§ 157.051. DEFINITIONS. In this subchapter:
(1) "Advanced practice registered nurse" has the meaning
assigned to that term by Section 301.152. The term includes an
advanced nurse practitioner and advanced practice nurse.
(2) "Controlled substance" has the meaning assigned to
that term by Section 481.002, Health and Safety Code.
(3) "Dangerous drug" has the meaning assigned to that term
by Section 483.001, Health and Safety Code.
(4) "Device" has the meaning assigned by Section 551.003,
and includes durable medical equipment.
(5) "Health professional shortage area" means:
(A) an urban or rural area of this state that:
(i) is not required to conform to the geographic
boundaries of a political subdivision but is a rational area for the
delivery of health services;
(ii) the secretary of health and human services
determines has a health professional shortage; and
(iii) is not reasonably accessible to an adequately
served area;
(B) a population group that the secretary of health and
human services determines has a health professional shortage; or
(C) a public or nonprofit private medical facility or
other facility that the secretary of health and human services
determines has a health professional shortage, as described by 42
U.S.C. Section 254e(a)(1).
(6) "Hospital" means a facility that:
(A) is:
(i) a general hospital or a special hospital, as
those terms are defined by Section 241.003, Health and Safety Code,
including a hospital maintained or operated by the state; or
(ii) a mental hospital licensed under Chapter 577,
Health and Safety Code; and
(B) has an organized medical staff.
(7) "Medication order" has the meanings assigned by Section
551.003 of this code and Section 481.002, Health and Safety Code.
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 284 -
(8) "Nonprescription drug" has the meaning assigned by
Section 551.003.
(9) "Physician assistant" means a person who holds a
license issued under Chapter 204.
(10) "Physician group practice" means an entity through
which two or more physicians deliver health care to the public
through the practice of medicine on a regular basis and that is:
(A) owned and operated by two or more physicians; or
(B) a freestanding clinic, center, or office of a
nonprofit health organization certified by the board under Section
162.001(b) that complies with the requirements of Chapter 162.
(11) "Practice serving a medically underserved population"
means:
(A) a practice in a health professional shortage area;
(B) a clinic designated as a rural health clinic under
42 U.S.C. Section 1395x(aa);
(C) a public health clinic or a family planning clinic
under contract with the Health and Human Services Commission or the
Department of State Health Services;
(D) a clinic designated as a federally qualified health
center under 42 U.S.C. Section 1396d(l)(2)(B);
(E) a county, state, or federal correctional facility;
(F) a practice:
(i) that either:
(a) is located in an area in which the
Department of State Health Services determines there is an
insufficient number of physicians providing services to eligible
clients of federally, state, or locally funded health care programs;
or
(b) is a practice that the Department of State
Health Services determines serves a disproportionate number of
clients eligible to participate in federally, state, or locally
funded health care programs; and
(ii) for which the Department of State Health
Services publishes notice of the department's determination in the
Texas Register and provides an opportunity for public comment in the
manner provided for a proposed rule under Chapter 2001, Government
Code; or
(G) a practice at which a physician was delegating
prescriptive authority to an advanced practice registered nurse or
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 285 -
physician assistant on or before March 1, 2013, based on the practice
qualifying as a site serving a medically underserved population.
(12) "Prescribe or order a drug or device" means
prescribing or ordering a drug or device, including the issuing of a
prescription drug order or a medication order.
(13) "Prescription drug" has the meaning assigned by
Section 551.003.
(14) "Prescriptive authority agreement" means an agreement
entered into by a physician and an advanced practice registered nurse
or physician assistant through which the physician delegates to the
advanced practice registered nurse or physician assistant the act of
prescribing or ordering a drug or device.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, Sec. 1, eff. May 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 269 (S.B. 419), Sec. 1.27, eff.
September 1, 2005.
Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 2, eff.
November 1, 2013.
Sec. 157.0511. DELEGATION OF PRESCRIBING AND ORDERING DRUGS AND
DEVICES. (a) A physician's authority to delegate the prescribing or
ordering of a drug or device under this subchapter is limited to:
(1) nonprescription drugs;
(2) dangerous drugs; and
(3) controlled substances to the extent provided by
Subsections (b) and (b-1).
(b) Except as provided by Subsection (b-1), a physician may
delegate the prescribing or ordering of a controlled substance only
if: (1) the prescription is for a controlled substance listed
in Schedule III, IV, or V as established by the commissioner of the
Department of State Health Services under Chapter 481, Health and
Safety Code;
(2) the prescription, including a refill of the
prescription, is for a period not to exceed 90 days;
(3) with regard to the refill of a prescription, the refill
is authorized after consultation with the delegating physician and
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 286 -
the consultation is noted in the patient's chart; and
(4) with regard to a prescription for a child less than two
years of age, the prescription is made after consultation with the
delegating physician and the consultation is noted in the patient's
chart.
