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RULE §193.4Scope of Standing Delegation Orders

Providing the authorizing physician is satisfied as to the ability and competence of those for whom the physician is assuming responsibility, and with due regard for the safety of the patient and in keeping with sound medical practice, standing delegation orders may be authorized for the performance of acts and duties which do not require the exercise of independent medical judgment. Limitations on the physician's use of standing delegation orders which are stated in this section shall not apply to patient care delivered by physician assistants or advanced practice registered nurses, as authorized by §§157.051 - 157.060 of the Act, or §§193.6 - 193.14 of this title (relating to Delegation of Prescribing and Ordering Drugs and Devices; Prescriptive Authority Agreements Generally; Prescriptive Authority Agreements: Minimum Requirements; Delegation of Prescriptive Authority at a Facility-Based Practice Site; Registration of Delegation and Prescriptive Authority Agreements; Prescription Forms; Prescriptive Authority Agreement Inspections; Delegation to Certified Registered Nurse Anesthetists; and Delegation Related to Obstetrical Services). When care is delivered under other circumstances, standing delegation orders may include authority to undertake the following as listed in paragraphs (1) - (8) of this section:

  (1) the taking of personal and medical history;

  (2) the performance of appropriate physical examination and the recording of physical findings;

  (3) the ordering of tests appropriate to the services provided under such orders, such as tuberculin tests, skin tests, VD tests, VDRL tests, gram stains, pap smears, and serological tests;

  (4) the administration or providing of drugs ordered by direct personal or voice communication by the authorizing physician who shall assume responsibility for the patient's welfare, providing such administration or provision of drugs shall be in compliance with other state or federal laws and providing further that pre-signed prescriptions shall be utilized by the authorizing physician only under the following conditions shown in subparagraphs (A) - (D) of this paragraph.

    (A) The prescription shall be prepared in full compliance with the Texas Health and Safety Code, §483.001(13) except for the inclusion of the name of the patient and the date of issuance.

    (B) The prescription shall be for one of the following classes or types of drugs:

      (i) oral contraceptives;

      (ii) diaphragms and contraceptive creams and jellies;

      (iii) topical anti-infectives for vaginal use;

      (iv) oral anti-parasitic drugs for treatment of pinworms;

      (v) topical anti-parasitic drugs; or

      (vi) antibiotic drugs for treatment of venereal disease.

    (C) The prescriptions may not be issued for any controlled substance.

    (D) The providing of the drugs shall be in compliance with the Texas Pharmacy Act and rules adopted by the Texas State Board of Pharmacy.

  (5) the administration of immunization vaccines providing the recipient is free of any condition for which the immunization is contraindicated;

  (6) the providing of information regarding hygiene and the administration or providing of medications for health problems resulting from a lack of hygiene, including the institution of treatment for conditions such as scabies, ringworm, pinworm, head lice, diaper rash and other minor skin disorders, provided the administration or providing of drugs adheres to paragraph (4) of this section;

  (7) the provision of services and the administration of therapy by public health departments as officially prescribed by the Department of State Health Services for the prevention or treatment of specific communicable diseases or health conditions for which the Department of State Health Services is responsible for control under state law;

  (8) the issuance of a nonprescription drug for the symptomatic relief of minor illnesses provided that such medications are packaged and labeled in compliance with state and federal laws and regulations.

Source Note: The provisions of this §193.4 adopted to be effective November 7, 2013, 38 TexReg 7711

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