined under §157.052 of the Medical
the physician presents recommendations in his or her Practice Act.
behalf from the chief administrative officer and the (1) Length of Temporary License. The DSHS-
president of the institution. A recommendation must MUA temporary licenses may be valid for up to 31
include verification that the physician has completed at days and a physician may not be issued more than one
least three years in a teaching faculty position at the temporary license in any 12-month period.
level of assistant professor or higher and that the duties (2) Eligibility.
of the physician in such position required activities that (A) The physician must hold a current
demonstrate that the physician's medical competence is medical license that is free of any restriction,
substantially equivalent to the competence of a person disciplinary order or probation in another state,
who has completed three years of an approved territory, a Canadian province, or uniformed service of
postgraduate residency program as described in Section the United States.
171.3(a)(1) of this title (relating to Physician-in- (B) Each medical license held in another
Training Permits) state, territory, Canadian province, or uniformed service
of the United States must be free of any restrictions,
.Source Note: The provisions of this §172.8 adopted to disciplinary order or probation.
be effective November 7, 2004, 29 TexReg 10111; (C) The physician must be employed by
amended to be effective January 25, 2006, 31 TexReg the Texas Army National Guard, the uniformed service
387; amended to be effective August 10, 2008, 33 of the United States, or the national branches of the
TexReg 6135. military reserves.
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Chapter 172, Temporary and Limited Licenses
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TEXAS MEDICAL BOARD RULES
Chapter 172, Temporary and Limited Licenses
§§172.12-15
§172.12. Telemedicine License. person holds a current full license to practice medicine
(a) Qualifications. A person may not engage in the in this state pursuant to this chapter and the provisions
practice of medicine across state lines in this State, hold of the Medical Practice Act, Chapter 155 (relating to
oneself as qualified to do the same, or use any title, License to Practice Medicine), a person holding a
word, or abbreviation to indicate or induce others to special purpose telemedicine license shall not be
believe that one is licensed to practice across state lines authorized to physically practice medicine in the state
in this state unless the person is actually so licensed. of Texas.
For a person to be eligible for a special purpose (d) Registration Requirements. All special purpose
telemedicine license to practice medicine across state telemedicine licenses to practice medicine across state
lines under the Medical Practice Act, §151.056, and lines licenses must be renewed and maintained
§163.1 of this title (relating to Definitions), the person according to registration requirements of Section 166.1
must: of this title (relating to Physician Registration).
(1) be 21 years of age or older; (e) Disciplinary Action. The issuance by the board
(2) be actively licensed to practice medicine in of a special purpose telemedicine license subjects the
another state which is recognized by the board for licensee to the jurisdiction of the board in all matters set
purposes of licensure, and not the recipient of a forth in the Medical Practice Act and all rules and
previous disciplinary action by any other state or regulations, including all matters related to discipline.
jurisdiction; (f) Exemptions. The following activities shall be
(3) not be the subject of a pending exempt from the requirements of a special purpose
investigation by a state medical board or another state telemedicine license and this chapter:
or federal agency; (1) episodic consultation by a medical
(4) be certified in a medical specialty pursuant specialist located in another jurisdiction who provides
to the standards of and approved by the American such consultation services on request to a person
Board of Medical Specialties or the Bureau of licensed in this state;
Osteopathic Specialists and Boards of Certification; (2) consultation services provided by a
(5) have passed the Texas Medical physician located in another jurisdiction to a medical
Jurisprudence Examination; school as defined in the Education Code, §61.501;
(6) complete a board-approved application for (3) consultation services provided by a
a special purpose telemedicine license for the practice physician located in another jurisdiction to an
of medicine across state lines and submit the requisite institution defined in either Subchapter C, Chapter 73,
initial fee; and or Subchapter K, Chapter 74 of the Education Code;
(7) not be determined ineligible for licensure (4) informal consultation performed outside
under subsection (b) of this section. the context of a contractual relationship and on an
(b) Denial of Special Purpose Telemedicine irregular or infrequent basis without the expectation or
License. An application for a special purpose exchange of direct or indirect compensation;
telemedicine license to practice medicine across state (5) furnishing of medical assistance in case of
lines may be denied based on failure to demonstrate the an emergency or disaster if no charge is made for the
requisite qualifications for issuance of a special purpose medical assistance; and
license, any grounds for denial of an application for a (6) a physician located in another jurisdiction
full license, failure to submit the required fee, and any of a state having borders contiguous with the borders of
grounds for disciplinary action of a licensee under the this state who is the treating physician of a patient and
Medical Practice Act, §164.051 (relating to Grounds for orders home health or hospice services for a resident of
Denial or Disciplinary Action). this state to be delivered by a home and community
(c) Limits on Special Purpose Telemedicine support services agency licensed in this state.
License. A special purpose telemedicine license to
practice medicine across state lines shall be limited Source Note: The provisions of this §172.12 adopted to
exclusively to the practice of medicine as defined by be effective January 25, 2006, 31 TexReg 387.
Section 163.1 of this title and limited to the specialty or
specialization upon which the license was granted §172.13. Conceded Eminence.
under subsection (a)(3) of this section, and the license (a) The board may issue a license to an applicant
holder shall practice medicine in a manner so as to pursuant to the authority of §155.006, Tex. Occ. Code,
comply with all other statutes and laws governing the by virtue of the applicant's conceded eminence and
practice of medicine in the state of Texas. Unless a authority in the applicant's specialty.
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Chapter 172, Temporary and Limited Licenses
(b) "Conceded eminence and authority in the §172.11 of this title (relating to Temporary Licensure--
applicant's specialty," as used in this section, shall mean Regular).
that the physician has achieved a high level of academic (e) The holder of a conceded eminence license
or professional recognition for excellence in research, shall be limited to the practice of only a specialty of
teaching, or the practice of medicine, as evidenced by medicine for which the license holder has conceded
objective factors, including academic appointments, eminence and authority, as identified in the application.
length of time in a profession, scholarly publications The license holder may only practice medicine within
and presentations, professional accomplishments, and the setting of the institution or program that
awards. recommended the license holder under subsection (c)(1)
(c) An applicant for a license based on conceded of this section, including a setting that is part of the
eminence must complete an application showing that institution or program by contractual arrangement.
the applicant: (f) If the holder of a conceded eminence license
(1) is recommended to the board by the dean, terminates the relationship with the institution or
president, or chief academic officer of: program that recommended the license holder under
(A) a school of medicine in this state subsection (c)(1) of this section, the conceded eminence
accredited by the LCME or AOA; license shall be considered automatically canceled. To
(B) The University of Texas Health practice medicine in Texas, the license holder must:
Center at Tyler; (1) file a new application with the
(C) The University of Texas M.D. recommendation of a new institution or program, as
Anderson Cancer Center; or required by subsection (c)(1) of this section, or
(D) a program of graduate medical (2) file an application for another Texas
education, accredited by the Accreditation Council for medical license or permit.
Graduate Medical Education, that exceeds the (g) The holder of a conceded eminence license
requirements for eligibility for first board certification shall be required to pay the same fees and meet all other
in the discipline; procedural requirements for issuance and renewal of the
(2) is expected to receive an appointment at license as a person holding a full Texas medical license.
the institution or program making the recommendation (h) The holder of a conceded eminence license
under paragraph (1) of this subsection; shall be subject to disciplinary action under the Medical
(3) has not failed a licensing examination Practice Act and board rules.
within the three-attempt limit provided by §163.6(b)
and §163.6(f)(1) of this title; Source Note: The provisions of this §172.13 adopted to
(4) has passed the Texas Medical be effective June 29, 2006, 31 TexReg 5104; amended
Jurisprudence Examination; to be effective August 10, 2008, 33 TexReg 6135.
(5) has successfully completed at least one
year of approved subspecialty training accredited by the §172.15. Public Health License.
Accreditation Council for Graduate Medical Education (a) The board may issue a license that is limited to
or the American Osteopathic Association; public health medicine to an applicant pursuant to the
(6) is of good professional character, as authority of §155.009, Tex. Occ. Code, authorizing the
defined by §163.1(a)(9) of this title; board to issue a limited license for the practice of
(7) has conceded eminence and authority in a administrative medicine.
medical specialty identified in the application; (b) "Public health medicine," as used in this
(8) has not been the subject of disciplinary section, means professional managerial, administrative,
action by any other state, the uniformed services of the or supervisory activities related to public health or the
United States, or the applicant's peers in a local, practice of medicine on behalf of and as defined by a
regional, state, or national professional medical governmental entity serving as a public health agency
association or staff of a hospital; or institution, including prescriptive authority for public
(9) has not been convicted of, or placed on health purposes, preventive interventions, diagnosis and
deferred adjudication, community supervision, or treatment of communicable and vaccine preventable
deferred disposition for a felony, a misdemeanor diseases, pharmacological interventions for smoking
connected with the practice of medicine, or a cessation and contraception, and other clinical
misdemeanor involving moral turpitude; and preventive medicine interventions such as those to
(10) has read and will abide by board rules and prevent obesity and diabetes.
the Medical Practice Act. (c) An applicant for a public health license must
(d) Applicants with complete applications may complete the same application and meet the same
qualify for a Temporary License prior to being requirements as an applicant for a full Texas medical
considered by the board for licensure, as required by license, except:
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Texas Administrative Code, Title 22, Part 9
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Chapter 173, Physician Profiles
2002, 27 TexReg 8770; amended to be effective (3) An initial conviction, final conviction, or
January 9, 2003, 28 TexReg 71; amended to be placement on deferred adjudication, community
effective November 30, 2003, 28 TexReg 10489; supervision, or deferred disposition for:
amended to be effective December 30, 2007, 32 TexReg (A) a felony;
9629; amended to be effective January 20, 2009, 34 (B) a misdemeanor that directly relates to
TexReg 338; amended to be effective June 24, 2009, 34 the duties and responsibilities of a physician licensed by
TexReg 4124. the board;
(C) a misdemeanor involving moral
§173.2. Profile Update and Correction Form. turpitude;
(a) The board shall develop a Profile Update and (D) a misdemeanor under Chapter 22,
Correction Form (the "Form") which allows for Penal Code (relating to assaultive offenses), other than
corrections and/or updates to the profile information to a misdemeanor punishable by fine only;
be made by the physician. The physician must submit (E) a misdemeanor on conviction of
all changes to profile information upon this Form, or which a defendant is required to register as a sex
indicate on the Form that no changes are necessary. The offender under Chapter 62, Code of Criminal
Form shall contain the date the information will be Procedure;
made available to the public and will allow the (F) a misdemeanor under §25.07, Penal
physician to request a copy of the physician's profile. Code (relating to the violation of a protective order or a
Upon such request, and when the profile information magistrate's order); or
has been updated, the board shall provide a copy to the (G) a misdemeanor under §25.071, Penal
physician. The Form will be made available in hard Code (relating to the violation of a protective order
copy and on the Internet. preventing offenses caused by bias or prejudice) ; or
(b) Compliance with the request for information (4) An initial finding by the trier of fact of
from the board is mandatory. Failure to return the guilt of a felony under:
completed Form to the board shall be considered non- (A) Chapter 481 or 483, Health and Safety
compliance. Non-compliance shall result in nonrenewal Code (relating to offenses involving controlled
of the physician's license until such time as the substances and dangerous drugs);
physician provides the requested information. (B) Section 485.033, Health and Safety
(c) Submission of false or misleading information Code (relating to offenses involving inhalant
or omission of required information by the physician paraphernalia); or
shall be considered grounds for disciplinary action. (C) the Comprehensive Drug Abuse
(d) All data contained in the profile shall indicate Prevention and Control Act of 1970 (21 U.S.C. §801 et
the source of the data and the last update date. seq.).
Source Note: The provisions of this §173.2 adopted to Source Note: The provisions of this §173.3 adopted to
be effective March 5, 2000, 25 TexReg 1623; amended be effective March 5, 2000, 25 TexReg 1623; amended
to be effective December 30, 2007, 32 TexReg 9629. to be effective November 3, 2002, 27 TexReg 10026;
amended to be effective November 30, 2003, 28 TexReg
§173.3. Physician-Initiated Updates. 10489; amended to be effective July 3, 2007, 32 TexReg
(a) Physicians are required to attest as to whether 3993; amended to be effective May 12, 2008, 33
or not the physician's profile information is correct at TexReg 3741.
the time of the physician's registration and to initiate
correction of any incorrect information. §173.4. Updates to the Physician's Profile Due to
(b) Physicians should maintain current profile Board Action.
information by submitting updates and corrections as When the board takes disciplinary action or files a
changes occur. formal complaint at the State Office of Administrative
(c) The physician shall make necessary corrections Proceedings pursuant to Section 164.005 of the Act
and updates by submitting a profile update and against a physician, such action shall be noted on the
correction form or by submitting it online if completing physician's profile not later than the 10th working day
the registration via the internet. after the board's action occurs and shall be made
(d) A physician shall report the following to the available to the public.
Board within 30 days after the event:
(1) Any change of address; Source Note: The provisions of this §173.4 adopted to
(2) Incarceration in a state or federal be effective March 5, 2000, 25 TexReg 1623; amended
penitentiary; to be effective November 30, 2003, 28 TexReg 10489.
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Chapter 173, Physician Profiles
§173.5. Updates to the Physician's Profile Due to physician must then submit proof of factual error to the
Information Received by a Third Party. board within one month of the date of the notification in
(a) When the board is notified by a third party of a subsection (e) of this section.
change in profile information for a physician, the board (g) Upon receipt of the formal letter of dispute
shall send a copy of the Form to the physician with the from the physician, a notation that the information
changes noted. The physician shall have one month in under dispute is "Not available" shall be attached to the
which to correct factual errors or dispute the appropriate category of the physician's profile and such
information. notation shall be made available to the public on the
(b) Amendments to a physician's profile shall be profile.
made by the board when: (h) After review of the proof provided by the
(1) the board receives information from non- physician during the dispute process as described in
governmental third-parties that has been verified by the subsection (f) of this section, the board shall make a
board and contradicts information reported on a determination as to the profile information to be
physician's profile; provided to the public.
(2) the board receives information from state (i) (i) Upon determination by the board of the dispute,
or federal governmental authorities regarding criminal the board shall notify the physician of the
convictions described in §173.1(b)(18) of this title determination, shall update the physician's profile with
(relating to Profile Contents); the information, shall remove the "Not available"
(3) the board determines that information notation and shall make the profile available to the
provided on a physician's profile would violate state or public.
federal confidentiality laws; or
(4) the board otherwise determines that Source Note: The provisions of this §173.7 adopted to
information provided on a physician's profile is false or be effective March 5, 2000, 25 TexReg 1623; amended
misleading. to be effective May 12, 2008, 33 TexReg 3741.
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Chapter 174, Telemedicine
issuing a prescription via electronic means, will be held (8) uses and response times for e-mails,
to the same standards of appropriate practice as those in electronic messages, and other communications
traditional (face-to-face) settings. An online or transmitted via the site;
telephonic evaluation by questionnaire does not (9) to whom patient health information may be
constitute an acceptable standard of care. disclosed and for what purpose;
(c) State Licensure. Physicians who treat and (10) rights of patients with respect to patient
prescribe through the Internet are practicing medicine health information; and
and must possess appropriate licensure in all (11) information collected and any passive
jurisdictions where patients reside. tracking mechanisms utilized.
(d) Electronic Communications. (g) Accountability. Medical practice sites must
(1) Written policies and procedures must be provide patients with a clear mechanism to:
maintained when using electronic mail for physician- (1) access, supplement, and amend patient-
patient communications. Policies must be evaluated provided personal health information;
periodically for currency. Such policies and procedures (2) provide feedback regarding the site and the
must address: quality of information and services; and
(A) privacy to assure confidentiality and (3) register complaints, including information
integrity of patient-identifiable information; regarding filing a complaint with the Texas State Board
(B) health care personnel, in addition to of Medical Examiners as provided for in Chapter 178 of
the physician, who will process messages; this title (relating to Complaints).
(C) hours of operation and availability; (h) Advertising/Promotion of Goods or Products.
(D) types of transactions that will be Advertising or promotion of goods or products from
permitted electronically; which the physician receives direct remuneration or
(E) required patient information to be incentives is prohibited.
included in the communication, such as patient name,
identification number and type of transaction; Source Note: The provisions of this §174.4 adopted to
(F) archival and retrieval; and be effective July 4, 2004, 29 TexReg 6088.
(G) quality oversight mechanisms.
(2) All patient-physician e-mail, as well as §174.5. Notice of Privacy Practices.
other patient-related electronic communications, must (a) Physicians that communicate with patients by e-
be stored and filed in the patient's medical record. mail or other electronic means other than telephone or
(3) Patients must be informed of alternative facsimile must make a good faith effort to notify
forms of communication for urgent matters. patients in writing of the physicians' privacy practices.
(e) Medical Records. (b) The notice of privacy practices shall include
(1) Medical records must include copies of all language that is consistent with federal standards under
patient-related electronic communications, including 45 CFR Parts 160 and 164 relating to privacy of
patient-physician e-mail, prescriptions, laboratory and individually identifiable health information.
test results, evaluations and consultations, records of
past care and instructions. Source Note: The provisions of this §174.5 adopted to
(2) Notice of privacy practices related to the be effective July 4, 2004, 29 TexReg 6088.
use of e-mail must be filed in the medical
record. §174.6. Delegation to and Supervision of
(f) Disclosure. Physician medical practice sites Telepresenters.
must clearly disclose: (a) A physician may delegate tasks and activities to
(1) ownership of the website; a telepresenter who is qualified by licensing, training or
(2) specific services provided; experience for the performance of the task or activity as
(3) office address and contact information; long as the task or activity does not require the exercise
(4) licensure and qualifications of physician(s) of independent medical judgment for its performance;
and associated health care providers; (b) A physician delegating tasks or activities to a
(5) fees for online consultation and services telepresenter shall ensure that the telepresenter to whom
and how payment is to be made; delegation is made is qualified by licensure, training, or
(6) financial interest in any information, experience to perform the task or activity delegated;
products, or services; (c) A physician delegating tasks or activities to a
(7) appropriate uses and limitations of the site, telepresenter shall ensure that the telepresenter to whom
including providing health advice and emergency health delegation is made is adequately supervised.
situations;
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Chapter 175, Fee, Penalties, and Forms
(B) Subsequent biennial permit (includes (A) Application for full physician
surcharges of $2)--$470. licensure.
(B) Application for telemedicine license.
Source Note: The provisions of this §175.2 adopted to (C) Application for administrative
be effective January 25, 2006, 31 TexReg 389; amended medicine license.
to be effective May 1, 2006, 31 TexReg 3534; amended (D) Application for reissuance of license
to be effective September 28, 2006, 31 TexReg 8093. following revocation.
(E) Application for distinguished
§175.3. Penalties. professor temporary license.
In addition to any other application, registration, or (F) Application for state health agency
renewal fees, the board shall charge the following late temporary license.
fee penalties: (G) Application for a visiting physician
(1) Physicians: temporary license.
(A) Physician's registration permit expired (H) Application for visiting professor
for 31 - 90 days--$75. temporary license.
(B) Physician's registration permit expired (I) Application for National Health
for longer than 90 days but less than one year--$150. Service Corps temporary license.
(2) Physician Assistants: (J) Application for faculty temporary
(A) Physician assistant's registration license.
permit expired for 90 days or less--half the registration (K) Application for postgraduate research
fee. temporary license.
(B) Physician assistant's registration (L) Application for medically underserved
permit expired for longer than 90 days but less than one area temporary license.
year--full registration fee. (M) Application for regular temporary
(3) Acupuncturists/Acudetox Specialists: license.
(A) Acupuncturist's registration permit (N) Application for initial physician in
expired for 90 days or less--half the registration fee. training permit.
(B) Acupuncturist's registration permit (O) Application for physician in training
expired for longer than 90 days but less than one year-- permit for program transfer.
full registration fee. (P) Application for evaluation or re-
(C) Renewal of acudetox specialist evaluation of postgraduate training program.
certification expired for less than one year--$25. (Q) Initial biennial registration permit.
(4) Non-Certified Radiologic Technicians. (R) Subsequent biennial registration
Renewal of non-certified radiologic technician's permit.
registration expired for 1 - 90 days--$25. (S) Additional biennial office-based
(5) Certification as a Non-Profit Health anesthesia registration.
Organization fee for a late application for biennial (T) Continuing medical education
recertification--$1,000. temporary license.
(6) Surgical Assistants: (U) Application for a duplicate wall
(A) Surgical Assistant's registration certificate.
permit expired for 90 days or less--half the registration (2) Physician Assistants:
fee. (A) Application for licensure.
(B) Surgical Assistant - registration permit (B) Application for reissuance of license
expired for longer than 90 days but less than one year-- following revocation.
full registration fee. (C) Application for temporary license.
(D) Notice of intent to supervise a
Source Note: The provisions of this §175.3 adopted to physician assistant.
be effective January 25, 2006, 31 TexReg 389; amended (E) Notice of intent to practice as a
to be effective March 9, 2009, 34 TexReg 1590. physician assistant.
(F) Initial annual permit.
§175.4. Application Forms. (G) Subsequent annual permit.
(a) All information required on applications used (3) Acupuncturists/Acudetox
by this board will conform to the Medical Practice Act Specialists/Continuing Education Providers:
and rules promulgated by this board. The board hereby (A) Application for acupuncture licensure.
adopts by reference the following forms: (B) Application for temporary license for
(1) Physicians: an acupuncturist.
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Chapter 175, Fee, Penalties, and Forms
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Texas Administrative Code, Title 22, Part 9
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Chapter 176, Health Care Liability Lawsuits and Settlements
filed under Texas Civil Practices and Remedies Code §176.7. Claims not Required to be Reported.
Section 74.351, must be attached. If the expert report is (a) Examples of claims that are not required to be
not filed with the Court at the time the lawsuit is filed, reported under this chapter, but which may be reported,
the expert report shall be filed with the board, together include the following:
with an updated Part I of the form, not later than the (1) product liability claims (i.e. where a
30th day after receipt of the expert report. licensee invented a medical device that may have
(b) Part II of the form, reporting the settlement of a injured a patient but the licensee has had no personal
health care liability claim, shall be filed not later than physician-patient relationship with the specific patient
the 30th day after the date of settlement of a health care claiming injury by the device);
liability claim, whether or not a lawsuit has been filed. (2) antitrust allegations;
(3) allegations involving improper peer review
Source Note: The provisions of this §176.4 adopted to activities;
be effective January 8, 2004, 29 TexReg 97; amended (4) civil rights violations; and
to be effective September 20, 2007, 32 TexReg 6314. (5) allegations of liability for injuries
occurring on a licensee's property, but not involving a
§176.5. Alternate Reporting Formats. breach of duty in the physician-patient relationship (i.e.
(a) The information may be reported either on the slip and fall accidents).
reporting form set out in Section 176.9 of this chapter (b) Claims that are not required to be reported
or in an alternate format. under this chapter may be voluntarily reported pursuant
(b) If an alternate format is used, the information to the provision of the Medical Practice Act, TEX.
must include at least the information requested in the OCC. CODE, Title 3, Subtitle B.
reporting forms and must be legible.
(c) If an alternate format is used for Part II of the Source Note: The provisions of this §176.7 adopted to
reporting form and a lawsuit has been filed on the be effective January 8, 2004, 29 TexReg 97.
health care liability claim, there must be enough
identification data provided to enable board staff to §176.8. Board Review of Health Care Liability
match the report to the original report of the lawsuit. Lawsuits and Settlements.
The data required to accomplish this include:
(1) name and license number of the defendant
licensee;
(2) name of plaintiff;
(3) cause number;
(4) court; and
(5) county of suit.
(d) A court order or settlement agreement is an
acceptable alternative submission for Part II. An order
or settlement agreement should contain the necessary
information to match the report to the original report of
the lawsuit. If the order or agreement is lacking some of
the required data, the additional information may be
legibly written on the order or agreement.
§176.6. Penalty.
Failure by a licensed insurer to report under this chapter
shall be referred to the Texas Department of Insurance. §176.9. Reporting Form.
Sanctions under Chapter 82 of the Texas Insurance The reporting form shall be as follows.
Code, may be imposed for failure to report.
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Figure: 22 TAC §176.9
2. Licensee:_________________________________________________________
3. Plaintiff’s name:_____________________________________________________________
_____________________________________ ________________________________
Person completing this report Phone number
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Attach a copy of any Court Order or Settlement Agreement. "Settlement"is defined in 22 TAC
§176.1(3), and includes payment on a claim on which a lawsuit has not been filed and
dismissal, settlement, or judgment in a lawsuit that is based on a health care liability claim.
____________________________________________________
10. Amount of indemnity agreed upon or ordered on behalf of this defendant: $_____________.
Note: If percentage of fault was not determined by the court or insurer in the case of multiple
defendants, the insurer may report the total amount paid for the claim followed by a slash and
the number of insured defendants. (Example: $100,000/3)
11. Appeal, if known: _____ Yes _____ No. If yes, which party: ______
_____________________________________ ________________________________
Person completing this report Phone number
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Chapter 177, Certification of Non-Profit Organizations
intent to circumvent any of the provisions of the Act; initial board of directors consistent with the mission,
and goals, and purposes of the health organization;
(5) the health organization makes application, (C) the by-laws of the health organization
submits reports, pays fees and otherwise complies with shall be interpreted in a manner that reserves to the
the provisions of this chapter. health organization through its retained physicians the
sole authority to engage in the practice of medicine and
Source Note: The provisions of this §177.3 adopted to reserves to the health organization through its board of
be effective January 12, 1996, 21 TexReg 107; amended directors the sole authority to direct the medical,
to be effective July 4, 2004, 29 TexReg 6089; amended professional, and ethical aspects of the practice of
to be effective March 16, 2008, 33 TexReg 2025 medicine;
(D) each director is required to
§177.4. Applications for Certification as a 162.001(b) immediately report to the board any action or event
Health Organization. which such director reasonably and in good faith
A health organization seeking certification under believes constitutes a violation or attempted violation of
§162.001(b) of the Act shall submit an application to the Act or the Rules;
the board, to the attention of the Non-Profits (E) each director is required to
department, on a form approved by the board. The individually disclose to the member(s), if any, and to
application shall include: the board of directors (at the times of nomination and
(1) Initial Identification Statement. A appointment) and to the board (at the times of initial
statement signed and verified by the chief executive application and biennial reports) the identity of each
officer: financial relationship known to such director, if any,
(A) indicating the name and mailing which such director has with any member, any other
address of the health organization; director, any supplier of the health organization or any
(B) indicating the names and mailing affiliate of any member, other director, or supplier of
addresses of all members or that there are no members; the health organization, and to provide a concise
(C) indicating the names and mailing explanation of the nature of each such financial
addresses of all officers; and relationship; and
(D) indicating the names and mailing (F) the termination of the retention of any
addresses of all directors. physician to provide medical services on behalf of the
(2) Initial Document Statement. A statement health organization during such physician's term of
signed and verified by the chief executive officer retention may be accomplished only by the board of
attaching a copy of the current certificate of directors or its physician designee(s) and such
incorporation of the health organization and attaching a termination shall be subject to due process procedures
copy of the current by-laws of the health organization adopted by the board of directors or its physician
including provisions that: designee(s) or provided by the retention agreement
(A) the health organization is organized between the health organization and the subject
for any or all of the following purposes: physician.
(i) the carrying out of scientific (3) Initial Director Statements. Statements
research and research projects in the public interest in signed and verified by each current director indicating
the fields of medical sciences, medical economics, that:
public health, sociology, or related areas; (A) such director is licensed by the board;
(ii) the supporting of medical (B) such director is actively engaged in
education in medical schools through grants and the practice of medicine and has no restrictions on his
scholarships; or her Texas medical license;
(iii) the improving and developing of (C) such director will, as a director,
the abilities of individuals and institutions studying, exercise independent judgment in all matters and,
teaching, and practicing medicine; specifically, matters relating to credentialing, quality
(iv) the delivery of health care to the assurance, utilization review, peer review, and the
public; practice of medicine;
(v) the engaging in the instruction of (D) such director will, as a director,
the general public in the area of medical science, public exercise best efforts to cause the health organization to
health, and hygiene and related instruction useful to the comply with all relevant provisions of the Act and the
individual and beneficial to the community. Rules;
(B) the physician(s) organizing and (E) such director will, as a director,
incorporating the health organization shall select the immediately report to the board any action or event
which such director reasonably and in good faith
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Chapter 177, Certification of Non-Profit Organizations
believes constitutes a violation or attempted violation of law including requirements to obtain or maintain tax
the Act or the Rules; and exemption.
(F) such director has disclosed within (3) Without the approval of at least a majority
such director's statement the identity of all of such of the board of directors, the member may not
director's financial relationships, if any, of the type unilaterally amend the bylaws of the health
described in paragraph (2)(E) of this subsection and organization unless required by law including
provided a concise explanation of the nature of each requirements to obtain or maintain tax exemption.
such financial relationship within such director's
statement. Source Note: The provisions of this §177.5 adopted to
(4) Initial Compliance Statement. A statement be effective January 12, 1996, 21 TexReg 107; amended
signed and verified by the chief executive officer to be effective July 4, 2004, 29 TexReg 6089.
indicating that the health organization is in compliance
with the requirements for certification and continued §177.6. Biennial Reports for 162.001(b) Health
certification as required by the provisions of the Act Organizations.
and the Rules. Each health organization certified under the Act,
(5) Initial Fee Payment. A fee in the amount §162.001(b), shall file with the board a biennial report
and form specified by §175.1 of this title (relating to in September of each odd numbered year if certified in
Application Fees). an odd numbered year, and in September of each even
numbered year if certified in an even numbered year,
Source Note: The provisions of this §177.4 adopted to and the biennial report shall include:
be effective January 12, 1996, 21 TexReg 107; amended (1) Biennial Identification Statement. A
to be effective March 8, 2001, 26 TexReg 1864; statement signed and verified by the chief executive
amended to be effective July 4, 2004, 29 TexReg 6089; officer:
amended to be effective March 16, 2008, 33 TexReg (A) indicating the name and mailing
2025. address of the health organization;
(B) indicating the names and mailing
§177.5. Special Requirements for 162.001(b) Health addresses of all members or that there are no members;
Organizations. (C) indicating the names and mailing
In addition to the general by-law requirements set forth addresses of all officers;
herein for health organizations seeking certification (D) indicating the names and mailing
under §162.001(b) of the Act, any health organization addresses of all directors; and
in which a member is either a person who is not a (E) disclosing any changes in the
physician actively engaged in the practice of medicine composition of the board of directors since the last
or an entity or organization that is not wholly owned biennial report.
and controlled by physicians actively engaged in the (2) Biennial Document Statement. A statement
practice of medicine must comply with the following signed and verified by the chief executive officer
requirement: attaching a copy of the current certificate of
(1) All credentialing, quality assurance, incorporation and by-laws of the health organization if
utilization review and peer review policies shall be not already on file with the board and indicating:
made exclusively by the board of directors; however, (A) whether or not the by-laws or articles
following consultation with the board of directors, the of incorporation of the health organization have been
member(s) may retain the right to approve, or in the revised since the last biennial report;
case of a health organization seeking to obtain or (B) whether or not such revisions, if any,
maintain tax exempt status the right to make, any were recommended or approved by the board of
financial decision of the health organization including, directors; and
but not limited to, decisions regarding capital and (C) a concise explanation of such
operating budgets, physician compensation and revisions, if any.
benefits, expenditures of monies, and managed care (3) Biennial Director Statements. Statements
contracts in which the health organization is at financial signed and verified by each current director indicating
risk, the substance of which requirements shall be that:
provided for in the by-laws of the health organization. (A) such director is licensed by the board;
(2) Subsequent to the appointment of the (B) such director is actively engaged in
initial board of directors, a member may not appoint or the practice of medicine and has no restrictions on his
elect any director without the approval of at least a or her Texas medical license;
majority of the board of directors unless required by (C) such director will, as a director,
exercise independent judgment in all matters and,
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specifically, matters relating to credentialing, quality Source Note: The provisions of this §177.7 adopted to
assurance, utilization review, peer review, and the be effective January 12, 1996, 21 TexReg 107; amended
practice of medicine; to be effective March 8, 2001, 26 TexReg 1864;
(D) such director will, as a director, amended to be effective July 4, 2004, 29 TexReg 6089.
exercise best efforts to cause the health organization to
comply with all relevant provisions of the Act and the §177.8. Failure to Submit Reports or Fees for
Rules; 162.001(b) Health Organizations.
(E) such director will, as a director, (a) The failure of a health organization seeking
immediately report to the board any action or event certification under the Act, §162.001(b), and the Rules
which such director reasonably and in good faith to submit any required fee shall be grounds for the
believes constitutes a violation or attempted violation of board to stop the processing of the application for
such Act or the Rules; and certification and to deny the application.
(F) such director has disclosed within (b) The failure of a health organization which is
such director's statement the identity of all of such certified under the Act, §162.001(b), and the Rules to
director's financial relationships, if any, of the type timely submit an accurate biennial report along with
described in §177.4(2)(E) of this title (relating to any required fee within 90 days of its due date may
Applications for Certification as a 162.001(b) Health result in decertification at the next board meeting of the
Organization) and provided a concise explanation of the board.
nature of each such financial relationship within such (c) If a health organization has been decertified, it
director's statement. will be required to submit a new application for
(4) Biennial Compliance Statement. A certification as a nonprofit health organization under
statement signed and verified by the chief executive §162.001(b) of the Act and applicable fee with the
officer indicating that the Health Organization is in application for certification.
compliance with the requirements for certification and
continued certification as required by the provisions of Source Note: The provisions of this §177.8 adopted to
the Act and the Rules. be effective January 12, 1996, 21 TexReg 107; amended
(5) Biennial Fee Payment. A fee in the amount to be effective March 8, 2001, 26 TexReg 1864;
and form specified by §175.2 of this title (relating to amended to be effective July 4, 2004, 29 TexReg 6089.
Registration and Renewal Fees).
§177.9. Migrant, Community or Homeless Health
Source Note: The provisions of this §177.6 adopted to Centers.
be effective January 12, 1996, 21 TexReg 107; amended (a) Section 162.001(c), non-profit health
to be effective March 8, 2001, 26 TexReg 1864; organizations. Migrant, community, or homeless health
amended to be effective July 4, 2004, 29 TexReg 6089; centers organized and operated under the authority of
amended to be effective March 16, 2008, 33 TexReg and in compliance with 42 U.S.C. §254b or §254c, or
2025. federally qualified health centers under 42 U.S.C.
§1396(d)(1)(2)(B), that are non-profit corporations
§177.7. Establishment of Fees. under Bus. Org. Code, Chapter 22, and the Internal
(a) Fees established pursuant to §153.011 and Revenue Code, §501(c)(3), and who wish to obtain
§153.051 of the Act relating to initial certification, approval and certification to contract with and employ
recertification, and late applications for recertification physicians pursuant to the Medical Practice Act,
are set forth under Chapter 175 of this title (relating to §162.001(c), Texas Occupations Code Annotated, Title
Fees, Penalties, and Applications). 3 Subtitle B, may do so by submitting an application on
(b) In addition to all other requirements for a form approved by the board to the permits department
continued certification under the Act, §162.001(b), if of the board with the following attached
the health organization is more than 30 days late in documentation:
submitting their completed biennial report and biennial (1) a copy of the certificate of incorporation
fee as specified in §177.6 of this title (relating to under the Texas Non-Profit Corporation Act;
Biennial Reports for 162.001(b) Health Organizations), (2) a copy of documentation verifying that a
the health organization will be required to pay a late fee determination has been made that the organization is
penalty at the time of submission of their late biennial tax exempt under the Internal Revenue Code pursuant
report in addition to the biennial fee in the form of a to §501(c)(3); and,
check or money order payable to the board. (3) a copy of documentation verifying that the
(c) Fees shall not be refundable. organization is organized and operated as a migrant,
community, or homeless health center under the
authority of and in compliance with 42 U.S.C. §254b or
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Chapter 177, Certification of Non-Profit Organizations
§254c, or is a federally qualified health center under 42 (e) In the event that such compliance cannot be
U.S.C. §1396(d)(1)(2)(B). determined or is otherwise in question for any reason
(b) Initial Fee Payment. A fee in the amount and including complaints of actions by the health
form specified by board rules. organization in contravention of this section or the Act,
(c) Biennial reports. Each organization approved including but not limited to failure to provide due
and certified under the Act, §162.001(c), shall file with process or evidence of undue influence on the practice
the board a completed biennial report on a board- of medicine, the application or statement and any
approved form that contains updated and current supporting documentation shall be submitted to the
information which would otherwise be required for board or a committee of the board for further review,
initial approval and certification to contract with and investigation, approval, denial, or decertification.
employ physicians. The biennial report shall be
submitted in September of each odd numbered year if Source Note: The provisions of this §177.10 adopted to
certified in an odd numbered year, and in September of be effective July 4, 2004, 29 TexReg 6089.
each even numbered year if certified in an even
numbered year. Failure to timely submit a required §177.11. Denial of Certification.
biennial report shall be grounds for denial of Subject to due process procedures, the board may
recertification to contract with and employ physicians refuse to certify any health organization making
pursuant to §177.10(e) of this chapter (relating to application to the board if in the board's determination
Review of Applications and Reports). the applying health organization is established or
(d) Biennial Fee Payment. There is no biennial fee organized or operated in contravention to or with the
for health organizations certified pursuant to intent to circumvent any of the provisions of the Act.
§162.001(c) of the Act.
Source Note: The provisions of this §177.11 adopted to
Source Note: The provisions of this §177.9 adopted to be effective July 4, 2004, 29 TexReg 6089.
be effective July 4, 2004, 29 TexReg 6089; amended to
be effective March 16, 2008, 33 TexReg 2025. §177.12. Revocation of Certification.
(a) In the event that the Board receives information
§177.10. Review of Applications and Reports. about a health organization including complaints of
(a) Applications for certification and biennial actions by the Health Organization in contravention of
reports under this section shall be initially reviewed by this chapter or the Act, including but not limited to
the permits and legal staffs of the board or other failure to provide due process or evidence of undue
designees of the board to determine compliance with influence on the practice of medicine information, such
the requirements for certification. information shall be referred to the board's investigation
(b) If an application for certification is insufficient department.
or there is any other basis for denial, the health (b) Subject to due process procedures, the board
organization will be notified in writing that unless it shall revoke a certification if in the board's
takes corrective action or remedies the insufficiency, determination the health organization is established,
the health organization's application will be denied. The organized, or operated in contravention of or with the
health organization shall have 60 days from the date of intent to circumvent any of the provisions of the Act or
the mailing by the board to submit the corrected the board's rules.
application. (c) Chapter 187 of this title (relating to Procedural
(c) If a biennial report is insufficient or there is any Rules) shall govern procedures relating to revocation of
other basis for decertification, the health organization certification where applicable. If the provisions of
will be notified in writing that unless it takes corrective Chapter 187 of this title conflict with the Act or rules
action, the health organization will be recommended for under this chapter, the Act and provisions of this
decertification at the next meeting of the board. The chapter shall control.
health organization shall have 60 days from the date of
the mailing by the board to submit the corrected Source Note: The provisions of this §177.12 adopted to
biennial report. be effective July 4, 2004, 29 TexReg 6089.
(d) If upon review of the application or biennial
report and any supporting documentation, the applying §177.13. Complaint Procedure Notification.
or reporting appears to be in compliance for (a) Method of Notification. For the purpose of
certification or continued certification, such directing complaints to the board regarding health-care
certification or recertification shall be made upon delivery by licensees of the board practicing through
approval of the board or a committee of the board. non-profit health organizations certified pursuant to the
Medical Practice Act, §162.001, the non-profit health
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NOTICE CONCERNING COMPLAINTS REGARDING
NON-PROFIT HEALTH ORGANIZATIONS
The provision of medical care at this location is through a non-profit health organization which has been approved
and certified by the Texas State Board of Medical Examiners. Complaints about the delivery of medical care
through this organization and/or its physicians, as well as other licensees and registrants of the Texas State Board of
Medical Examiners, including physician assistants, acupuncturists, and surgical assistants may be reported for
investigation at the following address:
Texas State Board of Medical Examiners
Attention: Investigations
333 Guadalupe, Tower 3, Suite 610
P.O. Box 2018, MC-263
Austin, Texas 78768-2018
Assistance in filing a complaint is available by calling the following telephone number:
1-800-201-9353
For more information, please visit our web site at www.tsbme.state.tx.us.
La atención médica en esta instalación se brinda a través de una organización médica sin fines de lucro, aprobada y
certificada por la Junta de Examinadores Médicos del Estado de Texas. Las quejas sobre la atención médica prestada
por esta organización y/o sus médicos, así como por otros profesionales acreditados e inscritos en la Junta de
Examinadores Médicos del Estado de Texas, incluyendo asistentes de médicos, practicantes de acupuntura, y
asistentes de cirugía, se pueden presentar en la siguiente dirección para ser investigadas:
Texas State Board of Medical Examiners
Attention: Investigations
333 Guadalupe, Tower 3, Suite 610
P.O. Box 2018, MC-263
Austin, Texas 78768-2018
Si necesita ayuda para presentar una queja, llame al:
1-800-201-9353
Para más información, visite nuestro sitio web en www.tsbme.state.tx.us.