(b-1) A physician may delegate the prescribing or ordering of a
controlled substance listed in Schedule II as established by the
commissioner of the Department of State Health Services under Chapter
481, Health and Safety Code, only:
(1) in a hospital facility-based practice under Section
157.054, in accordance with policies approved by the hospital's
medical staff or a committee of the hospital's medical staff as
provided by the hospital bylaws to ensure patient safety, and as part
of the care provided to a patient who:
(A) has been admitted to the hospital for an intended
length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department
of the hospital; or
(2) as part of the plan of care for the treatment of a
person who has executed a written certification of a terminal
illness, has elected to receive hospice care, and is receiving
hospice treatment from a qualified hospice provider.
(b-2) The board shall adopt rules that require a physician who
delegates the prescribing or ordering of a drug or device to register
with the board the name and license number of the physician assistant
or advanced practice registered nurse to whom a delegation is made.
The board may develop and use an electronic online delegation
registration process for registration under this subsection.
(c) This subchapter does not modify the authority granted by
law for a licensed registered nurse or physician assistant to
administer or provide a medication, including a controlled substance
listed in Schedule II as established by the commissioner of the
Department of State Health Services under Chapter 481, Health and
Safety Code, that is authorized by a physician under a physician's
order, standing medical order, standing delegation order, or
protocol.
Added by Acts 2003, 78th Leg., ch. 88, Sec. 2, eff. May 20, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 269 (S.B. 419), Sec. 1.28, eff.
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 287 -
September 1, 2005.
Acts 2009, 81st Leg., R.S., Ch. 746 (S.B. 532), Sec. 1, eff.
September 1, 2009.
Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 3, eff.
November 1, 2013.
Sec. 157.0512. PRESCRIPTIVE AUTHORITY AGREEMENT.
(a) A
physician may delegate to an advanced practice registered nurse or
physician assistant, acting under adequate physician supervision, the
act of prescribing or ordering a drug or device as authorized through
a prescriptive authority agreement between the physician and the
advanced practice registered nurse or physician assistant, as
applicable.
(b) A physician and an advanced practice registered nurse or
physician assistant are eligible to enter into or be parties to a
prescriptive authority agreement only if:
(1) if applicable, the Texas Board of Nursing has approved
the advanced practice registered nurse's authority to prescribe or
order a drug or device as authorized under this subchapter;
(2) the advanced practice registered nurse or physician
assistant:
(A) holds an active license to practice in this state
as an advanced practice registered nurse or physician assistant, as
applicable, and is in good standing in this state; and
(B) is not currently prohibited by the Texas Board of
Nursing or the Texas Physician Assistant Board, as applicable, from
executing a prescriptive authority agreement; and
(3) before executing the prescriptive authority agreement,
the physician and the advanced practice registered nurse or physician
assistant disclose to the other prospective party to the agreement
any prior disciplinary action by the board, the Texas Board of
Nursing, or the Texas Physician Assistant Board, as applicable.
(c) Except as provided by Subsection
(d), the combined number
of advanced practice registered nurses and physician assistants with
whom a physician may enter into a prescriptive authority agreement
may not exceed seven advanced practice registered nurses and
physician assistants or the full-time equivalent of seven advanced
practice registered nurses and physician assistants.
(d) Subsection (c) does not apply to a prescriptive authority
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 288 -
agreement if the prescriptive authority is being exercised in:
(1) a practice serving a medically underserved population;
or
(2) a facility-based practice in a hospital under Section
157.054.
(e) A prescriptive authority agreement must, at a minimum:
(1) be in writing and signed and dated by the parties to
the agreement;
(2) state the name, address, and all professional license
numbers of the parties to the agreement;
(3) state the nature of the practice, practice locations,
or practice settings;
(4) identify the types or categories of drugs or devices
that may be prescribed or the types or categories of drugs or devices
that may not be prescribed;
(5) provide a general plan for addressing consultation and
referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and the
sharing of information between the physician and the advanced
practice registered nurse or physician assistant to whom the
physician has delegated prescriptive authority related to the care
and treatment of patients;
(8) if alternate physician supervision is to be utilized,
designate one or more alternate physicians who may:
(A) provide appropriate supervision on a temporary
basis in accordance with the requirements established by the
prescriptive authority agreement and the requirements of this
subchapter; and
(B) participate in the prescriptive authority quality
assurance and improvement plan meetings required under this section;
and
(9) describe a prescriptive authority quality assurance and
improvement plan and specify methods for documenting the
implementation of the plan that include the following:
(A) chart review, with the number of charts to be
reviewed determined by the physician and advanced practice registered
nurse or physician assistant; and
(B) periodic meetings between the advanced practice
registered nurse or physician assistant and the physician.
