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A BILL TO BE ENTITLED
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AN ACT
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relating to the regulation of the practice of medicine, including |
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the performance of cosmetic medical procedures and the provision of |
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elective intravenous therapy. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle B, Title 3, Occupations Code, is |
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amended by adding Chapters 172 and 173 to read as follows: |
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CHAPTER 172. MEDICAL SPAS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 172.001. DEFINITIONS. In this chapter: |
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(1) "Cosmetic medical procedure" means a medical |
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procedure or medical treatment that is performed to alter or |
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reshape normal structures of the human body or to ablate or remove |
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living tissue solely to improve physical appearance. The term |
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includes the administration of a neuromodulator or dermal filler, |
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an ablative or non-ablative laser procedure, and a procedure using |
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an energy-emitting device. |
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(2) "Medical spa" means a facility outside a |
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physician's primary office location where cosmetic medical |
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procedures are performed. |
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(3) "Medical spa director" means a physician who |
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assumes the role of or represents that the person is the medical |
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director of a medical spa. |
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Sec. 172.002. STATUS OF MEDICAL SPA. A medical spa is a |
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medical practice setting. |
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Sec. 172.003. NOTICE REQUIRED IF PHYSICIAN NOT PRESENT. A |
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medical spa must post a notice stating that a physician is not |
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present at the location at any time when a physician is not present |
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at the medical spa. |
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SUBCHAPTER B. MEDICAL SPA DIRECTOR |
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Sec. 171.051. MEDICAL SPA DIRECTOR REQUIRED. A cosmetic |
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medical procedure may not be performed at a medical spa unless the |
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medical spa has a medical director. |
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Sec. 172.052. MEDICAL SPA DIRECTOR ELIGIBILITY. A person |
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may not act as a medical spa director unless the person is a |
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physician trained in: |
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(1) the indications for and performance of cosmetic |
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medical procedures; and |
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(2) the use of medical devices or instruments capable |
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of altering, causing biologic change to, or penetrating skin and |
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subcutaneous tissue. |
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Sec. 172.053. MEDICAL SPA DIRECTOR DUTIES. A medical spa |
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director shall: |
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(1) implement policies and procedures to: |
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(A) promote quality patient care; and |
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(B) provide for physician delegation and |
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supervision of the performance of cosmetic medical procedures; |
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(2) provide overall supervision for cosmetic medical |
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procedures performed at the medical spa, whether by a physician or a |
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non-physician provider; and |
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(3) oversee the training of physician and |
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non-physician providers to safely and effectively perform each |
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cosmetic medical procedure performed at the medical spa. |
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SUBCHAPTER C. PHYSICIAN PERFORMANCE, DELEGATION, OR SUPERVISION OF |
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COSMETIC MEDICAL PROCEDURE |
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Sec. 172.101. PHYSICIAN TRAINING REQUIREMENTS REGARDING |
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COSMETIC MEDICAL PROCEDURE. (a) A physician may not perform a |
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cosmetic medical procedure or supervise the performance of a |
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cosmetic medical procedure by a non-physician provider unless the |
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physician has completed training in the indications for and |
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performance of the cosmetic medical procedure and is able to |
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perform the procedure according to the standard of care. |
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(b) For purposes of Subsection (a), training provided by the |
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vendor or manufacturer of an injectable or medical device used to |
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perform a cosmetic medical procedure does not satisfy the training |
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requirements of that subsection. |
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Sec. 172.102. PHYSICIAN DELEGATION OR SUPERVISION OF |
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COSMETIC MEDICAL PROCEDURES. (a) A physician's authority to |
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delegate the prescribing or ordering of a drug or device relating to |
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cosmetic medical procedures is subject to Subchapter B, Chapter |
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157. |
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(b) A prescriptive authority agreement relating to cosmetic |
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medical procedures is included in the number of prescriptive |
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authority agreements authorized under Section 157.0512(c). The |
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exception provided in Section 157.0512(d) does not apply to a |
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prescriptive authority agreement relating to cosmetic medical |
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procedures. |
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(c) A physician who delegates or supervises the performance |
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of a cosmetic medical procedure shall: |
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(1) for each cosmetic medical procedure performed |
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under the physician's delegation and supervision: |
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(A) develop and maintain a written protocol; or |
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(B) review and approve in writing a written |
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protocol developed and maintained by another physician at the |
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medical spa; |
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(2) perform an initial assessment of the patient on |
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whom a cosmetic medical procedure will be performed; |
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(3) prepare a written treatment plan for each patient |
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on whom a cosmetic medical procedure will be performed, including |
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diagnosis, course of treatment, and specifications for any device |
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being used; |
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(4) if a cosmetic medical procedure is being performed |
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by a non-physician provider: |
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(A) obtain the patient's consent to the procedure |