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Texas Administrative Code, Title 22, Part 9
§178.1. Purpose and Scope. physicians assistants, and the Texas State Board of
(a) Purpose. Pursuant to §§154.051 - 154.058 of Acupuncture for acupuncturists.
the Medical Practice Act, the Board is authorized to (6) Complaint--Information provided to the
adopt rules relating to complaint procedures. The board that alleges a violation of the Act.
purpose of this chapter is to provide a system of (7) Complainant--Any person, including an
procedures for the initiation, filing and appeals of individual, partnership, association, corporation, or
complaints that will promote their just and efficient other entity, who initiates a complaint with the board
disposition. against a licensee. A complainant may be a patient, a
(b) Scope. This chapter shall govern the initiation, family member of a patient, a health care professional,
filing, referral, resolution and appeal of all complaints or any other person who has information regarding the
before the board. possible violation of the Act. A complainant may be
anonymous, in which case the complaint will be
Source Note: The provisions of this §178.1 adopted to investigated to the extent that information is provided
be effective November 30, 2003, 28 TexReg 10489; on which an investigation can be initiated.
amended to be effective January 20, 2009, 34 TexReg (8) Jurisdictional--A matter over which the
338. board has authority.
(9) Licensee--A person to whom the board has
(a) Purpose. The purpose of this chapter is to issued a license, permit, certificate, approved
provide a system of procedures for the initiation, filing registration, or similar form of permission authorized
and appeals of complaints that will promote their just by law.
and efficient disposition. (10) Official Investigation--an investigation
(b) Scope. This chapter shall govern the initiation, conducted by the agency of a complaint that, after
filing, referral, resolution and appeal of all complaints preliminary investigation, has been determined to be
before the board. jurisdictional and has been officially filed.
(11) Preliminary Investigation--an
Source Note: The provisions of this §178.1 adopted to investigation conducted by the agency upon the
be effective November 30, 2003, 28 TexReg 10489. initiation of a complaint to determine whether the
complaint is jurisdictional and whether the complaint
§178.2. Definitions. should be filed and an official investigation conducted.
The following words and terms, when used in this (12) Subject licensee--The licensee against
chapter, shall have the following meanings, unless the whom a complaint is filed.
context clearly indicate otherwise.
(1) Act--Title 3, Subtitle B, Chapter 151-165, Source Note: The provisions of this §178.2 adopted to
Tex Occ. Code Ann. for physicians; Title 3, Subtitle C, be effective November 30, 2003, 28 TexReg 10489;
Chapter. 204, Tex Occ. Code Ann. for physician amended to be effective January 25, 2006, 31 TexReg
assistants; Title 3 Subtitle C, Chapter 206, Tex Occ. 390.
Code Ann. for surgical assistants; and Title 3, Subtitle
C, Chapter 205, Tex Occ. Code Ann. for §178.3. Complaint Procedure Notification.
acupuncturists. (a) Methods of Notification. Pursuant to the Act,
(2) Address of record--The mailing address of for the purpose of directing complaints to the board, the
each subject licensee as provided to the board pursuant board and its licensees shall provide notification to the
to the Act. public of the name, mailing address, and telephone
(3) Agency--The divisions, departments, and number of the board by one or more of the following
employees of the Texas Medical Board, the Texas methods:
Physician Assistant Board, and the Texas State Board (1) displaying in a prominent location at a
of Acupuncture Examiners. licensee's place of business, signs in English and
(4) Baseless or unfounded--Not based on any Spanish of no less than 8 1/2 inches by 11 inches in size
evidence or fact. with the board-approved notification statement printed
(5) Board--The appointed members of the alone and in its entirety in black on white background
Texas Medical Board for physicians and surgical in type no smaller than standard 24-point Times Roman
assistants, the Texas Physician Assistant Board for print with no alterations, deletions, or additions to the
language of the board-approved statement; or
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TEXAS MEDICAL BOARD RULES
Chapter 178, Complaints
(2) placing the board-approved notification P.O. Box 2018, MC-263, Austin, Texas 78768-2018,
statement printed in English and Spanish in black type Assistance in filing a complaint is available by calling
no smaller than standard 10-point 12-pitch typewriter the following telephone number: 1-800-201-9353, For
print on each bill for services by a licensee with no more information, please visit our website at
alterations, deletions, or additions to the language of the www.tmb.state.tx.us.
board-approved statement; or (c) Approved Spanish Notification Statement. The
(3) placing the board-approved notification following notification statement in Spanish is approved
statement printed in English and Spanish in black type by the board for purposes of these rules and the Act:
no smaller than standard 10-point, 12-pitch typewriter AVISO SOBRE LAS QUEJAS, Las quejas sobre
print on each registration form, application, or written médicos, así como sobre otros profesionales acreditados
contract for services of a licensee with no alterations, e inscritos en la Junta de Examinadores Médicos del
deletions, or additions to the language of the board- Estado de Texas, incluyendo asistentes de médicos,
approved statement. practicantes de acupuntura y asistentes de cirugía, se
(b) Approved English Notification Statement. The pueden presentar en la siguiente dirección para ser
following notification statement in English is approved investigadas: Texas Medical Board, Attention:
by the board for purposes of these rules and the Act: Investigations, 333 Guadalupe, Tower 3, Suite 610,
NOTICE CONCERNING COMPLAINTS, Complaints P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si
about physicians, as well as other licensees and necesita ayuda para presentar una queja, llame al: 1-
registrants of the Texas Medical Board, including 800-201-9353, Para obtener más información, visite
physician assistants, acupuncturists, and surgical nuestro sitio web en www.tmb.state.tx.us.
assistants may be reported for investigation at the (d) Figures 1 and 2 are samples of the type print
following address: Texas Medical Board, Attention: referenced in subsection (a) of this section.
Investigations, 333 Guadalupe, Tower 3, Suite 610,
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NOTICE CONCERNING COMPLAINTS
1-800-201-9353
www.tmb.state.tx.us
Las quejas sobre médicos, así como sobre otros profesionales acreditados e inscritos en la Junta de Examinadores
Médicos del Estado de Texas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugía,
se pueden presentar en la siguiente dirección para ser investigadas:
1-800-201-9353
www.tmb.state.tx.us
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Chapter 179, Investigations
executive director to a person authorized by the board (A) sworn statements from two people,
to pursue legal action. willing to testify before the board, that a certain
(5) to other persons if required during the licensee is impaired;
course of the investigation; (B) a sworn statement from a
(6) to other regulatory agencies as required by representative of the Texas Medical Association's or the
law; and Texas Osteopathic Medical Association's impaired
(7) a person who has provided a statement may physician program, stating that the representative is
receive a copy of the statement. willing to testify before the board that a certain licensee
is impaired;
Source Note: The provisions of this §179.3 adopted to (C) evidence that a licensee left a
be effective November 30, 2003, 28 TexReg 10491; treatment program for alcohol or chemical dependency
amended to be effective January 25, 2006, 31 TexReg before a completion of that program;
390. (D) evidence that a licensee has engaged
in the intemperate use of drugs or alcohol at a time and
§179.4. Request for Information and Records from under circumstances that would lead a reasonable
Physicians. person to believe that the licensee is impaired;
(a) Medical records. Upon the request by the board (E) evidence of repeated arrests of a
or board representatives, a licensee shall furnish to the licensee for intoxication;
board copies of medical records or the original records (F) evidence of recurring temporary
within a reasonable time period, as prescribed at the commitments to a mental institution of a licensee;
time of the request. "Reasonable time," as used in this (G) medical records showing that a
section, shall mean fourteen calendar days or a shorter licensee has an illness or condition that results in the
time if required by the urgency of the situation or the inability to function properly in his or her practice; or
possibility that the records may be lost, damaged, or (H) actions or statements by a licensee at
destroyed. a hearing conducted by the Board that gives the Board
(b) Application for license renewal and registration reason to believe that the licensee has an impairment.
permits. A licensee shall furnish a written explanation (d) Prescription drugs and controlled substances.
of his or her answer to any question asked on the The board or its authorized representative shall have the
application for license renewal or registration permit, if power to inspect a licensee's inventory of prescription
requested by the board. This explanation shall include drugs and obtain samples of those substances, and to
all details as the board may request and shall be inspect and copy records of purchases and disposals of
furnished within two weeks of the date of receipt of the drugs, including those listed in the Texas Controlled
board's request. Substances Act or controlled substances scheduled in
(c) Impaired licensees. the Federal Comprehensive Drug Abuse Prevention and
(1) A licensee shall report to the board if the Control Act of 1970.
licensee is aware of another licensee who poses a (e) Response to Board Requests. In addition to the
continuing threat to the public welfare because the said requirements of responding or reporting to the board
licensee is unable to practice medicine with reasonable under this section, a physician or license holder of the
skill and safety to patients because of illness; board shall respond in writing to all written board
drunkenness; excessive use of drugs, narcotics, requests for information within 10 days of receipt of
chemicals, or another substance; or a mental or physical such request. Failure to timely respond may be grounds
condition. for disciplinary action by the board.
(2) If the board has probable cause to believe
that a licensee is impaired, the board shall require a Source Note: The provisions of this §179.4 adopted to
licensee to submit to a mental and/or physical be effective November 30, 2003, 28 TexReg 10491;
examination by a physician or physicians designated by amended to be effective January 25, 2006, 31 TexReg
the board. Under the Act, an impaired licensee is 390; amended to be effective January 20, 2009, 34
considered to be one who is unable to practice within TexReg 339.
his field with reasonable skill and safety to patients by
reason of age, illness, drunkenness, excessive use of §179.5. Investigation of Professional Review Actions.
drugs, narcotics, chemicals, or any other type of A written report of a professional review action taken
material; or as a result of any mental or physical by a medical peer review committee or a health care
condition. Probable cause may include, but is not entity provided to the board as required by §§160.002,
limited to, any one of the following: 204.208, and 205.304 of the Tex. Occ. Code Ann., must
contain the results and circumstances of the
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Chapter 179, Investigations
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Texas Administrative Code, Title 22, Part 9
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Chapter 180, Rehabilitation Orders
manner affecting the standard of care has been received submitted to the board or board staff by mail, email,
by the board, and the status of the investigation of the messenger, telefacsimile transmission, or hand-
complaint; delivery. The self-report may be made through
(C) licensee or applicant caused harm to responses provided as part of an application for a
any individual or entity; license or writing submitted for purposes of licensure
(D) licensee or applicant has a renewal; and
disciplinary history, including criminal convictions, (6) the licensee or applicant must provide a
disciplinary orders with board or other state medical complete self-report of the intemperate use of alcohol
boards, disciplinary actions by other state or federal or drugs that includes, but is not limited to, the
regulatory agencies, and peer review actions by following information:
hospitals or medical societies; (A) the approximate dates of intemperate
(E) licensee or applicant inappropriately use;
self-treated or self-prescribed; (B) the extent of intemperate use;
(F) licensee or applicant violated (C) the substance(s) used;
provisions of the Act other than §§164.051(a)(4), (a)(5) (D) the method(s) of ingestion;
and 164.052(a)(5); (E) all history of substance abuse
(G) applicability of any other aggravating treatment to include approximate dates of treatment and
factors set forth in Section 190.15(a) of this title the specific locations where treatment was received;
(relating to Aggravating and Mitigating Factors). and
(e) Concurrent public agreed order. The board may (F) a description of any incident that a
approve a public agreed order to run concurrently with reasonably prudent physician would believe could
any confidential rehabilitation order, authorized by this result in an allegation of the physician's violation of the
section. standard of care that occurred during the time of
(f) Requirements for self-reports. To be eligible for intemperate use or, if no violation of the standard of
a rehabilitation order based on a self-report of care has occurred, a statement that no violation of the
intemperate use of drugs or alcohol: standard of care occurred during the time of
(1) the self-report must have been made to the intemperate use.
board: (g) Guidelines for determination of a mental or
(A) within five years after the last physical condition.
commission of intemperate use of drugs or alcohol; (1) Mental condition. Absent a showing of
(B) before the filing of any criminal good cause, a licensee or applicant suffering from a
charges involving drugs or alcohol use; and mental condition should provide evidence to the board,
(C) before the board receives a complaint including medical records, of a clinical diagnosis by a
or other report of intemperate use; physician or mental health care provider of a condition
(2) the licensee or applicant making the self- listed under DSM-IV.
report has no prior board orders based on use of drugs (2) Physical condition. Absent a showing of
or alcohol; good cause, a licensee or applicant suffering from a
(3) the licensee or applicant has not committed physical condition should provide evidence to the
a violation of the standard of care as a result of the board, including medical records, of a clinical diagnosis
intemperate use of drugs or alcohol; by a physician.
(4) no valid complaint with regard to the (3) Additional factors for consideration. A
licensee or applicant based on intemperate use of drugs licensee's or applicant's diagnosis shall be considered
or alcohol in a manner affecting the standard of care has along with the licensee's or applicant's:
been received by the board prior to the time the licensee (A) current and past levels of functioning;
or applicant signs the proposed rehabilitation order. If (B) concurrent medical disorders;
the board receives any complaint regarding the standard (C) complicating factors such as
of care before the licensee or applicant signs the substance-related disorders;
proposed rehabilitation order, the licensee or applicant (D) compliance with treatments;
is not eligible for a rehabilitation order unless the board (E) response to treatment;
makes a determination that the licensee or applicant did (F) prognosis; and
not violate the standard of care as a result of the (G) stage of recovery from the illness.
intemperate use of drugs or alcohol; (4) Hearing. An informal show compliance
(5) self-reports of intemperate use of drugs or proceeding shall be considered an evidentiary hearing
alcohol by licensees or applicants must be made for the purposes of this subsection and in accordance
through a written statement by the licensee or applicant, with §164.202 of the Act.
or the authorized agent of the licensee or applicant,
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Texas Administrative Code, Title 22, Part 9
§181.1. Purpose.
These rules are promulgated under the authority of the §181.3. Release of Contact Lens Prescription.
Medical Practice Act, Texas Occupations Code Ann., (a) Except as provided in subsection (d) of this
Title 3, Subtitle B, and the Texas Contact Lens section, each physician who performs an eye
Prescription Act, Texas Occupations Code Ann., Title examination and fits a patient for contact lenses shall,
3, Subtitle F, Chapter 353, to set forth the criteria under on request, prepare and give a contact lens prescription
which a patient may request and receive a contact lens to the patient, and as directed by any person designated
prescription and under which a physician shall provide to act on behalf of the patient, provide the prescription
such prescription. or verify the prescription as provided by Tex. Occ.
Code Section 353.1015. The physician may exclude
Source Note: The provisions of this §181.1 adopted to categories of contact lenses if the exclusion is clinically
be effective March 4, 1998, 23 TexReg 1950; amended indicated. The physician may not charge the patient a
to be adopted March 7, 2002, 27 TexReg 1488. fee for providing the contact lens prescription but may
charge a fee for examination and a fee for fitting of
§181.2. Definitions. contact lenses as a condition for giving a contact lens
prescription to the patient.
(b) If a patient requests a contact lens prescription
during an initial or annual examination, the physician
must prepare and give the contact lens prescription to
the patient at the time the physician determines all of
the parameters of the contact lens prescription, as that
term is defined in section 181.2 of this title (relating to
definitions). If the physician has delegated the fitting of
the contact lens as authorized by the Texas Contact
Lens Prescription Act, the physician is not required to
provide the prescription for the patient.
(c) If the patient does not request or receive an
original contact lens prescription during the patient's
initial or annual examination, the patient may request
the patient's contact lens prescription at any time during
which the prescription is valid. On receipt of a request,
the physician shall provide the patient with a contact
lens prescription if the physician has fit the patient. If
the patient requests the physician to deliver the
prescription to the patient or to another person, the
physician may charge the cost of delivery to the patient.
(d) A physician may refuse to give a contact lens
prescription to a patient if:
(1) the patient's ocular health presents a
contraindication for contact lenses;
(2) refusal is warranted due to potential harm
to the patient's ocular health;
(3) the patient has not paid for the examination
and fitting, or has not paid other financial obligations to
the physician if the patient would have been required to
make an immediate or similar payment if the
examination revealed that ophthalmic goods were not
Source Note: The provisions of this §181.2 adopted to required;
be effective March 4, 1998, 23 TexReg 1950; amended (4) the patient has an existing medical
to be adopted March 7, 2002, 27 TexReg 1488; condition that indicates that the patient's ocular health
amended to be effective September 20, 2007, 32 TexReg would be damaged if the prescription were released to
6315.
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the patient, or if further monitoring of the patient is contact lens dispensing services under the direct
needed; or supervision and control of the physician.
(5) the request is made after the first
anniversary date of the patient's last eye examination. Source Note: The provisions of this §181.5 adopted to
(e) Subsection (d) of this section does not prohibit be effective March 4, 1998, 23 TexReg 1950; amended
a physician from giving a patient the patient's contact to be adopted March 7, 2002, 27 TexReg 1488.
lens prescription.
(f) A physician may not condition the availability §181.6. Physician's Prescriptions: Delegation.
to a patient of an eye examination, a fitting for contact (a) These rules shall not be interpreted to prevent,
lenses, the issuance or verification of a contact lens or restrict a physician from treating or prescribing for
prescription, or any combination of these services on a the physician's patients or from directing or instructing
requirement that the patient agree to purchase contact others under the physician's control, supervision or
lenses or other ophthalmic goods from the physician. instruction who assists those patients according to
(g) Unless a shorter prescription period is specific directions, orders, instructions, or prescriptions.
warranted by the patient's ocular health or by a potential (b) If a physician's directions, instructions, orders,
harm to the patient's ocular health, a physician may not or prescriptions are to be performed or filled by an
issue a contact lens prescription that expires before the optician who is independent of the physician's office,
first anniversary of the date the person's prescription the directions, instructions, orders or prescriptions must
parameters are determined. The physician may extend be:
the expiration date of the prescription without (1) in writing or verified under Tex. Occ. Code
completing another eye examination or may require the Section 353.1015;
patient to undergo another eye examination. (2) of a scope and content and communicated
(h) If a physician refuses to give a patient the to the optician in a form and manner that in the
patient's contact lens prescription for a reason permitted professional judgment of the physician best serves the
under subsection (d) of this section or writes the health, safety, and welfare of the physician's patients;
prescription for a period of less than one year, the and
physician must: (3) in form in detail consistent with the
(1) give the patient a verbal explanation of the particular optician's skill and knowledge.
reason for the action at the time of the action; and (c) A person holding a contact lens dispensing
(2) maintain in the patient's records a written permit may take measurements of the eye or cornea and
explanation of the reason. may evaluate the physical fit of the lenses for a
particular patient of the physician and may instruct the
patient in the use and care of the contact lenses if the
physician has delegated in writing those responsibilities
with regard to that specific patient to the contact lens
dispenser.
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Chapter 183, Acupuncture
(ii) herbal formulas including must be readable by the Texas Department of Public
traditional herbal formulas and their modifications or Safety;
variations based on traditional methods of herbal (C) all documents required under
therapy; §183.4(c) of this title (relating to Licensure
(iii) patent herbs including the names Documentation); and
of the more common patent herbal medications and (D) the required fee, payable by check
their uses; and through a United States bank.
(iv) clinical training emphasizing (11) Assistant Presiding Officer--A member
herbal uses; or of the acupuncture board elected by the acupuncture
(C) a school of acupuncture located board to fulfill the duties of the presiding officer in the
outside the United States or Canada that is determined event the presiding officer is incapacitated or absent, or
by the board to be substantially equivalent to a Texas the presiding officer's duly qualified successor under
acupuncture school or a school defined in subparagraph Robert's Rules of Order Newly Revised or board rules.
(B) of this paragraph. An evaluation by the American (12) Board member--One of the members of
Association of Collegiate Registrars and Admissions the acupuncture board, appointed and qualified
Officers (AACRAO) or an evaluation requested by the pursuant to §§205.051 - 205.053 of the Act.
board may be utilized when making a determination of (13) Chiropractor--A licensee of the Texas
substantial equivalence. State Board of Chiropractic Examiners.
(3) Acupuncture Act or "the Act"--Chapter (14) Contested case--A proceeding, including
205 of the Texas Occupations Code. but not restricted to, licensing, in which the legal rights,
(4) Acupuncture-- duties, or privileges of a party are to be determined by
(A) The insertion of an acupuncture the board after an opportunity for adjudicative hearing.
needle and the application of moxibustion to specific (15) Documents--Applications, petitions,
areas of the human body as a primary mode of therapy complaints, motions, protests, replies, exceptions,
to treat and mitigate a human condition, including the answers, notices, or other written instruments filed with
evaluation and assessment of the condition; and the medical board or acupuncture board in a licensure
(B) the administration of thermal or proceeding or by a party in a contested case.
electrical treatments or the recommendation of dietary (16) Eligible for legal practice and/or
guidelines, energy flow exercise, or dietary or herbal licensure in country of graduation--An applicant who
supplements in conjunction with the treatment has completed all requirements for legal practice of
described by subparagraph (A) of this paragraph. acupuncture and/or licensure in the country in which
(5) Acupuncture board or "board"--The Texas the school is located except for any citizenship
State Board of Acupuncture Examiners. requirements.
(6) Acupuncturist--A licensee of the (17) Executive Director--The executive
acupuncture board who directly or indirectly charges a director of the agency or the authorized designee of the
fee for the performance of acupuncture services. executive director.
(7) Agency--The divisions, departments, and (18) Full force--Applicants for licensure who
employees of the Texas Medical Board, the Texas possess a license in another jurisdiction must have it in
Physician Assistant Board, and the Texas State Board full force and not restricted, canceled, suspended or
of Acupuncture Examiners. revoked. An acupuncturist with a license in full force
(8) APA--The Administrative Procedure Act, may include an acupuncturist who does not have a
Government Code, §2001.001 et seq. current, active, valid annual permit in another
(9) Applicant--A party seeking a license from jurisdiction because that jurisdiction requires the
the board. acupuncturist to practice in the jurisdiction before the
(10) Application--An application is all annual permit is current.
documents and information necessary to complete an (19) Full NCCAOM examination--The
applicant's request for licensure including the National Certification Commission for Acupuncture
following: and Oriental Medicine examination, consisting of the
(A) forms furnished by the board, following:
completed by the applicant: (A) if taken before June 1, 2004: the
(i) all forms and addenda requiring a Comprehensive Written Exam (CWE), the Clean
written response must be printed in ink or typed; Needle Technique Portion (CNTP), the Practical
(ii) photographs must meet United Examination of Point Location Skills (PEPLS), and the
States Government passport standards; Chinese Herbology Exam; or
(B) a fingerprint card, furnished by the (B) if taken on or after June 1, 2004: the
acupuncture board, completed by the applicant, that NCCAOM Foundation of Oriental Medicine Module,
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Chapter 183, Acupuncture
Acupuncture Module, Point Location Module, the (34) Substantially equivalent to a Texas
Chinese Herbology Module, and the Biomedicine acupuncture school--A school or college of acupuncture
Module. that is an institution of higher learning designed to
(20) Good professional character--An select and educate acupuncture students; provide
applicant for licensure must not be in violation of or students with the opportunity to acquire a sound basic
have committed any act described in the Act, §205.351. acupuncture education through training; to develop
(21) Administrative Law Judge (ALJ)--An programs of acupuncture education to produce
individual appointed to preside over administrative practitioners, teachers, and researchers; and to afford
hearings pursuant to the APA. opportunity for postgraduate and continuing medical
(22) License--Includes the whole or part of education. The school must provide resources,
any board permit, certificate, approval, registration, or including faculty and facilities, sufficient to support a
similar form of permission required by law; curriculum offered in an intellectual and practical
specifically, a license and a registration. environment that enables the program to meet these
(23) Licensing--Includes the medical board's standards. The faculty of the school shall actively
and acupuncture board's process respecting the contribute to the development and transmission of new
granting, denial, renewal, revocation, suspension, knowledge. The school of acupuncture shall contribute
annulment, withdrawal, or amendment of a license. to the advancement of knowledge and to the intellectual
(24) Medical board--The Texas Medical growth of its students and faculty through scholarly
Board. activity, including research. The school of acupuncture
(25) Misdemeanors involving moral shall include, but not be limited to, the following
turpitude--Any misdemeanor of which fraud, characteristics:
dishonesty, or deceit is an essential element; burglary; (A) the facilities for didactic and clinical
robbery; sexual offense; theft; child molesting; training (i.e., laboratories, hospitals, library, etc.) shall
substance diversion or substance abuse; an offense be adequate to ensure opportunity for proper education.
involving baseness, vileness, or depravity in the private (B) the admissions standards shall be
social duties one owes to others or to society in general; substantially equivalent to a Texas school of
or an offense committed with knowing disregard for acupuncture.
justice or honesty. (C) the basic curriculum shall include
(26) Party--The acupuncture board and each courses substantially equivalent to those delineated in
person named or admitted as a party in a SOAH hearing the Accreditation Commission for Acupuncture and
or contested case before the acupuncture board. Oriental Medicine (ACAOM) core curriculum at the
(27) Person--Any individual, partnership, time of applicant's graduation.
corporation, association, governmental subdivision, or (D) the curriculum shall be of at least
public or private organization of any character. 1800 hours in duration.
(28) Physician--A licensee of the medical
board. Source Note: The provisions of this §183.2 adopted to
(29) Pleading--Written documents filed by be effective May 16, 1994, 19 TexReg 3366; amended
parties concerning their respective claims. to be effective December 20, 1994, 19 TexReg 9598;
(30) Presiding officer--The member of the amended to be effective January 12, 1996, 21 TexReg
acupuncture board appointed by the governor to preside 108; amended to be effective October 22, 1996, 21
over acupuncture board proceedings or the presiding TexReg 9828; amended to be effective September 15,
officer's duly qualified successor in accordance with 1997, 22 TexReg 8998; amended to be effective May
Robert's Rules of Order Newly Revised or board rules. 10, 1998, 23 TexReg 4266; amended to be effective
(31) Register--The Texas Register. September 21, 2000, 25 TexReg 9217; amended to be
(32) Rule--Any agency statement of general effective May 6, 2001, 26 TexReg 3217; amended to be
applicability that implements, interprets, or prescribes effective January 6, 2002, 26 TexReg 10866; amended
law or policy, or describes the procedures or practice to be effective March 6, 2003, 28 TexReg 1883;
requirements of this board. The term includes the amended to be effective September 12, 2004, 29 TexReg
amendment or repeal of a prior section but does not 8511; amended to be effective January 9, 2005,
include statements concerning only the internal 29TexReg12188;amended to be effective May 1, 2006,
management or organization of any agency and not 31 TexReg 3534; amended to be effective January 4,
affecting private rights or procedures. This definition 2007, 31 TexReg 10799; amended to be effective May
includes substantive regulations. 6, 2009, 34 TexReg 2675
(33) Secretary--The secretary-treasurer of the
acupuncture board.
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of the board's offices or, at the discretion of the accredited by an agency recognized by the Higher
acupuncture board's presiding officer, in the meeting Education Coordinating Board or its equivalent in other
room after recess or adjournment; no interview may be states as a regional accrediting body. Coursework
conducted in the hallways of the board's offices; and the completed as a part of a degree program in acupuncture
acupuncture board's presiding officer may exclude from or Oriental medicine may be accepted by the
a meeting any person who, after being duly warned, acupuncture board if, in the opinion of the acupuncture
persists in conduct described in this subsection and board, such coursework is substantially equivalent to
subsection (h) of this section. the required hours of general academic college level
(j) The assistant presiding officer of the coursework;
acupuncture board shall assume the duties of the (4) is a graduate of an acceptable approved
presiding officer in the event of the presiding officer's acupuncture school;
absence or incapacity. (5) has taken and passed, within five attempts,
(k) In the absence or incapacity of both the each component of the full National Certification
presiding officer and the assistant presiding officer, the Commission for Acupuncture and Oriental Medicine
secretary-treasurer shall assume the duties of the (NCCAOM) examination. If an applicant submits to
presiding officer. multiple attempts on a component before and on or
(l) In the event of the absence or incapacity of the after June 1, 2004, the number of attempts shall be
presiding officer, the assistant presiding officer, and combined based on the subject matter tested;
secretary-treasurer, the members of the acupuncture (6) has taken and passed the CCAOM
board may elect another member to act as the presiding (Council of Colleges of Acupuncture and Oriental
officer of a board meeting or may elect an interim Medicine) Clean Needle Technique (CNT) course and
acting presiding officer for the duration of the absences practical examination;
or incapacity or until another presiding officer is (7) for applicants who apply for a license on
appointed by the governor. or after September 1, 2007, passes a jurisprudence
(m) Upon the death, resignation, or permanent examination ("JP exam"), which shall be conducted on
incapacity of the assistant presiding officer or the the licensing requirements and other laws, rules, or
secretary-treasurer, the acupuncture board shall elect regulations applicable to the acupuncture profession in
from its membership an officer to fill the vacant this state. The jurisprudence examination shall be
position. Such an election shall be conducted as soon as developed and administered as follows:
practicable at a regular or special meeting of the (A) Questions for the JP Exam shall be
acupuncture board. prepared by agency staff with input from the
Acupuncture board and the agency staff shall make
Source Note: The provisions of this §183.3 adopted to arrangements for a facility by which applicants can take
be effective May 16, 1994, 19 TexReg 3366; amended the examination.
to be effective December 20, 1994, 19 TexReg 9598; (B) Applicants must pass the JP exam
amended to be effective October 22, 1996, 21 TexReg with a score of 75 or better within three attempts.
9828; amended to be effective September 21, 2000, 25 (C) An examinee shall not be permitted
TexReg 9217; amended to be effective January 6, 2002, to bring medical books, compends, notes, medical
26 TexReg 10866; amended to be effective March 6, journals, calculators or other help into the examination
2003, 28 TexReg 1883; amended to be effective June room, nor be allowed to communicate by word or sign
29, 2003, 28 TexReg 4633; amended to be effective with another examinee while the examination is in
May 1, 2006, 31 TexReg 3534. progress without permission of the presiding examiner,
nor be allowed to leave the examination room except
§183.4. Licensure. when so permitted by the presiding examiner.
(a) Qualifications. An applicant must present (D) Irregularities during an examination
satisfactory proof to the acupuncture board that the such as giving or obtaining unauthorized information or
applicant: aid as evidenced by observation or subsequent
(1) is at least 21 years of age; statistical analysis of answer sheets, shall be sufficient
(2) is of good professional character as cause to terminate an applicant's participation in an
defined in §183.2 of this title (relating to Definitions); examination, invalidate the applicant's examination
(3) has successfully completed 60 semester results, or take other appropriate action.
hours of general academic college level courses, other (E) A person who has passed the JP
than in acupuncture school, that are not remedial and Exam shall not be required to retake the Exam for
would be acceptable at the time they were completed another or similar license, except as a specific
for credit on an academic degree at a two or four year requirement of the board.
institution of higher education within the United States
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(8) is able to communicate in English as board, are necessary to determine competency of the
demonstrated by one of the following: applicant;
(A) passage of the NCCAOM (G) must have the application for
examination taken in English; licensure completed and legible in every detail 60 days
(B) passage of the TOEFL (Test of prior to the acupuncture board meeting in which they
English as a Foreign Language) with a score of 550 or are to be considered for licensure unless otherwise
higher on the paper based test or with a score of 213 or determined by the acupuncture board based on good
higher on the computer based test; cause.
(C) passage of the TSE (Test of Spoken (2) Applicants for licensure who wish to
English) with a score of 45 or higher; request reasonable accommodation due to a disability
(D) passage of the TOEIC (Test of must submit the request at the time of filing the
English for International Communication) with a score application.
of 500 or higher; (3) Applicants who have been licensed in any
(E) graduation from an acceptable other state, province, or country shall complete a
approved school of acupuncture located in the United notarized oath or other verified sworn statement in
States or Canada; or regard to the following:
(F) at the discretion of the acupuncture (A) whether the license, certificate, or
board, passage of any other similar, validated exam authority has been the subject of proceedings against
testing English competency given by a testing service the applicant for the restriction for cause, cancellation
with results reported directly to the acupuncture board for cause, suspension for cause, or revocation of the
or with results otherwise subject to verification by license, certificate, or authority to practice in the state,
direct contact between the testing service and the province, or country, and if so, the status of such
acupuncture board. proceedings and any resulting action; and
(b) Procedural rules for licensure applicants. The (B) whether an investigation in regard to
following provisions shall apply to all licensure the applicant is pending in any jurisdiction or a
applicants. prosecution is pending against the applicant in any
(1) Applicants for licensure: state, federal, national, local, or provincial court for any
(A) whose documentation indicates any offense that under the laws of the state of Texas is a
name other than the name under which the applicant felony, and if so, the status of such prosecution or
has applied must furnish proof of the name change; investigation.
(B) whose application for licensure which (4) An applicant for a license to practice
has been filed with the board office and which is in acupuncture may not be required to appear before the
excess of one year old from the date of receipt shall be acupuncture board or any of its committees unless the
considered expired. Any fee previously submitted with application raises questions about the applicant's:
that application shall be forfeited. Any further (A) physical or mental impairment;
application procedure for licensure will require (B) criminal conviction; or
submission of a new application and inclusion of the (C) revocation of a professional license.
current licensure fee; (c) Licensure documentation.
(C) who in any way falsify the (1) Original documents/interview. Upon
application may be required to appear before the request, any applicant must appear for a personal
acupuncture board. It will be at the discretion of the interview at the board offices and present original
acupuncture board whether or not the applicant will be documents to a representative of the board for
issued a Texas acupuncture license; inspection. Original documents may include, but are not
(D) on whom adverse information is limited to, those listed in paragraph (2) of this
received by the acupuncture board may be required to subsection.
appear before the acupuncture board. It will be at the (2) Required documentation. Documentation
discretion of the acupuncture board whether or not the required of all applicants for licensure shall include the
applicant will be issued a Texas license; following:
(E) shall be required to comply with the (A) Birth certificate/proof of age. Each
acupuncture board's rules and regulations which are in applicant for licensure must provide a copy of either a
effect at the time the completed application form and birth certificate and translation, if necessary, to prove
fee are filed with the board; that the applicant is at least 21 years of age. In instances
(F) may be required to sit for additional where a birth certificate is not available, the applicant
oral, written, or practical examinations or must provide copies of a passport or other suitable
demonstrations that, in the opinion of the acupuncture alternate documentation.
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(B) Name change. Any applicant who (I) Fingerprint card. Each applicant must
submits documentation showing a name other than the submit his or her fingerprints according to the
name under which the applicant has applied must procedure prescribed by the board.
present copies of marriage licenses, divorce decrees, or (J) Other verification. For good cause
court orders stating the name change. In cases where shown, with the approval of the acupuncture board,
the applicant's name has been changed by naturalization verification of any information required by this
the applicant must submit the original naturalization subsection may be made by a means not otherwise
certificate by hand delivery or by certified mail to the provided for in this subsection.
board office for inspection. (3) Additional documentation. Applicants
(C) Examination scores. Each applicant may be required to submit other documentation,
for licensure must have a certified transcript of grades including but not limited to the following:
submitted directly from the appropriate testing service (A) Translations. An accurate certified
to the acupuncture board for all examinations used in translation of any document that is in a language other
Texas for purposes of licensure in Texas. than the English language along with the original
(D) Dean's certification. Each applicant document or a certified copy of the original document
for licensure must have a certificate of graduation which has been translated.
submitted directly from the school of acupuncture on a (B) Arrest Records. If an applicant has
form provided by the acupuncture board. The applicant ever been arrested, a copy of the arrest and arrest
shall attach to the form a recent photograph, meeting disposition from the arresting authority and submitted
United States Government passport standards, before by that authority directly to the acupuncture board.
submitting it to the school of acupuncture. The school (C) Malpractice. If an applicant has ever
shall have the Dean or the designated appointee sign the been named in a malpractice claim filed with any
form attesting to the information on the form and liability carrier or if an applicant has ever been named
placing the school seal over the photograph. in a malpractice suit, the applicant shall submit the
(E) Diploma or certificate. All applicants following:
for licensure must submit a copy of their diploma or (i) a completed liability carrier form
certificate of graduation. furnished by the acupuncture board regarding each
(F) Evaluations. All applicants must claim filed against the applicant's insurance;
provide, on a form furnished by the acupuncture board, (ii) for each claim that becomes a
evaluations of their professional affiliations for the past malpractice suit, a letter from the attorney representing
ten years or since graduation from acupuncture school, the applicant directly to this board explaining the
whichever is the shorter period. allegation, dates of the allegation, and current status of
(G) Preacupuncture school transcript. the suit. If the suit has been closed, the attorney must
Each applicant must have the appropriate school or state the disposition of the suit, and if any money was
schools submit a copy of the record of their paid, the amount of the settlement, unless release of
undergraduate education directly to the acupuncture such information is prohibited by law or an order of a
board. Transcripts must show courses taken and grades court with competent jurisdiction. If such letter is not
obtained. If determined that the documentation available, the applicant will be required to furnish a
submitted by the applicant is not sufficient to show notarized affidavit explaining why this letter cannot be
proof of the completion of 60 semester hours of college provided; and
courses other than in acupuncture school, the applicant (iii) a statement, composed by the
must obtain coursework verification by submitting applicant, explaining the circumstances pertaining to
documentation to the acupuncture board for a patient care in defense of the allegations.
determination as to the adequacy of such education or (D) Inpatient treatment for
to a two or four year institution of higher education alcohol/substance abuse or mental illness. Each
within the United States. The institution must be applicant that has been admitted to an inpatient facility
preapproved by the board's executive director and within the last five years for the treatment of
accredited by an agency recognized as a regional alcohol/substance abuse or mental illness must submit
accrediting body by the Texas Higher Education the following:
Coordinating Board or its equivalent in another state. (i) an applicant's statement
(H) School of acupuncture transcript. explaining the circumstances of the hospitalization;
Each applicant must have his or her acupuncture school
submit a transcript of courses taken and grades obtained (ii) an admitting summary and
directly to the acupuncture board. Transcripts must discharge summary, submitted directly from the
clearly demonstrate completion of 1,800 instructional inpatient facility;
hours, with at least 450 hours of herbal studies.
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(iii) a statement from the applicant's temporary license may be subject to restrictions at the
treating physician/psychotherapist as to diagnosis, discretion of the executive director and shall not be
prognosis, medications prescribed, and follow-up deemed dispositive in regard to the decision by the
treatment recommended; and acupuncture board to grant or deny an application for a
(iv) a copy of any contracts or permanent license.
agreements signed with any licensing authority. (e) Distinguished professor temporary license.
(E) Outpatient treatment for (1) Issuance. The acupuncture board may
alcohol/substance abuse or mental illness. Each issue a distinguished professor temporary license to an
applicant that has been treated on an outpatient basis acupuncturist who:
within the last five years for alcohol/substance abuse or (A) holds a substantially equivalent
mental illness must submit the following: license, certificate, or authority to practice acupuncture
(i) an applicant's statement in another state, province, or country;
explaining th (B) agrees to and limits any acupuncture
practice in this state to acupuncture practice for
e circumstances of the outpatient treatment; demonstration or teaching purposes for acupuncture
(ii) a statement from the applicant's students and/or instructors, and in direct affiliation with
treating physician/psychotherapist as to diagnosis, an acupuncture school that is a candidate for
prognosis, medications prescribed, and follow-up accreditation or has accreditation through the
treatment recommended; and Accreditation Commission for Acupuncture and
(iii) a copy of any contracts or Oriental Medicine (ACAOM) at which the students are
agreements signed with any licensing authority. trained and/or the instructors teach;
(F) Additional documentation. Additional (C) agrees to and limits practice to
documentation as is deemed necessary to facilitate the demonstrations or instruction under the direct
investigation of any application for licensure. supervision of a licensed Texas acupuncturist who
(G) DD214. A copy of the DD214 holds an unrestricted license to practice acupuncture in
indicating separation from any branch of the United this state;
States military. (D) pays any required fees for issuance or
(H) Other verification. For good cause renewal of the distinguished professor temporary
shown, with the approval of the acupuncture board, license; and
verification of any information required by this (E) passes the JP Exam, as provided in
subsection may be made by a means not otherwise subsection (a)(7) of this section.
provided for in this subsection. (2) Duration. The distinguished professor
(I) False documentation. Falsification of temporary license shall be valid for a continuous one-
any affidavit or submission of false information to year period; however, the permit is revocable at any
obtain a license may subject an acupuncturist to denial time the board deems necessary. The distinguished
of a license or to discipline pursuant to the Act, professor temporary license shall automatically expire
§205.351. one year after the date of issuance. The distinguished
(4) Substitute documents/proof. The professor temporary license may not be renewed or
acupuncture board may, at its discretion, allow reissued.
substitute documents where proof of exhaustive efforts (3) Disciplinary action. A distinguished
on the applicant's part to secure the required documents professor temporary license or renewal may be denied,
is presented. These exceptions are reviewed by the terminated, canceled, suspended, or revoked for any
acupuncture board, a board committee, or the board's violation of acupuncture board rules or the Act,
executive director on an individual case-by-case basis. Subchapter H.
