Body
Revision 26-2; Effective Sept. 1, 2026
Grantees that provide clinical services must develop and maintain written clinical prescriptive authority agreements (PAAs), protocols and standing orders (SOs) to comply with statutes and rules that govern medical, dental and nursing practice and consistent with national evidence-based clinical guidelines.
5310 Prescriptive Authority Agreements
Revision 26-2; Effective Sept. 1, 2026
The grantee must make sure that advanced practice providers (APPs) maintain a properly executed prescriptive authority agreement (PAA). APPs include advanced practice registered nurses (APRNs) and physician assistants (PAs). The PAA must meet all the requirements of the Texas Occupations Code (TOC), Title 3, Subtitle B, Chapter 157. The PAA and any amendments must be reviewed at least annually, dated and signed by the parties to the agreement. The PAA must:
- be in writing and signed and dated by the parties to the agreement;
- state the name, address and all professional license numbers of the parties to the agreement;
- state the nature of the practice, practice locations or practice settings;
- 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;
- provide a general plan for addressing consultation and referral;
- provide a plan for addressing patient emergencies;
- state the general process for communication and sharing information between the physician and the APRN or PA to whom the physician has delegated prescriptive authority related to the care and treatment of patients;
- if alternate physician supervision is to be used, designate one or more alternate physicians who may:
- provide appropriate supervision on a temporary basis per the requirements established by the PAA and the requirements of TOC Chapter 157, Subchapter A; and
- participate in the prescriptive authority quality assurance and improvement plan meetings required under TOC Section 157.0512; and
- describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that include:
- chart review, with the number of charts to be reviewed determined by the physician and advanced practice registered nurse or physician assistant; and
- periodic meetings between the advanced practice registered nurse or physician assistant and the physician.
References
TAC, Title 22, Part 11, Chapter 222 Advanced Practice Registered Nurses with Prescriptive Authority
Delegation Protocol for Advanced Practice Providers
APRNs and PAs are required to have delegated authority from a licensed physician to provide medical aspects of patient care. Physician delegation occurs through protocols or other written authorization. This delegation historically has occurred through a protocol or other written authorization. Rather than require multiple documents, delegation protocols can be included in the PAA.
References
TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(11) Protocols and Rule 169.2(a)
TAC Title 22, Part 11, Rule 221.13(d)(1-2) Texas Board of Nursing, Delegation Protocols or written authorization requirements for APRNs
5320 Protocols
Revision 26-2; Effective Sept. 1, 2026
APRNs and PAs are required to have delegated authority from a licensed physician to provide medical aspects of patient care. Physician delegation occurs through protocols or other written authorization. This delegation has historically occurred through a protocol or other written authorization. Rather than require multiple documents, delegation protocols can be included in the PAA.
References
TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(11) Protocols and Rule 169.2(a)
TAC Title 22, Part 11, Rule 221.13(d)(1-2) Texas Board of Nursing, Delegation Protocols or written authorization requirements for APRNs
5330 Standing Orders
Revision 26-2; Effective Sept. 1, 2026
Standing Orders (SOs) include Standing Delegation Orders, Standing Medical Orders and written protocols. These terms are defined in TAC Title 22, Part 9, Chapter 169, Subchapter A, Rule 169.1(12-14).
General standards for Standing Delegation Orders, Standing Medical Orders and Protocols require:
- development and approval by the delegating physician per facility bylaws and policies
- the order or protocol to be in writing and signed by the delegating physician
- a description of the specific instructions, orders, protocols or procedures to follow
- a notation of the level of supervision required, unless specified by other law
- plans for addressing patient emergencies
- annual review signed by the delegating physician
- maintenance at the facility or practice site