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to be performed by the non-physician provider; and |
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(B) identify the name and credentials of the |
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non-physician provider who will perform the procedure; and |
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(5) create and maintain medical records in a manner |
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consistent with accepted medical practice and in compliance with |
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board rules. |
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Sec. 172.103. AVAILABILITY OF MEDICAL SPA SUPERVISING |
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PHYSICIAN. A physician supervising the performance of a cosmetic |
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medical procedure at a medical spa must be immediately able to be |
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present on site and respond in person, if needed. |
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SUBCHAPTER D. NON-PHYSICIAN PROVIDER PERFORMANCE OF COSMETIC |
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MEDICAL PROCEDURES |
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Sec. 172.151. NON-PHYSICIAN PROVIDER REQUIREMENTS FOR |
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COSMETIC MEDICAL PROCEDURES. (a) A non-physician provider may |
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perform cosmetic medical procedures only if the provider has been |
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properly trained, the procedure has been delegated to the provider |
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by a supervising physician, and the provider is acting under |
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physician supervision. |
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(b) Training provided by a vendor or manufacturer of an |
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injectable or medical device used to perform a cosmetic medical |
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procedure does not qualify the individual to perform a cosmetic |
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medical procedure. |
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(c) A non-physician provider shall: |
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(1) wear identification that clearly indicates any |
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license the person holds and states that the person is not a |
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physician; |
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(2) review and follow written protocols for each |
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delegated cosmetic medical procedure; |
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(3) verify that the supervising physician has assessed |
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the patient and given written treatment instructions for each |
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procedure to be performed; |
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(4) review with each patient the cosmetic medical |
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procedure to be performed; |
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(5) notify the medical spa director and supervising |
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physician of any adverse events or complications before the patient |
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leaves the medical spa or, if the patient has already left the |
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medical spa, immediately on becoming aware of the adverse event or |
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complication; |
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(6) communicate post-procedure instructions to each |
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patient; |
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(7) document all relevant details of the cosmetic |
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medical procedure in the patient's medical record; and |
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(8) satisfy any requirement of the non-physician |
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provider's licensing board. |
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(d) A cosmetic medical procedure may not be performed at a |
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medical spa unless: |
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(1) a physician is physically present at the medical |
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spa; or |
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(2) at least one non-physician provider trained in |
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basic life support is physically present at the medical spa. |
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CHAPTER 173. PROVISION OF ELECTIVE INTRAVENOUS THERAPY |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 173.001. DEFINITIONS. In this chapter: |
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(1) "Elective intravenous therapy" means a procedure: |
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(A) to administer fluids, nutrients, |
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medications, or blood directly into a patient's bloodstream through |
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a vein; |
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(B) that is sought by the patient to alleviate |
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symptoms of temporary discomfort or improve temporary wellness; and |
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(C) that is not administered in: |
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(i) a physician's office; |
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(ii) a health facility licensed under |
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Subtitle B, Title 4, Health and Safety Code; |
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(iii) a mental hospital licensed under |
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Chapter 577, Health and Safety Code; or |
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(iv) a hospital maintained or operated by |
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this state. |
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(2) "Registered nurse" means a person licensed by the |
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Texas Board of Nursing to practice professional nursing. |
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SUBCHAPTER B. ELECTIVE INTRAVENOUS THERAPY |
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Sec. 173.051. DELEGATION OF PRESCRIBING OR ORDERING |
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ELECTIVE INTRAVENOUS THERAPY. (a) A physician may delegate the act |
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of prescribing or ordering elective intravenous therapy to: |
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(1) a physician assistant acting under adequate |
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physician supervision; or |
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(2) a registered nurse acting under adequate physician |
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supervision. |
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(b) A physician's authority to delegate the act of |
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prescribing or ordering elective intravenous therapy is subject to |
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Subchapter B, Chapter 157. |
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(c) A prescriptive authority agreement relating to elective |
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intravenous therapy is included in the maximum number of |
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prescriptive authority agreements authorized under Section |
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157.0512(c). The exception provided in Section 157.0512(d) does |
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not apply to a prescriptive authority agreement relating to |
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elective intravenous therapy. |
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SECTION 2. The changes in law made by this Act apply to the |
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performance of a medical act on or after the effective date of this |
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Act under a physician's delegation, including the act of |
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prescribing, ordering, or administering a controlled substance, |
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dangerous drug, or device, regardless of: |
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(1) the manner in which the delegation is made; and |
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(2) whether the delegation is made before, on, or |
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after the effective date of this Act. |
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SECTION 3. This Act takes effect September 1, 2025. |