(d) Temporary license. (f) Relicensure. If an acupuncturist's license has
(1) Issuance. The acupuncture board may, been expired for one year, it is considered to have been
through the executive director of the agency, issue a canceled, and the acupuncturist may not renew the
temporary license to a licensure applicant who appears license. The acupuncturist may submit an application
to meet all the qualifications for an acupuncture license for relicensure and must comply with the requirements
under the Act, but is waiting for the next scheduled and procedures for obtaining an original license.
meeting of the acupuncture board for review and for the
license to be issued. Source Note: The provisions of this §183.4 adopted to
(2) Duration/renewal. A temporary license be effective May 5, 1997, 22 TexReg 3651; amended to
shall be valid for 100 days from the date issued and be effective May 10, 1998, 23 TexReg 4266; amended
may be extended only for another 30 days after the date to be effective March 5, 2000, 25 TexReg 1625;
the initial temporary license expires. Issuance of a amended to be effective September 21, 2000, 25 TexReg
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shall include a narrative statement describing the time, (5) Penalty. Failure by a licensed insurer to
date, and place of the acts or omissions on which the report under this section shall be referred to the State
report is based. Board of Insurance. Sanctions under the Insurance
(2) A report that an acupuncturist's practice Code, Article 1.10, section 7, may be imposed for
constitutes a continuing threat to the public welfare failure to report.
shall be made to the acupuncture board as soon as (6) Definition. For the purposes of this
possible after the peer review committee, licensed subsection a professional liability claim or complaint
acupuncturist or acupuncture student involved reaches shall be defined as a cause of action against an
that conclusion and is able to assemble the relevant acupuncturist for treatment, lack of treatment, or other
information. claimed departure from accepted standards of health
(f) Reporting Professional Liability Claims. care or safety which proximately results in injury to or
(1) Reporting responsibilities. The reporting death of the patient, whether the patient's claim or cause
form must be completed and forwarded to the of action sounds in tort or contract.
acupuncture board for each defendant acupuncturist (7) Claims not required to be reported.
against whom a professional liability claim or Examples of claims that are not required to be reported
complaint has been filed. The information is to be under this chapter but which may be reported include,
reported by insurers or other entities providing but are not limited to, the following:
professional liability insurance for an acupuncturist. If a (A) product liability claims (i.e. where an
nonadmitted insurance carrier does not report or if the acupuncturist invented a device which may have
acupuncturist has no insurance carrier, reporting shall injured a patient but the acupuncturist has had no
be the responsibility of the acupuncturist. personal acupuncturist-patient relationship with the
(2) Separate reports required and identifying specific patient claiming injury by the device);
information. One separate report shall be filed for each (B) antitrust allegations;
defendant acupuncturist insured. When Part II is filed, it (C) allegations involving improper peer
shall be accompanied by the completed Part I or other review activities;
identifying information as described in paragraph (D) civil rights violations; or
(4)(A) of this subsection. (E) allegations of liability for injuries
(3) Timeframes and attachments. The occurring on an acupuncturist's property, but not
information in Part I of the form must be provided involving a breach of duty to the patient (i.e. slip and
within 30 days of receipt of the claim or suit. A copy of fall accidents).
the claim letter or petition must be attached. The (8) Claims that are not required to be reported
information in Part II must be reported within 105 days under this chapter may, however, be voluntarily
after disposition of the claim. Disposed claims shall be reported.
defined as those claims where a court order has been (9) The reporting form shall be as follows:
entered, a settlement agreement has been reached, or
the complaint has been dropped or dismissed.
(4) Alternate reporting formats. The
information may be reported either on the form
provided or in any other legible format which contains
at least the requested data.
(A) If the reporter elects to use a reporting
format other than the acupuncture board's form for data
required in Part II, there must be enough identification
data available to board staff to match the closure report
to the original file. The data required to accomplish this
include:
(i) name and license number of
defendant acupuncturist(s); and
(ii) name of plaintiff.
(B) A court order or settlement agreement
is an acceptable alternative submission for Part II. An
order or settlement agreement should contain the
necessary information to match the closure information
to the original file. If the order or agreement is lacking
some of the required data, the additional information
may be legibly written on the order or agreement.
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TEXAS STATE BOARD OF ACUPUNCTURE EXAMINERS
PART I COMPLETE FOR ALL CLAIMS OR COMPLAINTS AND FILE WITH THE TEXAS STATE BOARD
OF ACUPUNCTURE EXAMINERS WITHIN 30 DAYS FROM RECEIPT OF COMPLAINT OR CLAIM.
INCLUDE COPY OF CLAIM LETTER AND/OR PLAINTIFF'S COMPLAINT.
________________________________________________
________________________________________________
2. Defendant acupuncturist:
________________________________________________
License number:_________________
3. Plaintiff's name:
____________________________________________
4. Policy number:
____________________________________________
__________________
____________________________________________
(If this is not determined within 30 days, report this data within 105 days of filing the Part I report with T.S.B.A.E.)
__________________________________ ___________________
Person completing this report Phone number
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PART II COMPLETE AFTER DISPOSITION OF THE CLAIM AS DEFINED IN 22 T.A.C., INCLUDING
DISMISSALS OR SETTLEMENTS. FILE WITH T.S.B.A.E. WITHIN 105 DAYS AFTER DISPOSITION OF
THE CLAIM. A COPY OF COURT ORDER OR SETTLEMENT AGREEMENT MAY BE USED AS
PROVIDED IN 22 T.A.C.
8. Date of disposition:________________
9. Type of Disposition:
____________________________________________________________
$ _______________________. Note: If percentage of fault was not determined by the court or insurer in the case of
multiple defendants, the insurer may report the total amount paid for the claim followed by a slash and the number
of insured defendants. (Example: $100,000/3)
_____________________________________________________________
_______________________________ ________________________
Person completing this report Phone number
Source Note: The provisions of this §183.8 adopted to Acupuncturists or the Texas Association of
be effective March 6, 2003, 28 TexReg 1883. Acupuncture and Oriental Medicine stating that the
representative is willing to testify before the board that
§183.9. Impaired Acupuncturists. a certain licensee or applicant is impaired;
(a) Mental or physical examination requirement. (C) evidence that a licensee or applicant
(1) The board may require a licensee or left a treatment program for alcohol or chemical
applicant to submit to a mental and/or physical dependency before completion of that program;
examination by a physician or physicians designated by (D) evidence that a licensee or applicant is
the board if the board has probable cause to believe that guilty of intemperate use of drugs or alcohol;
the licensee or applicant is impaired. Impairment is (E) evidence of repeated arrests of a
present if one appears to be unable to practice with licensee or applicant for intoxication;
reasonable skill and safety to patients by reason of age, (F) evidence of recurring temporary
illness, drunkenness, excessive use of drugs, narcotics, commitments of a licensee or applicant to a mental
chemicals, or any other type of material; or as a result institution; or
of any mental or physical condition. (G) medical records indicating that a
(2) Probable cause may include, but is not licensee or applicant has an illness or condition which
limited to, any one of the following: results in the inability to function properly in his or her
(A) sworn statements from two people, practice.
willing to testify before the acupuncture board, or the (b) Rehabilitation Order. The board through an
State Office of Administrative Hearings that a certain agreed order or after a contested proceeding, may
licensee or applicant is impaired; impose a nondisciplinary rehabilitation order on any
(B) a sworn statement from an official licensee, or as a prerequisite for licensure, on any
representative of the Texas Association of licensure applicant. Chapter 180 of this title (relating to
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Rehabilitation Orders) shall govern procedures relating the licensee is unable to determine that the evaluation
to acupuncturists who are found eligible for a took place, a written statement signed by the patient
rehabilitation order. If the provisions of Chapter 180 stating that the patient has been evaluated by a
conflict with the Act or rules under this chapter, the Act physician within the required time frame on a copy of
and provisions of this chapter shall control. the following form:
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Form to be Completed by Patient, Notifying the Acupuncturist of Whether He/She
Has Been Evaluated by a Physician, and Other Information.
(Pursuant to the requirements of 22 TAC §183.7 of the Texas State Board of Acupuncture Examiners’ rules (relating
to Scope of Practice and Tex. Occ. Code Ann., §205.351, governing the practice of acupuncture.)
___ Yes ___ No I have been evaluated by a physician or dentist for the condition being treated within 12 months
before the acupuncture was performed. I recognize that I should be evaluated by a physician or dentist for the
condition being treated by the acupuncturist.
___ Yes ___ No I have received a referral from my chiropractor within the last 30 days for acupuncture.
After being referred by a chiropractor, if after two months or 20 treatments, whichever comes first, no substantial
improvement occurs in the condition being treated, I understand that the acupuncturist is required to refer me to a
physician. It is my responsibility and choice whether to follow this advice.
(Pursuant to the requirement of 22 TAC §183.7 of the Texas State Board of Acupuncture Examiners’ rules (relating
to Scope of Practice) and Tex. Occ. Code Ann. §205.351, governing the practice of acupuncture.)
The acupuncturist has referred me to see a physician. It is my responsibility and choice whether to follow his or her
advice.
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§183.11. Complaint Procedure Notification. 3, Subtitle C, Chapter 205, may practice as an acudetox
Pursuant to §205.152 of the Act, Chapter 188 of this specialist for the sole purpose of the treatment of
title (relating to Complaint Procedure Notification) alcoholism, substance abuse, or chemical dependency
shall govern acupuncturists with regard to methods of upon obtaining certification as an acudetox specialist
notification for filing complaints with the agency. If the only under the following conditions listed in paragraphs
provisions of Chapter 188 conflict with the Act or rules (1) - (4) of this subsection:
under this chapter, the Act and provisions of this (1) after issuance of certification by the
chapter shall control. Medical Board, payment of any required fee and receipt
of written confirmation of certification from the
Source Note: The provisions of this §183.11 adopted to Medical Board;
be effective March 6, 2003, 28 TexReg 1883. (2) after successful completion of a training
program in acupuncture for the treatment of alcoholism,
§183.12. Medical Board Review and Approval. substance abuse, or chemical dependency, which has
(a) Pursuant to §205.202 of the Act, the been approved by the Medical Board with advice from
acupuncture board shall issue a license to practice the acupuncture board. Such program in auricular
acupuncture in this state to a person who meets the acupuncture shall be 70 hours in length, and shall
requirements of the Act and the rules adopted pursuant include a clean needle technique course or equivalent
to the Act without approval of the Medical Board . universal infection control precaution procedures
(b) Pursuant to §205.352 of the Act, the course approved by the Medical Board;
acupuncture board shall take disciplinary action against (3) if the individual holds an unrestricted and
a license holder without approval of the Medical Board. current license, registration, or certification issued by
(c) Pursuant to §205.101(b) of the Act, a rule the appropriate Texas regulatory agency authorizing
adopted by the acupuncture board is subject to Medical practice as a social worker, a licensed professional
board approval , which shall be memorialized in the counselor, a licensed psychologist, a licensed chemical
minutes of the medical board, the minutes of a dependency counselor, a licensed vocational nurse, or a
committee of the medical board, or in a writing signed licensed registered nurse; provided, however, that such
by the medical board's presiding officer, secretary- practice of acudetox is not prohibited by the regulatory
treasurer, or authorized committee chairman after agency authorizing such practice as a social worker,
consideration of the recommendations of the professional counselor, psychologist, chemical
acupuncture board. dependency counselor, licensed vocational nurse, or
registered nurse; and,
Source Note: The provisions of this §183.12 adopted to (4) if the individual works under protocol and
be effective March 6, 2003, 28 TexReg 1883; amended has access to a licensed Texas physician or a licensed
to be effective May 1, 2006, 31 TexReg 3534. Texas acupuncturist readily available by telephonic
means or other methods of communication.
§183.13. Construction. (c) For purposes of this chapter, auricular
The provisions of this chapter shall be construed and acupuncture shall be defined as acupuncture treatment
interpreted so as to be consistent with the statutory limited to the insertion of needles into five acupuncture
provisions of the Act. In the event of a conflict between points in the ear. These points being the liver, kidney,
this chapter and the provisions of the Act, the lung, sympathetic and shen men.
provisions of the Act shall control; however, this (d) Certification as an acudetox specialist shall be
chapter shall be construed so that all other provisions of subject to suspension, revocation, or cancellation on
this chapter which are not in conflict with the Act shall any grounds substantially similar to those set forth in
remain in effect. the Act, §205.351 or for practicing acupuncture in
Source Note: The provisions of this §183.13 adopted to violation of this chapter.
be effective March 6, 2003, 28 TexReg 1883. (e) Practitioners certified as acudetox specialists
shall keep records of patient care which at a minimum
§183.14. Acudetox Specialist. shall include the dates of treatment, the purpose for the
(a) For purposes of this chapter, an "acudetox treatment, the name of the patient, the points used, and
specialist" shall be defined as a person who is certified the name, signature, and title of the certificate-holder.
to practice auricular acupuncture for the limited (f) The fee for certification as an acudetox
purpose of treating alcoholism, substance abuse, and specialist for the treatment of alcoholism, substance
chemical dependency. abuse, or chemical dependency shall be set in such an
(b) Any person who does not possess a Texas amount as to cover the reasonable cost of administering
acupuncture license or is not otherwise authorized to and enforcing this chapter without recourse to any other
practice acupuncture under Tex. Occ. Code Ann. Title funds generated by the Medical or the Acupuncture
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Board. Such fee shall be $50 for the initial application name.
for certification and $25 per renewal. (b) If a licensee uses any additional title or
(g) Certificate-holders under this chapter shall keep designation, it shall be the responsibility of the licensee
a current mailing and practice address on file with the to comply with the provisions of the Healing Art
Medical Board and shall notify the Medical Board in Identification Act, Tex. Occ. Code Ann., Chapter 104.
writing of any address change within ten days of the
change of address. Source Note: The provisions of this §183.15 adopted to
(h) Individuals practicing as an acudetox specialist be effective March 6, 2003, 28 TexReg 1883; amended
under the provisions of this chapter shall ensure that to be effective May 2, 2004, 29 TexReg 3962; amended
any patient receiving such treatment is notified in to be effective January 4, 2007, 31 TexReg 10799
writing of the qualifications of the individual providing
the acudetox treatment and the process for filing §183.16. Texas Acupuncture Schools.
complaints with the Medical Board, and shall ensure (a) A licensed Texas acupuncturist operating an
that a copy of the notification is retained in the patient's acupuncture school in Texas which has not yet been
record. accredited by the Accreditation Commission for
(i) Applications for certification as an acudetox Acupuncture and Oriental Medicine (ACAOM) or
specialist shall be submitted in writing on a form reached candidate status for accreditation by ACAOM,
approved by the Medical Board which contains the a licensed Texas acupuncturist with any ownership
information set forth in subsection (b) of this section interest in such a school, or a licensed Texas
and any supporting documentation necessary to confirm acupuncturist who teaches in or operates such a school,
such information. shall ensure that students of the school and applicants to
(j) Each individual who is certified as an acudetox the school are made aware of the provisions of the
specialist may annually renew certification by Medical Practice Act governing acupuncture practice,
completing and submitting to the Medical Board an the rules and regulations adopted by the Texas State
approved renewal form together with the following as Board of Acupuncture Examiners, and the educational
listed in paragraphs (1)-(3) of this subsection: requirements for obtaining a Texas acupuncture license
(1) documentation that the certification or to include the rules and regulations establishing the
license as required by subsection (b)(3) of this section criteria for an approved acupuncture school for
is still valid; purposes of licensure as an acupuncturist by the Texas
(2) proof of any Continuing Auricular State Board of Acupuncture Examiners as set forth in
Acupuncture Education (CAAE) obtained as provided subsection (b) of this section.
for in §183.21 of this title (relating to Continuing (b) Compliance with the provisions of subsection
Auricular Acupuncture Education for Acudetox (a) of this section shall be accomplished by providing
Specialists); and, students and applicants with a copy of Subchapter H of
(3) payment of a certification renewal fee in the Act, a copy of Chapter 183 (Acupuncture)
the amount of $25. contained in the Rules of the Texas Medical Board, and
(k) Each individual who obtains certification as an the following typed statement:
acudetox specialist under this section may only use the
titles "Certified Acudetox Specialist" or "C.A.S." to
denote his or her specialized training.
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ACUPUNCTURE TRAINING ADVISORY STATEMENT
You are advised that the practice of acupuncture in Texas requires licensure by the Texas State Board of
Acupuncture Examiners and is governed by Chapter 205 of the Texas Occupations Code and the rules of the Texas
Medical Board, 22 TAC §183.1 et. seq.
You are further advised that for an acupuncture school located in the United States or Canada to be considered to be
an approved acupuncture school by the Texas State Board of Acupuncture Examiners for purposes of meeting the
educational requirements for obtaining an acupuncture license, the school must comply and must meet the
requirements set forth below:
Acceptable approved acupuncture school - Effective January 1, 1996, and in addition to and consistent with the
requirements of §205.206 of the Tex. Occ. Code and with the exception of the provisions outlined in §183.4(h) of
this title (relating to Exceptions),
(A) a school of acupuncture located in the United States or Canada which, at the time of the applicant’s graduation,
was a candidate for accreditation by the Accreditation Commission for Acupuncture and Oriental Medicine
(ACAOM), offered no more than a certificate upon graduation, and had a curriculum of 1,800 hours with at least
450 hours of herbal studies which at a minimum included the following:
(B) a school of acupuncture located in the United States or Canada which, at the time of the applicant’s graduation,
was accredited by ACAOM, offered a masters degree or a professional certificate or diploma upon graduation, and
had a curriculum of 1,800 hours with at least 450 hours of herbal studies which at a minimum included the
following:
(C) a school of acupuncture located outside the United States or Canada that is determined by the board to be
substantially equivalent to a Texas acupuncture school or a school defined in subparagraph (B) of this paragraph
through an evaluation by the American Association of Collegiate Registrars and Admissions Officers (AACRAO).
You are additionally advised that _______________________ (name of institution) is not currently a candidate for
accreditation by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) and is not
currently accredited by ACAOM. If such candidate status or accreditation is not obtained by this institution by the
time of your graduation, under the current rules of the Texas State Board of Acupuncture Examiners you will not be
eligible for a Texas acupuncture license based on training received at this institution.
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(6) failure to provide show compliance any such print medium reflects the current Texas
proceeding information in the prescribed time shall be acupuncture license number of the acupuncturist.
grounds for imposition of an administrative penalty of (b) Exceptions. The following forms of advertising
no less than $100 and no more than $5,000 for each shall be exempt from the provisions of subsection (a) of
separate violation; and this section:
(7) for any other violation other than quality of (1) business cards;
care that the board deems appropriate shall be grounds (2) office, clinic, or facility signs at the office,
for imposition of an administrative penalty of no less clinic, or facility location;
than $100 and no more than $5,000 for each separate (3) single line telephone listings; and,
violation. (4) billboard advertising.
(g) In the case of untimely compliance with a board (c) Misleading or deceptive advertising.
order, the board staff shall not be authorized to impose Acupuncturists shall not authorize or use false,
an administrative penalty without an informal show misleading, or deceptive advertising, and, in addition,
compliance proceeding if the person licensed or shall not engage in any of the following:
regulated under the Act has not first been brought into (1) hold themselves out as a physician or
compliance with the terms, conditions, and surgeon or any combination or derivative of those terms
requirements of the order other than the time factors unless also licensed by the medical board as a physician
involved. or surgeon as defined under the Medical Practice Act,
(h) Any order proposed under this section shall be Tex. Occ. Code Ann. §151.002(a)(13) (relating to
subject to final approval by the board. Definitions);
(i) Failure to pay an administrative penalty (2) use the terms "board certified" unless the
imposed through an order shall be grounds for advertising also discloses the complete name of the
disciplinary action by the board pursuant to the Act, board which conferred the referenced certification; or,
§205.351(a)(10), regarding unprofessional or (3) use the terms "board certified" or any
dishonorable conduct likely to deceive or defraud, or similar words or phrases calculated to convey the same
injure the public, and shall also be grounds for the meaning if the advertised board certification has
executive director to refer the matter to the attorney expired and has not been renewed at the time the
general for collection of the amount of the penalty. advertising in question was published, broadcast, or
(j) A person who becomes financially unable to otherwise promulgated.
pay an administrative penalty after entry of an order
imposing such a penalty, upon a showing of good cause Source Note: The provisions of this §183.19 adopted to
by a writing executed by the person under oath and at be effective September 21, 2000, 25 TexReg 9217;
the discretion of the Discipline and Ethics Committee amended to be effective January 6, 2002, 26 TexReg
of the board, may be granted an extension of time or 10866.
deferral of no more than one year from the date the
administrative penalty is due. Upon the conclusion of §183.20. Continuing Acupuncture Education.
any such extension of time or deferral, if payment has (a) Purpose. This section is promulgated to
not been made in the manner and in the amount promote the health, safety, and welfare of the people of
required, action authorized by the terms of the order or Texas through the establishment of minimum
subsection (i) of this section. requirements for continuing acupuncture education
(CAE) for licensed Texas acupuncturists so as to further
Source Note: The provisions of this §183.18 adopted to enhance their professional skills and knowledge.
be effective March 6, 2003, 28 TexReg 1883. (b) Minimum Continuing Acupuncture Education.
As a prerequisite to the annual registration of the
§183.19. Acupuncture Advertising. license of an acupuncturist, the acupuncturist shall
(a) License number on print advertising. Except as complete 17 hours of continuing acupuncture education
provided for in subsection (b) of this section, all written (CAE) each year.
advertising communicated by any means or medium (1) The required hours shall be from courses
which is authorized, procured, promulgated, or used by that:
any acupuncturist shall reflect the current Texas (A) are designated or otherwise approved
acupuncture license number of the acupuncturist who for credit by the Texas State Board of Acupuncture
authorized, procured, promulgated, or used the Examiners at the time the courses were taken based on
advertisement and/or is the subject of the advertising. In a review and recommendation of the course content by
the event that more than one acupuncturist authorizes, the Education Committee of the board as described in
procures, promulgates, uses, and/or is the subject of the subsection (n) of this section;
advertising, each such acupuncturist shall ensure that (B) are offered by approved providers; or
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(C) have been approved for CAE credit days of the date of the request. Failure to timely provide
for a minimum of three years by another state the requested verification may result in disciplinary
acupuncture board having first gone through a formal action by the board.
approval process. (h) Nonrenewal for Insufficient Continuing
(2) At least eight hours shall be in general Acupuncture Education. Unless exempted under the
acupuncture in order to ensure that a licensee's CAE is terms of this section, the apparent failure of an
comprehensive and that the licensee's overall acupuncturist to obtain and timely report the 17 hours
acupuncture knowledge, skills, and competence are of continuing education hours as required and provided
enhanced. for in this section shall result in nonrenewal of the
(3) At least one of the required hours shall be license until such time as the acupuncturist obtains and
from a course in ethics. reports the required hours; however, the executive
(4) At least two of the required hours shall be director of the board may issue to such an acupuncturist
in herbology. More than two hours shall be expected of a temporary license numbered so as to correspond to
a licensee whose primary practice includes the nonrenewed license. Such a temporary license
prescriptions of herbs. issued pursuant to this subsection may be issued to
(5) Effective for licensees applying for allow the board to verify the accuracy of information
renewal of their licensees on or after November 30, related to the continuing acupuncture education hours
2010, at least one hour of biomedicine. of the acupuncturist and to allow the acupuncturist who
(6) No more than two of the required hours has not obtained or timely reported the required number
may be from courses that primarily relate to practice of hours an opportunity to correct any deficiency so as
enhancement or business or office administration. not to require termination of ongoing patient care.
(7) Courses may be taught through live (i) Fee for Issuance of Temporary License. The fee
lecture, distance learning, or the Internet. for issuance of a temporary license pursuant to the
(c) Reporting Continuing Acupuncture Education. provisions of this section shall be in the amount
An acupuncturist must report on the licensee's annual specified under §175.1 of this title (relating to
registration form whether the licensee has completed Application Fees); however, the fee need not be paid
the required acupuncture education during the previous prior to the issuance of the temporary license, but shall
year. be paid prior to the renewal of a permanent license.
(d) Grounds for Exemption from Continuing (j) Application of Additional Hours. Continuing
Acupuncture Education. An acupuncturist may request acupuncture education hours that are obtained to
in writing and may be exempt from the annual comply with the requirements for the preceding year as
minimum continuing acupuncture education a prerequisite for licensure renewal, shall first be
requirements for one or more of the following reasons: credited to meet the requirements for that previous year.
(1) catastrophic illness; Once the requirements of the previous year are
(2) military service of longer than one year in satisfied, any additional hours obtained shall be credited
duration; to meet the continuing acupuncture education
(3) acupuncture practice and residence of requirements of the current year. A licensee may carry
longer than one year in duration outside the United forward CAE hours earned prior to an annual
States; and/or registration report which are in excess of the 17-hour
(4) good cause shown on written application annual requirement and such excess hours may be
of the licensee which gives satisfactory evidence to the applied to the following years' requirements. A
board that the licensee is unable to comply with the maximum of 34 total excess hours may be carried
requirements of continuing acupuncture education. forward. Excess CAE hours may not be carried forward
(e) Exemption Requests. Exemption requests shall or applied to an annual report of CAE more than two
be subject to the approval of the executive director of years beyond the date of the annual registration
the board, and shall be submitted in writing at least 30 following the period during which the hours were
days prior to the expiration of the license. earned.
(f) Exemption Duration and Renewal. An (k) False Reports/Statements. An intentionally
exemption granted under subsections (d) and (e) of this false report or statement to the board by a licensee
section may not exceed one year, but may be renewed regarding continuing acupuncture education hours
annually upon written request submitted at least 30 days reportedly obtained shall be a basis for disciplinary
prior to the expiration of the current exemption. action by the board pursuant to the Act, §205.351(a)(2)
(g) Verification of Credits. The board may require and (6).
written verification of continuing acupuncture (l) Monetary Penalty. Failure to obtain and timely
education hours from any licensee and the licensee shall report the continuing acupuncture education hours for
provide the requested verification within 30 calendar renewal of a license shall subject the licensee to a
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monetary penalty for late registration in the amount set and to verify compliance with the requirements set forth
forth in §175.2 and §175.3 of this title (relating to in subsection (n) of this section. At the discretion of the
Registration and Renewal Fees and Penalties). board or the Education Committee, inspection of
(m) Disciplinary Action, Conditional Licensure, original supporting documents may be required for a
and Construction. This section shall be construed to determination on an approval request. The Acupuncture
allow the board to impose requirements for completion Board shall have the authority to conduct random and
of additional continuing acupuncture education hours periodic checks of courses, programs, or activities to
for purposes of disciplinary action and conditional ensure that criteria for education approval as set forth in
licensure. subsection (n) of this section have been met and
(n) Required Content for Continuing Acupuncture continue to be met by the education provider. Upon
Education Courses. Continuing Acupuncture Education requesting approval of a course, program, or activity,
courses must meet the following requirements: the education provider shall agree to such checks by the
(1) the content of the course, program, or Acupuncture Board or its designees, and shall further
activity is related to the practice of acupuncture or agree to provide supplemental information, documents,
oriental medicine, and shall: and material describing the course, program, or activity
(A) be related to the knowledge and/or which, in the discretion of the Acupuncture Board, may
technical skills required to practice acupuncture; or be needed for approval or continued approval of the
(B) be related to direct and/or indirect course, program, or activity. Failure of an education
patient care. provider to provide the necessary information,
(2) the method of instruction is adequate to documents, and materials to show compliance with the
teach the content of the course, program, or activity; standards set forth in subsection (n) of this section shall
(3) the credentials of the instructor(s) indicate be grounds for denial of CAE approval or recision of
competency and sufficient training, education, and prior approval in regard to the course, program, or
experience to teach the specific course, program, or activity.
activity; (p) Reconsideration of Denials of Approval
(4) the education provider maintains an Requests. Determinations to deny approval of a CAE
accurate attendance/participation record on individuals course, program, or activity may be reconsidered by the
completing the course, program, or activity; Education Committee or the board based on additional
(5) each credit hour for the course, program, information concerning the course, program, or activity,
or activity is equal to no less than 50 minutes of actual or upon a showing of good cause for reconsideration. A
instruction or training; decision to reconsider a denial determination shall be a
(6) the course, program, or activity is discretionary decision based on consideration of the
provided by a knowledgeable health care provider or additional information or the good cause showing.
reputable school, state, or professional organization; Requests for reconsideration shall be made in writing
(7) the course description provides adequate by the education provider, and may be made orally or in
information so that each participant understands the writing by board staff or a committee of the board.
basis for the program and the goals and objectives to be (q) Reconsideration of Approvals. Determinations
met; and, to approve a CAE course, program, or activity may be
(8) the education provider obtains written reconsidered by the Education Committee or the board
evaluations at the end of each program, collate the based on additional information concerning the course,
evaluations in a statistical summary, and makes the program, or activity, or upon a showing of good cause.
summary available to the board upon request. A decision to reconsider an approval determination
(o) Continuing Acupuncture Education Approval shall be a discretionary decision based on consideration
Requests. All requests for approval of courses, of the additional information or the good cause
programs, or activities for purposes of satisfying CAE showing. Requests for reconsideration may be made in
credit requirements shall be submitted in writing to the writing by a member of the public or may be made
Education Committee of the board on a form approved orally or in writing by board staff or a committee of the
by the board, along with any required fee, and board.
accompanied by information, documents, and materials (r) Criteria for Provider Approval.
accurately describing the course, program, or activity, (1) In order to be an approved provider, a
and necessary for verifying compliance with the provider shall submit to the board a provider
requirements set forth in subsection (n) of this section. application on a form approved by the board, along
At the discretion of the board or the Education with any required fee. All provider applications and
Committee, supplemental information, documents, and documentation submitted to the board shall be
materials may be requested as needed to obtain an typewritten and in English.
adequate description of the course, program, or activity
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(2) To become an approved provider, a who has completed the course, a certificate of
provider shall submit to the board evidence that the completion that contains the following information:
provider has three continuous years of previous (A) Provider's name and number.
experience providing CAE courses in Texas that were (B) Course title.
approved by the board. In addition the provider must (C) Participant's name and, if applicable,
have no history of complaints or reprimands with the his or her acupuncture license number.
board. (D) Date and location of course.
(3) The approval of the provider shall expire (E) Number of continuing education
three years after it is issued by the board and may be hours completed.
renewed upon the filing of the required application, (F) Description of hours indicating
along with any required fee. whether hours completed are in general acupuncture,
(4) Acupuncture schools and colleges which ethics, herbology, or practice management.
have been approved by the board, as defined under (G) Statement directing the acupuncturist
§183.2(2) of this title (relating to Definitions), who seek to retain the certificate for at least four years from the
to be approved providers shall be required to submit an date of completion of the course.
application for an approved provider number to the (7) Approved providers shall notify the board
board. within 30 days of any changes in organizational
(s) Requirements of Approved Providers. structure of a provider and/or the person(s) responsible
(1) For the purpose of this chapter, the title for the provider's continuing education course,
"approved provider" can only be used when a person or including name, address, or telephone number changes.
organization has submitted a provider application form, (8) Provider approval is non-transferable.
and has been issued a provider number unless otherwise (9) The board may audit during reasonable
provided. business hours records, courses, instructors and related
(2) A person or organization may be issued activities of an approved provider.
only one provider number. When two or more approved (t) Instructors.
providers co-sponsor a course, the course shall be (1) Minimum qualifications of an
identified by only one provider number and that acupuncturist instructor. The instructor must:
provider shall assume responsibility for recordkeeping, (A) hold a current valid license to
advertising, issuance of certificates and instructor(s) practice acupuncture in Texas or other state and be free
qualifications. of any disciplinary order or probation by a state
(3) An approved provider shall offer CAE licensing authority, and
programs that are presented or instructed by persons (B) be knowledgeable, current and
who meet the minimum criteria as described in skillful in the subject matter of the course as evidenced
subsection (t) of this section. through one of the following:
(4) An approved provider shall keep the (i) hold a minimum of a master's
following records for a period of four years in one degree from an accredited college or university or a
identified location: post-secondary educational institution, with a major in
(A) Course outlines of each course given. the subject directly related to the content of the program
(B) Record of time and places of each to be presented;
course given. (ii) have experience in teaching
(C) Course instructor curriculum vitaes or similar subject matter content within the last two years
resumes. in the specialized area in which he or she is teaching;
(D) The attendance record for each (iii) have at least one year's
course. experience within the last two years in the specialized
(E) Participant evaluation forms for each area in which he or she is teaching; or
course given. (iv) have graduated from an
(5) An approved provider shall submit to the acceptable acupuncture school, as defined under
board the following within ten days of the board's §183.2(2) of this title, and have completed 3 years of
request: professional experience in the licensed practice of
(A) A copy of the attendance record acupuncture.
showing the name, signature and license number of any (2) Minimum qualifications of a non-
licensed acupuncturists who attended the course. acupuncturist instructor. The instructor must:
(B) The participant evaluation forms of (A) be currently licensed or certified in
the course. his or her area of expertise if appropriate;
(6) Approved providers shall issue, within 60 (B) show written evidence of specialized
days of the conclusion of a course, to each participant training or experience, which may include, but not be
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limited to, a certificate of training or an advanced Texas through the establishment of minimum
degree in a given subject area; and requirements for continuing auricular acupuncture
(C) have at least one year's teaching education (CAAE) for certified acudetox specialists so
experience within the last two years in the specialized as to further enhance their professional skills and
area in which he or she teaches. knowledge.
(u) CAE Credit for Course Instruction. Instructors (b) Minimum continuing auricular acupuncture
of board-approved CAE courses or courses taught education. As a prerequisite to the re-certification of an
through a program offered by an approved provider for acudetox specialist, the acudetox specialist shall
CAE credit may receive three hours of CAE credit for provide documentation to the Medical Board that the
each hour of lecture, not to exceed six hours of individual has successfully met the continuing
continuing education credit per year, regardless of how education requirements established by the board which
many hours taught. Participation as a member of a includes the following listed in paragraphs (1)-(2) of
panel presentation for the approved course shall not this subsection:
entitle the participant to earn CAE credit as an (1) At least six hours of CAAE each year shall
instructor. No CAE credit shall be granted to school be in the practice of auricular acupuncture;
faculty members as credit for their regular teaching (2) The required hours shall be from courses
assignments. that are designated or otherwise approved for credit by
(v) Expiration, Denial and Withdrawal of the Medical Board at the time the course was taken.
Approval. (c) Reporting continuing auricular acupuncture
(1) Approval of any CAE course shall expire education. An acudetox specialist must report on the
three years after the date of approval. certificate-holder's re-certification form the number of
(2) The board may withdraw its approval of a hours and type of continuing auricular acupuncture
provider or deny an application for approval if the education completed during the previous year.
provider is convicted of a crime substantially related to (d) Grounds for exemption from continuing
the activities of a provider. auricular acupuncture education. An acudetox specialist
(3) Any material misrepresentation of fact by may request in writing and may be exempt from the
a provider or applicant in any information required to annual minimum continuing auricular acupuncture
be submitted to the board is grounds for withdrawal of education requirements for one or more of the
approval or denial of an application. following reasons listed in paragraphs (1)-(2) of this
(4) The board may withdraw its approval of a subsection:
provider after giving the provider written notice setting (1) catastrophic illness; and/or
forth its reasons for withdrawal and after giving the (2) military service of longer than one year in
provider a reasonable opportunity to be heard by the duration;
board or its designee. (e) Exemption requests. Exemption requests shall
(5) Should the board deny approval of a be subject to the approval of the executive director of
provider, the provider may appeal the action by filing a the Medical Board, and shall be submitted in writing at
letter stating the reason(s) with the board. The letter of least 30 days prior to the expiration of the certificate.
appeal shall be filed with the board within ten days of (f) Exemption duration and renewal. An exemption
the mailing of the applicant's notification of the board's granted under subsections (d) and (e) of this section
denial. The appeal shall be considered by the board. may not exceed one year, but may be renewed annually
upon written request submitted at least 30 days prior to
Source Note: The provisions of this §183.20 adopted to the expiration of the current exemption.
be effective September 21, 2000, 25 TexReg 9217; (g) Verification of credits. The board may require
amended to be effective January 6, 2002, 26 TexReg written verification of continuing auricular acupuncture
10866; amended to be effective September 19, 2002, 27 education hours from any certified acudetox specialist
TexReg 8770; amended to be effective June 29, 2003, and the certificate-holder shall provide the requested
28 TexReg 4633; amended to be effective September 14, verification within 30 calendar days of the date of the
2003, 28 TexReg 7704; amended to be effective March request. Failure to timely provide the requested
6, 2005, 30 TexReg 1076; amended to be effective verification may result in disciplinary action by the
January 4, 2007, 31 TexReg 10799; amended to be board.
effective May 6, 2009, 34 TexReg 2675. (h) Approval of continuing auricular acupuncture
education. Continuing Auricular Acupuncture
§183.21. Continuing Auricular Acupuncture Education (CAAE) credit hours shall be approved by
Education for Acudetox Specialists. the Medical Board and shall include education by a
(a) Purpose. This section is promulgated to ACAOM accredited school or other nationally
promote the health, safety, and welfare of the people of recognized institution, organization, or training
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program approved by the Medical Board. Approval of Source Note: The provisions of this §183.22 adopted to
courses shall be by January 1, 1999. The first reporting be effective September 14, 2003, 28 TexReg 7704.
of CAE shall be required for certification renewal in
2000. Approval shall be based on a showing by the §183.23. Voluntary Surrender of Acupuncture
education provider that: License.
(1) the content of the course, program, or Pursuant to Section 205.3522 of the Act, the Board may
activity is related to the practice of acudetox, and is not accept the voluntary surrender of an acupuncture
a course on practice enhancement, business, or office license. Chapter 196 of this title (relating to Voluntary
administration; Surrender of a Medical License) shall govern the
(2) the method of instruction is adequate to voluntary surrender of an acupuncture license in a
teach the content of the course, program, or activity; similar manner as that chapter applies to a medical
(3) the credentials of the instructor(s) indicate license. Section 183.4 of this title (relating to
competency and sufficient training, education, and Licensure) shall govern reapplication after a voluntary
experience to teach the specific course, program, or surrender.
activity;
(4) the education provider maintains an Source Note: The provisions of this §183.23 adopted to
accurate attendance/participation record on individuals be effective May 1, 2006, 31 TexReg 3534.
completing the course, program, or activity; and,
(5) each credit hour for the course, program, or
activity is equal to no less than 50 minutes of actual
instruction or training.
(i) False Reports/Statements. An intentionally false
report or statement to the board by a certificate-holder
regarding continuing auricular acupuncture education
hours reportedly obtained shall be a basis for
disciplinary action by the board pursuant to the Act,
§205.351(a)(2) and (6).
(j) Monetary penalty. Failure to obtain and timely
report the continuing auricular acupuncture education
hours for renewal of a certificate shall subject the
certificate-holder to a monetary penalty for late
registration in the amount set forth in §175.2 of this title
(relating to Fees, Penalties, and Applications).
(k) Disciplinary action, conditional licensure, and
construction. This section shall be construed to allow
the board to impose requirements for completion of
additional continuing auricular acupuncture education
hours for purposes of disciplinary action and
conditional licensure.
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BOARD RULES
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the board, titled "Temporary License Affidavit" prior to (C) a statement from the applicant's
the issuance of a temporary license. treating physician/psychotherapist as to diagnosis,
(7) License verifications. Each applicant for prognosis, medications prescribed, and follow-up
licensure who is licensed, registered, or certified in treatment recommended; and
another state must have that state submit directly to the (D) a copy of any contracts signed with
board, that the applicant's license, registration, or any licensing authority, professional society or
certification is current and in full force and that the impaired practitioner committee.
license, registration, or certification has not been (4) Outpatient treatment for alcohol/substance
restricted, suspended, revoked or otherwise subject to disorder or mental illness. Each applicant that has been
disciplinary action. The other state shall also include a treated on an outpatient basis within the past five years
description of any sanctions imposed by or disciplinary for alcohol/substance disorder must submit the
matters pending in the state. following:
(c) Applicants may be required to submit other (A) applicant's statement explaining the
documentation, which may include the following: circumstances of the outpatient treatment;
(1) Translations. Any document that is in a (B) a statement from the applicant's
language other than the English language will need to treating physician/psychotherapist as to diagnosis,
have a certified translation prepared and a copy of the prognosis, medications prescribed, and follow-up
translation submitted with the translated document. treatment recommended; and
(A) An official translation from the school (C) a copy of any contracts signed with
or appropriate agency attached to the foreign language any licensing authority, professional society or
transcript or other document is acceptable. impaired practitioners committee.