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 289 -
(f) The periodic meetings described by Subsection (e)(9)(B)
must:
(1) include:
(A) the sharing of information relating to patient
treatment and care, needed changes in patient care plans, and issues
relating to referrals; and
(B) discussion of patient care improvement;
(2) be documented; and
(3) take place at least once a month in a manner determined
by the physician and the advanced practice registered nurse or
physician assistant.
(f-1) Repealed by Acts 2019, 86th Leg., R.S., Ch. 38 (H.B. 278
), Sec. 2, eff. September 1, 2019.
(g) The prescriptive authority agreement may include other
provisions agreed to by the physician and advanced practice
registered nurse or physician assistant.
(h) If the parties to the prescriptive authority agreement
practice in a physician group practice, the physician may appoint one
or more alternate supervising physicians designated under Subsection
(e)(8), if any, to conduct and document the quality assurance
meetings in accordance with the requirements of this subchapter.
(i) The prescriptive authority agreement need not describe the
exact steps that an advanced practice registered nurse or physician
assistant must take with respect to each specific condition, disease,
or symptom.
(j) A physician, advanced practice registered nurse, or
physician assistant who is a party to a prescriptive authority
agreement must retain a copy of the agreement until the second
anniversary of the date the agreement is terminated.
(k) A party to a prescriptive authority agreement may not by
contract waive, void, or nullify any provision of this section or
Section 157.0513.
(l) In the event that a party to a prescriptive authority
agreement is notified that the individual has become the subject of
an investigation by the board, the Texas Board of Nursing, or the
Texas Physician Assistant Board, the individual shall immediately
notify the other party to the prescriptive authority agreement.
(m) The prescriptive authority agreement and any amendments
must be reviewed at least annually, dated, and signed by the parties
to the agreement. The prescriptive authority agreement and any
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 290 -
amendments must be made available to the board, the Texas Board of
Nursing, or the Texas Physician Assistant Board not later than the
third business day after the date of receipt of request, if any.
(n) The prescriptive authority agreement should promote the
exercise of professional judgment by the advanced practice registered
nurse or physician assistant commensurate with the advanced practice
registered nurse's or physician assistant's education and experience
and the relationship between the advanced practice registered nurse
or physician assistant and the physician.
(o) This section shall be liberally construed to allow the use
of prescriptive authority agreements to safely and effectively
utilize the skills and services of advanced practice registered
nurses and physician assistants.
(p) The board may not adopt rules pertaining to the elements of
a prescriptive authority agreement that would impose requirements in
addition to the requirements under this section. The board may adopt
other rules relating to physician delegation under this chapter.
Added by Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 4, eff.
November 1, 2013.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 928 (S.B. 1625), Sec. 1, eff.
September 1, 2017.
Acts 2019, 86th Leg., R.S., Ch. 38 (H.B. 278), Sec. 1, eff.
September 1, 2019.
Acts 2019, 86th Leg., R.S., Ch. 38 (H.B. 278), Sec. 2, eff.
September 1, 2019.
Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT: INFORMATION.
(a) The board, the Texas Board of Nursing, and the Texas Physician
Assistant Board shall jointly develop a process:
(1) to exchange information regarding the names, locations,
and license numbers of each physician, advanced practice registered
nurse, and physician assistant who has entered into a prescriptive
authority agreement;
(2) by which each board shall immediately notify the other
boards when a license holder of the board becomes the subject of an
investigation involving the delegation and supervision of
prescriptive authority, as well as the final disposition of any such
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 291 -
investigation;
(3) by which each board shall maintain and share a list of
the board's license holders who have been subject to a final adverse
disciplinary action for an act involving the delegation and
supervision of prescriptive authority; and
(4) to ensure that each advanced practice registered nurse
or physician assistant who has entered into a prescriptive authority
agreement authorizing the prescribing of opioids is required to
complete not less than two hours of continuing education annually
regarding safe and effective pain management related to the
prescription of opioids and other controlled substances, including
education regarding:
(A) reasonable standards of care;
(B) the identification of drug-seeking behavior in
patients; and
(C) effectively communicating with patients regarding
the prescription of an opioid or other controlled substance.
(b) If the board, the Texas Board of Nursing, or the Texas
Physician Assistant Board receives a notice under Subsection (a)(2),
the board that received notice may open an investigation against a
license holder of the board who is a party to a prescriptive
authority agreement with the license holder who is under
investigation by the board that provided notice under Subsection
(a)(2).