(B) If a foreign document is received (5) Malpractice. If an applicant has ever been
without a translation, the board will send the applicant a named in a malpractice claim filed with any liability
copy of the document to be translated and returned to carrier or if an applicant has ever been named in a
the board. malpractice suit, the applicant must:
(C) Documents must be translated by a (A) have each liability carrier complete a
translation agency who is a member of the American form furnished by this board regarding each claim filed
Translation Association or a United States college or against the applicant's insurance;
university official. (B) for each claim that becomes a
(D) The translation must be on the malpractice suit, have the attorney representing the
translator's letterhead, and the translator must verify applicant in each suit submit a letter to the board
that it is a "true word for word translation" to the best of explaining the allegation, relevant dates of the
his/her knowledge, and that he/she is fluent in the allegation, and current status of the suit. If the suit has
language translated, and is qualified to translate the been closed, the attorney must state the disposition of
document. the suit, and if any money was paid, the amount of the
(E) The translation must be signed in the settlement. If such letter is not available, the applicant
presence of a notary public and then notarized. The will be required to furnish a notarized affidavit
translator's name must be printed below his/her explaining why this letter cannot be provided; and
signature. The notary public must use the phrase: (C) provide a statement composed by the
"Subscribed and Sworn this _______ day of ________, applicant, explaining the circumstances pertaining to
20___." The notary must then sign and date the patient care in defense of the allegations.
translation, and affix his/her notary seal to the (6) Additional documentation. Additional
document. documentation may be required as is deemed necessary
(2) Arrest records. If an applicant has ever to facilitate the investigation of any application for
been arrested the applicant must request that the medical licensure.
arresting authority submit to the board copies of the
arrest and arrest disposition. Source Note: The provisions of this §184.6 adopted to
(3) Inpatient treatment for alcohol/substance be effective June 18, 2002, 27 TexReg 5205; amended
disorder or mental illness. Each applicant that has been to be effective November 3, 2002, 27 TexReg 10027;
admitted to an inpatient facility within the last five amended to be effective March 6, 2003, 28 TexReg
years for treatment of alcohol/substance disorder or 1884; amended to be effective June 29, 2003, 28
mental illness must submit the following: TexReg 4634; amended to be effective August 10, 2008,
(A) applicant's statement explaining the 33 TexReg 6135.
circumstances of the hospitalization;
(B) all records, submitted directly from
the inpatient facility;
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Chapter 184, Surgical Assistants
§184.7. Temporary Licensure. fee, and the penalty fee, as defined in §175.3(2) of this
(a) The executive director of the board may issue a title (relating to Penalties).
temporary license to an applicant: (2) If a surgical assistant's registration permit
(1) whose completed application has been has been expired for longer than 90 days but less than
filed, processed, and found to be in order; and one year, the surgical assistant may obtain a new permit
(2) who has met all other requirements for by submitting a completed permit application, the
licensure under the Act but is waiting for the next registration fee, and a penalty fee as defined in
scheduled meeting of the board for the license to be §175.3(2) of this title.
issued. (3) If a surgical assistant's registration permit
(b) A temporary license is valid for 100 days from has been expired for one year or longer, the surgical
the date issued and may be extended for not more than assistant's license is automatically canceled, unless an
an additional 30 days after the expiration date of the investigation is pending, and the surgical assistant may
initial temporary license. not obtain a new permit.
(4) A surgical assistant may not hold himself
Source Note: The provisions of this §184.7 adopted to out as a licensed surgical assistant if he holds an
be effective April 28, 2002, 27 TexReg 3355. expired permit.
§184.8. License Renewal. Source Note: The provisions of this §184.8 adopted to
(a) Surgical assistants licensed by the board shall be effective June 18, 2002, 27 TexReg 5205; amended
register biennially and pay a fee. A surgical assistant to be effective March 6, 2003, 28 TexReg 1884;
may, on notification from the board, renew an amended to be effective November 30, 2003, 28 TexReg
unexpired licensed by submitting a required form and 10493; amended to be effective July 3, 2007, 32 TexReg
paying the required renewal fee to the board on or 3994; amended to be effective August 10, 2008, 33
before the expiration date of the license. The fee shall TexReg 6135.
accompany a written application that sets forth the
licensee's name, mailing address, residence, the address §184.9. Relicensure.
of each of the licensee's offices, and other necessary If a surgical assistant's license has been expired for one
information prescribed by the board. year or longer, the license is considered to have been
(b) The board may prorate the length of the initial canceled, unless an investigation is pending, and the
surgical assistant registration and registration fees, so person may not renew the license. The surgical assistant
that registrations expire on a single date, regardless of may obtain a new license by complying with the
the board meeting at which the surgical assistant is requirements and procedures for obtaining an original
licensed. license.
(c) The board shall provide written notice to each
practitioner at the practitioner's address of record at Source Note: The provisions of this §184.9 adopted to
least 30 days prior to the expiration date of the license. be effective April 28, 2002, 27 TexReg 3355; amended
(d) Within 30 days of a surgical assistant's change to be effective August 10, 2008, 33 TexReg 6135.
of mailing, residence or office address from the address
on file with the board, a surgical assistant shall notify §184.12. Surgical Assistant Scope of Practice.
the board in writing of such change. The practice of surgical assisting is limited to surgical
(e) A licensee shall furnish a written explanation of assisting performed under the direct supervision of a
his or her affirmative answer to any question asked on physician who delegates the acts. A surgical assistant
the application for license renewal, if requested by the may practice in any place authorized by a delegating
board. This explanation shall include all details as the licensed physician, including, but not limited to a clinic,
board may request and shall be furnished within 14 hospital, ambulatory surgical center, or other
days of the date of the board's request. institutional setting.
(f) Falsification of an affidavit or submission of
false information to obtain renewal of a license shall Source Note: The provisions of this §184.12 adopted to
subject a surgical assistant to denial of the renewal be effective April 28, 2002, 27 TexReg 3355.
and/or to discipline pursuant to §206.301 of the Act.
(g) Expired Annual Registration Permits. §184.13. Physician Supervision.
(1) If a surgical assistant's registration permit (a) Supervision shall be continuous, and shall
has been expired for 90 days or less, the surgical require that the delegating physician be physically
assistant may obtain a new permit by submitting to the present and immediately available in the operating
board a completed permit application, the registration room to personally respond to any emergency until the
patient is released from the operating room and care has
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been transferred to another physician. act involving baseness, vileness, or depravity in the
Telecommunication is insufficient for supervision private and social duties one owes to others or to
purposes. society in general, or an act committed with knowing
(b) It is the obligation of each team of physician(s) disregard for justice, honesty, principles, or good
and surgical assistant(s) to ensure that: morals;
(1) the surgical assistant's scope of practice is (9) has acted in an unprofessional or
identified; dishonorable manner that is likely to deceive, defraud,
(2) delegation of medical tasks is appropriate or injure any member of the public;
to the surgical assistant's level of competence; (10) has failed to practice as a surgical
(3) the relationship between the members of assistant in an acceptable manner consistent with public
the team is defined; health and welfare;
(4) that the relationship of, and access to, the (11) has committed any act that is in violation
supervising physician is defined; of the laws of this state if the act is connected with
(5) a process for evaluation of the surgical practice as a surgical assistant; a complaint, indictment,
assistant's performance is established; and or conviction of a law violation is not necessary for the
(6) the physician and surgical assistant comply enforcement of this provision. Proof of the commission
with the provisions of Chapter 193 of this title (relating of the act while in practice as a surgical assistant or
to Standing Delegation Orders) when applicable. under the guise of practice as a surgical assistant is
sufficient for action by the board under this section;
Source Note: The provisions of this §184.13 adopted to (12) has had the person's license or other
be effective June 18, 2002, 27 TexReg 5205. authorization to practice as a surgical assistant
suspended, revoked, or restricted or who has had other
§184.14. Supervising Physician. disciplinary action taken by another state regarding
To be authorized to supervise a surgical assistant, a practice as a surgical assistant or had disciplinary action
physician must be currently licensed as a physician in taken by the uniformed services of the United States. A
this state by the medical board. The license must be certified copy of the record of the state or uniformed
unrestricted and active. services of the United States taking the action is
conclusive evidence of it;
Source Note: The provisions of this §184.14 adopted to (13) unlawfully advertises in a false,
be effective April 28, 2002, 27 TexReg 3355; amended misleading, or deceptive manner as defined by
to be effective July 4, 2004, 29 TexReg 6090. §101.201 of the Tex. Occ. Code;
(14) alters, with fraudulent intent, any surgical
§184.15. Grounds for Denial of Licensure and for assistant license, certificate, or diploma;
Disciplinary Action. (15) uses any surgical assistant license,
The board may refuse to issue a license to any person certificate, or diploma that has been fraudulently
and may, following notice of hearing as provided for in purchased, issued, or counterfeited or that has been
the APA, take disciplinary action against any surgical materially altered;
assistant that: (16) is removed or suspended or has
(1) fraudulently or deceptively obtains or disciplinary action taken by his peers in any
attempts to obtain a license; professional association or society, whether the
(2) fraudulently or deceptively uses a license; association or society is local, regional, state, or
(3) falsely represents that the person is a national in scope, or is being disciplined by a licensed
physician; hospital or medical staff of a hospital, including
(4) violates the Act, or any rules relating to the removal, suspension, limitation of privileges, or other
practice of surgical assisting; disciplinary action, if that action, in the opinion of the
(5) is convicted of a felony, or has imposition board, was based on unprofessional conduct or
of deferred adjudication or pre-trial diversion; professional incompetence that was likely to harm the
(6) habitually uses drugs or alcohol to the public. This action does not constitute state action on
extent that, in the opinion of the board, the person the part of the association, society, or hospital medical
cannot safely perform as a surgical assistant; staff;
(7) has been adjudicated as mentally (17) has repeated or recurring meritorious
incompetent or has a mental or physical condition that health care liability claims that in the opinion of the
renders the person unable to safely perform as a board evidence professional incompetence likely to
surgical assistant; harm the public; or
(8) has committed an act of moral turpitude. (18) sexually abuses or exploits another person
An act involving moral turpitude shall be defined as an during the licensee's practice as a surgical assistant.
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administrative penalty of no less than $100 and no more amended to be effective August 10, 2008, 33 TexReg
than $5,000 for each separate violation; 6135.
(4) failure to timely respond to a patient's
communications shall be grounds for imposition of an §184.19. Complaint Procedure Notification.
administrative penalty of no less than $100 and no more Pursuant to §206.153 of the Act, §178.3 of this title
than $5,000 for each separate violation; (relating to Complaint Procedure Notification) shall
(5) failure to comply with the complaint govern surgical assistants with regard to methods of
procedure notification requirements as set forth in notification for filing complaints with the agency. If the
§184.19 of this title (relating to Complaint Procedure provisions of §178.3 of this title conflict with the Act or
Notification) shall be grounds for imposition of an rules under this chapter, the Act and provisions of this
administrative penalty of no less than $100 and no more chapter shall control.
than $5,000 for each separate violation;
(6) failure to provide show compliance Source Note: The provisions of this §184.19 adopted to
proceeding information in the prescribed time shall be be effective September 19, 2002, 27 TexReg 8771;
grounds for imposition of an administrative penalty of amended to be effective January 9, 2003, 28 TexReg
no less than $100 and no more than $5,000 for each 72; amended to be effective August 10, 2008, 33
separate violation; and TexReg 6135.
(7) for any other violation other than quality of
care that the board deems appropriate shall be grounds §184.20. Investigations.
for imposition of an administrative penalty of no less (a) Confidentiality. All complaints, adverse reports,
than $100 and no more than $5,000 for each separate investigation files, other investigation reports, and other
violation. investigative information in the possession of, or
(f) In the case of untimely compliance with a board received, or gathered by the board or its employees or
order, the board staff shall not be authorized to impose agents relating to a licensee, an application for license,
an administrative penalty without an informal show or a criminal investigation or proceeding are privileged
compliance proceeding if the person licensed or and confidential and are not subject to discovery,
regulated under the Act has not first been brought into subpoena, or other means of legal compulsion for their
compliance with the terms, conditions, and release to anyone other than the board or its employees
requirements of the order other than the time factors or agents involved in licensee discipline.
involved. (b) Permitted disclosure of investigative
(g) Any order proposed under this section shall be information. Investigative information in the possession
subject to final approval by the board. of the board or its employees or agents that relates to
(h) Failure to pay an administrative penalty discipline of a licensee and information contained in
imposed through an order shall be grounds for such files may not be disclosed except in the following
disciplinary action by the board pursuant to the Act, circumstances:
§206.302(a)(4), regarding unprofessional or (1) to the appropriate licensing or regulatory
dishonorable conduct likely to deceive or defraud, or authorities in other states or the District of Columbia or
injure the public, and shall also be grounds for the a territory or country where the surgical assistant is
executive director to refer the matter to the attorney licensed, registered, or certified or has applied for a
general for collection of the amount of the penalty. license or to a peer review committee reviewing an
(i) A person who becomes financially unable to application for privileges or the qualifications of the
pay an administrative penalty after entry of an order licensee with respect to retaining privileges;
imposing such a penalty, upon a showing of good cause (2) to appropriate law enforcement agencies if
by a writing executed by the person under oath and at the investigative information indicates a crime may
the discretion of the Disciplinary Process Review have been committed and the board shall cooperate
Committee of the board, may be granted an extension with and assist all law enforcement agencies conducting
of time or deferral of no more than one year from the criminal investigations of licensees by providing
date the administrative penalty is due. Upon the information relevant to the criminal investigation to the
conclusion of any such extension of time or deferral, if investigating agency and any information disclosed by
payment has not been made in the manner and in the the board to an investigative agency shall remain
amount required, action authorized by the terms of the confidential and shall not be disclosed by the
order or subsection (h) of this section and the Act, investigating agency except as necessary to further the
§206.301(a)(4) may be pursued. investigation;
(3) to a health-care entity upon receipt of
Source Note: The provisions of this §184.18 adopted to written request. Disclosures by the board to a health-
be effective September 19, 2002, 27 TexReg 8771; care entity shall include only information about a
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complaint filed against a surgical assistant that was (4) evidence that a licensee is guilty of
resolved after investigation by a disciplinary order of intemperate use of drugs or alcohol;
the board or by an agreed settlement, and the basis and (5) evidence of repeated arrests of a licensee
current status of any complaint under active for intoxication;
investigation that has been referred by the executive (6) evidence of recurring temporary
director or the director's designee for legal action; and commitments of a licensee to a mental institution; or
(4) to other persons if required during the (7) medical records indicating that a licensee
investigation. has an illness or condition which results in the inability
(c) Reports to the Board. to function properly in his or her practice.
(1) Relevant information required to be (b) Rehabilitation Order. The board through an
reported to the board pursuant to §206.159 of the Act, agreed order or after a contested proceeding, may
indicating that a surgical assistant's practice poses a impose a nondisciplinary rehabilitation order on any
continuing threat to the public welfare shall include a licensee, or as a prerequisite for licensure, on any
narrative statement describing the time, date, and place licensure applicant. Chapter 180 of this title (relating to
of the acts or omissions on which the report is based. Rehabilitation Orders) shall govern procedures relating
(2) A report that a surgical assistant's practice to surgical assistants who are found eligible for a
constitutes a continuing threat to the public's welfare rehabilitation order. If the provisions of Chapter 180
shall be made as soon as possible after the peer review conflict with the Act or rules under this chapter, the Act
committee, quality assurance committee, surgical and provisions of this chapter shall control.
assistant, surgical assistant student, physician or any
person usually present in the operating room, including Source Note: The provisions of this §184.21 adopted to
a nurse or surgical technologist involved reaches that be effective September 19, 2002, 27 TexReg 8771;
conclusion and is able to assemble the relevant amended to be effective January 9, 2003, 28 TexReg 72.
information.
§184.22. Procedure.
Source Note: The provisions of this §184.20 adopted to Chapter 187 of this title (relating to Procedural Rules)
be effective September 19, 2002, 27 TexReg 8771; shall govern procedures relating to surgical assistants
amended to be effective August 10, 2008, 33 TexReg where applicable. If the provisions of Chapter 187
6135. conflict with the Act or rules under this chapter, the Act
and provisions of this chapter shall control.
§184.21. Impaired Surgical Assistants.
(a) Mental or physical examination requirement. Source Note: The provisions of this §184.22 adopted to
The board may require a licensee to submit to a mental be effective September 19, 2002, 27 TexReg 8771.
and/or physical examination by a physician or
physicians designated by the board if the board has §184.23. Compliance.
probable cause to believe that the licensee is impaired. Chapter 189 of this title (relating to Compliance) shall
Impairment is present if one appears to be unable to be applied to surgical assistants who are under board
practice with reasonable skill and safety to patients by orders. If the provisions of Chapter 189 conflict with
reason of age, illness, drunkenness, excessive use of the Act or rules under this chapter, the Act and
drugs, narcotics, chemicals, or any other type of provisions of this chapter shall control.
material; or as a result of any mental or physical
condition. Probable cause may include, but is not Source Note: The provisions of this §184.23 adopted to
limited to, any one of the following: be effective September 19, 2002, 27 TexReg 8771.
(1) sworn statements from two people, willing
to testify before the board, medical board, or the State §184.24. Construction.
Office of Administrative Hearings that a certain The provisions of this chapter shall be construed and
licensee is impaired; interpreted so as to be consistent with the statutory
(2) a sworn statement from an official provisions of the Act and the Medical Practice Act. In
representative of the Texas Society of Surgical the event of a conflict between this chapter and the
Assistants stating that the representative is willing to provisions of the Acts, the provisions of the Acts shall
testify before the board that a certain licensee is control; however, this chapter shall be construed so that
impaired; all other provisions of this chapter which are not in
(3) evidence that a licensee left a treatment conflict with the Acts shall remain in effect.
program for alcohol or chemical dependency before
completion of that program; Source Note: The provisions of this §184.24 adopted to
be effective September 19, 2002, 27 TexReg 8771.
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assistant, and who has notified the Medical Board of the meeting, shall elect from its membership a secretary for
intent to supervise a specific physician assistant and of one year.
the termination of such supervision. (f) The board, at a regular meeting or special
(18) Supervision--Overseeing the activities of, meeting, upon majority vote of the members present,
and accepting responsibility for, the medical services may remove the secretary from office.
rendered by a physician assistant. Supervision does not (g) The following are standing and permanent
require the constant physical presence of the committees of the board. Each committee, with the
supervising physician but includes a situation where a exception of the Executive Committee, shall consist of
supervising physician and the person being supervised at least one board member who is a licensed physician,
are, or can easily be, in contact with one another by one board member who is a licensed physician
radio, telephone, or another telecommunication device. assistant, and one public board member. In the event
(19) Unrestricted medical license--a license that a committee does not have a representative of one
held by a physician issued by the Medical Board that is or more of these groups, the presiding officer shall
not subject to an order with restrictions that would appoint additional members as necessary to maintain
impair a physician's ability to supervise a PA this composition. The Executive Committee shall
inconsistent with the public's well being that could include the presiding officer, secretary, and other
harm patients. members as named by the presiding officer. The
presiding officer shall name the chair and assign the
Source Note: The provisions of this §185.2 adopted to members of the other committees. The responsibilities
be effective January 12, 1996, 21 TexReg 109; amended and authority of these committees shall include those
to be effective December 23, 1997, 22 TexReg 12492; duties and powers as defined in paragraphs (1) - (3) of
amended to be effective May 9, 1999, 24 TexReg 3347; this subsection and such other responsibilities and
amended to be effective September 21, 2000, 25 TexReg authority which the board may from time to time
9218; amended to be effective January 6, 2002, 26 delegate to these committees.
TexReg 10867; amended to be effective November 3, (1) Licensure Committee.
2002, 27 TexReg 10027; amended to be effective June (A) Draft and review proposed rules
29, 2006, 31 TexReg 5105; amended to be effective regarding licensure, and make recommendations to the
March 9, 2009, 34 TexReg 1590. board regarding changes or implementation of such
rules.
§185.3. Meetings and Committees. (B) Draft and review proposed rules
(a) The board may meet up to four times a year, pertaining to the overall licensure process, and make
with a minimum of two times a year to carry out the recommendations to the board regarding changes or
mandates of the Act. implementation of such rules.
(b) Special meetings may be called by the (C) Receive and review applications for
presiding officer of the board, by resolution of the licensure in the event the eligibility for licensure of an
board, or upon written request to the presiding officer applicant is in question.
of the board signed by at least three members of the (D) Present the results of reviews of
board. applications for licensure, and make recommendations
(c) Board and committee meetings shall, to the to the board regarding licensure of applicants whose
extent possible, be conducted pursuant to the provisions eligibility is in question.
of Robert's Rules of Order Newly Revised unless, by (E) Make recommendations to the board
rule, the board adopts a different procedure. regarding matters brought to the attention of the
(d) All elections and any other issues requiring a Licensure Committee.
vote of the board shall be decided by a simple majority (F) Oversee and make recommendations
of the members present. A quorum for transaction of to the physician assistant board regarding any aspect of
any business by the board shall be one more than half the examination process including the approval of an
the board's membership at the time of the meeting. If appropriate licensure examination and the
more than two candidates contest an election or if no administration of such an examination and
candidate receives a majority of the votes cast on the documentation and verification of records from all
first ballot, a second ballot shall be conducted between applicants for licensure;
the two candidates receiving the highest number of (2) Disciplinary Committee.
votes. (A) Draft and review proposed rules
(e) The governor shall designate a member of the regarding the discipline of physician assistants and
physician assistant board as the presiding officer of the enforcement of the Act.
board to serve in that capacity at the will of the (B) Oversee the disciplinary process and
governor. The board, at a regular meeting or special give guidance to the board and staff regarding methods
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to improve the disciplinary process and more as open to the public. Members of the public shall not
effectively enforce the Act. address or question board members during meetings
(C) Monitor the effectiveness, unless recognized by the board's presiding officer
appropriateness, and timeliness of the disciplinary pursuant to a published agenda item.
process. (i) Journalists have the same right of access as
(D) Make recommendations regarding other members of the public to board meetings
resolution and disposition of specific cases and conducted in open session, and are also subject to the
approve, adopt, modify, or reject recommendations same rules. Observers of any board meeting may not
from staff or representatives of the board regarding disrupt the meeting or disturb participants. Observers
actions to be taken on pending cases. Approve may make audio or visual recordings of such
dismissals of complaints and closure of investigations. proceedings conducted in open session as long as these
(E) Make recommendations to the board activities do not disrupt the meeting and subject to the
and staff regarding policies, priorities, budget, and any following limitations: the board's presiding officer may
other matters related to the disciplinary process and request periodically that camera operators extinguish
enforcement of the Act. their artificial lights to allow excessive heat to dissipate;
(F) Make recommendations to the board camera operators may not assemble or disassemble
regarding matters brought to the attention of the their equipment while the board is in session and
Disciplinary Committee. conducting business; persons seeking to position
(3) Executive Committee. microphones for recording board proceedings may not
(A) Ensure records are maintained of all disrupt the meeting or disturb participants. Journalists
committee actions; may conduct interviews in the reception area of the
(B) Review requests from the public to agency's offices or, at the discretion of the board's
appear before the board and provide opportunities for presiding officer, in the meeting room after recess or
the public to speak regarding issues related to the adjournment; no interview may be conducted in the
regulations of practice of Physician Assistants; hallways of the agency's offices; and the board's
(C) Review inquiries regarding policy or presiding officer may exclude from a meeting any
administrative procedure; person who, after being duly warned, persists in
(D) Delegate tasks to other committees; conduct described in this subsection and subsection (h)
(E) Take action on matter of urgency that of this section.
may arise between board meetings; such matters shall (j) The secretary of the board shall assume the
be presented to the board at the next board meeting; duties of the presiding officer in the event of the
(F) Assist the Medical Board in the presiding officer's absence or incapacity.
organization, preparation, and delivery of information (k) In the event of the absence or temporary
and testimony to the Legislators and committees of the incapacity of the presiding officer, and the secretary,
Legislature; the members of the board may elect another member to
(G) Formulate and make act as the presiding officer of a board meeting or may
recommendations to the board regarding future board elect an interim acting presiding officer for the duration
goals and objectives and the establishment of priorities of the absences or incapacity or until another presiding
and methods for their accomplishment; officer is appointed by the governor.
(H) Study and make recommendations to (l) Upon the death, resignation, removal or
the board regarding the role and responsibility of the permanent incapacity of the presiding officer or the
board officers and committees; secretary, the board shall elect a secretary from its
(I) Review staff reports regarding finances membership an officer to fill the vacant position. The
and the budget; and board may elect an interim acting presiding officer until
(J) Make recommendations to the board another presiding officer is appointed by the governor.
regarding matters brought to the attention of the Such an election shall be conducted as soon as
Executive Committee. practicable at a regular or special meeting of the board.
(h) Meetings of the board and of its committees are
open to the public unless such meetings are conducted Source Note: The provisions of this §185.3 adopted to
in executive session pursuant to the Open Meetings be effective January 12, 1996, 21 TexReg 109; amended
Act, the Act, or the Medical Practice Act. In order that to be effective November 3, 2002, 27 TexReg 10027;
board meetings may be conducted safely, efficiently, amended to be effective June 29, 2003, 28 TexReg
and with decorum, attendees may not engage in 4634; amended to be effective June 29, 2006, 31
disruptive activity that interferes with board TexReg 5105.
proceedings. The public shall remain within those areas
of the board offices and board meeting room designated
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§185.4. Procedural Rules for Licensure Applicants. room, nor be allowed to communicate by word or sign
(a) Except as otherwise provided in this section, an with another examinee while the examination is in
individual shall be licensed by the board before the progress without permission of the presiding examiner,
individual may function as a physician assistant. A nor be allowed to leave the examination room except
license shall be granted to an applicant who: when so permitted by the presiding examiner.
(1) submits an application on forms approved (D) Irregularities during an examination
by the board; such as giving or obtaining unauthorized information or
(2) pays the appropriate application fee as aid as evidenced by observation or subsequent
prescribed by the board; statistical analysis of answer sheets, shall be sufficient
(3) has successfully completed an educational cause to terminate an applicant's participation in an
program for physician assistants or surgeon assistants examination, invalidate the applicant's examination
accredited by the Accreditation Review Commission results, or take other appropriate action.
for the Education of Physician Assistants (ARC-PA), or (E) An applicant who is unable to pass the
by that committee's predecessor or successor entities, JP exam within three attempts must appear before a
and holds a valid and current certificate issued by the committee of the board to address the applicant's
National Commission on Certification of Physician inability to pass the examination and to re-evaluate the
Assistants ("NCCPA"); applicant's eligibility for licensure. It is at the discretion
(4) certifies that the applicant is mentally and of the committee to allow an applicant additional
physically able to function safely as a physician attempts to take the JP exam.
assistant; (b) The following documentation shall be
(5) does not have a license, certification, or submitted as a part of the licensure process:
registration as a physician assistant in this state or from (1) Name Change. Any applicant who submits
any other licensing authority that is currently revoked documentation showing a name other than the name
or on suspension or the applicant is not subject to under which the applicant has applied must present
probation or other disciplinary action for cause certified copies of marriage licenses, divorce decrees,
resulting from the applicant's acts as a physician or court orders stating the name change. In cases where
assistant, unless the board takes that fact into the applicant's name has been changed by naturalization
consideration in determining whether to issue the the applicant should send the original naturalization
license; certificate by certified mail to the board for inspection.
(6) is of good moral character; (2) Certification. Each applicant for licensure
(7) is of good professional character as defined must submit:
under §185.1(7) of this title. (A) a letter of verification of current
(8) submits to the board any other information NCCPA certification sent directly from NCCPA, and
the board considers necessary to evaluate the applicant's (B) a certificate of successful completion
qualifications; of an educational program submitted directly from the
(9) meets any other requirement established by program on a form provided by the board.
rules adopted by the board; and (3) Examination Scores. Each applicant for
(10) for applicants who apply for a license on licensure must have a certified transcript of grades
or after January 1, 2007, passes the national licensing submitted directly from the appropriate testing service
examination required for NCCPA certification within to the board for all examinations accepted by the board
no more than six attempts. for licensure.
(11) for applicants who apply for a license on (4) Verification from other states. Each
or after September 1, 2007, passes a jurisprudence applicant for licensure who is licensed, registered, or
examination ("JP exam"), which shall be conducted on certified in another state must have that state submit
the licensing requirements and other laws, rules, or directly to the board, on a form provided by the board,
regulations applicable to the physician assistant that the physician assistant's license, registration, or
profession in this state. The jurisprudence examination certification is current and in full force and that the
shall be developed and administered as follows: license, registration, or certification has not been
(A) The staff of the Medical Board shall restricted, canceled, suspended, or revoked. The other
prepare questions for the JP exam and provide a facility state shall also include a description of any sanctions
by which applicants can take the examination. imposed by or disciplinary matters pending in the state.
(B) Applicants must pass the JP exam (5) State License Registration. Each applicant,
with a score of 75 or better within three attempts. if licensed, registered, or certified in another state as a
(C) An examinee shall not be permitted to physician assistant, must submit a copy of the license
bring medical books, compends, notes, medical registration certificate to the board. The license,
journals, calculators or other help into the examination
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registration, or certificate number and the date of receiving the administrative law judge's proposed
expiration must be visible on the copy. findings of fact and conclusions of law, determine the
(6) Arrest Records. If an applicant has ever eligibility of the applicant for licensure. A physician
been arrested, a copy of the arrest and arrest disposition assistant whose application for licensure is denied by
needs to be requested from the arresting authority and the board shall receive a written statement containing
that authority must submit copies directly to the board. the reasons for the board's action. All reports received
(7) Malpractice. If an applicant has ever been or gathered by the board on each applicant are
named in a malpractice claim filed with any liability confidential and are not subject to disclosure under the
carrier or if an applicant has ever been named in a Public Information Act. The board may disclose such
malpractice suit, the applicant must: reports to appropriate licensing authorities in other
(A) have each liability carrier complete a states.
form furnished by this board regarding each claim filed (d) All physician assistant applicants shall provide
against the applicant's insurance; sufficient documentation to the board that the applicant
(B) for each claim that becomes a has, on a full-time basis, actively practiced as a
malpractice suit, have the attorney representing the physician assistant, has been a student at an acceptable
applicant in each suit submit a letter directly to the approved physician assistant program, or has been on
board explaining the allegation, dates of the allegation, the active teaching faculty of an acceptable approved
and current status of the suit. If the suit has been closed, physician assistant program, within either of the last
the attorney must state the disposition of the suit, and if two years preceding receipt of an application for
any money was paid, the amount of the settlement. The licensure. The term "full-time basis," for purposes of
letter shall be accompanied by supporting this section, shall mean at least 20 hours per week for
documentation including court records if applicable. If 40 weeks duration during a given year. Applicants who
such letter is not available, the applicant will be do not meet the requirements of subsections (a) and (b)
required to furnish a notarized affidavit explaining why of this section may, in the discretion of the board, be
this letter cannot be provided; and eligible for an unrestricted license or a restricted license
(C) provide a statement, composed by the subject to one or more of the following conditions or
applicant, explaining the circumstances pertaining to restrictions as set forth in paragraphs (1)-(4) of this
patient care in defense of the allegations. subsection:
(8) Additional Documentation. Additional (1) completion of specified continuing medical
documentation as is deemed necessary to facilitate the education hours approved for Category 1 credits by a
investigation of any application for licensure must be CME sponsor approved by the American Academy of
submitted. Physician Assistants;
(c) The executive director shall review each (2) limitation and/or exclusion of the practice
application for licensure and shall recommend to the of the applicant to specified activities of the practice as
board all applicants eligible for licensure. The executive a physician assistant;
director also shall report to the board the names of all (3) remedial education; and
applicants determined to be ineligible for licensure, (4) such other remedial or restrictive
together with the reasons for each recommendation. An conditions or requirements which, in the discretion of
applicant deemed ineligible for licensure by the the board are necessary to ensure protection of the
executive director may request review of such public and minimal competency of the applicant to
recommendation by a committee of the board within 20 safely practice as a physician assistant.
days of receipt of such notice, and the executive (e) Applicants for licensure:
director may refer any application to said committee for (1) whose application for licensure which has
a recommendation concerning eligibility. If the been filed with the board office and which is in excess
committee finds the applicant ineligible for licensure, of one year old from the date of receipt, shall be
such recommendation, together with the reasons considered inactive. Any fee previously submitted with
therefor, shall be submitted to the board unless the the application shall be forfeited. Any further
applicant requests a hearing within 20 days of receipt of application procedure for licensure will require
notice of the committee's determination. The hearing submission of a new application and inclusion of the
shall be before an administrative law judge of the State current licensure fee;
Office of Administrative Hearings and shall comply (2) who in any way falsify the application may
with the Administrative Procedure Act and its be required to appear before the board;
subsequent amendments and the rules of the State (3) on whom adverse information is received
Office of Administrative Hearings and the board. The by the board may be required to appear before the
committee may refer any application for determination board;
of eligibility to the full board. The board shall, after
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(4) shall be required to comply with the (1) Continuing Medical Education. As a
board's rules and regulations which are in effect at the prerequisite to the annual registration of a physician
time the completed application form and fee are filed assistant's license, 40 hours of continuing medical
with the board; education (CME) are required to be completed in the
(5) may be required to sit for additional oral or following categories:
written examinations that, in the opinion of the board, (A) at least one-half of the hours are to be
are necessary to determine competency of the applicant; from formal courses that are designated for Category I
(6) must have the application of licensure credit by a CME sponsor approved by the American
complete in every detail 20 days prior to the board Academy of Physician Assistants.
meeting in which they are considered for licensure. (B) The remaining hours may be from
Applicants may qualify for a Temporary License prior Category II composed of informal self-study,
to being considered by the board for licensure, as attendance at hospital lectures, grand rounds, case
required by §185.7 of this title (relating to Temporary conferences, or by providing volunteer medical services
License); at a site serving a medically underserved population,
(7) who previously held a Texas health care other than at a site that is the primary practice site of the
provider license, certificate, permit, or registration may license holder, and shall be recorded in a manner that
be required to complete additional forms as required. can be easily transmitted to the board upon request.
(2) A physician assistant must report on the
Source Note: The provisions of this §185.4 adopted to annual registration form if she or he has completed the
be effective January 12, 1996, 21 TexReg 109; amended required continuing medical education during the
to be effective December 12, 1996, 21 TexReg 11788; previous year. A licensee may carry forward CME
amended to be effective May 5, 1997, 22 TexReg 3654; credit hours earned prior to annual registration which
amended to be effective September 15, 1997, 22 TexReg are in excess of the 40 hour annual requirement and
8998; amended to be effective December 23, 1997, 22 such excess hours may be applied to the following
TexReg 12492; amended to be effective September 21, years' requirements. A maximum of 80 total excess
2000, 25 TexReg 9218; amended to be effective March credit hours may be carried forward and shall be
7, 2002, 27 TexReg 1488; amended to be effective reported according to whether the hours are Category I
November 3, 2002, 27 TexReg 10027; amended to be and/or Category II. Excess CME credit hours of any
effective June 29, 2006, 31 TexReg 5105. type may not be carried forward or applied to an annual
report of CME more than two years beyond the date of
§185.5. Relicensure. the annual registration following the period during
If a physician assistant's license has been expired for which the hours were earned.
one year, it is considered to have been canceled, unless (3) A physician assistant may request in
an investigation is pending. The physician assistant may writing an exemption for the following reasons:
obtain a new license by complying with the (A) catastrophic illness;
requirements and procedures for obtaining an original (B) military service of longer than one
license. year's duration outside the United States;
(C) residence of longer than one year's
Source Note: The provisions of this §185.5 adopted to duration outside the United States; or
be effective January 12, 1996, 21 TexReg 109; amended (D) good cause shown on written
to be effective September 21, 2000, 25 TexReg 9218. application of the licensee that gives satisfactory
evidence to the board that the licensee is unable to
§185.6. Annual Renewal of License. comply with the requirement for continuing medical
(a) Physician assistants licensed under the education.
Physician Assistant Licensing Act shall register (4) Exemptions are subject to the approval of
annually and pay a fee. A physician assistant may, on the licensure committee of the board.
notification from the board, renew an unexpired license (5) A temporary exception under paragraph (3)
by submitting the required form and documents and by of this subsection may not exceed one year but may be
paying the required renewal fee to the board on or renewed annually, subject to the approval of the board.
before the expiration date of the permit. The fee shall (6) This section does not prevent the board
accompany the required form which legibly sets forth from taking disciplinary action with respect to a
the licensee's name, mailing address, business address, licensee or an applicant for a license by requiring
and other necessary information prescribed by the additional hours of continuing medical education or of
board. specific course subjects.
(b) The following documentation shall be (7) The board may require written verification
submitted as part of the renewal process: of both formal and informal credits from any licensee
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within 30 days of request. Failure to provide such (3) If a physician assistant's registration permit
verification may result in disciplinary action by the has been expired for one year or longer, the physician
board. assistant's license is automatically canceled, unless an
(8) Unless exempted under the terms of this investigation is pending, and the physician assistant
section, a physician assistant licensee's apparent failure may not obtain a new permit.
to obtain and timely report the 40 hours of CME as (4) Practicing as a physician assistant after the
required and provided for in this section shall result in expiration of the 30-day grace period under subsection
nonrenewal of the license until such time as the (a) of this section without obtaining a new registration
physician assistant obtains and reports the required permit for the current registration period has the same
CME hours; however, the executive director of the effect as, and is subject to all penalties of, practicing as
board may issue to such a physician assistant a a physician assistant without a license.
temporary license numbered so as to correspond to the
nonrenewed license. Such a temporary license shall be Source Note: The provisions of this §185.6 adopted to
issued at the direction of the executive director for a be effective January 12, 1996, 21 TexReg 109; amended
period of no longer than 90 days. A temporary license to be effective October 22, 1996, 21 TexReg 9831;
issued pursuant to this subsection may be issued to amended to be effective May 5, 1997, 22 TexReg 3654;
allow the physician assistant who has not obtained or amended to be effective September 15, 1997, 22 TexReg
timely reported the required number of hours an 8998; amended to be effective December 23, 1997, 22
opportunity to correct any deficiency so as not to TexReg 12492; amended to be effective September 21,
require termination of ongoing patient care. 2000, 25 TexReg 9218; amended to be effective
(c) Falsification of an affidavit or submission of November 3, 2002, 27 TexReg 10027; amended to be
false information to obtain renewal of a license shall effective June 29, 2006, 31 TexReg 5105.
subject a physician assistant to denial of the renewal
and/or to discipline pursuant to the Act, §§204.301- §185.7. Temporary License.
.303. (a) The board, or its designee may issue a
(d) If the renewal fee and completed application temporary license to an applicant who:
form are not received on or before the expiration date of (1) meets all the qualifications for a license
the permit, the fees set forth in Chapter 175 of this title under the Act but is waiting for the next scheduled
(Fees, Penalties, and Applications) shall apply. meeting of the board for the license to be issued;
(e) The board shall not waive fees or penalties. (2) seeks to temporarily substitute for a
(f) The board shall stagger annual registration of licensed physician assistant during the licensee's
physician assistants proportionally on a periodic basis. absence, if the applicant:
(g) Practicing as a physician assistant as defined in (A) is licensed or registered in good
the Act without an annual registration permit for the standing in another state, territory, or the District of
current year as provided for in the board rules has the Columbia;
same force and effect as and is subject to all penalties (B) submits an application on a form
of practicing as a physician assistant without a license. prescribed by the board; and
(h) Physician assistants shall inform the board of (C) pays the appropriate fee prescribed by
address changes within two weeks of the effective date the board;
of the address change. (3) has graduated from an educational program
(i) Expired Annual Registration Permits. for physician assistants or surgeon assistants accredited
(1) If a physician assistant's registration permit by the Accreditation Review Commission for the
has expired, the physician assistant may register for a Education of Physician Assistants (ARC-PA) or by the
new permit without monetary penalty during the first 30 committee's predecessor or successor entities no later
days following expiration. If a physician assistant's than six months previous to the application for
permit has been expired for longer than 30 days, but temporary licensure and is waiting for examination
less than 91, the physician may obtain a new permit by results from the National Commission on Certification
submitting to the board a completed permit application, of Physician Assistants; or
the registration fee, and the penalty fee, as defined in (4) has not, on a full-time basis, actively
§175.3(2) of this title. practiced as a physician assistant, as defined under
(2) If a physician assistant's registration permit §185.4(d) of this title, but meets guidelines set by the
has been expired for longer than 90 days but less than physician assistant board including, but not limited to,
one year, the physician assistant may obtain a new length of time out of active practice as a physician
permit by submitting a completed permit application, assistant and duration of temporary licenses.
the registration fee, and a penalty fee as defined in (b) A temporary license may be valid for not more
§175.3(2) of this title. than one year from the date issued.
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(1) obtaining patient histories and performing (1) the name, business address, Texas
physical examinations; physician assistant license number, and telephone
(2) ordering and/or performing diagnostic and number of the physician assistant; and
therapeutic procedures; (2) the name, business address, Texas medical
(3) formulating a working diagnosis; license number, and telephone number of the
(4) developing and implementing a treatment supervising physician.
plan; (b) A physician assistant must submit notification
(5) monitoring the effectiveness of therapeutic of any changes in, or additions to, the person acting as a
interventions; supervising physician for the physician assistant not
(6) assisting at surgery; later than the 30th day after the date the change or
(7) offering counseling and education to meet addition is made.
patient needs; (c) For the purposes of this section, a single form
(8) requesting, receiving, and signing for the prescribed by the board shall be used to provide
receipt of pharmaceutical sample prescription notification of the license holder's intent to begin
medications and distributing the samples to patients in a practice or termination of, and any changes in, or
specific practice setting where the physician assistant is additions to, the person acting as a supervising
authorized to prescribe pharmaceutical medications and physician.
sign prescription drug orders at a site, as provided by (d) If a supervising physician will be unavailable to
the Medical Practice Act, Chapter 157, and its supervise the physician assistant as required by this
subsequent amendments, or as otherwise authorized by section, arrangements shall be made for an alternate
this Act or board rule; physician to provide that supervision. The alternate
(9) the signing or completion of a prescription physician providing that supervision shall affirm in
as provided by the Medical Practice Act, Chapter 157; writing and document through a log where the
and physician assistant is located that he or she is familiar
(10) making appropriate referrals. with the protocols or standing delegation orders in use
and is accountable for adequately supervising care
Source Note: The provisions of this §185.10 adopted to provided pursuant to those protocols or standing
be effective November 3, 2002, 27 TexReg 10027. delegation orders. The log shall be kept with the
protocols or standing orders. The log shall contain dates
§185.11. Tasks Not Permitted to be Delegated to a of the alternate physician supervision and be signed by
Physician Assistant. the alternate physician acknowledging this
Except at sites designated by the Medical Practice Act, responsibility. The physician assistant is responsible for
Chapter 157, the supervising physician shall not allow a verifying that the alternate physician is a licensed Texas
physician assistant to prescribe or supply medication. physician holding an unrestricted and active license.
Source Note: The provisions of this §185.11 adopted to Source Note: The provisions of this §185.13 adopted to
be effective November 3, 2002, 27 TexReg 10027. be effective November 3, 2002, 27 TexReg 10027;
amended to be effective June 29, 2006, 31 TexReg
§185.12. Identification Requirements. 5105.
A physician assistant licensed by the board shall keep
the physician assistant's Texas license available for §185.14. Physician Supervision.
inspection at the physician assistant's primary place of (a) Supervision shall be continuous, but shall not
business and shall, when engaged in professional be construed as necessarily requiring the constant
activities, wear a name tag identifying the physician physical presence of the supervising physician at a
assistant as a physician assistant. place where physician assistant services are performed
while the services are performed. Telecommunication
Source Note: The provisions of this §185.12 adopted to shall always be available.
be effective November 3, 2002, 27 TexReg 10027. (b) It is the obligation of each team of physician(s)
and physician assistant(s) to ensure that:
§185.13. Notification of Intent to Practice and (1) the physician assistant's scope of practice is
Supervise. identified;
(a) A physician assistant licensed under the Act (2) delegation of medical tasks is appropriate
must, before beginning practice or upon changing to the physician assistant's level of competence;
practice, submit notification of the license holder's (3) the relationship between the members of
intent to begin practice. Notification under this section the team is defined;
must include:
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(4) the relationship of, and access to, the Code, a physician assistant shall not practice at a site
supervising physician is defined; where that physician assistant's supervising physician is
(5) a process for evaluation of the physician not present at least 20 percent of the site's listed
assistant's performance is established; and business hours. This provision shall not be interpreted
(6) the physician assistant's annual registration to prevent a physician who has delegated prescriptive
permit is current. authority to a PA or APN pursuant to Chapter 157 of
(c) A physician assistant may have more than one the Tex. Occ. Code from applying for a waiver in
supervising physician. accordance with Sec. 157.0542 of the Tex. Occ. Code
(d) Physician assistants must utilize mechanisms and §193.6(i) of this title (relating to Waivers).
which provide medical authority when such (d) A physician who provides medical services in
mechanisms are indicated, including, but not limited to, preventive medicine, disease management, health and
standing delegation orders, standing medical orders, wellness education, or similar services in an accredited
protocols, or practice guidelines. academic/teaching institution listed in paragraphs (1) -
(10) of this subsection, or its affiliates, may be denoted
Source Note: The provisions of this §185.14 adopted to as the supervising physician for more than five
be effective November 3, 2002, 27 TexReg 10027. physician assistants in that institution or its affiliates,
provided the supervising physician determines that the
§185.15. Supervising Physician. physician assistants are properly trained to deliver the
(a) A physician assistant may only be supervised services, that the services are of such a nature that they
by a physician who: may be safely and competently delivered by the
(1) is currently licensed as a physician in this supervised physician assistants, and the proper
state by the medical board. The license must be paperwork has been filed with the Medical Board. The
unrestricted and active; supervision of physician assistants must comply with
(2) has notified the board of the physician's all institutional rules and there must be accurate and
intent to supervise a physician assistant; and timely internal institutional records, which are available
(3) has submitted a statement to the board that upon request within 24 hours to the Medical Board,
the physician will: which list the name and license number of the physician
(A) supervise the physician assistant who is specifically assigned to actively supervise each
according to rules adopted by the board; and physician assistant at one of the following institutions:
(B) retain professional and legal (1) University of Texas Medical Branch at
responsibility for the care rendered by the physician Galveston;
assistant. (2) University of Texas Southwestern Medical
(b) A physician assistant may be supervised by an Center at Dallas;
alternate supervising physician in the absence of the (3) University of Texas Health Science Center
supervising physician consistent with this chapter, the at Houston;
Texas Medical Practice Act, the Act, board rules, (4) University of Texas Health Science Center
medical board rules, and any standing orders or at San Antonio;
protocols established in accordance with these statutes (5) University of Texas Health Center at Tyler;
and rules. (6) University of Texas M.D. Anderson
Cancer Center;
Source Note: The provisions of this §185.15 adopted to (7) Texas A&M University College of
be effective November 3, 2002, 27 TexReg 10027; Medicine;
amended to be effective January 8, 2004, 29 TexReg (8) Texas Tech University School of
97; amended to be effective June 29, 2006, 31 TexReg Medicine;
5105. (9) Baylor College of Medicine; or
(10) University of North Texas Health Science
§185.16. Employment Guidelines. Center at Fort Worth.
(a) Except as otherwise provided in this section, a (e) A physician who holds the position of Medical
physician may supervise up to five physician assistants, Director, Chief of Staff, or Emergency Room
or their full-time equivalents. "Full time" shall mean no Department Chair at a licensed hospital may be denoted
more than 50 hours per week. as the supervising physician for more than five
(b) A physician assistant may not independently physician assistants for the purpose of staffing a
bill patients for the services provided by the physician hospital emergency room. This physician may then
assistant except where provided by law. delegate the direct supervision of the physician assistant
(c) Except at a site serving medically underserved to staff physicians providing medical services within
populations as defined by Sec. 157.052 of the Tex. Occ. the emergency room, provided that the supervising
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physician determines that the physician assistants are (9) has acted in an unprofessional or
properly trained to deliver services, that the services are dishonorable manner which is likely to deceive,
of such a nature that they may be safely and defraud, or injure any member of the public;
competently delivered by the supervised physician (10) has failed to practice as a physician
assistants, and that the proper paperwork has been filed assistant in an acceptable manner consistent with public
with the Medical Board. The supervision of physician health and welfare;
assistants must comply with all institutional rules and (11) has committed any act that is in violation
there must be accurate and timely internal institutional of the laws of the State of Texas if the act is connected
records, which are available upon request within 24 with practice as a physician assistant; a complaint,
hours to the Texas Medical Board, which list the name indictment, or conviction of a law violation is not
and license number of the physician who is specifically necessary for the enforcement of this provision; proof
assigned to actively supervise each physician assistant. of the commission of the act while in practice as a
(f) The provisions of subsections (a), (d), and (e) of physician assistant or under the guise of practice as a
this section relating to the number of physician physician assistant is sufficient for action by the board
assistants authorized to be supervised shall not be under this section;
interpreted to change or modify rules or statutes relating (12) has had the person's license or other
to the number of physician assistants to whom authorization to practice as a physician assistant
prescriptive authority may be delegated. suspended, revoked, or restricted or who has had other
disciplinary action taken by another state regarding
Source Note: The provisions of this §185.16 adopted to practice as a physician assistant or had disciplinary
be effective November 3, 2002, 27 TexReg 10027; action taken by the uniformed services of the United
amended to be effective June 29, 2003, 28 TexReg States. A certified copy of the record of the state or
4634; amended to be effective July 4, 2004, 29 TexReg uniformed services of the United States taking the
6091; amended to be effective June 29, 2006, 31 action is conclusive evidence of it;
TexReg 5105. (13) fails to keep complete and accurate
records of purchases and disposal of drugs listed in
§185.17. Grounds for Denial of Licensure and for Chapter 483, Health and Safety Code, as required by
Disciplinary Action. Chapter 483, Health and Safety Code, or any
The board may refuse to issue a license to any person subsequent rules. A failure to keep the records for a
and may, following notice of hearing and a hearing as reasonable time is grounds for disciplinary action
provided for in the APA, take disciplinary action against the license of a physician assistant. The board or
against any physician assistant who: its representative may enter and inspect a physician
(1) fraudulently or deceptively obtains or assistant's place of practice during reasonable business
attempts to obtain a license; hours for the purpose of verifying the correctness of
(2) fraudulently or deceptively uses a license; these records and of taking inventory of the drugs on
(3) violates the Act, or any rules relating to the hand;
practice of a physician assistant; (14) writes a false or fictitious prescription for
(4) is convicted of a felony, or has imposition a scheduled or a dangerous drug as defined by Chapters
of deferred adjudication or pre-trial diversion; 481 and 483, Health and Safety Code;
(5) habitually uses drugs or intoxicating (15) prescribes, dispenses, or administers a
liqueurs to the extent that, in the opinion of the board, drug or treatment that is nontherapeutic in nature or
the person cannot safely perform as a physician nontherapeutic in the manner the drug or treatment is
assistant; prescribed, dispensed, or administered;
(6) has been adjudicated as mentally (16) unlawfully advertises in a false,
incompetent or has a mental or physical condition that misleading, or deceptive manner. Advertisements shall
renders the person unable to safely perform as a be defined as false, misleading, or deceptive consistent
physician assistant; with §101.201 of the Texas Occupations Code;
(7) has committed an act of moral turpitude. (17) alters, with fraudulent intent, any
An act involving moral turpitude shall be defined as an physician assistant license, certificate, or diploma;
act involving baseness, vileness, or depravity in the (18) uses any physician assistant license,
private and social duties one owes to others or to certificate, or diploma that has been fraudulently
society in general, or an act committed with knowing purchased, issued, or counterfeited or that has been
disregard for justice, honesty, principles, or good materially altered;
morals; (19) aids or abets, directly or indirectly, the
(8) represents that the person is a physician; practice as a physician assistant by any person not duly
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licensed to practice as a physician assistant by the Source Note: The provisions of this §185.18 adopted to
board; be effective November 3, 2002, 27 TexReg 10027;
(20) is removed or suspended or has amended to be effective June 29, 2006, 31 TexReg
disciplinary action taken by his peers in any 5105.
professional association or society, whether the
association or society is local, regional, state, or §185.19. Administrative Penalties.
national in scope, or is being disciplined by a licensed (a) The board by order may impose an
hospital or medical staff of a hospital, including administrative penalty, subject to the provisions of the
removal, suspension, limitation of privileges, or other APA, against a person licensed or regulated under the
disciplinary action, if that action, in the opinion of the Act who violates the Act or a rule or order adopted
board, was based on unprofessional conduct or under the Act.
professional incompetence that was likely to harm the (b) The penalty for a violation may be in an
public. This action does not constitute state action on amount not to exceed $5,000. Each day a violation
the part of the association, society, or hospital medical continues or occurs is a separate violation for purposes
staff; of imposing a penalty.
(21) has repeated or recurring meritorious (c) The amount of the penalty shall be based on
health care liability claims that in the opinion of the factors set forth under §204.351(c) of the Act, and
board evidence professional incompetence likely to Chapter 190 of this title (relating to Disciplinary
harm the public; or Guidelines).
(22) through his practice as a physician
assistant sexually abuses or exploits another person. Source Note: The provisions of this §185.19 adopted to
be effective November 3, 2002, 27 TexReg 10027;
Source Note: The provisions of this §185.17 adopted to amended to be effective June 29, 2006, 31 TexReg
be effective November 3, 2002, 27 TexReg 10027; 5105.
amended to be effective June 29, 2006, 31 TexReg
5105. §185.20. Complaints.
Chapter 178 of this title (relating to Complaints) shall
§185.18. Discipline of Physician Assistants. govern physician assistants with regard to procedures
(a) The board, upon finding a physician assistant for the initiation, filing and appeals of complaints and
has committed any of the acts set forth in §185.17 of methods of notification for filing complaints with the
this title (relating to Grounds for Denial of Licensure agency. If the provisions of Chapter 178 conflict with
and for Disciplinary Action), shall enter an order the Act or rules under this chapter, the Act and
imposing one or more of the allowable actions set forth provisions of this chapter shall control.
under §204.301 of the Act.
(b) Disciplinary Guidelines. Source Note: The provisions of this §185.20 adopted to
(1) Chapter 190 of this title (relating to be effective November 3, 2002, 27 TexReg 10027;
Disciplinary Guidelines) shall apply to physician amended to be effective July 4, 2004, 29 TexReg 6091.
assistants regulated under this chapter to be used as
guidelines for the following areas as they relate to the §185.21. Investigations.
denial of licensure or disciplinary action of a licensee: (a) Confidentiality. All complaints, adverse reports,
(A) practice inconsistent with public investigation files, other investigation reports, and other
health and welfare; investigative information in the possession of, or
(B) unprofessional and dishonorable received, or gathered by the board or its employees or
conduct; agents relating to a licensee, an application for license,
(C) disciplinary actions by state boards or a criminal investigation or proceeding are privileged
and peer groups; and confidential and are not subject to discovery,
(D) repeated and recurring meritorious subpoena, or other means of legal compulsion for their
health care liability claims; release to anyone other than the board or its employees
(E) aggravating and mitigating factors; or agents involved in licensee discipline.
and (b) Patient identity. In any disciplinary
(F) criminal convictions. investigation or proceeding regarding a physician
(2) If the provisions of Chapter 190 of this title assistant conducted under or pursuant to the Act, the
conflict with the Act or rules under this chapter, the Act board shall protect the identity of any patient whose
and provisions of this chapter shall control. medical records are examined and utilized in a public
proceeding except for those patients who testify in the
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public proceeding or who submit a written release in Source Note: The provisions of this §185.21 adopted to
regard to their records or identity. be effective November 3, 2002, 27 TexReg 10027.
(c) Permitted disclosure of investigative
information. Investigative information in the possession §185.22. Impaired Physician Assistants.
of the board or its employees or agents which relates to (a) Mental or physical examination requirement.
licensee discipline and information contained in such (1) The board may require a licensee to submit
files may not be disclosed except in the following to a mental and/or physical examination by a physician
circumstances: or physicians designated by the board if the board has
(1) to the appropriate licensing or regulatory probable cause to believe that the licensee is impaired.
authorities in other states or the District of Columbia or Impairment is present if one appears to be unable to
a territory or country where the physician assistant is practice with reasonable skill and safety to patients by
licensed, registered, or certified or has applied for a reason of age, illness, drunkenness, excessive use of
license or to a peer review committee reviewing an drugs, narcotics, chemicals, or any other type of
application for privileges or the qualifications of the material; or as a result of any mental or physical
licensee with respect to retaining privileges; condition.
(2) to appropriate law enforcement agencies if (2) Probable cause may include, but is not
the investigative information indicates a crime may limited to, any one of the following:
have been committed and the board shall cooperate (A) sworn statements from two people,
with and assist all law enforcement agencies conducting willing to testify before the board, the medical board, or
criminal investigations of licensees by providing the State Office of Administrative Hearings that a
information relevant to the criminal investigation to the certain licensee is impaired;
investigating agency and any information disclosed by (B) a sworn statement from an official
the board to an investigative agency shall remain representative of the Texas Academy of Physician
confidential and shall not be disclosed by the Assistants stating that the representative is willing to
investigating agency except as necessary to further the testify before the board that a certain licensee is
investigation; impaired;
(3) to a health-care entity upon receipt of (C) evidence that a licensee left a
written request. Disclosures by the board to a health- treatment program for alcohol or chemical dependency
care entity shall include only information about a before completion of that program;
complaint filed against a physician assistant that was (D) evidence that a licensee is guilty of
resolved after investigation by a disciplinary order of intemperate use of drugs or alcohol;
the board or by an agreed settlement, and the basis and (E) evidence of repeated arrests of a
current status of any complaint under active licensee for intoxication;
investigation; and (F) evidence of recurring temporary
(4) to other persons if required during the commitments of a licensee to a mental institution; or
investigation. (G) medical records indicating that a
(d) Complaints. The board shall keep information licensee has an illness or condition which results in the
on file about each complaint filed with the board, inability to function properly in his or her practice.
consistent with the Act. If a written complaint is filed (b) Rehabilitation Orders.
with the board that the board has the authority to (1) The board, through an agreed order or after
resolve relating to a person licensed by the board, the a contested proceeding, may impose a nondisciplinary
board, at least as frequently as quarterly and until final rehabilitation order on any licensee or, as a prerequisite
determination of the action to be taken relative to the for issuing a license, on any licensure applicant.
complaint, shall notify in a manner consistent with the Chapter 180 of this title (relating to Rehabilitation
Act, the parties to the complaint of the status of the Orders) shall govern procedures relating to physician
complaint unless the notice would jeopardize an active assistants who are found eligible for a rehabilitation
investigation. order. If the provisions of Chapter 180 conflict with the
(e) Renewal of licenses. A licensee shall furnish a Act or rules under this chapter, the Act and provisions
written explanation of his or her answer to any question of this chapter shall control.
asked on the application for license renewal, if (2) A rehabilitation order entered pursuant to
requested by the board. This explanation shall include this section may impose a revocation, cancellation,
all details as the board may request and shall be suspension, period of probation or restriction, or any
furnished within 14 days of the date of the board's other terms and conditions authorized under this Act or
request. as otherwise agreed to by the board and the individual
subject to the order.
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(3) Violation of a rehabilitation order entered (1) Relevant information shall be reported to
pursuant to this section may result in disciplinary action the board indicating that a physician assistant's practice
under the provisions of the Act for contested matters or poses a continuing threat to the public welfare and shall
pursuant to the terms of the agreed order. A violation of include a narrative statement describing the time, date,
a rehabilitation order may be grounds for disciplinary and place of the acts or omissions on which the report is
action based on unprofessional or dishonorable conduct based.
or on any of the provisions of this Act which may apply (2) A report that a physician assistant's
to the misconduct which resulted in violation of the practice constitutes a continuing threat to the public
rehabilitation order. welfare shall be made to the board as soon as possible
(4) The rehabilitation orders entered pursuant after the peer review committee or the physician
to this section shall be kept in a confidential file which involved reaches that conclusion and is able to
shall be subject to an independent audit by state assemble the relevant information.
auditors or private auditors contracted with by the board (d) Reporting Professional Liability Claims.
to perform such an audit. Audits may be performed at (1) Reporting responsibilities. The reporting
any time at the direction of the board but shall be form must be completed and forwarded to the board for
performed at least once every three years. The audit each defendant physician assistant against whom a
results shall be reported in a manner that maintains the professional liability claim or complaint has been filed.
confidentiality of all licensees who are subject to The information is to be reported by insurers or other
rehabilitation orders and shall be a public record. The entities providing professional liability insurance for a
audit shall be for the purposes of ensuring that only physician assistant. If a nonadmitted insurance carrier
qualified licensees are subject to rehabilitation orders. does not report or if the physician assistant has no
insurance carrier, reporting shall be the responsibility of
Source Note: The provisions of this §185.22 adopted to the physician assistant.
be effective November 3, 2002, 27 TexReg 10027; (2) Separate reports required and identifying
amended to be effective June 29, 2006, 31 TexReg information. One separate report shall be filed for each
5105. defendant physician assistant insured. When Part II is
filed, it shall be accompanied by the completed Part I or
§185.23. Third Party Reports to the Board. other identifying information as described in paragraph
(a) Any medical peer review committee in this (4)(A) of this subsection.
state, any physician assistant licensed to practice in this (3) Time frames and attachments. The
state, any physician assistant student, or any physician information in Part I of the form must be provided
licensed to practice medicine or otherwise lawfully within 30 days of receipt of the claim or suit. A copy of
practicing medicine in this state shall report relevant the claim letter or petition must be attached. The
information to the board related to the acts of any information in Part II must be reported within 105 days
physician assistant in this state if, in the opinion of the after disposition of the claim. Disposed claims shall be
medical peer review committee, physician assistant, defined as those claims where a court order has been
physician assistant student, or a physician, a physician entered, a settlement agreement has been reached, or
assistant poses a continuing threat to the public welfare the complaint has been dropped or dismissed.
through his practice as a physician assistant. The duty (4) Alternate reporting formats. The
to report under this section shall not be nullified information may be reported either on the form
through contract. provided or in any other legible format which contains
(b) Professional Review Actions. A written report at least the requested data.
of a professional review action taken by a peer review (A) If the reporter elects to use a reporting
committee or a health-care entity provided to the board format other than the board's form for data required in
must contain the results and circumstances of the Part II, there must be enough identification data
professional review action. Such results and available to staff to match the closure report to the
circumstances shall include: original file. The data required to accomplish this
(1) the specific basis for the professional include:
review action, whether or not such action was directly (i) name and license number of
related to the care of individual patients; and defendant physician assistant(s); and
(2) the specific limitations imposed upon the (ii) name of plaintiff.
physician assistant's clinical privileges, upon (B) A court order or a copy of the
membership in the professional society or association, settlement agreement is an acceptable alternative
and the duration of such limitations. submission for Part II. An order or settlement
(c) Reporting a Physician Assistant's Continuing agreement should contain the necessary information to
Threat to the Public. match the closure information to the original file. If the
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Chapter 185, Physician Assistants
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TEXAS PHYSICIAN ASSISTANT BOARD
P.O. Box 2018, MC-263
Austin, Texas 78768-2018
PART I COMPLETE FOR ALL CLAIMS OR COMPLAINTS AND FILE WITH THE TEXAS - PHYSICIAN
ASSISTANT BOARD WITHIN 30 DAYS FROM RECEIPT OF COMPLAINT OR CLAIM. INCLUDE COPY OF
CLAIM LETTER AND/OR PLAINTIFF'S COMPLAINT.
3. Plaintiff's name:
__________________________________________________________________
4. Policy number:
__________________________________________________________________
_________________________________________
Person completing this report (SIGNATURE)
_________________________________________ ________________
Person completing this report (PRINT NAME) Phone number
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PART II COMPLETE AFTER DISPOSITION OF THE CLAIM AS DEFINED IN 22 TAC, INCLUDING
DISMISSALS OR SETTLEMENTS. FILE WITH THE TEXAS PHYSICIAN ASSISTANT BOARD WITHIN 105
DAYS AFTER DISPOSITION OF THE CLAIM. A COPY OF A COURT ORDER OR SETTLEMENT
AGREEMENT MAY BE USED AS PROVIDED IN 22 TAC.
9. Type of Disposition:
_______ (1) Settlement
_______ (2) Judgment after trial
_______ (3) Other (please specify)
_____________________________________
_________________________________________
Person completing this report (SIGNATURE)
_________________________________________ ________________
Person completing this report (PRINT NAME) Phone number
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Chapter 185, Physician Assistants
(10) Professional Liability Suits and Claims. Procedural Rules for Licensure Applicants) shall
Following receipt of a notice of claim letter or a govern reapplication after a voluntary surrender.
complaint filed in court against a licensee that is
reported to the board, the licensee shall furnish to the Source Note: The provisions of this §185.26 adopted to
board the following information within 14 days of the be effective June 29, 2006, 31 TexReg 5105.
date of receipt of the board's request for said
information:
(A) a completed questionnaire to provide
summary information concerning the suit or claim;
(B) a completed questionnaire to provide
information deemed necessary in assessing the
licensee's competency;
(C) information on the status of any suit
or claim previously reported to either the board or the
medical board.
(e) Immunity and Reporting Requirements. A
person, health care entity, medical peer review
committee, or other entity that without malice furnishes
records, information, or assistance to the board is
immune from any civil liability arising from such act.
§185.24. Procedure.
Chapter 187 of this title (relating to Procedural Rules )
shall govern procedures relating to physician assistants
where applicable. If the provisions of Chapter 187
conflict with the Act or rules under this chapter, the Act
and provisions of this chapter shall control.
§185.25. Compliance.
Chapter 189 of this title (relating to Compliance) shall
be applied to physician assistants who are under board
orders. If the provisions of Chapter 189 conflict with
the Act or rules under this chapter, the Act and
provisions of this chapter shall control.
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BOARD RULES
Texas Administrative Code, Title 22, Part 9
§§187.1-187.9
§187.1. Purpose and Scope. Physician Assistant Board, and the Texas State Board
(a) Purpose. The purpose of this chapter is to of Acupuncture Examiners.
provide a system of procedures for practice before the (5) APA--The Administrative Procedure Act,
Texas Medical Board, the Texas Physician Assistant Texas Government Code, Chapter 2001 as amended.
Board, and the Texas State Board of Acupuncture (6) Applicant--A person seeking a license from
Examiners, and to govern the formal disposition of the board.
contested cases at SOAH, as required by Section (7) Attorney of record--A person licensed to
164.007(a) of the Act, that will promote just and practice law in Texas who has provided staff with
efficient disposition of proceedings and public written notice of representation.
participation in the decision-making process. The (8) Authorized representative--A person who
provisions of this chapter shall be given a fair and has been designated in writing by a party to represent
impartial construction to obtain these objectives. the party at a board proceeding or an attorney of record.
(b) Scope. (9) Board--The Texas Medical Board for
(1) This chapter shall govern the initiation, physicians and surgical assistants, the Texas State
conduct, and determination of proceedings required or Board of Acupuncture Examiners for acupuncturists,
permitted by law, including proceedings referred to and the Texas Physician Assistant Board for physician
SOAH. assistants.
(2) This chapter shall not be construed so as to (10) Board member--One of the members of
enlarge, diminish, modify, or otherwise alter the the board appointed pursuant to the Act.
jurisdiction, powers or authority of the board, board (11) Board proceeding--Any proceeding
staff, or the substantive rights of any person. before the board or at which the board is a party to an
(3) This chapter shall control the practice and action, including a hearing before SOAH.
procedure of all board proceedings to include SOAH (12) Board representative--a board member or
proceedings. district review committee member who sits on a panel
at an informal proceeding.
Source Note: The provisions of this §187.1 adopted to (13) Complaint--Pleading filed at SOAH by
be effective January 6, 2002, 26 TexReg 10867; the board alleging a violation of the Act, board rules, or
amended to be effective November 7, 2004, 29 TexReg board order. The word "complaint" is also used in this
10113; amended to be effective January 25, 2006, 31 rule in the context of complaints made to the board as
TexReg 394. provided in Section 153.012 of the Act.
(14) Contested case--A proceeding, including
§187.2. Definitions. but not restricted to licensing, in which the legal rights,
The following words and terms, when used in this duties, or privileges of a party are to be determined by
chapter, shall have the following meanings, unless the the board after an opportunity for an administrative
context clearly indicates otherwise. hearing to be held at SOAH.
(1) Act--Tex. Occ. Code Ann. Title 3 Subtitle (15) Default Order--A board order in which
B, for physicians; Tex. Occ. Code Ann. Chapter 204 for the factual allegations against a party are deemed
physician assistants; Tex. Occ. Code Ann. Chapter 205 admitted as true upon the party's failure to file a timely
for acupuncturists; and Tex. Occ. Code Ann. Chapter answer to a Complaint or to appear at a properly
206 for surgical assistants. noticed SOAH hearing.
(2) Address of record--The last mailing (16) Executive director--The executive
address of each licensee or applicant, as provided to the director of the agency, the authorized designee of the
agency pursuant to the Act. executive director, or the secretary of the board if and
(3) Administrative law judge (ALJ)--An whenever the executive director and authorized
individual appointed to preside over administrative designee are unavailable.
hearings pursuant to the APA. (17) Formal board proceeding--any proceeding
(4) Agency--The divisions, departments, and requiring action by the board, including a temporary
employees of the Texas Medical Board, the Texas suspension hearing.
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(18) Group practice--Any business entity, (33) Respondent--A licensee or applicant who
including a partnership, professional association, or is the subject of disciplinary, non-disciplinary, or
corporation, organized under Texas law and established rehabilitative action by the board.
for the purpose of practicing medicine in which two or (34) Rule--Any agency statement of general
more physicians licensed in Texas are members of the applicability that implements, interprets, or prescribes
practice. law or policy, or describes the procedures or practice
(19) Informal board proceeding--Any requirements of this board. The term includes the
proceeding involving matters before the board prior to amendment or repeal of a prior section but does not
the filing of a pleading at SOAH, to include, but not include statements concerning only the internal
limited to show compliance proceedings, eligibility management or organization of the agency and not
determinations, and informal resolutions. affecting private rights or procedures. This definition
(20) Informal show compliance proceeding includes substantive regulations.
and settlement conference (ISC)--A board proceeding (35) Secretary--The secretary-treasurer of the
that provides a licensee the opportunity to demonstrate board.
compliance with all requirements of the Act and board (36) SOAH--The State Office of
rules and an opportunity to enter into an agreed Administrative Hearings.
settlement. (37) SOAH hearing--A public adjudication
(21) License--Includes the whole or part of proceeding at SOAH.
any board permit, certificate, approval, registration or (38) SOAH rules--1 Texas Administrative
similar form of permission authorized by law. Code §155.1 et. seq.
(22) Licensee--Any person to whom the (39) Texas Public Information Act--Texas
agency has issued a license, permit, certificate, Government Code, Chapter 552.
approval, registration or similar form of permission (40) Witness--Any person offering testimony
authorized by law. or evidence at a board proceeding.
(23) Licensing--The agency process relating to
the granting, denial, renewal, cancellation, limitation, or Source Note: The provisions of this §187.2 adopted to
reissuance of a license. be effective January 6, 2002, 26 TexReg 10867;
(24) Party--The board and each person named amended to be effective November 30, 2003, 28 TexReg
or admitted as a party in a SOAH hearing or contested 10494; amended to be effective July 4, 2004, 29 TexReg
case before the board. 6091; amended to be effective November 7, 2004, 29
(25) Person--Any individual, partnership, TexReg 10113; amended to be effective January 25,
corporation, association, governmental subdivision, or 2006, 31 TexReg 394.
public or private organization.
(26) Petition--Pleading filed at SOAH by the §187.3. Computation of Time.
board alleging the reasons for the denial of a license. (a) Counting days. Unless otherwise required by
(27) Pleading--A written document that statute, in computing time periods prescribed by this
requests procedural or substantive relief, makes claims, chapter or by a State Office of Administrative Hearings
alleges facts, makes legal arguments, or otherwise (SOAH) order, the period shall begin to run on the day
addresses matters involved in a board proceeding. after the act, event or default in question. The day of the
(28) Presiding officer--The president of the act, event or default on which the designated period
board or the duly qualified successor of the president or time begins to run is not included. The period shall
other person presiding over a board proceeding. conclude on the last day of the designated period,
(29) Probationer--A licensee who is under a unless that day is a day the agency is not open for
board order. business, in which case the designated period runs until
(30) Probationer show compliance proceeding- the end of the next day on which the agency is open for
-A board proceeding that provides a probationer the business. When these rules specify a deadline or a set
opportunity to demonstrate compliance with the Act, number of days for filing documents or taking other
board rules, and board order prior to the board finding actions, the computation of time shall be calendar days
that a probationer is in noncompliance with the rather than business days, unless otherwise provided in
probationer's order. this chapter or pursuant to a SOAH or board order.
(31) Register--The Texas Register. However, if the period to act is five days or less, the
(32) Rehabilitation Order--An agreed order intervening Saturdays, Sundays and legal holidays are
entered pursuant to the authority of Section 164.201 of not counted.
the Act. (b) Dispute. Disputes regarding computation of
time for periods not specified by this chapter or by a
board or SOAH order will be resolved by reference to
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necessary expenses incurred by the witness who under the Act or board rules, or has violated an order of
appears in response to the subpoena. the board, shall enter an order imposing any action
(2) If the subpoena is for the attendance of a authorized by law:
witness, the written request shall contain the name, (b) The board may stay enforcement of any order
address, and title, if any, of the witness and the date and and place the person on probation. The board shall
location at which the attendance of the witness is retain the right to vacate the probationary stay and
sought. enforce the original order for noncompliance with the
(3) If the subpoena is for the production of terms of the probation or to impose any other
books, records, writings, or other tangible items, the disciplinary action authorized by law in addition to or
written request shall contain a description of the item instead of enforcing the original order.
sought; the name, address, and title, if any, of the (c) An agreed order, including a private
person or entity who has custody or control over the nondisciplinary rehabilitation order, may impose
items and the date; and the location at which the items actions as agreed to by the board and person subject to
are sought to be produced. the order.
(4) The party requesting a subpoena duces (d) An agreed order may include a refund, as
tecum shall describe and recite with clarity, specificity, provided by Sec. 164.206, Tex. Occ. Code. A refund
and particularity the books, records, documents to be may only be ordered to be paid to a patient of the
produced. licensee who is the subject of disciplinary action and
(c) Service and expenses. shall not exceed the amounts that the patient paid
(1) A subpoena issued at the request of the directly to the licensee related to medical services
board's staff may be served either by a board provided by the licensee that are the subject of the
investigator or by certified mail in accordance with the complaint involved. Refunds may be ordered to be paid
Act §153.007. The board shall pay reasonable charges by the licensee directly to a patient, with proof of
for photocopies produced in response to a subpoena payment provided to the board to show compliance
requested by the board's staff, but such charges may not with the board order. As used in this subsection,
exceed those billed by the board for producing copies "patient" includes the legal guardian of a patient, but
of its own records. does not include any third-party payer.
(2) A subpoena issued at the request of any (e) The time period of an order shall be extended
party other than the board shall be addressed to a sheriff for any period of time in which a person subject to an
or constable for service in accordance with the APA order subsequently resides or practices outside the State
§2001.089. of Texas, for any period during which the person's
(d) Fees and travel. A witness called at the request license is subsequently cancelled for nonpayment of
of the board shall be paid a compensation fee as set by licensure fees, or as provided in a board order. This
agency policy and reimbursed for travel in like manner subsection does not apply to locum tenens practice if
as board employees. An expert witness called at the the licensee maintains a residence in this state and fully
request of the board shall be paid a compensation fee as cooperates with his compliance officer.
set by agency policy and reimbursed for travel in like
manner as board members. Source Note: The provisions of this §187.9 adopted to
(e) Additional reasons for granting a subpoena. be effective January 6, 2002, 26 TexReg 10867;
Notwithstanding any other provisions of this section, amended to be effective November 30, 2003, 28 TexReg
the executive director may issue a subpoena if, in the 10494; amended to be effective November 7, 2004, 29
opinion of the executive director, such a subpoena is TexReg 10113; amended to be effective January 25,
necessary to preserve evidence and testimony regarding 2006, 31 TexReg 394.
any potential violation or lack of compliance with the
Act, the rules and regulations or orders of the board.
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§§187.10-187.21
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applicant receives notice of the committee's suspension under §164.059 of the Act, or in accordance
determination to make the request. with the terms of an agreement between the board and a
(B) If the applicant timely requests a licensee.
SOAH hearing, the matter shall be referred to the (6) Any modification made by the board to any
agency's legal division. proposed agreed order before the initial effective date
(C) If the applicant does not timely of the order must be approved by the licensee.
request a SOAH hearing or withdrawal of application, (7) Informal Resolution of Violations.
the committee's determination shall be submitted to the (A) Pursuant to §164.0025 of the Act, the
full board and shall become administratively final at the Quality Assurance ("QA") Committee of board
next scheduled board meeting. employees may recommend dismissal or an agreed
(D) If an applicant is determined settlement of any complaint, except a complaint that
ineligible for licensure, the applicant may request a relates directly to patient care. For purposes of this
rehearing of the application before a committee of the section, the term "relates directly to patient care" means
board. The request must be made within 20 days receipt that there is an allegation regarding the standard of care,
of notice of the committee's initial determination of sexual misconduct affecting patients, or any harm to
ineligibility. It is at the discretion of the committee patients resulting from intemperate use of drugs or
whether to grant a rehearing. The request for rehearing alcohol.
must be based on information not previously presented (B) The QA Committee shall include the
to or considered by the board. Executive Director or the Deputy Executive Director,
the manager of the investigation division, and the
Source Note: The provisions of this §187.13 adopted to manager of the legal division.
be effective January 6, 2002, 26 TexReg 10867; (C) The QA Committee shall review all
amended to be effective April 27, 2003, 28 TexReg complaints that are referred by the investigation
3326; amended to be effective November 30, 2003, 28 division to determine whether
TexReg 10494; amended to be effective November 7, (i) the complaint should be accepted
2004, 29 TexReg 10113; amended to be effective for legal action, and
January 20, 2009, 34 TexReg 340. (ii) the complaint relates directly to
patient care.
§187.14. Informal Resolution of Disciplinary Issues (D) If the QA Committee determines that
Against a Licensee. an offer of settlement should be made regarding a
Pursuant to §§164.003 - 164.004 of the Act and complaint that does not relate directly to patient care,
§§2001.054 - 2001.056 of the Administrative Procedure the offer of settlement shall be presented to the licensee.
Act (APA), the following rules shall apply to informal (i) If the licensee accepts the offer of
resolution: settlement, the signed proposed agreed order shall be
(1) Any matter within the board's jurisdiction presented to the board at a public meeting for approval.
may be resolved informally by agreed order, dismissal, (ii) If the licensee fails to timely
or default. accept the offer of settlement, or if the licensee requests
(2) Prior to the imposition of any disciplinary that an Informal Settlement Conference (ISC) be held,
action against a licensee, the licensee shall be given the the offer shall be deemed to be rejected and an ISC
opportunity to show compliance with all the shall be scheduled.
requirements of the law for the retention of an
unrestricted license before one or more board Source Note: The provisions of this §187.14 adopted to
representatives. be effective January 6, 2002, 26 TexReg 10867;
(3) If a determination is made by the board amended to be effective November 7, 2004, 29 TexReg
representatives that there has been no violation, the 10113; amended to be effective January 25, 2006, 31
board representatives may recommend that the TexReg 394; amended to be effective January 20, 2009,
complaint or allegations be dismissed. 34 TexReg 340.
(4) If a determination is made by the board
representatives that a licensee has violated the Act, §187.15. Investigation and Collection of
board rules, or board order, the board representatives Information.
may make recommendations for resolution of the issues Failure of a licensee to comply with reasonable requests
to be reduced to writing and processed in accordance to produce records, documents, or other information
with §187.19 of this title (relating to Resolution by requested by board staff in connection with an informal
Agreed Order). board proceeding shall constitute unprofessional and
(5) An opportunity for the licensee to show dishonorable conduct.
compliance shall not be required prior to a temporary
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Source Note: The provisions of this §187.15 adopted to for scheduling the informal meeting after that date. For
be effective January 6, 2002, 26 TexReg 10867; purposes of this subsection:
amended to be effective January 25, 2006, 31 TexReg (1) "Scheduled" means the act of the agency to
394. reserve a date for the ISC.
(2) "Good cause" shall have the meaning set
§187.16. Informal Show Compliance Proceedings forth in Section 179.6 of this title (relating to Time
(ISCs). Limits).
(a) Notice of the time, date and place of the ISC
shall be extended to the licensee and the complainant(s) Source Note: The provisions of this §187.16 adopted to
in writing, by hand delivery, regular mail, certified mail be effective January 6, 2002, 26 TexReg 10867;
- return receipt requested, overnight or express mail, amended to be effective January 9, 2003, 28 TexReg
courier service, or registered mail, to the address of 72; amended to be effective November 30, 2003, 28
record of the complainants and the address of record of TexReg 10494; amended to be effective November 7,
the licensee or the licensee's authorized representative 2004, 29 TexReg 10113; amended to be effective
to be sent by the Board at least 30 days prior to the date January 25, 2006, 31 TexReg 394.
of the ISC. The notice shall include:
(1) a statement that the licensee has the §187.18. Informal Show Compliance Proceeding and
opportunity to attend and participate in the informal Settlement Conference Based on Personal
meeting; Appearance.
(2) a written statement of the nature of the (a) After referral of an investigation to the agency's
allegations; and legal division, the Hearings Coordinator of the board
(3) a copy of the information the board intends shall schedule an ISC before an ISC Panel, composed
to use at the ISC. If the complaint includes an allegation of two or more board representatives to be held after
that the licensee has violated the standard of care, the proper notice to the licensee. One board representative
notice shall also include a copy of the Expert Physician must be a public member. If the matter is before the
Reviewers' Report, prepared in accordance with Section Medical Board, at least one board representative must
154.0561, Tex. Occ. Code. In addition, the board will be a physician member.
also provide the licensee with the rules governing the (b) Requests to reschedule the ISC by a licensee
proceeding and guidelines to assist the licensee to must be in writing and shall be referred to the Hearings
prepare for the ISC, including requirements regarding Counsel for consideration. To avoid undue disruption of
requests to reschedule the ISC. The information the ISC schedule, the Hearings Counsel should grant a
required by this section may be given in separate request only after conferring with the Hearings
communications at different times, provided all of the Coordinator and strictly applying the following
information has been provided at least 30 days prior to guidelines:
the date of the ISC. (1) A request by a licensee to reschedule an
(b) If the information that the board intends to use ISC must be in writing and may be granted only if the
at the ISC includes only excerpts of any medical record, licensee provides satisfactory evidence of the following
the licensee has a right to obtain the complete medical requirements:
record within 14 days after a request is mailed. (A) A request received by the agency
(c) A licensee may be asked to respond in writing within five business days after the licensee received
to questions from the board staff concerning the matter. notice of the date of the ISC, must provide details
If the licensee is asked to respond to written questions, showing that:
the licensee shall respond within 14 days after the (i) the licensee has a conflicting event
notice is mailed. The licensee's response may include that had been scheduled prior to receipt of notice of the
any additional information the licensee wants the board ISC;
representatives to consider. (ii) the licensee has made reasonable
(d) All information provided by the board staff and efforts to reschedule such event but a conflict cannot
the licensee shall be provided to the board reasonably be avoided.
representatives for review prior to the board (B) A request received by the agency
representatives making a determination of whether the more than five business days after the licensee received
licensee has violated the Act, board rules, or board notice of the date of the ISC must provide details
order. showing that an extraordinary event or circumstance
(e) All informal show compliance proceedings has arisen since receipt of the notice that will prevent
shall be scheduled not later than the 180th day after the the licensee from attending the ISC. The request must
date the board's official investigation of the complaint show that the request is made within five business days
is commenced, unless good cause is shown by the board
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after the licensee first becomes aware of the event or and the licensee or authorized representative may
circumstance. respond.