(c) The board shall maintain and make available to the public a
searchable online list of physicians, advanced practice registered
nurses, and physician assistants who have entered into a prescriptive
authority agreement authorized under Section 157.0512 and identify
the physician, advanced practice registered nurse, or physician
assistant with whom each physician, advanced practice registered
nurse, and physician assistant has entered into a prescriptive
authority agreement.
(d) The board shall collaborate with the Texas Board of Nursing
and the Texas Physician Assistant Board to maintain and make
available to the public a list of physicians, advanced practice
registered nurses, and physician assistants who are prohibited from
entering into or practicing under a prescriptive authority agreement.
Added by Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 4, eff.
November 1, 2013.
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 292 -
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 818 (H.B. 2454), Sec. 2, eff.
September 1, 2019.
Sec. 157.0514. PRESCRIPTIVE AUTHORITY AGREEMENT: INSPECTIONS.
If the board receives a notice under Section 157.0513(a)(2), the
board or an authorized board representative may enter, with
reasonable notice and at a reasonable time, unless the notice would
jeopardize an investigation, a site where a party to a prescriptive
authority agreement practices to inspect and audit any records or
activities relating to the implementation and operation of the
agreement. To the extent reasonably possible, the board and the
board's authorized representative shall conduct any inspection or
audit under this section in a manner that minimizes disruption to the
delivery of patient care.
Added by Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 4, eff.
November 1, 2013.
Sec. 157.054. PRESCRIBING AT FACILITY-BASED PRACTICE SITES.
(a) One or more physicians licensed by the board may delegate, to
one or more physician assistants or advanced practice registered
nurses acting under adequate physician supervision whose practice is
facility-based at a hospital or licensed long-term care facility, the
administration or provision of a drug and the prescribing or ordering
of a drug or device if each of the delegating physicians is: (1) the medical director or chief of medical staff of the
facility in which the physician assistant or advanced practice
registered nurse practices;
(2) the chair of the facility's credentialing committee;
(3) a department chair of a facility department in which
the physician assistant or advanced practice registered nurse
practices; or
(4) a physician who consents to the request of the medical
director or chief of medical staff to delegate the prescribing or
ordering of a drug or device at the facility in which the physician
assistant or advanced practice registered nurse practices.
(a-1) The limits on the number of advanced practice registered
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 293 -
nurses or physician assistants to whom a physician may delegate under
Section 157.0512 do not apply to a physician under Subsection (a)
whose practice is facility-based under this section, provided that
the physician is not delegating in a freestanding clinic, center, or
practice of the facility.
(b) A physician's authority to delegate under Subsection (a) is
limited as follows:
(1) the delegation must be made under a physician's order,
standing medical order, standing delegation order, or another order
or protocol developed in accordance with policies approved by the
facility's medical staff or a committee of the facility's medical
staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which the
physician is the medical director, the chief of medical staff, the
chair of the credentialing committee, a department chair, or a
physician who consents to delegate under Subsection (a)(4);
(3) the delegation may not permit the prescribing or
ordering of a drug or device for the care or treatment of the
patients of any other physician without the prior consent of that
physician; and
(4) delegation in a long-term care facility must be by the
medical director and is limited to the prescribing or ordering of a
drug or device to not more than seven advanced practice registered
nurses or physician assistants or their full-time equivalents.
(b-1) A facility-based physician may not delegate at more than
one hospital or more than two long-term care facilities under this
section unless approved by the board. The facility-based physician
may not be prohibited from delegating the prescribing or ordering of
drugs or devices under Section 157.0512 at other practice locations,
including hospitals or long-term care facilities, provided that the
delegation at those locations complies with all the requirements of
Section 157.0512.
(c) Physician supervision of the prescribing or ordering of a
drug or device must conform to what a reasonable, prudent physician
would find consistent with sound medical judgment but may vary with
the education and experience of the particular advanced practice
registered nurse or physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
(d) An alternate physician may provide appropriate supervision
OCCUPATIONS CODE
Statute text rendered on: 12/4/2025 - 294 -
on a temporary basis as defined and established by board rule.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Amended
by Acts 2003, 78th Leg., ch. 88, Sec. 5, eff. May 20, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 746 (S.B. 532), Sec. 3, eff.
September 1, 2009.
Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 5, eff.
November 1, 2013.
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other order
shall be defined in a manner that promotes the exercise of
professional judgment by the advanced practice registered nurse and
physician assistant commensurate with the education and experience of
that person. Under this section, an order or protocol used by a
reasonable and prudent physician exercising sound medical judgment:
(1) is not required to describe the exact steps that an
advanced practice registered nurse or a physician assistant must take
with respect to each specific condition, disease, or symptom; and
(2) may state the types or categories of medications that
may be prescribed or the types or categories of medications that may
not be prescribed.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2013,
Last amended: 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 6, eff.
November 1, 2013.
Entered: Dec 11, 2025