(2) A request by a licensee to reschedule an (f) The board representatives, board staff, the
ISC based on the failure of the agency to send notice licensee, and the licensee's authorized representative
not later that the 30th day before the date scheduled for shall be present during the presentation of statements
the ISC, as required by Section 164.003 of the Act, and testimony during the ISC.
shall be granted, provided the request is received by the (g) Notwithstanding subsection (f) of this section,
agency within five business days after the late notice is the board representatives may allow a complainant or
received by the licensee. witness to testify outside the physical presence of the
(c) Prior to the ISC, the board representatives shall licensee to protect the person from harassment and/or
be provided with the information sent to the licensee by undue embarrassment, for personal safety concerns, or
the board staff and all information timely received in for any other demonstrated and legitimate need. If such
response from the licensee. Information must be testimony is allowed, arrangements will be made to
received from the licensee at least five business days allow the licensee to listen to the testimony
prior to the ISC. contemporaneously as it is given.
(d) An ISC may be conducted by only one panelist (h) All evidence that a licensee wishes the board
if: representatives to consider at the ISC must be received
(1) the ISC is related to an order of the board, by the board at least five business days before the ISC.
such as to show compliance, a probation appearance, or The board representatives may refuse to consider any
a request for termination or modification, or evidence not submitted in a timely manner without
(2) the affected licensee waives the good cause. If the board representatives allow the
requirement that at least two panelists conduct the ISC. licensee to submit late evidence, the representatives
In such situations, the panelist may be either a may reschedule and/or recommend an additional
physician, physician assistant, or acupuncturist administrative penalty for the late submission.
(depending on the licensee involved) or a member who (i) A board attorney, who has not been involved
represents the public. with the preparation of the case, shall be designated as
(e) The board representatives shall allow: the Hearings Counsel and shall be present during the
(1) the board staff to present a summary of the ISC and the panel's deliberations to advise the panel on
allegations and the facts that the board staff reasonably legal issues that arise during the ISC. The Hearings
believes could be proven by competent evidence at a Counsel shall be permitted to ask questions of
formal hearing; participants in the ISC to clarify any statement made by
(2) the licensee to reply to the board staff's the participant. The Hearings Counsel shall provide to
presentation and present facts the licensee reasonably the ISC panel a historical perspective on comparable
believes could be proven by competent evidence at a cases that have appeared before the board, keep the
formal hearing; proceedings focused on the case being discussed, and
(3) presentation of evidence by the board staff ensure that the board's employees and the licensee have
and the licensee, which may include medical and office an opportunity to present information related to the
records, x-rays, pictures, film recordings of all kinds, case.
audio and video recordings, diagrams, charts, drawings, (j) At the ISC, the board representatives shall
and any other illustrative or explanatory materials attempt to resolve disputed matters and the
which in the discretion of the board representatives are representatives may call upon the board staff at any
relevant to the proceeding; time for assistance in conducting the ISC.
(4) representation of the licensee by an (k) The board representatives shall prohibit or limit
authorized representative; access to the board's investigative file by the licensee,
(5) presentation of oral or written statements the licensee's authorized representative, the
by the licensee or authorized representative; complainant(s), witnesses, and the public consistent
(6) presentation of oral or written statements with Act, §164.007(c).
or testimony by witnesses; (l) Although the participants may make notes,
(7) questioning of the witnesses in a manner mechanical or electronic recordings shall not be made
prescribed by the panel; of the ISC, settlement discussions, or mediation efforts.
(8) questioning of the licensee; (m) The ISC shall be informal and shall not follow
(9) closing statement by the licensee; the procedures established under this title for formal
(10) closing statement by the board's staff; and board proceedings.
(11) upon request by board representatives, the (n) At the conclusion of the presentations, the
board staff may propose appropriate disciplinary action board representatives shall deliberate in order to make
recommendations for the disposition of the complaint
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or allegations. An employee of the board who staff may proceed with the filing of a Complaint at
participated in the presentation of the allegation or SOAH.
information gathered in the investigation of the (d) Additional negotiations may be held between
complaint, the affected licensee, the licensee's board staff and the licensee or the authorized
authorized representative, the complainant, the representative. In consultation with the board
witnesses, and members of the public may not be representatives, as available, the recommendations of
present during the deliberations. The Hearings Counsel the board representatives may be subsequently modified
may be present only to advise the panel on legal issues based on new information, a change of circumstances,
and to provide information on comparable cases that or to expedite a resolution in the interest of protecting
have appeared before the board. the public.
(o) The board representatives may: (e) At the discretion of board staff, a licensee may
(1) make recommendations to dismiss the be invited to participate in negotiations. One or both of
complaint or allegations. The dismissal of any matter is the board representatives from the informal show
without prejudice to additional investigation and/or compliance proceeding, or a board member if no such
reconsideration of the matter at any time; board representative is available, may participate in the
(2) make recommendations regarding an negotiations, either in person or by telephone.
agreed order and propose resolution of the issues to the (f) The board representative(s) shall be consulted
licensee to be reduced to writing and processed in and must concur with any subsequent substantive
accordance with §187.19 of this title (relating to modifications before any recommendations are sent to
Resolution by Agreed Order); the full board for approval.
(3) defer the ISC, pending further (g) The recommendations may be adopted,
investigation; modified, or rejected by the board.
(4) direct that a formal Complaint be filed with (h) Board staff may communicate directly with the
SOAH; board representative(s) after the ISC for the purpose of
(5) recommend to the President of the board discussing settlement of the case.
that a Disciplinary Panel be convened to consider the
temporary suspension or restriction of the licensee's Source Note: The provisions of this §187.19 adopted to
license; or be effective January 6, 2002, 26 TexReg 10867;
(6) recommend the imposition of an amended to be effective November 7, 2004, 29 TexReg
administrative penalty pursuant to §§187.75 - 187.82 of 10113.
this chapter (relating to Procedural Rules).
§187.20. Board Action.
Source Note: The provisions of this §187.18 adopted to (a) Following the acceptance and execution by the
be effective January 6, 2002, 26 TexReg 10867; licensee or applicant of the settlement agreement, the
amended to be effective March 6, 2003, 28 TexReg agreement shall be submitted to the board for approval.
1884; amended to be effective June 29, 2003, 28 (b) The following relate to the consideration of an
TexReg 4634; amended to be effective November 30, agreed disposition by the board:
2003, 28 TexReg 10494; amended to be effective (1) Upon an affirmative majority vote of
November 7, 2004, 29 TexReg 10113; amended to be members present to approve an agreed order, the
effective January 25, 2006, 31 TexReg 394; amended to president of the board or of the officer presiding at such
be effective January 22, 2009, 34 TexReg 341. meeting shall sign and enter the agreed order and the
action shall be referenced in the minutes of the board.
§187.19. Resolution by Agreed Order. (2) If the board does not approve a proposed
(a) If the board representatives determine that the settlement agreement, the licensee or applicant shall be
licensee has violated the Act, board rules, or board so informed and the matter shall be referred to board
order, the board representatives may recommend board staff for appropriate action that may include dismissal,
action and terms and conditions for informal resolution. closure, further negotiation, further investigation, an
(b) The recommendation of the board additional informal resolution conference or a SOAH
representatives shall be reduced to writing in an agreed hearing. In determining the appropriate further action to
order prepared by board staff and presented to the be taken, the board shall consider previous attempts to
licensee and the authorized representative. resolve the matter. The board must specify their
(c) The licensee may accept the proposed rationale for the rejection of the proposed settlement
settlement by signing and returning the agreed order agreement that shall be referenced in the minutes of the
within the time period prescribed. If the licensee rejects board.
or fails to timely accept the proposed agreement, board (3) The board may approve the proposed
agreed order with specified modifications, which shall
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§§187.22-187.33
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(1) In accordance with §2001.052 of the APA, (1) Service by hand delivery shall be complete
notice of adjudicative hearing shall include: upon hand delivery to the respondent or respondent's
(A) a statement of time, place, and nature agent at the respondent's address of record.
of the hearing; (2) Service by mail shall be complete upon
(B) a statement of the legal authority and deposit of the paper, enclosed in a postpaid, properly
jurisdiction under which the hearing is to be held; addressed wrapper, in a post office or official
(C) a reference to the particular sections depository under the care and custody of the United
of the statutes and rules involved; States Postal Service.
(D) a short and plain statement of the (3) Service by courier service shall be
matters asserted; and. complete upon deposit of the paper, enclosed in a
(2) In addition, the Notice of Adjudicatory properly addressed wrapper, in a depository under the
Hearing shall include a notice that failure to answer or care and custody of a courier service, with payment
appear may result in a default order. The notice shall under a contract with the board.
include the following language in at least 10-point bold (b) Service of other documents in contested cases
type: "If you do not file a written answer to this notice pending before SOAH shall be governed by the rules of
with the State Office of Administrative Hearings within SOAH.
20 days after the date this Notice of Adjudicative
Hearing was mailed, a default order may be entered Source Note: The provisions of this §187.26 adopted to
against you, which may include the denial of licensure be effective July 4, 2004, 29 TexReg 6091; amended to
or any or all of the requested sanctions, including the be effective November 7, 2004, 29 TexReg 10113;
revocation of your license. If you file a written answer, amended to be effective January 25, 2006, 31 TexReg
but then fail to attend the hearing, a default order may 394.
be entered against you, which may include the denial of
licensure or any or all of the requested sanctions, §187.27. Written Answers in SOAH Proceedings and
including the revocation of your license. A copy of any Default Orders.
response you file with the State Office of (a) Written Answers in SOAH Proceedings. As
Administrative Hearings shall also be provided to the authorized by SOAH rules, 1 TAC §155.55(f) (relating
hearings coordinator of the Texas State Board of to Rules of Procedures), a respondent is required to file
Medical Examiners." a written answer, in accordance with the following:
(3) A copy of the original pleading filed with (1) Within 20 days after the date that service
the board may be substituted for subsection (b)(1) and of a notice of adjudicative proceeding and Complaint is
(b)(2) of this section to the extent that it contains the complete, as provided in §187.26 of this title (related to
required information. Service in SOAH Proceedings), the respondent shall
(c) Service. The notice of adjudicative hearing file a written answer with the State Office of
shall be served as specified in §187.26 of this title Administrative Hearings and with the Hearings
(relating to Service in SOAH Proceedings). Coordinator of the board.
(2) Upon the filing of a Notice of Adjudicative
Source Note: The provisions of this §187.25 adopted to Hearing, the Hearings Coordinator for the board shall
be effective January 6, 2002, 26 TexReg 10867; calculate the date that a written answer must be filed.
amended to be effective November 3, 2002, 27 TexReg (b) Default Orders.
10027; amended to be effective November 7, 2004, 29 (1) If no written answer has been filed within
TexReg 10113. 20 days after the date of service, the Hearings
Coordinator shall present the administrative record of
§187.26. Service in SOAH Proceedings. the case to the Hearings Counsel for the board,
(a) Service of a notice of adjudicative hearing and including the Complaint and the notice of adjudicative
Complaint shall be made by hand delivery, regular, hearing. The Hearings Counsel shall determine whether
registered or certified mail, courier service, or the notice was properly served.
otherwise in accordance with the APA and the Rules of (2) In the event the Hearings Counsel
SOAH. The notice shall be delivered to the respondent determines that the notice of adjudicative hearing was
at the address of record on file with the board. A properly served and that respondent has failed to timely
certificate of service indicating service in the manner file a written answer, as required by subsection (a)(1) of
provided for in this subsection shall be prima facie this section, the Hearings Counsel shall issue a
evidence of proper service of notice of adjudicative Determination of Default, which shall be served on
hearing. respondent and filed at SOAH. The Determination of
Default shall specifically state the facts on which the
Hearings Counsel has based the Determination of
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Default, request that the matter be abated or continued reasonable opportunity and methods of discovery as
at SOAH pending informal disposition by the board, described in the APA, §164.005 of the Act, and SOAH
and summarize the requirements by which a rules.
Determination of Default or Default Order may be set (b) Testifying expert witnesses. Unless otherwise
aside, as provided in paragraphs (4) - (7) of this agreed in writing by the parties or ordered by the ALJ,
subsection. the Board shall file a designation of testifying expert
(3) An answer received after a Determination witnesses, if any, no later than 90 days before the end
of Default has been issued shall not be filed. of the discovery period. Other parties shall file a
(4) In the event that the respondent wishes to designation of testifying expert witnesses, if any, no
file an answer after a Determination of Default has been later than 45 days after the Board's designation or 60
issued, but before a Default Order has been adopted by days before the end of the discovery period, whichever
the board, the respondent must file a Motion to Set date is earlier. A party shall not be allowed to present a
Aside the Determination of Default, which shall show testifying expert witness who has not been timely
the board that: designated, except by a pre-hearing order of the ALJ.
(A) the failure to timely file a written (1) A designation of testifying expert
answer was not intentional or the result of conscious witnesses shall include:
indifference but was due to a mistake or accident; (A) the name, address, and telephone
(B) respondent has a meritorious defense; number of each expert witness and, unless the party
and shows that the testifying expert witness is not retained
(C) the setting aside of the Determination by, employed by, testifying as a courtesy, or otherwise
of Default will not cause any delay or injury to the in the control of the party:
board. (B) a current curriculum vitae, résumé,
(5) The board shall consider the Complaint, and bibliography of each expert witness; and
the Determination of Default, and any Motion to Set (C) an expert report, prepared in writing
Aside the Determination of Default, at a meeting of the by each expert witness, that provides a fair summary of
board not less than twenty days after the date of the the expert's opinions as of the date of the report. If the
Determination of Default. If the board concurs with the expert witness is to testify regarding the medical
findings in the Determination of Default, the board may standard of care, the expert report shall state the
deem the allegations in the Complaint as true and enter standard of care, the manner in which the care rendered
a Default Order. by the physician met or failed to meet the standards,
(6) In the event that the respondent wishes to and whether there is any causal relationship between
file an answer after a Default Order has been entered by the care rendered and any injury or harm alleged. The
the board, but before the time for filing a Motion for expert report must be supplemented in accordance with
Rehearing has expired, the respondent must file a SOAH Rule, 1 TAC §155.31(h) (relating to Discovery).
Motion for Rehearing to Set Aside Default Order, (2) Unless a party shows that a testifying
which shall show that: expert witness is not retained by, employed by,
(A) the failure to timely file a written testifying as a courtesy, or otherwise in the control of
answer was caused by fraud, accident, or wrongful act the party, the party shall make the testifying expert
or official mistake of the board; witness available for deposition reasonably promptly
(B) the failure to timely file a written after the expert witness is designated.
answer was not the result of respondent's fault or (c) Remedies and Sanctions. Upon the failure to
negligence; and comply with a discovery request to the extent required
(C) the respondent has a meritorious by the APA, §164.005 of the Act, SOAH rules or
defense. SOAH Order, or as agreed to between the parties in a
(7) The Motion for Rehearing shall be discovery agreement, the presiding ALJ should, after
supported by affidavits and documentary evidence that notice and hearing, make such orders in regard to the
present a prima facie case for a meritorious defense. failure as are just, and such orders may include one or
more of the following:
Source Note: The provisions of this §187.27 adopted to (1) an order granting a continuance;
be effective July 4, 2004, 29 TexReg 6091; amended to (2) an order limiting or restricting the
be effective November 7, 2004, 29 TexReg 10113; admissibility and use of evidence, to include exclusion
amended to be effective January 25, 2006, 31 TexReg of evidence or testimony;
394. (3) an order for payment by a party of the
actual travel, lodging, discovery expenses; hearing and
§187.28. Discovery. court reporter costs; but not attorney fees, incurred by
(a) Parties to SOAH proceedings shall have an opposing party as a result of the failure to comply
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with the discovery requirements; reliable records such as tax returns show that a party is
(4) an order imposing a scheduling order incapable of paying part of the costs of mediation.
providing for discovery deadlines necessary to remedy
the failure to comply discovery requirements; Source Note: The provisions of this §187.29 adopted to
(5) an order for remedies and sanctions agreed be effective January 6, 2002, 26 TexReg 10867;
to by the parties in writing or on the record; amended to be effective November 7, 2004, 29 TexReg
(6) an order disallowing further discovery of 10113; amended to be effective January 25, 2006, 31
any kind or of a particular kind by the offending party; TexReg 394; amended to be effective January 20, 2009,
(7) an order holding that designated facts be 34 TexReg 340.
considered admitted for purposes of the proceeding;
(8) an order refusing to allow the offending §187.30. Reporter and Transcripts.
party to support or oppose a designated claim or Recording by a court reporter. Each contested hearing
defense or prohibiting the party from introducing shall be recorded. Any recording of contested case
designated matters into evidence; proceedings shall be conducted in accordance with
(9) an order disallowing in whole or in part §§2001.059 - .060 of the APA and §155.43 of SOAH
requests for relief by the offending party and excluding rules.
evidence in support of those requests; or
(10) an order striking pleadings or testimony, Source Note: The provisions of this §187.30 adopted to
or both, in whole or in part. be effective January 6, 2002, 26 TexReg 10867;
amended to be effective January 25, 2006, 31 TexReg
Source Note: The provisions of this §187.28 adopted to 394.
be effective November 7, 2004, 29 TexReg 10113;
amended to be effective January 25, 2006, 31 TexReg §187.31. Evidence.
394; amended to be effective January 4, 2007, 31 (a) Medical records. Medical records of patients
TexReg 10799 shall be accompanied by an affidavit in the form
approved and furnished by the board that contains the
§187.29. Mediated Settlement Conferences. requisite elements to comply with the Texas Rules of
(a) In an effort to expeditiously resolve disputed Evidence, 902(10)(b), relating to form of affidavits.
issues, mediation may be held through State Office of (b) Peer review proceedings.
Administrative Hearings (SOAH) in compliance with (1) Pursuant to Section 164.0071 of the Act, a
§155.37 of SOAH rules. record, report, or other information that has been
(1) Board members and District Review submitted to the board in accordance with Chapter 160
Committee (DRC) members are not parties to actions of the Act by a medical peer review committee,
pending before SOAH, and accordingly will not be professional review body or any health care entity may
ordered or expected to attend Mediated Settlement be disclosed by Board Staff and shall be admitted into
Conferences (MSCs) before SOAH. Board members evidence as the basis for the opinion of an expert
and DRC members who attended the informal show witness called by the board. The authorization to
compliance proceeding or Licensure Committee disclose such records in a disciplinary hearing, provided
hearing will be invited by board staff to attend the in Section 160.006(a)(1) and Section 164.0071 of the
MSC. If the board and DRC members who attended the Act, creates a statutory exception to the hearsay rule, as
informal show compliance proceeding, or the Licensure stated in Article VIII, Texas Rules of Evidence.
Committee members are unable to attend the MSC, (2) In accordance with §160.009 of the Act,
then other members of the board and DRC may be parties and witnesses can be required to produce
invited to attend the MSC. In appropriate cases, board documents and information. As provided in
staff will make every effort to have a physician-member §160.0071(c) of the Act, however, a member of a peer
present. review committee is not subject to subpoena and may
(2) All proposed mediated agreed orders are not be compelled to provide evidence in a hearing or a
not considered final until they are approved by the deposition regarding medical peer review proceedings
board. otherwise privileged pursuant to §160.007 of the Act.
(3) All mediated agreed orders shall be in (c) Deferred adjudications. In accordance with
writing and shall contain findings of facts, conclusions §2001.081 of the APA and consistent with
of law and board actions consistent with §187.9 of this §§164.053(a)(1) and 164.053(b) of the Act, deferred
title (relating to Board Actions). adjudications are admissible as evidence that the
(b) The costs of mediation shall be born equally by respondent violated the law with which the respondent
the parties, unless proof through affidavit and other was charged and pled to, which gave rise to the
deferred adjudication.
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§§187.35-187.42
§187.35. Presentation of Proposal for Decision. (c) Board action. The board shall enter in the
(a) Notice of oral argument. All parties and the minutes of the meeting the board's decision on the
ALJ who has issued a proposal for decision shall be certified question or interlocutory appeal. A board
given notice of the opportunity to attend and provide decision on a certified question or interlocutory appeal
oral argument concerning a proposal for decision before is not subject to motion for rehearing.
the board. Notice shall be sent by hand delivery, regular (d) Judicial review. Nothing in this section shall be
mail, certified mail - return receipt requested, courier interpreted to affect a licensee's right to seek judicial
service, or registered service to the ALJ's office and the review of any disciplinary action taken by the board
parties' addresses of record. against the licensee as provided by §164.009 of the Act.
(b) Arguments before the Board. The order of the
proceeding shall be as follows: Source Note: The provisions of this §187.36 adopted to
(1) the ALJ shall present and explain the be effective January 6, 2002, 26 TexReg 10867;
proposal for decision; amended to be effective November 7, 2004, 29 TexReg
(2) the party adversely affected shall briefly 10113; amended to be effective January 25, 2006, 31
state the party's reasons for being so affected supported TexReg 394.
by the evidence of record;
(3) the other party or parties shall be given the §187.37. Final Decisions and Orders.
opportunity to respond; (a) Board action. A copy of the final decision or
(4) the party with the burden of proof shall order shall be delivered or mailed to any party and to
have the right to close; the attorney of record.
(5) board members may question any party as (b) Recorded. All final decisions and orders of the
to any matter relevant to the proposal for decision and board shall be in writing and shall be signed by the
evidence presented at the hearing; president, vice-president, or secretary and reported in
(6) at the end of all arguments by the parties, the minutes of the meeting. A final order shall include
the board may deliberate in closed session and shall findings of fact and conclusions of law, separately
take action on a final decision in open session. stated.
(c) Limitation. A party shall not inquire into the (c) Imminent peril. If the board finds that imminent
mental processes used by the board in arriving at its peril to the public's health, safety, or welfare requires
decision, nor be disruptive of the orderly procedure of immediate effect of a final decision or order in a
the board's routines. contested case, it shall recite the finding in the decision
or order as well as the fact that the decision or order is
Source Note: The provisions of this §187.35 adopted to final and effective on the date rendered, in which event
be effective January 6, 2002, 26 TexReg 10867. the decision or order is final and appealable on the date
rendered and no motion for rehearing is required as a
§187.36. Interlocutory Appeals and Certification of prerequisite for appeal.
Questions. (d) Changes to findings of fact and conclusions of
(a) Interlocutory appeals and certification of law.
questions. Interlocutory appeals to the board and (1) Reasons to Change Findings of Fact and
certification of questions filed pursuant to §187.23 of Conclusions of Law. The board is charged by the
this title (relating to General Provisions of Formal legislature to protect the public interest, is an
Proceedings at SOAH) shall be filed with the hearings independent agency of the executive branch of the
coordinator of the board and served on the respondent government of the State of Texas, and is the primary
or authorized representative and the ALJ. The means of licensing, regulating and disciplining
respondent or authorized representative and the ALJ physicians and surgeons, physician assistants, and
shall be given ten days from the date of filing by board acupuncturists. Therefore, to ensure that sound medical
staff to file a written response with the Hearings principles govern the decisions of the board, it is the
Coordinator. The staff attorney, the respondent and policy of the board to change a finding of fact or
authorized representative, and the ALJ may appear at a conclusion of law or to vacate or modify any proposed
meeting to make oral argument on the appeal. order of an ALJ only when the board determines:
(b) Abatement of proceeding. The ALJ shall abate (A) that the ALJ did not properly apply or
the proceeding while a certified question or interpret applicable law, board rules, written policies, or
interlocutory appeal is pending. prior administrative decisions;
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(B) that a prior administrative decision on telephone, telegraph, or another suitable means of
which the ALJ relied is incorrect or should be changed; communication. The board may by written order extend
or; the period of time for filing the motions and replies and
(C) that a technical error in a finding of taking board action, except that an extension may not
fact should be changed. extend the period for board action beyond 90 days after
(2) Recommendations regarding the the date of rendition of the final decision or order. In
appropriate sanction. Section 164.007(a) requires that, the event of an extension, the motion for rehearing is
after receiving the ALJ's findings of fact and overruled by operation of law on the date fixed by the
conclusions of law, the board shall determine the order, or in the absence of a fixed date, 90 days after the
charges on the merits. The board interprets this date of the final decision or order. The parties may by
requirement as imposing on the board the responsibility agreement with the approval of the board provide for a
of assessing the proper sanction. While the board modification of the times provided in this section.
welcomes the recommendations of ALJs regarding the
appropriate sanction, the board does not consider the Source Note: The provisions of this §187.38 adopted to
findings of fact and conclusions of law to be be effective January 6, 2002, 26 TexReg 10867.
appropriate for stating such recommendations.
Therefore, sanction recommendations in the form of §187.39. Costs of Administrative Hearings.
findings of fact and conclusions of law are considered (a) Default Orders. In cases brought before SOAH,
to be an improper application of applicable law and in the event that the respondent is adjudged to be in
these rules. violation of the Act by default, the board has the
(3) Changes Stated in Final Order. If the board authority to assess, in addition to penalty imposed, costs
modifies, amends, or changes the ALJ's proposed of the administrative hearing.
findings of fact or conclusions of law, an order shall be (b) Trial on the Merits. In cases brought before
prepared reflecting the specific reason and legal basis SOAH, in the event that the respondent is adjudged to
for each change made. be in violation of the Act after a trial on the merits, the
(e) Administrative finality. A final order or board board has the authority to assess in addition to the
decision is administratively final: penalty imposed, the costs of the administrative
(1) upon a finding of imminent peril to the hearing.
public's health, safety or welfare, as outlined in (c) Appeal. The costs of transcribing the testimony
subsection (c) of this section; and preparing the record for an appeal by judicial
(2) when no motion for rehearing has been review shall be paid by the party who appeals.
filed within 20 days after the date the final order or
board decision is entered; or Source Note: The provisions of this §187.39 adopted to
(3) when a timely motion for rehearing is filed be effective January 6, 2002, 26 TexReg 10867;
and the motion for rehearing is denied by board order or amended to be effective March 6, 2003, 28 TexReg
operation of law as outlined in §187.38 of this title 1884; amended to be effective November 7, 2004, 29
(relating to Motions for Rehearing). TexReg 10113.
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(1) A board member should exercise sound member so recused shall be allowed to remain in the
discretion in choosing to be recused from participation room during any portion of the related proceeding and
and voting regarding any matter. shall be counted for purposes of determining a quorum,
(2) A board member should choose to be but shall not participate in any discussions, questioning,
recused if the board member: deliberations, or vote pertaining to the proceeding.
(A) has a direct financial interest or
relationship with any matter, party, or witness that Source Note: The provisions of this §187.42 adopted to
would give the appearance of a conflict of interest; be effective January 6, 2002, 26 TexReg 10867;
(B) has a familial relationship within the amended to be effective January 25, 2006, 31 TexReg
third degree of affinity with any party or witness; or 394.
(C) determines that he/she has knowledge
of information that is not in the administrative record of
a contested case and that he/she cannot set aside that
knowledge and fairly and impartially consider the
matter based solely on the administrative record.
(3) The fact that a board member participated
in an ISC, a temporary suspension, or any other matter
regarding a respondent shall not require the board
member to be recused from any other matter, unless the
board member determines that he or she cannot set
aside knowledge of any information that is not in the
administrative records and fairly and impartially
consider the matter based solely on the administrative
record.
(c) Motion for Disqualification by a Party.
(1) Any party may move for the
disqualification of a board member stating with
particularity why the board member should not sit. The
motion shall be made on personal knowledge, shall set
forth such facts as would be admissible in evidence, and
shall be verified by affidavit.
(2) The motion must be filed with the Hearings
Coordinator of the Board at least five business days
prior to a board meeting at which the matter is on the
agenda. The Hearings Coordinator shall immediately
send a copy of the Motion for Disqualification to all
board members.
(3) The board member sought to be
disqualified shall determine whether the motion raises
valid issues and whether the board member can fairly
and impartially consider the matter based solely on the
administrative record, setting aside knowledge of any
information that is not in the administrative record. If
the board member determines that he/she can fairly and
impartially consider the matter and chooses not to be
recused, the board member shall inform the board of
that decision and shall be allowed to participate in all
discussion and voting regarding the matter. The board
is not required to take a vote on the motion.
(4) Consent to Participation. Failure to timely
file a Motion for Disqualification regarding any board
member as provided for in this subsection shall
constitute a waiver of any objection and consent to
participation by the member.
(d) Upon exercising the right to be recused and
announcement of the recusal in open session, any board
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§§187.43-187.45
§187.43. Proceedings for the shall be in writing and filed with the director of
Modification/Termination of Agreed Orders and compliance for the board. The petition will then be
Disciplinary Orders. scheduled before an ISC Panel for consideration.
(a) Unless the board order specifies that the order (g) Modification or termination requests may be
shall or will be modified or terminated upon the made only once a year since the prior request for
fulfillment of certain conditions or the occurrence of modification or termination unless a board order
certain events, the decision to modify or terminate a otherwise specifies, or upon an assertion in writing
board order shall be a matter for the exercise of sound under oath by a petitioner indicating that a circumstance
discretion by the board. exists as described in subsection (d)(2) of this section.
(b) Modification or termination requests shall not Upon receipt of the petition, the Director of
be contested matters, but instead shall be matters to be Compliance shall determine whether such a request is
ruled upon through the exercise of sound discretion by valid and meets the requirements of subsection (d)(2) of
the board. this section. A finding by the Director of Compliance
(c) If a board order sets out certain conditions or does not equate to such a finding by representatives of
events for granting modification or termination of an the board.
order, the licensee shall have the burden of establishing (h) For purposes of administrative convenience,
that such conditions or events have taken place or been modification or termination requests may be heard by
met. the full board or by representatives of the board. If such
(d) If by the terms of the order no specific a request is heard by representatives of the board, the
conditions or events trigger the requirement that the representatives shall consist of at least one board
petition be granted, the licensee has the burden of proof member or one district review committee member. In
of demonstrating that one or more of the following the event such a request is heard by board
factors should be considered for purposes of analyzing representatives, the representatives of the board shall
the merits of the petition and exercising sound not be authorized to bind the board, but shall only make
discretion: recommendations to the board regarding an appropriate
(1) whether there has been a significant change disposition. The recommendation of such
in circumstances which indicates that it is in the best representatives shall be submitted to the full board for
interest of the public and the licensee to modify or adoption or rejection in the form of an order drafted by
terminate the order; board staff.
(2) whether there has been an unanticipated,
unique or undue hardship on the licensee as a result of Source Note: The provisions of this §187.43 adopted to
the board order which goes beyond the natural adverse be effective January 6, 2002, 26 TexReg 10867;
ramifications of the disciplinary action (i.e. amended to be effective November 7, 2004, 29 TexReg
impossibility of requirement, geographical problems). 10113; amended to be effective January 25, 2006, 31
Economic hardships such as the denial of insurance TexReg 394.
coverage or an adverse action taken by a medical
specialty board are not considered unanticipated, §187.44. Probationer Show Compliance
unique or undue hardships; Proceedings.
(3) whether the licensee has engaged in special Pursuant to §§164.003-.004 of the Act and §§2001.054-
activities which are particularly commendable or so .056 of the APA, the following rules shall apply to
meritorious as to make modification or termination probationer show compliance proceedings.
appropriate; and (1) If a licensee is placed under an order, the
(4) whether the licensee has fulfilled the licensee shall be monitored by the board to ensure
requirements of the licensee's order in a timely manner compliance. In the event that a licensee fails to comply
and cooperated with the board and board staff during with the licensee's order, such noncompliance will be
the period of probation or restriction. addressed at a probationer show compliance
(e) Probationers must be in compliance with the proceeding.
terms and conditions of their orders in order for the (2) All licensees under any order must
board to consider modification or termination of an maintain their licenses in good standing, including
order unless the modification or termination relates to meeting all fee and continuing medical education
the factors outlined in subsection (d)(2) of this section. requirements. Failure to keep a license in good standing
(f) Unless the terms of the board order specify shall be evidence of noncompliance with a board order
otherwise, petitions for modification or termination and considered a violation of the Act and board rules.
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§§187.55-187.62
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deliberations by the panel and shall advise the panel on §187.61. Ancillary Proceeding.
all legal issues that arise during the hearing including (a) A temporary suspension proceeding is ancillary
objections to evidence and other evidentiary matters. to a disciplinary proceeding concerning the licensee's
The Counsel to the Panel shall be permitted to ask alleged violation(s) of the Act.
questions of witnesses, the board staff, the attorney for (b) A temporary suspension order is effective
the licensee and other participants in the hearing. immediately on the date entered and shall remain in
effect until a final or further order of the board is
Source Note: The provisions of this §187.58 adopted to entered in the disciplinary proceeding.
be effective November 3, 2002, 27 TexReg 10027; (c) Upon the entry of a temporary suspension
amended to be effective June 29, 2003, 28 TexReg order, an ISC shall be scheduled as soon as practicable
4634; amended to be effective November 7, 2004, 29 in the disciplinary proceeding in accordance with
TexReg 10113. §164.004 of the Act, and §2001.054(c), Tex. Gov't
Code. A second ISC is not required, however, if an ISC
§187.59. Evidence. has previously been held in the disciplinary proceeding.
(a) In accordance with the Administrative (d) If the matter is not resolved by an Agreed Order
Procedure Act (APA), §2001.081, the determination of through the ISC, a formal Complaint shall be filed in
the disciplinary panel may be based not only on the disciplinary proceeding at the State Office of
evidence admissible under the Texas Rules of Administrative Hearings in accordance with §164.005
Evidence, but may be based on information of a type on of the Act as soon as practicable after the ISC.
which a reasonably prudent person commonly relies in
the conduct of the person's affairs, necessary to Source Note: The provisions of this §187.61 adopted to
ascertain facts not reasonably susceptive of proof under be effective November 3, 2002, 27 TexReg 10027;
those rules, and not precluded by statute. amended to be effective November 7, 2004, 29 TexReg
(b) Questioning of witnesses by the parties or panel 10113.
members shall be under the control of the chair of the
disciplinary panel with due consideration being given to §187.62. Continuing Threat Constitutes A Danger to
the need to obtain accurate information and prevent the the Public.
harassment or undue embarrassment of witnesses. Section 164.011(c) of the Act provides that the board's
(c) In receiving information on which to base its decision to suspend a license may not be enjoined if the
determination of a continuing threat to the public license holder's continued practice presents a danger to
welfare, the disciplinary panel may accept the the public. The board's determination that a licensee's
testimony of witnesses by telephone. continuation in practice would constitute a continuing
threat to the public welfare shall be deemed to be a
Source Note: The provisions of this §187.59 adopted to finding that the license holder's continued practice
be effective November 3, 2002, 27 TexReg 10027; presents a danger to the public.
amended to be effective November 7, 2004, 29 TexReg
10113; amended to be effective January 20, 2009, 34 Source Note: The provisions of this §187.62 adopted to
TexReg 340. be effective November 3, 2002, 27 TexReg 10027.
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Chapter 187, Procedural Rules
§§187.70-187.73
§187.70. Purposes and Construction. that probation is authorized by §164.101 and §164.102
The purpose of this subchapter is to set forth a of the Act and that the suspension should be probated.
procedure for the suspension of a medical license in the (f) A licensee shall be subject to further
case of initial conviction of certain offenses or the disciplinary action when a final conviction of the
incarceration of a physician in a state or federal offense occurs pursuant to §164.051(a)(2) and
penitentiary, as provided in §§164.057 - 164.058 of the §164.057(b) of the Act. A final conviction occurs when
Act. The board interprets this statute as providing for there has been an adjudication of guilt and a judgment
suspension by operation of law and that an initial entered.
conviction occurs when there has been adjudication of
guilt of the offense charged. Since the board's role in Source Note: The provisions of this §187.71 adopted to
such circumstances is limited to whether the licensee be effective July 3, 2007, 32 TexReg 3994; amended to
has been initially convicted of certain offenses or is be effective January 20, 2009, 34 TexReg 340.
incarcerated, the board has determined that the
procedures set forth in this subchapter will provide due §187.72. Decision of the Panel.
process to the licensee and protect the public. (a) If the panel determines that the licensee has
been initially convicted of an offense or is incarcerated,
Source Note: The provisions of this §187.70 adopted to but does not determine that the suspension should be
be effective July 3, 2007, 32 TexReg 3994; amended to probated, the panel shall direct the Executive Director
be effective January 20, 2009, 34 TexReg 340 to enter an order suspending the medical license of the
licensee in accordance with §164.057 or §164.058 of
§187.71. Hearing before a Panel of Board the Act. Because the Act requires suspension, the board
Representatives. has determined that an imminent peril to the public
(a) Upon receipt of information that a licensee has health, safety, or welfare requires immediate effect and
been initially convicted of certain offenses or is the order of the Executive Director shall be effective
incarcerated, the board shall schedule a hearing before a and final immediately upon entry.
panel of board representatives at the earliest practicable (b) If the panel determines that the suspension
time after providing the licensee with at least ten days should be probated, the panel may recommend the
notice. terms and conditions of an agreed order to be signed by
(b) The panel shall be composed of at least two the licensee and presented to the board for approval.
members of the board or District Review Committee. The agreed order shall be effective only after being
At least one member must be a physician and one signed by the licensee and approved by the board.
member must be a public member. The panel may be
the same panel that is scheduled for Informal Show Source Note: The provisions of this §187.72 adopted to
Cause and Settlement Conferences. be effective July 3, 2007, 32 TexReg 3994; amended to
(c) At the hearing, the licensee shall have the right be effective January 20, 2009, 34 TexReg 340.
to respond to the allegations, be represented by counsel,
and present evidence or information to the panel. §187.73. Termination of Suspension
(d) The panel must base its decision or Suspension may be terminated upon request by the
recommendation on evidence or information that is licensee after an appearance at an Informal Settlement
admissible under §2001.081, Texas Administrative Conference (ISC) at which time the licensee must
Procedure Act. demonstrate physical and mental competence to
(e) If the licensee disputes the fact that the licensee practice medicine and that the licensee is otherwise safe
has been initially convicted of the offense or that the to practice medicine.
licensee is incarcerated, the licensee may present
evidence or information. If the licensee admits that the Source Note: The provisions of this §187.73 adopted to
licensee has been initially convicted of an offense or is be effective July 3, 2007, 32 TexReg 3994; amended to
incarcerated, but requests that the panel probate an be effective January 20, 2009, 34 TexReg 340.
order suspending the licensee's medical license, the
licensee may present evidence or information showing
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Chapter 187, Procedural Rules
§§187.75-187.82
§187.75. Purposes and Construction. Source Note: The provisions of this §187.76 adopted to
The purpose of this subchapter is to set forth a be effective March 16, 2008, 33 TexReg 2026.
procedure for the imposition of an administrative
penalty as provided in Chapter 165, Subchapter A §187.77. Notice of Intention to Impose
(§165.001, et seq.) of the Act, for violations identified Administrative Penalty, Response
in §190.14 of this title (relating to Disciplinary Sanction If the licensee pays the administrative penalty, the
Guidelines) as administrative violations, but not payment shall be acknowledged on a copy of the notice,
including aggravated administrative violations. which shall constitute an agreed imposition of the
administrative penalty. A report of the payments upon
Source Note: The provisions of this §187.75 adopted to notice of intention to impose administrative penalties
be effective March 16, 2008, 33 TexReg 2026. shall be made to the board at the next regular meeting
for approval.
§187.76. Notice of Intention to Impose
Administrative Penalty, Response Source Note: The provisions of this §187.77 adopted to
(a) Before an administrative penalty is imposed, be effective March 16, 2008, 33 TexReg 2026.
the board will provide a licensee who is alleged to have
committed an administrative violation with a notice of §187.78. Written Response
the allegations regarding an administrative violation If, at any time prior to the imposition of an
and the amount of a proposed administrative penalty. administrative penalty, the licensee submits a written
(b) The Notice shall include, at a minimum: response without a request for a personal appearance at
(1) information regarding the allegations, an informal meeting, the allegations and the written
based on information then available, to allow the response shall be submitted to the Disciplinary Process
licensee to prepare a response; Review Committee of the board ("DPRC") at the next
(2) deadlines for a response and the regular meeting. The action of the DPRC shall be
consequences of failing to meet such deadlines; submitted to the Board for approval.
(3) the consequences of paying a proposed
administrative penalty, including the fact that payment Source Note: The provisions of this §187.78 adopted to
will constitute a public record; be effective March 16, 2008, 33 TexReg 2026.
(4) the licensee's right to submit a written
response or request a personal appearance; §187.79. Personal Appearance at an Informal
(5) a description of the procedural process for Meeting
consideration of a written response or request for a (a) If, within 30 days after the Notice of Intention
personal appearance; to Impose Administrative Penalty is sent to the licensee,
(6) the name and contact information for an the licensee submits a request for personal appearance
employee who can provide further information. at an informal meeting, an informal meeting shall be
(c) The licensee may respond to the notice as scheduled in accordance with §164.004(a)(2) of the Act
follows: before one or more board representatives.
(1) The licensee may pay the proposed (b) An informal meeting under this Subchapter
administrative penalty; may consider only dismissal of the matter or the
(2) The licensee may provide a written imposition of an administrative penalty. The board
response to the board; or representatives may not consider revocation,
(3) The licensee may request a personal suspension, or any other sanction. The provisions of
appearance at an informal meeting. §187.18 of this title (relating to Informal Show
(d) If the licensee submits a written response Compliance Proceeding and Settlement Conference
within 30 days after the complaint is received by the Based on Personal Appearance) shall apply to the
board, board staff may determine that the complaint informal meeting, except that there may be one or more
should not be filed and no investigation opened. board representatives at the informal meeting, who may
Because the board is limited to 30 days for the be either a physician or public member of the Board or
preliminary investigation, pursuant to §157.057(b), District Review Committee.
Occupations Code, no extensions may be granted to this (c) The recommendation of the board
deadline. representative(s) to impose the administrative penalty
or to dismiss the allegations shall be referred to the
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DPRC at the next regular meeting. The action of the Source Note: The provisions of this §187.81 adopted to
DPRC shall be submitted to the Board for approval. be effective March 16, 2008, 33 TexReg 2026.
Source Note: The provisions of this §187.79 adopted to §187.82. Unpaid Administrative Penalties
be effective March 16, 2008, 33 TexReg 2026. A licensee shall not be issued a registration permit until
all administrative penalties imposed by the board have
§187.80. Imposition of Administrative Penalty been paid.
(a) The board may enter an order imposing an
administrative penalty in accordance with §165.004 of Source Note: The provisions of this §187.82 adopted to
the Act at the next regular meeting of the board after be effective March 16, 2008, 33 TexReg 2026.
the expiration of 30 days after Notice of Intention to
Impose Administrative Penalty is sent to the licensee if:
(1) the licensee has failed to respond to the
notice; or
(2) the DPRC has approved the imposition of
an administrative penalty.
(b) Upon imposition of an administrative penalty,
the board shall notify the licensee of the board's order.
The notice shall include a statement of the right of the
licensee to judicial review of the order, in accordance
with §165.005 of the Act.
(c) If the licensee pursues judicial review of the
order, the administrative record shall include the Notice
of Intention to Impose Administrative Penalty, any
written response provided by the licensee, any
documents reviewed by board representatives at an
informal meeting, the recommendation of the board
representative(s), any documents considered by the
DPRC, the minutes of the DPRC, the minutes of the
board imposing an administrative penalty, and the order
imposing an administrative penalty.
(d) An administrative penalty imposed by the board
shall be due and payable to the board within 60 days
after the licensee receives notice of the board's order.
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Texas Administrative Code, Title 22, Part 9
§§190.1-190.2
§190.1. Purpose.
(a) Purpose. This chapter is promulgated to:
(1) promote consistency in the exercise of
sound discretion by board members in licensure and
disciplinary matters;
(2) provide guidance for board members for
the resolution of potentially contested matters; and
(3) provide guidance as to the types of conduct
that constitute violations of the Medical Practice Act
(the "Act") or board rules.
(b) Authority. Pursuant to §§164.001 - 164.103, the
Board may adopt rules relating to its disciplinary
authority to take action against a licensee.
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Chapter 190, Disciplinary Guidelines
§190.8
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the Acupuncture Act, (collectively, the "Licensing (II) arose out of the practice
Acts") authorize the board to take disciplinary action location of the physician;
based on a conviction, deferred adjudication, (III) involves a patient or former
community supervision, or deferred disposition for any patient;
felony. (IV) involves any other health
(ii) Chapter 53, Tex. Occ. Code professional with whom the physician has or has had a
authorizes the board to revoke or suspend a license on professional relationship;
the grounds that a person has been convicted of a felony (V) involves the prescribing,
that directly relates to the duties and responsibilities of sale, distribution, or use of any dangerous drug or
the licensed occupation. controlled substance; or
(iii) Because the provisions of the (VI) involves the billing for or
Licensing Acts may be based on either conviction or a any financial arrangement regarding any medical
form of deferred adjudication, the board determines that service;
the requirements of the Act are stricter than the (v) Misdemeanors involving moral
requirements of Chapter 53 and, therefore, the board is turpitude. Misdemeanors involving moral turpitude,
not required to comply with Chapter 53, pursuant to within the meaning of the Act, are those that involve
section 153.0045 of the Act. dishonesty, fraud, deceit, misrepresentation, deliberate
(iv) Upon the initial conviction for violence, or that reflect adversely on a licensee's
any felony, the board shall suspend a physician's honesty, trustworthiness, or fitness to practice under the
license, in accordance with section 164.057(a)(1)(A), of scope of the person's license.
the Act. (C) In accordance with section 164.058
(v) Upon final conviction for any of the Act, the board shall suspend the license of a
felony, the board shall revoke a physician's license, in licensee serving a prison term in a state or federal
accordance with section 164.057(b) of the Act penitentiary during the term of the incarceration
(B) Misdemeanors. regardless of the offense.
(i) Section 164.051(a)(2)(B) of the
Act authorizes the board to take disciplinary action Source Note: The provisions of this §190.8 adopted to
based on a conviction, deferred adjudication, be effective November 30, 2003, 28 TexReg 10496;
community supervision, or deferred disposition for any amended to be effective July 4, 2004, 29 TexReg 6092;
misdemeanor involving moral turpitude. amended to be effective January 25, 2006, 31 TexReg
(ii) Chapter 53, Tex. Occ. Code 396; amended to be effective July 3, 2007, 32 TexReg
authorizes the board to revoke or suspend a license on 3994; amended to be effective June 24, 2009, 34
the grounds that a person has been convicted of a TexReg 4124.
misdemeanor that directly relates to the duties and
responsibilities of the licensed occupation.
(iii) For a misdemeanor involving
moral turpitude, the provisions of section 164.051(a)(2)
of the Medical Practice Act and section 205.351(a)(7)
of the Acupuncture Act, may be based on either
conviction or a form of deferred adjudication, and
therefore the board determines that the requirements of
these licensing acts are stricter than the requirements of
Chapter 53 and the board is not required to comply with
Chapter 53, pursuant to section 153.0045 of the Act.
(iv) The Medical Practice Act and
the Acupuncture Act do not authorize disciplinary
action based on conviction for a misdemeanor that does
not involve moral turpitude. The Physician Assistant
Act does not authorize disciplinary action based on
conviction for a misdemeanor. Therefore these
licensing acts are not stricter than the requirements of
Chapter 53 in those situations. In such situations, the
conviction will be considered to directly relate to the
practice of medicine if the act:
(I) arose out of the practice of
medicine, as defined by the Act;
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Chapter 190, Disciplinary Guidelines
§§190.14-190.15
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(ii) Standard Sanction: probation for (II) comply with all restrictions,
2 years under terms and conditions, including, but not conditions and terms imposed by the disciplinary action
limited to: by peers; and
(I) competency testing; (III) administrative penalty of
(II) directed CME; $1,000 per violation.
(III) monitoring of practice; and (L) Disciplined by another state or
(IV) administrative penalty of military may be either an administrative violation or a
$2,000 per violation. patient care violation, depending on the facts
(J) Quality of Care is a patient care underlying the disciplinary action.
violation. (i) Within the meaning of
(i) Violations of: §164.051(a)(9).
(I) Section 164.051(a)(6) - failure (ii) Standard Sanction: See the
to practice medicine in a professional manner consistent applicable standard sanction for the most similar
with the public health and welfare; and violation of the Act. In addition, the licensee shall
(II) Section 164.051(a)(8) - comply with all restrictions, conditions and terms
repeated and meritorious medical malpractice claims. imposed by the other state or military.
(ii) Standard Sanction: (iii) Alternate Standard Sanction:
(I) The standard sanction, which (I) comply with all restrictions,
shall apply in the case of a single patient with no conditions and terms imposed by the other state or
substantial patient harm and no other aggravating or military; and
mitigating circumstances, shall be one or more of the (II) administrative penalty of
following : $1,000 per violation.
(-a-) limiting the practice of (iv) The standard sanction for a
the person, or excluding one or more specified activities licensee whose license has been revoked by another
of medicine; state or who has voluntarily surrendered his license
(-b-) proficiency testing; while an investigation or disciplinary action is pending
(-c-) directed CME; shall be revocation of the license.
(-d-) monitoring of the (M) Improper prescribing, dispensing, or
practice; administering of drugs is a patient care violation.
(-e-) public reprimand; and (i) Violation of:
(-f-) administrative penalty (I) Section 164.053(a)(3) -
of $3,000 per violation. prescribing or dispensing drugs to a drug abuser;
(II) Standard sanction in a case (II) Section 164.053(a)(5) -
involving patient harm or other aggravating factors prescribing or administering drugs in a non therapeutic
shall be: manner; and
(-a-) suspension of license (III) Section 164.053(a)(6) -
for 3 years; prescribing or administering drugs in a manner
(-b-) suspension may be inconsistent with the public health and welfare.
probated after 90 days under terms and conditions (ii) Standard Sanction: The standard
similar to those described in subclause (I) of this clause, sanction, which shall apply in the case of a single
immediately preceding. patient with no substantial patient harm and no other
(K) Discipline by peers may be either an aggravating or mitigating circumstances, shall be:
administrative violation or a patient care violation, (I) suspension of license for 2
depending on the facts underlying the disciplinary years.
action. (II) suspension probated after 60
(i) Within the meaning of days under terms and conditions, including, but not
§164.051(a)(7). limited to:
(ii) Standard Sanction: See the (-a-) restrictions on practice,
applicable standard sanction for the violation of the including prescribing, administering controlled
Texas Medical Practice Act that most closely relates to substances and dangerous drugs;
the basis of the disciplinary action by peers. In addition, (-b-) proficiency testing;
the licensee shall comply with all restrictions, (-c-) directed CME; and
conditions and terms imposed by the disciplinary action (-d-) administrative penalty
by peers. of $2,000 per violation.
(iii) Alternate Standard Sanction: (N) Writing false or fictitious
(I) public reprimand; prescriptions is a patient care violation.
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Chapter 190, Disciplinary Guidelines
§190.16
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Texas Administrative Code, Title 22, Part 9
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Chapter 191, District Review Committees
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Chapter 192, Office Based Anesthesia Services
abuse and addiction. (Schedule I includes drugs that (A) at least two personnel must be
carry an extremely high risk of abuse and addiction and present, including the physician who must be currently
have no legitimate medical use. Schedule V includes certified at least in AHA approved BCLS; and
drugs that have the lowest abuse/addiction risk). (B) the following age-appropriate
equipment must be present:
Source Note: The provisions of this §192.1 adopted to (i) bag mask valve;
be effective May 21, 2000, 25 TexReg 4350; amended (ii) oxygen; and
to be effective June 29, 2006, 31 TexReg 5107. (iii) AED or other defibrillator; and
(iv) epinephrine, atropine, adreno-
§192.2. Provision of Anesthesia Services in corticoids, and antihistamines.
Outpatient Settings. (2) Level II services:
(a) The purpose of these rules is to identify the (A) at least two personnel must be
roles and responsibilities of physicians providing, or present, including the physician who must be currently
overseeing by proper delegation, anesthesia services in certified at least in AHA approved ACLS or PALS, as
outpatient settings and to provide the minimum appropriate;
acceptable standards for the provision of anesthesia (i) another person must be currently
services in outpatient settings. certified at least in AHA approved BCLS; and
(b) The rules promulgated under this title do not (ii) a licensed health care provider,
apply to physicians who practice in the following who may be one of the two required personnel, must
settings listed in paragraphs (1) - (8) of this subsection: attend the patient, until the patient is ready for
(1) an outpatient setting in which only local discharge; and
anesthesia, peripheral nerve blocks, or both are used; (B) a crash cart must be present
(2) any setting physically located outside the containing drugs and equipment necessary to carry out
State of Texas; ACLS protocols, including, but not limited to, the
(3) a licensed hospital, including an outpatient following age-appropriate equipment:
facility of the hospital that is separately located apart (i) bag mask valve and appropriate
from the hospital; airway maintenance devices;
(4) a licensed ambulatory surgical center; (ii) oxygen;
(5) a clinic located on land recognized as tribal (iii) AED or other defibrillator;
land by the federal government and maintained or (iv) pre-measured doses of first line
operated by a federally recognized Indian tribe or tribal cardiac medications, including epinephrine, atropine,
organization as listed by the United States secretary of adreno-corticoids, and antihistamines;
the interior under 25 U.S.C. §479-1 or as listed under a (v) IV equipment;
successor federal statute or regulation; (vi) pulse oximeter; and
(6) a facility maintained or operated by a state (vii) EKG Monitor.
or governmental entity; (3) Level III services:
(7) a clinic directly maintained or operated by (A) at least two personnel must be
the United States or by any of its departments, officers, present, including the physician who must be currently
or agencies; and certified at least in AHA approved ACLS or PALS, as
(8) an outpatient setting accredited by: appropriate;
(A) the Joint Commission on (i) another person must be currently
Accreditation of Healthcare Organizations relating to certified at least in AHA approved BCLS;
ambulatory surgical centers; (ii) a licensed health care provider,
(B) the American Association for the which may be either of the two required personnel,
Accreditation of Ambulatory Surgery Facilities; or must attend the patient, until the patient is ready for
(C) the Accreditation Association for discharge; and
Ambulatory Health Care. (iii) a person, who may be either of
(c) Standards for Anesthesia Services. The the two required personnel, must be responsible for
following standards are required for outpatient settings monitoring the patient during the procedure; and
providing anesthesia services that are administered (B) the same equipment required for
within two hours before an out patient procedure. If Level II.
personnel and equipment meet the requirements of a (4) Level IV services: Physicians who practice
higher level, lower level anesthesia services may also medicine in this state and who administer anesthesia or
be provided. perform a procedure for which anesthesia services are
(1) Level I services: provided in outpatient settings at Level IV shall follow
current, applicable standards and guidelines as put forth
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by the American Society of Anesthesiologists (ASA) the CRNA. Informed consent for the planned anesthetic
including, but not limited to, the following listed in intervention shall be obtained from the patient/legal
subparagraphs (A) - (H) of this paragraph: guardian and maintained as part of the medical record.
(A) Basic Standards for Preanesthesia The consent must include explanation of the technique,
Care; expected results, and potential risks/complications.
(B) Standards for Basic Anesthetic Appropriate pre-anesthesia diagnostic testing and
Monitoring; consults shall be obtained per indications and
(C) Standards for Postanesthesia Care; assessment findings. Pre-anesthetic diagnostic testing
(D) Position on Monitored Anesthesia and specialist consultation should be obtained as
Care; indicated by the pre-anesthetic evaluation by the
(E) The ASA Physical Status anesthesiologist or suggested by the nurse anesthetist's
Classification System; pre-anesthetic assessment as reviewed by the surgeon.
(F) Guidelines for Nonoperating Room If responsibility for a patient's care is to be shared with
Anesthetizing Locations; other physicians or non-physician anesthesia providers,
(G) Guidelines for Ambulatory this arrangement should be explained to the patient.
Anesthesia and Surgery; and (g) Physiologic monitoring of the patient shall be
(H) Guidelines for Office-Based determined by the type of anesthesia and individual
Anesthesia. patient needs. Minimum monitoring shall include
(d) A physician delegating the provision of continuous monitoring of ventilation, oxygenation, and
anesthesia or anesthesia-related services to a certified cardiovascular status. Monitors shall include, but not be
registered nurse anesthetist shall be in compliance with limited to, pulse oximetry and EKG continuously and
ASA standards and guidelines when the certified non-invasive blood pressure to be measured at least
registered nurse anesthetist provides a service specified every five minutes. If general anesthesia is utilized,
in the ASA standards and guidelines to be provided by then an O2 analyzer and end-tidal CO2 analyzer must
an anesthesiologist. also be used. A means to measure temperature shall be
(e) In an outpatient setting, where a physician has readily available and utilized for continuous monitoring
delegated to a certified registered nurse anesthetist the when indicated per current ASA standards. An audible
ordering of drugs and devices necessary for the nurse signal alarm device capable of detecting disconnection
anesthetist to administer an anesthetic or an anesthesia- of any component of the breathing system shall be
related service ordered by a physician, a certified utilized. The patient shall be monitored continuously
registered nurse anesthetist may select, obtain and throughout the duration of the procedure.
administer drugs, including determination of Postoperatively, the patient shall be evaluated by
appropriate dosages, techniques and medical devices continuous monitoring and clinical observation until
for their administration and in maintaining the patient in stable by a licensed health care provider. Monitoring
sound physiologic status. This order need not be drug- and observations shall be documented per current ASA
specific, dosage specific, or administration-technique standards. In the event of an electrical outage which
specific. Pursuant to a physician's order for anesthesia disrupts the capability to continuously monitor all
or an anesthesia-related service, the certified registered specified patient parameters, at a minimum, heart rate
nurse anesthetist may order anesthesia-related and breath sounds will be monitored on a continuous
medications during perianesthesia periods in the basis using a precordial stethoscope or similar device,
preparation for or recovery from anesthesia. In and blood pressure measurements will be reestablished
providing anesthesia or an anesthesia-related service, using a non-electrical blood pressure measuring device
the certified registered nurse anesthetist shall select, until electricity is restored. There should be in each
order, obtain and administer drugs which fall within location, sufficient electrical outlets to satisfy
categories of drugs generally utilized for anesthesia or anesthesia machine and monitoring equipment
anesthesia-related services and provide the concomitant requirements, including clearly labeled outlets
care required to maintain the patient in sound connected to an emergency power supply. A two-way
physiologic status during those experiences. communication source not dependent on electrical
(f) The anesthesiologist or physician providing current shall be available. Sites shall also have a
anesthesia or anesthesia-related services in an secondary power source as appropriate for equipment in
outpatient setting shall perform a pre-anesthetic use in case of power failure.
evaluation, counsel the patient, and prepare the patient (h) All anesthesia-related equipment and monitors
for anesthesia per current ASA standards. If the shall be maintained to current operating room
physician has delegated the provision of anesthesia or standards. All devices shall have regular
anesthesia-related services to a CRNA, the CRNA may service/maintenance checks at least annually or per
perform those services within the scope of practice of manufacturer recommendations. Service/maintenance
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TEXAS MEDICAL BOARD RULES
Chapter 192, Office Based Anesthesia Services
checks shall be performed by appropriately qualified (D) ACLS (advanced cardiac life support)
biomedical personnel. Prior to the administration of or PALS (pediatric advanced life support) algorithms;
anesthesia, all equipment/monitors shall be checked (E) infection control;
using the current FDA recommendations as a guideline. (F) documentation and tracking use of
Records of equipment checks shall be maintained in a pharmaceuticals, including controlled substances,
separate, dedicated log which must be made available expired drugs and wasting of drugs; and
upon request. Documentation of any criteria deemed to (G) discharge criteria.
be substandard shall include a clear description of the (2) Management of emergencies. At a
problem and the intervention. If equipment is utilized minimum, these must include, but not be limited to:
despite the problem, documentation must clearly (A) cardiopulmonary emergencies;
indicate that patient safety is not in jeopardy. All (B) fire;
documentation relating to equipment shall be (C) bomb threat;
maintained for seven years or for a period of time as (D) chemical spill; and
determined by the board. (E) natural disasters.
(i) Each location must have emergency supplies (k) Physicians, and anesthesiologists shall maintain
immediately available. Supplies should include current competency in ACLS, PALS, or a course
emergency drugs and equipment appropriate for the approved by the board. In all settings under these rules,
purpose of cardiopulmonary resuscitation. This must at a minimum, at least two persons, including the
include a defibrillator, difficult airway equipment, and surgeon or anesthesiologist, shall maintain current
drugs and equipment necessary for the treatment of competency in basic life support.
malignant hyperthermia if "triggering agents" (l) Physicians or surgeons must notify the
associated with malignant hyperthermia are used or if board in writing within 15 days if a procedure
the patient is at risk for malignant hyperthermia. performed in any of the settings under these rules
Equipment shall be appropriately sized for the patient resulted in an unanticipated and unplanned transport of
population being served. Resources for determining the patient to a hospital for observation or treatment for
appropriate drug dosages shall be readily available. The a period in excess of 24 hours, or a patient's death
emergency supplies shall be maintained and inspected intraoperatively or within the immediate postoperative
by qualified personnel for presence and function of all period. Immediate postoperative period is defined as 72
appropriate equipment and drugs at intervals hours.
established by protocol to ensure that equipment is
functional and present, drugs are not expired, and office Source Note: The provisions of this §192.2 adopted to
personnel are familiar with equipment and supplies. be effective May 21, 2000, 25 TexReg 4350; amended
Records of emergency supply checks shall be to be effective November 30, 2003, 28 TexReg 10498;
maintained in a separate, dedicated log and made amended to be effective June 29, 2006, 31 TexReg
available upon request. Records of emergency supply 5107; amended to be effective January 20, 2009, 34
checks shall be maintained for seven years or for a TexReg 342.
period of time as determined by the board.
(j) The operating surgeon shall verify that the §192.3. Compliance with Office-Based Anesthesia
appropriate policies or procedures are in place. Policies, Rules.
procedure, or protocols shall be evaluated and reviewed (a) A physician who provides anesthesia services
at least annually. Agreements with local emergency or performs a procedure for which anesthesia services
medical service (EMS) shall be in place for purposes of are provided in an outpatient setting shall comply with
transfer of patients to the hospital in case of an the rules adopted under this title.
emergency. EMS agreements shall be evaluated and re- (b) The board may require a physician to submit
signed at least annually. Policies, procedure, and and comply with a corrective action plan to remedy or
transfer agreements shall be kept on file in the setting address any current or potential deficiencies with the
where procedures are performed and shall be made physician's provision of anesthesia services in an
available upon request. Policies or procedures must outpatient setting in accordance with the Medical
include, but are not limited to the following listed in Practice Act, Title 3 Subtitle C §§162.101-.107 of the
paragraphs (1) - (2) of this subsection: Texas Occupations Code, or rules of the board.
(1) Management of outpatient anesthesia. At a (c) Any physician who violates these rules shall be
minimum, these must address: subject to disciplinary action and/or termination of the
(A) patient selection criteria; registration issued by the board as authorized by the
(B) patients/providers with latex allergy; Medical Practice Act or rules of the board.
(C) pediatric drug dosage calculations,
where applicable;
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TEXAS MEDICAL BOARD RULES
Chapter 192, Office Based Anesthesia Services
Source Note: The provisions of this §192.3 adopted to (b) An advisory opinion issued by the board under
be effective May 21, 2000, 25 TexReg 4350; amended this section is not binding on the board, and the board,
to be effective November 30, 2003, 28 TexReg 10498; except as provided by subsection (c) of this section,
amended to be effective September 12, 2004, 29 TexReg may take any action under the Medical Practice Act, in
8512; amended to be effective June 29, 2006, 31 relation to the situation addressed by the advisory
TexReg 5107. opinion that the board considers appropriate.
(c) A physician who requests and relies on an
§192.4. Registration. advisory opinion of the board may use the opinion as
(a) Each physician who provides anesthesia mitigating evidence in an action or proceeding to
services or performs a procedure for which anesthesia impose an administrative or civil penalty under the
services are provided in an outpatient setting shall Medical Practice Act. The board or court, as
register with the board on a form prescribed by the appropriate, shall take proof of reliance on an advisory
board and pay a fee to the board in an amount opinion into consideration and mitigate the imposition
established by the board. of administrative or civil penalties accordingly.
(b) The board shall coordinate the registration
required under this section with the registration Source Note: The provisions of this §192.6 adopted to
required under the Medical Practice Act, Texas be effective May 21, 2000, 25 TexReg 4350; amended
Occupations Code Chapter 156, so that the times of to be effective November 30, 2003, 28 TexReg 10498.
registration, payment, notice, and imposition of
penalties for late payment are similar and provide a
minimum of administrative burden to the board and to
physicians.
§192.5. Inspections.
(a) The board may conduct inspections to enforce
these rules, including inspections of an office site and
of documents of a physician's practice that relate to the
provision of anesthesia services in an outpatient setting.
The board may contract with another state agency or
qualified person to conduct these inspections.
(b) Unless it would jeopardize an ongoing
investigation, the board shall provide at least five
business days' notice before conducting an on-site
inspection under this section.
(c) This section does not require the board to make
an on-site inspection of a physician's office.
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
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TEXAS MEDICAL BOARD RULES
Chapter 193, Standing Delegation Orders
Substances Act). The term includes the aggregate be prescribed. Protocols shall be defined to promote the
weight of any mixture, solution, or other substance exercise of professional judgment by the advanced
containing a controlled substance. practice nurse and physician assistant commensurate
(5) Dangerous drug--A device or a drug that is with their education and experience. The protocols used
unsafe for self medication and that is not included in the by a reasonable and prudent physician exercising sound
Texas Health and Safety Code, Schedules I-V or medical judgment need not describe the exact steps that
Penalty Groups I-IV of Chapter 481 (Texas Controlled an advanced practice nurse or a physician assistant must
Substances Act). The term includes a device or a drug take with respect to each specific condition, disease, or
that bears or is required to bear the legend: "Caution: symptom.
federal law prohibits dispensing without prescription". (11) Site serving a medically underserved
(6) Health professional shortage area (HPSA)- population--A site located in a medically underserved
- area; a site located in a health manpower shortage area;
(A) An area in an urban or rural area of a rural health clinic designated under Public Law 95-
Texas (which need not conform to the geographic 210, the Rural Health Clinic Services Act of 1977; a
boundaries of a political subdivision and which is a public health clinic or a family planning clinic
rational area for the delivery of health services) which operating under contract with the Texas Department of
the secretary of health and human services determines Human Services or the Department of State Health
has a health manpower shortage and which is not Services; a site located in an area in which there exists
reasonably accessible to an adequately served area; an insufficient number of physicians providing services
(B) a population group which the to eligible clients of federal, state, or locally funded
secretary determines to have such a shortage; or health care programs, as determined by the Department
(C) a public or nonprofit private medical of State Health Services; or a site that serves a
facility or other facility which the secretary determines disproportionate number of clients eligible to
has such a shortage as delineated in 42 United States participate in federal, state, or locally funded health
Code §254(e)(a)(1). care programs, as determined by the Department of
(7) Medically underserved area (MUA)--An State Health Services.
area or population group designated by the USDHHS as (12) Standing delegation order--Written
an area with a shortage of personal health services. Also instructions, orders, rules, regulations, or procedures
includes an area defined by rule adopted by the Texas prepared by a physician and designed for a patient
Board of Health that is based on demographics specific population with specific diseases, disorders, health
to this state, geographic factors that affect access to problems, or sets of symptoms. Such written
health care, and environmental health factors. instructions, orders, rules, regulations or procedures
(8) Physician Assistant--A person who is shall delineate under what set of conditions and
licensed as a physician assistant by the Texas Physician circumstances action should be instituted. These
Assistant Board. instructions, orders, rules, regulations or procedures are
(9) Physician's orders--The instructions of a to provide authority for and a plan for use with patients
physician for the care of an individual patient. presenting themselves prior to being examined or
(10) Protocols--Delegated written evaluated by a physician to assure that such acts are
authorization to initiate medical aspects of patient care carried out correctly and are distinct from specific
including authorizing a physician assistant or advanced orders written for a particular patient, and shall be
practice nurse to carry out or sign prescription drug limited in scope of authority to be delegated as
orders pursuant to the Medical Practice Act, Texas provided in §193.4 of this title (relating to Scope of
Occupations Code Annotated, §§157.051 - 157.060 and Standing Delegation Orders). As used in this chapter,
§193.6 of this title (relating to the Delegation of the standing delegation orders do not refer to treatment
Carrying Out or Signing of Prescription Drug Orders to programs ordered by a physician following examination
Physician Assistants and Advanced Practice Nurses). or evaluation by a physician, nor to established
The protocols must be agreed upon and signed by the procedures for providing of care by personnel under
physician, the physician assistant and/or advanced direct, personal supervision of a physician who is
practice nurse, reviewed and signed at least annually, directly supervising or overseeing the delivery of
maintained on site, and must contain a list of the types medical or health care. Such standing delegation orders
or categories of dangerous drugs and controlled should be developed and approved by the physician
substances available for prescription, limitations on the who is responsible for the delivery of medical care
number of dosage units and refills permitted, and covered by the orders. Such standing delegation orders,
instructions to be given the patient for follow-up at a minimum, should:
monitoring or contain a list of the types or categories of
dangerous drugs and controlled substances that may not
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TEXAS MEDICAL BOARD RULES
Chapter 193, Standing Delegation Orders
(A) include a written description of the stamped by the Board along with all required
method used in developing and approving them and any documentation and fees, if any.
revision thereof;
(B) be in writing, dated, and signed by the Source Note: The provisions of this §193.2 adopted to
physician; be effective December 23, 1997, 22 TexReg 12492;
(C) specify which acts require a particular amended to be effective May 9, 1999, 24 TexReg 3347;
level of training or licensure and under what amended to be effective November 19, 2000, 25 TexReg
circumstances they are to be performed; 11284; amended to be effective September 14, 2003, 28
(D) state specific requirements which are TexReg 7705; amended to be effective January 25,
to be followed by persons acting under same in 2006, 31 TexReg 397; amended to be effective August
performing particular functions; 10, 2008, 33 TexReg 6136.
(E) specify any experience, training,
and/or education requirements for those persons who §193.3. Exclusion from the Provisions of this
shall perform such orders; Chapter.
(F) establish a method for initial and The provisions of this chapter shall not be applicable,
continuing evaluation of the competence of those nor shall they restrict the use of pre-established
authorized to perform same; programs of health care, nor shall they restrict
(G) provide for a method of maintaining a physicians from authorizing the provision of patient
written record of those persons authorized to perform care by use of pre-established programs under the
same; following circumstances listed in paragraphs (1)-(8) of
(H) specify the scope of supervision this section:
required for performance of same, for example, (1) where a patient is institutionalized and the
immediate supervision of a physician; care is to be delivered in a hospital, nursing home, or
(I) set forth any specialized circumstances other institution which has an organized medical staff
under which a person performing same is to which has authorized or approved standing delegation
immediately communicate with the patient's physician orders or standing medical orders;
concerning the patient's condition; (2) where care is rendered in an emergency.
(J) state limitations on setting, if any, in Emergency care is that care provided to a person who is
which the plan is to be performed; unconscious, ill, or injured, when the reasonable
(K) specify patient record-keeping apparent circumstances require prompt decisions and
requirements which shall, at a minimum, provide for actions in care and when the necessity of immediate
accurate and detailed information regarding each care is so reasonably apparent that any delay in the
patient visit; personnel involved in treatment and rendering of care or treatment would seriously worsen
evaluation on each visit; drugs, or medications the physical condition or endanger the life of the
administered, prescribed or provided; and such other person;
information which is routinely noted on patient charts (3) where care is rendered as a part of disaster
and files by physicians in their offices; and relief and charges for the services are not made;
(L) provide for a method of periodic (4) where limitation from civil liability is
review, which shall be at least annually, of such plan provided under the Texas Civil Practice and Remedies
including the effective date of initiation and the date of Code, section 74.001;
termination of the plan after which date the physician (5) where first aid care is provided at the site
shall issue a new plan. of an injury or as an interim measure prior to transfer of
(13) Standing medical orders--Orders, rules, the patient to a medical facility where medical services
regulations or procedures prepared by a physician or are available;
approved by a physician or the medical staff of an (6) where care rendered is provided by
institution for patients which have been examined or licensed health professional acting within the scope of
evaluated by a physician and which are used as a guide the licensed profession as defined by Texas
in preparation for and carrying out medical or surgical Occupations Code Annotated;
procedures or both. These orders, rules, regulations or (7) where care is to be delivered in any setting
procedures are authority and direction for the under standing medical orders as defined in this
performance for certain prescribed acts for patients by chapter;
authorized persons as distinguished from specific orders (8) where care is to be delivered as authorized
written for a particular patient. by the Medical Practice Act, Texas Occupations Code
(14) Submit--The term used to indicate that a Annotated, §§157.051-157.060 except as provided in
completed item has been actually received and date- §193.6 of this title (relating to the Delegation of the
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TEXAS MEDICAL BOARD RULES
Chapter 193, Standing Delegation Orders
Carrying Out or Signing of Prescription Drug Orders to (iv) oral anti-parasitic drugs for
Physician Assistants and Advanced Practice Nurses). treatment of pinworms;
(v) topical anti-parasitic drugs; or
Source Note: The provisions of this §193.3 adopted to (vi) antibiotic drugs for treatment of
be effective December 23, 1997, 22 TexReg 12492; venereal disease.
amended to be effective November 19, 2000, 25 TexReg (C) The prescriptions may not be issued
11284. for any controlled substance.
(D) The providing of the drugs shall be in
§193.4. Scope of Standing Delegation Orders. compliance with the Texas Pharmacy Act and rules
Providing the authorizing physician is satisfied as to the adopted by the Texas State Board of Pharmacy.
ability and competence of those for whom the physician (5) the administration of immunization
is assuming responsibility, and with due regard for the vaccines providing the recipient is free of any condition
safety of the patient and in keeping with sound medical for which the immunization is contraindicated;
practice, standing delegation orders may be authorized (6) the providing of information regarding
for the performance of acts and duties which do not hygiene and the administration or providing of
require the exercise of independent medical judgment. medications for health problems resulting from a lack
Limitations on the physician's use of standing of hygiene, including the institution of treatment for
delegation orders which are stated in this section shall conditions such as scabies, ringworm, pinworm, head
not apply to patient care delivered by physician lice, diaper rash and other minor skin disorders,
assistants or advanced practice nurses, as authorized by provided the administration or providing of drugs
the Medical Practice Act, Texas Occupations Code adheres to paragraph (4) of this section;
Annotated, §§157.051 - 157.060 or §193.6 of this title (7) the provision of services and the
(relating to Delegation of the Carrying Out or Signing administration of therapy by public health departments
of Prescription Drug Orders to Physician Assistants and as officially prescribed by the Department of State
Advanced Practice Nurses). When care is delivered Health Services for the prevention or treatment of
under other circumstances, standing delegation orders specific communicable diseases or health conditions for
may include authority to undertake the following as which the Department of State Health Services is
listed in paragraphs (1) - (8) of this section: responsible for control under state law;
(1) the taking of personal and medical history; (8) the issuance of medications which do not
(2) the performance of appropriate physical require a prescription (over the counter medications) for
examination and the recording of physical findings; the symptomatic relief of minor illnesses provided that
(3) the ordering of tests appropriate to the such medications are packaged and labeled in
services provided under such orders, such as tuberculin compliance with state and federal laws and regulations.
tests, skin tests, VD tests, VDRL tests, gram stains, pap
smears, and serological tests; Source Note: The provisions of this §193.4 adopted to
(4) the administration or providing of drugs be effective December 23, 1997, 22 TexReg 12492;
ordered by direct personal or voice communication by amended to be effective November 19, 2000, 25 TexReg
the authorizing physician who shall assume 11284; amended to be effective August 10, 2008, 33
responsibility for the patient's welfare, providing such TexReg 6136.
administration or provision of drugs shall be in
compliance with other state or federal laws and §193.5. Enforcement.
providing further that pre-signed prescriptions shall be Any physician authorizing standing delegation orders or
utilized by the authorizing physician only under the standing medical orders which authorize the exercise of
following conditions shown in subparagraphs (A) - (D) independent medical judgment or treatment shall be
of this paragraph. subject to having his or her license to practice medicine
(A) The prescription shall be prepared in in the State of Texas revoked or suspended under Texas
full compliance with the Texas Health and Safety Code, Occupations Code Annotated, §§164.052 and 164.053.
§483.001(13) except for the inclusion of the name of
the patient and the date of issuance. Source Note: The provisions of this §193.5 adopted to
(B) The prescription shall be for one of be effective December 23, 1997, 22 TexReg 12492;
the following classes or types of drugs: amended to be effective November 19, 2000, 25 TexReg
(i) oral contraceptives; 11284.
(ii) diaphragms and contraceptive
creams and jellies;
(iii) topical anti-infectives for vaginal
use;
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TEXAS MEDICAL BOARD RULES
Chapter 193, Standing Delegation Orders
§193.6. Delegation of the Carrying Out or Signing of (2) Physician supervision at site serving
Prescription Drug Orders to Physician Assistants medically underserved populations. Physician
and Advanced Practice Nurses. supervision of a physician assistant or an advanced
(a) Purpose. The purpose of this section is to practice nurse at a site serving a medically underserved
provide guidelines for implementation of the Medical population will be adequate if a delegating physician:
Practice Act ("the Act"), Texas Occupations Code (A) receives a daily status report to be
Annotated, §§157.051 - 157.060, which provide for the conveyed in person, by telephone, or by radio from the
use by physicians of standing delegation orders, advanced practice nurse or physician assistant on any
standing medical orders, physician's orders, or other complications or problems encountered that are not
orders or protocols in delegating authority to physician covered by a protocol;
assistants or advanced practice nurses at a site serving (B) visits the clinic in person at least once
medically underserved populations, at a physician's every ten business days during regular business hours
primary practice or alternate practice site, or at a during which the advanced practice nurse or physician
facility-based practice site. This section establishes assistant is on site providing care, in order to observe
minimum standards for supervision by physicians when and provide medical direction and consultation to
delegating prescriptive authority to physician assistants include, but not be limited to:
and advanced practice nurses at such sites. This section (i) reviewing with the physician
also provides for the signing of a prescription by an assistant or advanced practice nurse the case histories of
advanced practice nurse or a physician assistant after patients with problems or complications encountered;
the person has been designated by the delegating (ii) personally diagnosing or treating
physician as a person delegated to sign a prescription patients requiring physician follow-up; and
which may be carried out by a physician assistant or (iii) verifying that patient care is
advanced practice nurse according to protocols. Such provided by the clinic in accordance with a written
protocols may authorize diagnosis of the patient's quality assurance plan on file at the clinic, which
condition and treatment, including prescription of includes a random review and countersignature of at
dangerous drugs or controlled substances Schedules III least 10% of the patient charts by the physician;
- V as provided under subsection (n) of this section. (C) is available by telephone or direct
Proper use of protocols allows integration of clinical telecommunication for consultation, assistance with
data gathered by the physician assistant or advanced medical emergencies, or patient referrals; and
practice nurse. Neither the Act, §§157.051 - 157.060, (D) is responsible for the formulation or
nor these rules authorize the exercise of independent approval of such physician's orders, standing medical
medical judgment by physician assistants or advanced orders, standing delegation orders, or other orders or
practice nurses, and the delegating physician remains protocols and periodically reviews such orders and the
responsible to the board and to his or her patients for services provided to patients under such orders.
acts performed under the physician's delegated (3) Supervision of clinics. A physician may
authority. Advanced practice nurses and physician not supervise more than three clinics serving medically
assistants remain professionally responsible for acts underserved populations without approval of the board.
performed under the scope and authority of their own A physician may not supervise any number of clinics
licenses. with combined regular business hours exceeding 150
(b) Delegation of prescriptive authority at site concurrent hours per week without approval of the
serving underserved populations. board.
(1) Acts that may be delegated. At a site (c) Delegation of prescriptive authority at primary
serving a medically underserved population, a practice site.
physician authorized by the board may delegate to a (1) "Primary practice site" means:
physician assistant or an advanced practice nurse the act (A) the practice location where the
or acts of administering, providing, or carrying out or physician spends the majority of the physician's time;
signing a prescription drug order as authorized through (B) a licensed hospital, long-term care
physician's orders, standing medical orders, standing facility, or adult care center where both the physician
delegation orders, or other orders or protocols as and the physician assistant or advanced practice nurse
defined by the board. Providing and carrying out or are authorized to practice;
signing a prescription drug order under this subdivision (C) a clinic operated by or for the benefit
is limited to dangerous drugs and controlled substances of a public school district for the purpose of providing
Schedules III - V as provided under subsection (n) of care to the students of that district and the siblings of
this section, and shall comply with other applicable those students, if consent to treatment at that clinic is
laws. obtained in a manner that complies with the Family
Code, Chapter 32;
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TEXAS MEDICAL BOARD RULES
Chapter 193, Standing Delegation Orders
(D) an established patient's residence; or defined by the board. Providing, carrying out or signing
(E) where the physician is physically a prescription drug order under this subsection is
present with the physician assistant or advanced limited to dangerous drugs and controlled substances
practice nurse. Schedules III - V as provided in subsection (n) of this
(2) Acts that may be delegated. At a section, and shall comply with other applicable laws.
physician's primary practice site, a licensed physician (3) Physician supervision is adequate for the
authorized by the board may delegate to a physician purposes of this subsection if the delegating physician:
assistant or an advanced practice nurse acting under (A) is on-site with the advanced practice
adequate physician supervision the act or acts of nurse or physician assistant at least 20 percent of the
administering, providing, carrying out or signing a time;
prescription drug order as authorized through (B) randomly reviews at least 10 percent
physician's orders, standing medical orders, standing of the medical charts of patients seen by a physician
delegation orders, or other orders or protocols as assistant or advanced practice nurse at the site; and
defined by the board. Providing and carrying out or (C) is available through direct
signing a prescription drug order under this subdivision telecommunication for consultation, patient referral, or
is limited to dangerous drugs and controlled substances assistance with a medical emergency.
Schedules III - V as provided in subsection (n) of this (4) A physician may not delegate to a
section, and shall comply with other applicable laws. combined number of more than three physician
(3) Physician supervision. Physician assistants or advanced practice nurses or their full-time
supervision of the carrying out and signing of equivalents at the physician's primary and alternate
prescription drug orders shall conform to what a practice sites.
reasonable, prudent physician would find consistent (e) Delegation of prescriptive authority at a
with sound medical judgment but may vary with the facility-based practice site.
education and experience of the advanced practice (1) Acts that may be delegated. A licensed
nurse or physician assistant. A physician shall provide physician authorized by the board shall be authorized to
continuous supervision, but the constant physical delegate, to one or more physician assistants or
presence of the physician is not required. advanced practice nurses acting under adequate
(4) Additional limitations. A physician's physician supervision whose practice is facility based at
authority to delegate the carrying out or signing of a a licensed hospital or licensed long-term care facility,
prescription drug order under this subsection is limited the carrying out or signing of prescription drug orders if
to: the physician is the medical director or chief of medical
(A) three physician assistants or advanced staff of the facility in which the physician assistant or
practice nurses or their full-time equivalents practicing advanced practice nurse practices, the chair of the
at the physician's primary or alternate practice site; and facility's credentialing committee, a department chair of
(B) the patients with whom the physician a facility department in which the physician assistant or
has established or will establish a physician-patient advanced practice nurse practices, or a physician who
relationship, but this shall not be construed as requiring consents to the request of the medical director or chief
the physician to see the patient within a specific period of medical staff to delegate the carrying out or signing
of time. of prescription drug orders at the facility in which the
(d) Delegation of prescriptive authority at a physician assistant or advanced practice nurse practices.
physician's alternate practice site. Providing and carrying out or signing a prescription
(1) "Alternate practice site" means a site: drug order under this subdivision is limited to
(A) where services similar to the services dangerous drugs and controlled substances Schedules
provided at the delegating physician's primary practice III - V as provided in subsection (n) of this section, and
site are provided; and shall comply with other applicable laws.
(B) located within 60 miles of the (2) Limitations on authority to delegate. A
delegating physician's primary practice site. physician's authority to delegate under this subsection is
(2) Acts that may be delegated. At a limited as follows:
physician's alternate practice site, a licensed physician (A) the delegation is pursuant to a
authorized by the board may delegate to a physician physician's order, standing medical order, standing
assistant or an advanced practice nurse acting under delegation order, or other order or protocol developed
adequate physician supervision the act or acts of in accordance with policies approved by the facility's
administering, providing, carrying out or signing a medical staff or a committee thereof as provided in
prescription drug order as authorized through facility bylaws;
physician's orders, standing medical orders, standing (B) the delegation occurs in the facility in
delegation orders, or other orders or protocols as which the physician is the medical director, the chief of
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medical staff, the chair of the credentialing committee, provide that supervision. The alternate (substitute)
or a department chair; physician providing that supervision shall affirm in
(C) the delegation does not permit the writing and document through a permanent record
carrying out or signing of prescription drug orders for where the physician assistant or advanced practice
the care or treatment of the patients of any other nurse is located that he or she is familiar with the
physician without the prior consent of that physician; protocols or standing delegation orders in use and is
(D) delegation in a long-term care facility accountable for adequately supervising prescriptive
must be by the medical director and the medical delegation provided pursuant to those protocols or
director is limited to delegating the carrying out and standing delegation orders. The permanent record shall
signing of prescription drug orders to no more than be kept with the protocols or standing orders. The
three advanced practice nurses or physician assistants permanent record shall contain dates of the alternate
or their full-time equivalents; and physician supervision and be signed by the alternate
(E) under this section, a physician may physician acknowledging this responsibility. The
not delegate at more than one licensed hospital or more physician assistant or advanced practice nurse is
than two long-term care facilities unless approved by responsible for verifying that the alternate physician is a
the board. licensed Texas physician holding an unrestricted and
(3) Physician supervision. Physician active license.
supervision of the carrying out and signing of a (h) Prescription forms. Prescription forms shall
prescription drug order shall conform to what a comply with applicable rules adopted by the Texas
reasonable, prudent physician would find consistent State Board of Pharmacy. Prescriptions issued pursuant
with sound medical judgment but may vary with the to this section may only be written for dangerous drugs
education and experience of the advanced practice and controlled substances Schedules III - V as provided
nurse or physician assistant. A physician shall provide in subsection (n) of this section. A delegating physician
continuous supervision, but the constant physical is responsible for devising and enforcing a system to
presence of the physician is not required. account for and monitor the issuance of prescriptions
(f) Documentation of supervision. under the physician's supervision.
(1) A physician shall document any delegation (i) Waivers.
of prescriptive authority to a physician assistant or (1) The board may waive or modify any of the
advanced practice nurse by a protocol, as defined in this site or supervision requirements for a physician to
section. The physician shall also maintain a permanent delegate the carrying out or signing of prescription drug
record of all protocols the physician has signed, orders to an advanced practice nurse of physician
showing to whom the delegation was made and the assistant at facilities serving medically underserved
dates of the original delegation, each annual review, populations, at physician primary and alternate practice
and termination. sites, and at facility-based practice sites.
(2) If the physician assistant or advanced (2) The board may grant a waiver under
practice nurse is located at a site other than the site paragraph (1) of this subsection if the board determines
where the physician spends the majority of the that:
physician's time, physician supervision shall be further (A) the practice site where the physician is
documented by a permanent record showing the names seeking to delegate prescriptive authority is unable to
or identification numbers of patients discussed during meet the requirements of Chapter 157 of the Act or this
the daily status reports, the times when the physician is section, or compliance would cause an undue burden
on site, and a summary of what the physician did while without a corresponding benefit to patient care;
on site. The summary shall include a description of the (B) safeguards exist for patient care and
quality assurance activities conducted and the names of for fostering a collaborative practice between the
any patients seen or whose case histories were reviewed physician and the advanced practice nurses and
with the physician assistant or advanced practice nurse. physician assistants; and
The supervising physician shall sign the documentation (C) if the requirement for which the
at the conclusion of each site visit. Documentation is waiver is sought is the amount of time the physician is
not required if the physician assistant or advanced on-site, the frequency and duration of time the
practice nurse is permanently located with the physician physician is on-site when the advanced practice nurse
at a site where the physician spends the majority of the or physician assistant is present is sufficient for
physician's time. collaboration to occur, taking into consideration the
(g) Alternate physicians. If a delegating physician other ways the physician collaborates with the
will be unavailable to supervise the physician assistant advanced practice nurse or physician assistant at other
or advanced practice nurse as required by this section, sites.
arrangements shall be made for another physician to
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(3) The board may not waive the limitation on to the order and in accordance with facility policies or
the number of primary or alternate practice sites at medical staff bylaws, the nurse anesthetist may select,
which a physician may delegate the carrying out or obtain, and administer those drugs and apply the
signing of prescription drug orders or the number of appropriate medical devices necessary to accomplish
advanced practice nurses or physician assistants to the order and maintain the patient within a sound
whom a physician may delegate the carrying out or physiological status.
signing of prescription drugs orders. (2) This paragraph shall be liberally construed
(4) Procedure. to permit the full use of safe and effective medication
(A) A physician may apply for a waiver orders to utilize the skills and services of certified
by submitting a written request to the licensure division registered nurse anesthetists.
of the board via the agency website, email, or regular (l) Delegation related to obstetrical services.
mail. The request shall then be submitted to the board (1) A physician may delegate to a physician
for review. assistant offering obstetrical services and certified by
(B) The Standing Orders Committee of the board as specializing in obstetrics or an advanced
the board shall review requests for waivers and may practice nurse recognized by the Texas State Board of
recommend to the full board that a waiver be granted, Nurse Examiners as a nurse midwife the act or acts of
denied or modified. administering or providing controlled substances to the
(C) The board may grant a waiver only if nurse midwife's or physician assistant's clients during
the board determines good cause exists to grant a intra-partum and immediate post-partum care. The
waiver. physician shall not delegate the use of a prescription
(D) The board may approve a waiver with sticker or the use or issuance of an official prescription
modifications. form relating to the prescription of Schedule II
(E) If the board denies a waiver, a written controlled substance as described under §481.075 of the
explanation for the denial shall be given to the Health and Safety Code.
physician along with any recommended modifications (2) The delegation of authority to administer
that would make the waiver application acceptable. or provide controlled substances under this paragraph
(F) The board may revoke, suspend or must be under a physician's order, medical order,
modify a waiver previously granted after providing the standing delegation order, or protocol which shall
physician notice and opportunity for a hearing as require adequate and documented availability for access
provided for by the Administrative Procedure Act and to medical care.
Chapter 187 of this title (relating to Procedural Rules). (3) The physician's orders, medical orders,
(j) Violations. Violation of this section by the standing delegation orders, or protocols shall provide
delegating physician may result in a refusal to approve for reporting or monitoring of client's progress
supervision or the cancellation of the physician's including complications of pregnancy and delivery and
authority to delegate to a physician assistant or an the administration and provision of controlled
advanced practice nurse under this section. Violation of substances by the nurse midwife or physician assistant
this section may also subject the physician to to the clients of the nurse midwife or physician
disciplinary action as provided by the Act, §164.001, assistant.
for violation of §164.051. If an advanced practice nurse (4) The authority of a physician to delegate
violates this section or the Act, §§157.051 - 157.060, under this paragraph is limited to:
the board shall promptly notify the Texas Board of (A) three nurse midwives or physician
Nurse Examiners of the alleged violation. If a physician assistants or their full-time equivalents; and
assistant violates this section or the Act, §§157.051 - (B) the designated facility at which the
157.060, the board shall promptly notify the Texas nurse midwife or physician assistant provides care.
State Board of Physician Assistant Examiners. (5) The administering or providing of
(k) Delegation to certified registered nurse controlled substances under this paragraph shall comply
anesthetists. with other applicable laws.
(1) In a licensed hospital or ambulatory (6) In this paragraph, "provide" means to
surgical center a physician may delegate to a certified supply one or more unit doses of a controlled substance
registered nurse anesthetist the ordering of drugs and for the immediate needs of a patient not to exceed 48
devices necessary for a certified registered nurse hours.
anesthetist to administer an anesthetic or an anesthesia- (7) The controlled substance shall be supplied
related service ordered by the physician. The in a suitable container that has been labeled in
physician's order for anesthesia or anesthesia-related compliance with the applicable drug laws and shall
services does not have to be drug-specific, dose- include the patient's name and address; the drug to be
specific, or administration-technique-specific. Pursuant provided; the name, address, and telephone number of
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the physician; the name, address, and telephone number made after consultation with the delegating physician
of the nurse midwife or physician assistant; and the and the consultation is noted in the patient's chart.
date.
(8) This paragraph does not permit the Source Note: The provisions of this §193.6 adopted to
physician or nurse midwife or physician assistant to be effective December 23, 1997, 22 TexReg 12492;
operate a retail pharmacy as defined under the Texas amended to be effective November 19, 2000, 25 TexReg
Pharmacy Act Texas Occupations Code Annotated 11284; amended to be effective March 8, 2001, 26
Subtitle J. TexReg 1864; amended to be effective May 9, 2002, 27
(9) This paragraph shall be construed to TexReg 3776; amended to be effective March 6, 2003,
provide a physician the authority to delegate the act or 28 TexReg 1885; amended to be effective September 14,
acts of administering or providing controlled substances 2003, 28 TexReg 7705; amended to be effective
to a nurse midwife or physician assistant but not as January 8, 2004, 29 TexReg 98; amended to be
requiring physician delegation of further acts to a nurse effective May 2, 2004, 29 TexReg 3963; amended to be
midwife or as requiring physician delegation of the effective January 9, 2005, 29 TexReg 12189; amended
administration of medications to registered nurses or to be effective January 25, 2006, 31 TexReg 397.
physician assistants other than as provided in this
paragraph. §193.7. Delegated Drug Therapy Management.
(10) This subsection does not limit the (a) Purpose. This section is promulgated to
authority of a physician to delegate the carrying out or promote the efficient administration and regulation of
signing of a prescription drug order involving a the delegation by physicians to pharmacists of drug
controlled substance under subsection (n) of this therapy management pursuant to the Medical Practice
section. Act, Texas Occupations Code Annotated, §157.001
(m) Liability. A physician shall not be liable for the (related to Delegation of Certain Functions).
act or acts of a physician assistant or advanced practice (b) Delegation. A physician licensed to practice
nurse solely on the basis of having signed an order, a medicine in Texas may delegate to a properly qualified
standing medical order, a standing delegation order, or and trained pharmacist acting under adequate
other order or protocols authorizing a physician supervision the performance of specific acts of drug
assistant or advanced practice nurse to perform the act therapy management authorized by the physician
or acts of administering, providing, carrying out, or through the physician's order, standing medical order,
signing a prescription drug order unless the physician standing delegation order, or other order or protocol as
has reason to believe the physician assistant or provided for in this section.
advanced practice nurse lacked the competency to (c) Drug therapy management. Drug therapy
perform the act or acts. management is the performance of specific acts by
(n) Prescription Drug Orders. pharmacists as authorized by a physician through
(1) Pursuant to the Medical Practice Act, Tex. written protocol. Drug therapy management does not
Occ. Code Ann. §157.0511, a physician's authority to include the selection of drug products not prescribed by
delegate the carrying out or signing of a prescription the physician unless the drug product is named in the
drug order is limited to: physician initiated protocol or the physician initiated
(A) dangerous drugs; and record of deviation from a standing protocol. Drug
(B) controlled substances to the extent therapy management may include the following listed
provided in paragraph (2) of this subsection. in paragraphs (1) - (6) of this subsection:
(2) A physician may delegate the carrying out (1) collecting and reviewing patient drug use
or signing of a prescription drug order for a controlled histories;
substance only if: (2) ordering or performing routine drug
(A) the prescription is for a controlled therapy related patient assessment procedures including
substance listed in Schedules III, IV, or V as temperature, pulse, and respiration;
established under Chapter 481 of the Texas Health and (3) ordering drug therapy related laboratory
Safety Code; tests;
(B) the prescription is for a period not to (4) implementing or modifying drug therapy
exceed 30 days; following diagnosis, initial patient assessment, and
(C) with regard to the refill of a ordering of drug therapy by a physician, as detailed in
prescription, the refill is authorized after consultation the protocol;
with the delegating physician and the consultation is (5) generically equivalent drug selection if the
noted in the patient's chart; and physician's signature does not clearly indicate that the
(D) with regard to a prescription for a prescription must be dispensed as written; or
child less than two years of age, the prescription is
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Chapter 193, Standing Delegation Orders
(6) any other drug therapy related act physician concerning specific decisions made.
delegated by a physician. Documentation shall be recorded within a reasonable
(d) Supervision. Physician supervision shall be time of each intervention and may be performed on the
considered adequate for purposes of this section if the patient medication record, patient medical chart, or in a
delegating physician is in compliance with this section separate log book; and
and the physician: (E) a statement that describes appropriate
(1) is responsible for the formulation or mechanisms and time schedule for the pharmacist to
approval of the written protocol and any patient- report to the physician monitoring the pharmacist's
specific deviation from the protocol and review of the exercise of delegated drug therapy management and the
written protocol and any patient-specific deviations results of the drug therapy management.
from the protocol at least annually and the services (2) A standard protocol may be used, or the
provided to a patient under the protocol on a schedule attending physician may develop a drug therapy
defined in the written protocol; management protocol for the individual patient. If a
(2) has established and maintains a physician- standard protocol is used, the physician shall record,
patient relationship with each patient provided drug what deviations if any, from the standard protocol are
therapy management by a delegated pharmacist and ordered for that patient.
informed the patient that drug therapy will be managed (f) Review and revision of protocols.
by a pharmacist under written protocol; (1) At least annually, written protocols shall be
(3) is geographically located so as to be able to reviewed by the physician and, if necessary, revised.
be physically present daily to provide medical care and (2) Documentation of all services provided to
supervision; the patient by the pharmacist shall be reviewed by the
(4) receives, on a schedule defined in the physician on the schedule established in the protocol.
written protocol, a periodic status report on the patient, (g) Construction and interpretation. This section
including any problem or complication encountered; shall not be construed or interpreted to restrict the use
(5) is available through direct of a pre-established health care program or restrict a
telecommunication for consultation, assistance, and physician from authorizing the provision of patient care
direction. by use of a pre-established health care program if the
(e) Written protocol. Written protocols for patient is institutionalized and the care is to be
purposes of this section shall mean a physician's order, delivered in a licensed hospital with an organized
standing medical order, standing delegation order, or medical staff that has authorized standing delegation
other written order. orders, standing medical orders, or protocols. This
(1) A written protocol must contain at a section may not be construed to limit, expand, or
minimum the following listed in subparagraphs (A) - change any provision of law concerning or relating to
(E) of this paragraph: therapeutic drug substitution or administration of
(A) a statement identifying the individual medication, including the Texas Pharmacy Act, Texas
physician authorized to prescribe drugs and responsible Occupations Code Chapter 551.
for the delegation of drug therapy management;
(B) a statement identifying the individual Source Note: The provisions of this §193.7 adopted to
pharmacist authorized to dispense drugs and to engage be effective December 23, 1997, 22 TexReg 12492;
in drug therapy management as delegated by the amended to be effective November 19, 2000, 25 TexReg
physician; 11284; amended to be effective August 10, 2008, 33
(C) a statement identifying the types of TexReg 6136.
drug therapy management decisions that the pharmacist
is authorized to make which shall include: §193.8. Delegated Administration of Immunizations
(i) a statement of the ailments or or Vaccinations by a Pharmacist under Written
diseases, drugs, and type of drug therapy management Protocol.
authorized; and (a) Purpose. This section is promulgated to
(ii) a specific statement of the promote the efficient administration and regulation of
procedures, decision criteria, or plan the pharmacist the delegation by physicians to pharmacists of the
shall follow when exercising drug therapy management administration of immunizations or vaccinations under
authority; written protocol pursuant to the Medical Practice Act,
(D) a statement of the activities the Texas Occupations Code Annotated, §157.001 (related
pharmacist shall follow in the course of exercising drug to Delegation of Certain Functions).
therapy management authority, including the method (b) Delegation. A physician licensed to practice
for documenting decisions made and a plan for medicine in Texas may delegate to a properly qualified
communication or feedback to the authorizing and trained pharmacist acting under adequate
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includes, but is not limited to telephone, facsimile written informed consent demonstrating that the patient
transmission, or electronic mail. understands that he or she is participating in a co-
(b) Do not resuscitate order. A do not resuscitate management of primary open angle glaucoma.
(DNR) order must be kept in the patient's file. (4) The necessity for follow-up visits will be at
(c) Required information. In order to make a the discretion of the ophthalmologist based on the
pronouncement of death through electronic communication of the patient's progress by the
communication, a physician must receive, at a optometrist.
minimum, the following information regarding the (5) The ophthalmologist must report any
condition of the patient: irregular behavior of the optometrist to the Texas
(1) absence of palpable pulse for a minimum Medical Board for referral to the Texas Optometry
of 60 seconds; Board.
(2) absence of discernible blood pressure for a (6) The ophthalmologist must enter into the
minimum of 60 seconds; patient's written medical records that the
(3) absence of evidence of respiration for a ophthalmologist has elected to enter into a co-
minimum of 60 seconds; management agreement with an optometrist.
(4) absence of evidence of heartbeat for a (7) It is at the discretion of the ophthalmologist
minimum of 60 seconds; and to complete a clinical skills assessment with each
(5) other information as the physician may optometrist in which a co-management arrangement
require. exists. The ophthalmologist will, however, receive
(d) Follow-up by physician. If a physician makes a written confirmation and documentation that the co-
pronouncement of death based on information received managing optometrist has completed all of the
pursuant to subsection (c) of this section, the physician requirements of the Optometric Health Care Advisory
retains responsibility for all acts related to this Committee to obtain the designation of "optometric
pronouncement. glaucoma specialist."
(8) A physician may charge a reasonable
Source Note: The provisions of this §193.9 adopted to consultation fee for a consultation given when a patient
be effective July 2, 2000, 25 TexReg 6133; amended to is referred with a diagnosis of primary open angle
be effective August 10, 2008, 33 TexReg 6136. glaucoma.
(9) When a physician examines a patient
§193.10. Collaborative Management of Glaucoma. involved in a co-management consultation with a
(a) Purpose. The purpose of this section is to therapeutic optometrist for treatment of primary open
implement the mandate of the 76th Legislature as it angle glaucoma, the physician shall forward to the
relates to the Optometry Act, Texas Occupations Code therapeutic optometrist, not later than the 30th day
Chapter 351, regarding the minimum standards for the following the examination, a written report on the
collaborative management of glaucoma. results of the examination. A physician who, for a
(b) Minimum requirements. At a minimum, the medically appropriate reason, does not return a patient
treating ophthalmologist should follow the guidelines to the therapeutic optometrist, shall state in the
outlined in paragraphs (1) - (10) of this subsection. physician's report to the therapeutic optometrist the
(1) The ophthalmologist will confirm the specific medical reason for failing to return the patient.
diagnosis within 30 days of the diagnosis of glaucoma (10) In order to enter into a co-management
made by the optometrist. While the ophthalmologist agreement with an optometrist, there must be an
may, in his or her discretion, require that the patient agreement between the two professionals that,
visit the ophthalmologist for a face-to-face visit, such a following each visit, specified information, previously
face-to-face visit is not mandated. The ophthalmologist agreed upon by both the ophthalmologist and the
may, at the ophthalmologist's discretion, rely upon the optometrist, about the patient examined will be
results of diagnostic tests performed originally by the forwarded to the other practitioner.
optometrist, unless reaffirmation is needed.
(2) The ophthalmologist must communicate in Source Note: The provisions of this §193.10 adopted to
written form the confirmation of the diagnosis within be effective September 21, 2000, 25 TexReg 9219;
30 days, as well as the refinement of the treatment plan amended to be effective August 10, 2008, 33 TexReg
as recommended by the optometrist. 6136.
(3) A proper medical record must be generated
for each patient by the ophthalmologist and shall §193.12. Immunization of Persons Over 65 by
include all correspondence and testing results. The Physician's Offices.
medical record must also include a written note made in (a) A physician responsible for the management of
the record by the ophthalmologist or a copy of the a physician's office that provides ongoing primary or
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TEXAS MEDICAL BOARD
BOARD RULES
Texas Administrative Code, Title 22, Part 9
§194.1. Purpose.
The purpose of these rules is to implement the §194.3. Registration.
provisions of the Medical Radiologic Technologist
Certification Act, Texas Occupations Code Ch. 601
("the Act") applicable to non-certified radiologic
technicians or non-certified technicians.
§194.2. Definitions.
The following words and terms, when used in this
chapter, shall have the following meanings, unless the
context clearly indicates otherwise.
(1) Board--The Texas Medical Board.
(2) Non-certified technician (NCT) or
registrant--A person who is registered with the board
and either:
(A) is listed on the current registry with
the Texas Department of State Health Services and
meets one of the following qualifications listed in
clauses (i) and (ii) of this subparagraph;
(i) has completed a mandatory
training program under 25 Texas Administrative Code,
§143.17 (relating to Mandatory Training Programs for
Non-Certified Technicians); or
(ii) if the person is licensed as a
physician assistant in the State of Texas, has completed
a mandatory training program under 25 Texas
Administrative Code, §143.17 (relating to Mandatory
Training Programs for Non-Certified Technicians) or
has met the alternate training requirements under 25
Texas Administrative Code, §143.20 (relating to
Alternate Training Requirements); or
(B) performs radiologic procedures for a
physician to whom a hardship exemption was granted
by the Texas Department of State Health Services
within the previous year, as defined in 25 Texas
Administrative Code, §143.19 (relating to Hardship
Exemptions).
(3) Supervision--Responsibility for and control
of quality, radiation safety and protection, and technical
aspects of the application of ionizing radiation to
human beings for diagnostic purposes.
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Chapter 194, Non-Certified Radiologic Technicians
§194.4. Annual Renewal. film or film screen combinations and an x-ray tube that
(a) Registrants shall renew the registration is stationary at the time of exposure; however, a
annually by: registrant may not perform a procedure which has been
(1) submitting a completed registration identified as dangerous or hazardous by the Texas
application; Department of State Health Services in 25 TAC
(2) paying a fee, as specified by the board §143.16 (Dangerous or Hazardous Procedures).
under Chapter 175 (relating to fees, penalties, and (b) A registrant, other than a physician assistant,
forms); and shall perform all radiologic procedures under the direct
(3) providing proof of the registrant's renewal supervision or instruction of a physician in the State of
of status on the Texas Department of State Health Texas.
Services registry or that the registrant is working under (c) A supervising physician may not order,
a physician hardship exemption, if applicable. instruct, or direct a registrant to perform a radiologic
(b) If the registrant fails to comply with subsection procedure other than in compliance with applicable
(a) of this section on or before the expiration date of the statutes and rules.
registration, the following penalties as shown in (d) All registrants must comply with the safety
paragraphs (1) and (2) of this subsection will be rules of the Texas Department of State Health Services
imposed: relating to the control of radiation as set forth in the
(1) one to 90 days late--penalty fee set under Texas Regulations for the Control of Radiation, 25
Section 175.3(4) (related to penalties for non-certified TAC Chapter 289.
radiologic technicians);
(2) over 90 days late the registrant may not Source Note: The provisions of this §194.5 adopted to
renew his or her registration, and the registration will be be effective December 23, 1997, 22 TexReg 12493;
considered expired, unless an investigation is pending. amended to be effective September 20, 2007, 32 TexReg
The registrant must submit a new application and 6316.
comply with the requirements and procedures for
obtaining a permit. §194.6. Suspension, Revocation or Nonrenewal of
(c) The board by rule may adopt a system under Registration.
which registrations expire on various dates during the (a) The board may refuse to issue a registration to
year. For the year in which the expiration date is an applicant and may, following notice of hearing and a
changed, registration fees payable on or before January hearing as provided for in the Administrative Procedure
1 shall be prorated on a monthly basis so that each Act, take disciplinary action against any non-certified
registrant shall pay only that portion of the registration technician who:
fee which is allocable to the number of months during (1) violates the Medical Practice Act, the rules
which the registration is valid. On renewal of the of the Texas Medical Board, an order of the board
registration on the new expiration date, the total previously entered in a disciplinary proceeding, or an
registration is payable. order to comply with a subpoena issued by the board;
(d) Registrants shall inform the board in writing of (2) violates the Medical Radiologic
address changes within two weeks. Technologist Certification Act or the rules promulgated
by the Texas Department of State Health Services;
Source Note: The provisions of this §194.4 adopted to (3) violates the rules of the Texas Department
be effective December 23, 1997, 22 TexReg 12493; of State Health Services for control of radiation;
amended to be effective November 19, 2000, 25 TexReg (4) obtains, attempts to obtain, or uses a
11284; amended to be effective January 8, 2004, 29 registration by bribery or fraud;
TexReg 98; amended to be effective September 20, (5) engages in unprofessional conduct,
2007, 32 TexReg 6316. including, but not limited to, conviction of a crime,
commission of any act that is in violation of the laws of
§194.5. Non-Certified Technician's Scope of the State of Texas if the act is connected with provision
Practice. of health care, and commission of an act of moral
(a) A registrant may only perform the following turpitude;
radiologic procedures, as listed in paragraphs (1) and (6) develops or has an incapacity that prevents
(2) of this subsection unless otherwise expressly the practice of radiologic technology with reasonable
permitted by statute or rule: skill, competence, and safety to the public as a result of:
(1) bone densitometry utilizing a dual energy (A) an illness;
x-ray densitometer; or (B) drug or alcohol dependency; or
(2) chest, spine, extremities, abdomen, skull habitual use of drugs or intoxicating liquors; or
studies or other radiologic procedures utilizing standard (C) another physical or mental condition;
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TEXAS MEDICAL BOARD RULES
Chapter 194, Non-Certified Radiologic Technicians
(7) fails to practice as a non-certified with the Act or rules under this chapter, the Act and
technician in an acceptable manner consistent with provisions of this chapter shall control.
public health and welfare;
(8) has disciplinary action taken against a Source Note: The provisions of this §194.9 adopted to
certification, permit, or registration in another state, be effective January 8, 2004, 29 TexReg 98.
territory, or country or by another regulatory agency;
(9) engages in acts requiring registration under §194.11. Construction.
these rules without a current registration from the board The provisions of this chapter shall be construed and
or; interpreted so as to be consistent with the statutory
(10) is removed, suspended, or has had provisions of the Medical Practice Act. In the event of a
disciplinary action taken against the registrant. conflict between this chapter and the provisions of the
(b) The board may suspend, revoke, or refuse to Medical Practice Act, the provisions of the Medical
renew the registration of a non-certified technician, Practice Act shall control; however, this chapter shall
upon a finding that a non-certified technician has be construed so that all other provisions of this chapter
committed any offense listed in this section. which are not in conflict with the Act shall remain in
effect.
Source Note: The provisions of this §194.6 adopted to
be effective December 23, 1997, 22 TexReg 12493; Source Note: The provisions of this §194.11 adopted to
amended to be effective January 8, 2004, 29 TexReg be effective December 23, 1997, 22 TexReg 12493.
98; amended to be effective September 20, 2007, 32
TexReg 6316.
§194.8. Procedure.
Chapter 187 of this title (relating to Procedural Rules)
shall govern procedures relating to registrants where
applicable. If the provisions of Chapter 187 conflict
with the Act or rules under this chapter, the Act and
provisions of this chapter shall control.
§194.9. Compliance.
Chapter 189 of this title (relating to Compliance
Program) shall be applied to registrants who are under
board orders. If the provisions of Chapter 189 conflict
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Texas Administrative Code, Title 22, Part 9
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Chapter 196, Voluntary Surrender of A Medical License
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Texas Administrative Code, Title 22, Part 9
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access and dispatch, communications, and receiving (6) familiar with dispatch and communications
medical facilities. operations of prehospital emergency units; and
(8) Intervenor physician--A physician licensed (7) knowledgeable about laws and regulations
by the board, who, without having established a prior affecting local, regional, and state EMS operations.
physician/patient relationship with the emergency (b) The off-line medical director shall be required
patient, accepts responsibility for the prehospital care, to:
and who shall provide proof of a current medical (1) approve the level of prehospital care which
license when requested. may be rendered locally by each of the EMS personnel
(9) Medical director--A physician licensed by employed by and/or volunteering with the EMS under
the board who is responsible for all aspects of the the medical director's supervision, regardless of the
operation of an EMS system concerning provision of level of state certification or licensure, before the
medical care. This physician may also be referred to as certificant or licensee is permitted to provide such care
the off-line medical director. to the public;
(10) Prehospital providers--All DSHS certified (2) establish and monitor compliance with
or licensed personnel providing medical care in an out- field performance guidelines for EMS personnel;
of-hospital environment. (3) establish and monitor compliance with
(11) Protocols--Written instructions providing training guidelines which meet or exceed the minimum
prehospital personnel with a standardized approach to standards set forth in the Texas Department of State
commonly encountered problems in the out-of-hospital Health Services EMS certification regulations;
setting, typically in regard to patient care. Protocols (4) develop, implement, and revise protocols
may include standing orders to be implemented prior to, and/or standing delegation orders, if appropriate,
or in lieu of, establishing communication with direct governing prehospital care and medical aspects of
medical control. patient triage, transport, transfer, dispatch, extrication,
(12) Standing delegation orders--Instructions rescue, and radio-telephone-telemetry communication
or orders provided by the EMS medical director to by the EMS;
EMS personnel, directing them to perform certain (5) direct an effective system audit and quality
medical care in the absence of any communication with assurance program;
direct medical control. (6) determine standards and objectives for all
medically related aspects of operation of the EMS
Source Note: The provisions of this §197.2 adopted to including the inspection, evaluation, and approval of
be effective February 28, 1999, 24 TexReg 1157; the system's performance specifications;
amended to be effective January 9, 2003, 28 TexReg (7) function as the primary liaison between the
73; amended to be effective September 20, 2007, 32 EMS administration and the local medical community,
TexReg 6316. ascertaining and being responsive to the needs of each;
(8) develop a letter or agreement or contract
§197.3. Off-line Medical Director. between the medical director(s) and the EMS
(a) An off-line medical director shall be: administration outlining the specific responsibilities and
(1) a physician licensed to practice in Texas authority of each. The agreement should describe the
and shall be registered as an EMS medical director with process or procedure by which a medical director may
the Texas Department of State Health Services; withdraw responsibility for EMS personnel for
(2) familiar with the design and operation of noncompliance with the Emergency Medical Services
EMS systems; Act, the Health and Safety Code, Chapter 773, the rules
(3) experienced in prehospital emergency care adopted in this chapter, and/or accepted medical
and emergency management of ill and injured patients; standards;
(4) actively involved in: (9) take or recommend appropriate remedial or
(A) the training and/or continuing corrective measures for EMS personnel, in conjunction
education of EMS personnel, under his or her direct with local EMS administration, which may include, but
supervision, at their respective levels of certification; are not limited to, counseling, retraining, testing,
(B) the medical audit, review, and critique probation, and/or field preceptorship;
of the performance of EMS personnel under his or her (10) suspend a certified EMS individual from
direct supervision; medical care duties for due cause pending review and
(C) the administrative and legislative evaluation;
environments affecting regional and/or state prehospital (11) establish the circumstances under which a
EMS organizations; patient might not be transported;
(5) knowledgeable about local multi-casualty (12) establish the circumstances under which a
plans; patient may be transported against his or her will in
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accordance with state law, including approval of protocols. The patient's personal physician shall
appropriate procedures, forms, and a review process; document in his or her orders in a manner acceptable to
(13) establish criteria for selection of a the EMS system. The physician providing on-line
patient's destination; medical direction shall be notified of the participation
(14) develop and implement a comprehensive of the patient's personal physician.
mechanism for management of patient care incidents, (d) If the medical orders of the patient's personal
including patient complaints, allegations of substandard physician conflict with system protocols, the personal
care, and deviations from established protocols and physician shall be placed in communication with the
patient care standards; and physician providing on-line medical direction. If the
personal physician and the on-line medical director
Source Note: The provisions of this §197.3 adopted to cannot agree on treatment, the personal physician must
be effective February 28, 1999, 24 TexReg 1157; either continue to provide direct patient care and
amended to be effective January 9, 2003, 28 TexReg accompany the patient to the hospital or must defer all
73; amended to be effective September 20, 2007, 32 remaining care to the on-line medical director.
TexReg 6316. (e) The system's medical director or on-line
medical control shall assume responsibility for directing
§197.4. On-Line Medical Direction. the activities of prehospital providers at any time the
(a) The EMS medical director shall assign the patient's personal physician is not in attendance.
prehospital provider under his or her direction to a (f) If an intervenor physician is present at the scene
specific on-line communication resource by a and has been satisfactorily identified as a licensed
predetermined policy. physician and has expressed his or her willingness to
(b) Specific local protocols shall define the assume responsibility for care of the patient, the on-line
circumstances under which on-line medical direction is physician should be contacted. Once the on-line
required. physician is contacted, he or she is ultimately
(c) A physician providing or delegating on-line responsible for the care of the patient unless or until the
medical direction ("on-line physician") shall be on-line physician allows the intervenor physician to
appropriately trained in the use of prehospital protocols. assume responsibility for the patient.
(d) A physician providing or delegating on-line (g) The on-line physician has the option of
medical direction shall have personal expertise in the managing the case exclusively, working with the
emergency care of ill and injured patients. intervenor physician, or allowing the intervenor
(e) A physician providing or delegating on-line physician to assume complete responsibility for the
medical direction for particular patients assumes patient.
responsibility for the appropriateness of prehospital (h) If there is any disagreement between the
care provided under his or her direction by EMS intervenor physician and the on-line physician, the
personnel. prehospital provider shall be responsible to the on-line
physician and shall place the intervenor physician in
Source Note: The provisions of this §197.4 adopted to contact with the on-line physician.
be effective February 28, 1999, 24 TexReg 1157; (i) If the intervenor physician is authorized to
amended to be effective September 20, 2007, 32 TexReg assume responsibility, all orders to the prehospital
6316. provider by the intervenor physician shall also be
repeated to medical control for recordkeeping purposes.
§197.5. Authority for Control of Medical Services at (j) The intervenor physician must document his or
the scene of a Medical Emergency. her intervention in a manner acceptable to the local
(a) Control at the scene of a medial emergency EMS.
shall be the responsibility of the individual in (k) The decision of the intervenor physician not to
attendance who is most appropriately trained and accompany the patient to the hospital shall be made
knowledgeable in providing prehospital emergency with the approval of the on-line physician.
stabilization and transport. (l) Nothing in this section implies that the
(b) The prehospital provider on the scene is prehospital provider can be required to deviate from
responsible for the management of the patient(s) and standard protocols.
acts as the agent of the physician providing medical
direction. Source Note: The provisions of this §197.5 adopted to
(c) If the patient's personal physician is present and be effective February 28, 1999, 24 TexReg 1157.
assumes responsibility for the patient's care, the
prehospital provider should defer to the orders of said
physician unless those orders conflict with established
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Chapter 200. Standards for Physicians Practicing Complementary and Alternative Medicine
§§200.1-200.3
§200.1. Purpose. for the patient's medical condition. The Texas State
The purpose of this chapter is to recognize that Board of Medical Examiners will use the following
physicians should be allowed a reasonable and guidelines to determine whether a physician's conduct
responsible degree of latitude in the kinds of therapies violates the Medical Practice Act, §§164.051-.053 in
they offer their patients. The Board also recognizes that regard to providing complementary and alternative
patients have a right to seek complementary and medical treatment.
alternative therapies. (1) Patient Assessment. Prior to offering
advice about complementary and alternative health care
Source Note: The provisions of this §200.1 adopted to therapies, the physician shall undertake an assessment
be effective November 22, 1998, 23 TexReg 11653; of the patient. This assessment should include but not
amended to be effective May 4, 2003, 28 TexReg 3495. be limited to, conventional methods of diagnosis and
may include non-conventional methods of diagnosis.
§200.2. Definitions. Such assessment shall be documented in the patient's
The following words and terms, when used in this medical record and be based on performance and
section, shall have the following meanings, unless the review of the following listed in subparagraphs (A)-(D)
context clearly indicates otherwise. of this paragraph:
(1) Complementary and Alternative Medicine- (A) an appropriate medical history and
-Those health care methods of diagnosis, treatment, or physician examination of the patient;
interventions that are not acknowledged to be (B) the conventional medical treatment
conventional but that may be offered by some licensed options to be discussed with the patient and referral
physicians in addition to, or as an alternative to, input, if necessary;
conventional medicine, and that provide a reasonable (C) any prior conventional medical
potential for therapeutic gain in a patient's medical treatments attempted and the outcomes obtained or
condition and that are not reasonably outweighed by the whether conventional options have been refused by the
risk of such methods. patient;
(2) Conventional Medicine--Those health care (D) whether the complementary health
methods of diagnosis, treatment, or interventions that care therapy could interfere with any other
are offered by most licensed physicians as generally recommended or ongoing treatment.
accepted methods of routine practice, based upon (2) Disclosure. Prior to rendering any
medical training, experience and review of the peer complementary or alternative treatment, the physician
reviewed scientific literature. shall provide information to the patient that includes the
(3) Reasonable Potential for Therapeutic Gain- following with the disclosure documented in the
-An expected beneficial outcome resulting from the patient's records:
application of a health care method containing (A) the objectives, expected outcomes, or
medicinal or healing properties that is supported by goals of the proposed treatment, such as functional
scientific evidence and does not solely rely on placebo improvement, pain relief, or expected psychosocial
effect. benefit;
(B) the risks and benefits of the proposed
Source Note: The provisions of this §200.2 adopted to treatment;
be effective November 22, 1998, 23 TexReg 11653; (C) the extent the proposed treatment
amended to be effective May 4, 2003, 28 TexReg 3495. could interfere with any ongoing or recommended
medical care;
§200.3. Practice Guidelines for the Provision of (D) a description of the underlying
Complementary and Alternative Medicine. therapeutic basis or mechanism of action of the
A licensed physician shall not be found guilty of proposed treatment purporting to have a reasonable
unprofessional conduct or be found to have committed potential for therapeutic gain that is written in a manner
professional failure to practice medicine in an understandable to the patient; and
acceptable manner solely on the basis of employing a (E) if applicable, whether a drug,
health care method of complementary or alternative supplement, or remedy employed in the treatment is:
medicine, unless it can be demonstrated that such (i) approved for human use by the
method has a safety risk for the patient that is U.S. Food and Drug Administration (FDA);
unreasonably greater than the conventional treatment
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