The following words and terms when used in this chapter shall
have the following meanings unless the context clearly indicates otherwise:
(1) Advanced health assessment--A course that offers
content supported by related clinical experience such that students
gain the knowledge and skills needed to perform comprehensive assessments
to acquire data, make diagnoses of health status, and formulate effective
clinical management plans. Content must include assessment of all
human systems, advanced assessment techniques, concepts, and approaches.
(2) Advanced Pharmacotherapeutics--A course that offers
advanced content in pharmacokinetics, pharmacodynamics, pharmacotherapeutics
of all broad categories of agents, and the application of drug therapy
to the treatment of disease and/or the promotion of health.
(3) Advanced Physiology and Pathophysiology--A dedicated,
comprehensive, system-focused pathology course(s) that provides students
with the knowledge and skills to analyze the relationship between
normal physiology and pathological phenomena produced by altered states
across the life span.
(4) Advanced practice registered nurse (APRN)--As defined
by §301.152, Occupations Code. The term includes an advanced
nurse practitioner and advanced practice nurse.
(5) Board--The Texas Board of Nursing.
(6) Controlled Substance--As defined by §481.002,
Health and Safety Code.
(7) Dangerous Drug--As defined by §483.001, Health
and Safety Code.
(8) Device--As defined by §551.003, Occupations
Code, and includes durable medical equipment.
(9) Diagnosis and management course--A course offering
both didactic and clinical content in clinical decision-making and
aspects of medical diagnosis and medical management of diseases and
conditions. Supervised clinical practice must include the opportunity
to provide pharmacological and non-pharmacological management of diseases
and conditions considered within the scope of practice of the APRN's
population focus area and role.
(10) Facility-based practice--A hospital, as defined
by §157.051(6), Occupations Code, or a licensed long term care
facility. A facility based practice does not include a freestanding
clinic, center, or other medical practice associated with or owned
or operated by a hospital or licensed long term care facility.
(11) Health professional shortage area--
(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
(B) A population group that the Secretary of Health
and Human Services determines has a health professional shortage;
(C) A public or non-profit private medical facility
or other facility that the Secretary of Health and Human Services
determines has a health profession shortage as described by 42 U.S.C. §254e(a)(1).
(12) Hospital--A facility that:
(i) a general hospital or a special hospital, as those
terms are defined by §241.003, Health and Safety Code, including
a hospital maintained or operated by a state; or
(ii) a mental hospital licensed under Chapter 577,
Health and Safety Code; and
(B) has an organized medical staff.
(13) Medication order--As defined by §551.003,
Occupations Code and §481.002, Health and Safety Code.
(14) Non-prescription drug--As defined by §551.003,
(15) Physician group practice--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 non-profit
health organization certified by the Texas Medical Board under §162.001(b),
Occupations Code, that complies with the requirements of Chapter 162.
(16) Population focus area--The section of the population
with which the APRN has been licensed to practice by the Board.
(17) Practice serving a medically under-served population--
(A) A practice in a health professional shortage area;
(B) A clinic designated as a rural health clinic under
(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. §1396d(1)(2)(B);
(E) A county, state, or federal correctional facility;
(F) A practice:
(i) that either:
(I) 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
(II) 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
(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 APRN or physician assistant on or before
March 1, 2013, based on the practice qualifying as a site serving
a medically under-served population.
(18) Prescribe or order a drug or device--Prescribing
or ordering a drug or device, including the issuing of a prescription
drug order or a medication order.
(19) Prescription drug--As defined by §551.003,
(20) Prescriptive authority agreement--An agreement
entered into by a physician and an APRN or physician assistant through
which the physician delegates to the APRN or physician assistant the
act of prescribing or ordering a drug or device.
(21) Protocols or other written authorization--Written
authorization to provide medical aspects of patient care that are
agreed upon and signed by the APRN and delegating physician, reviewed
and signed at least annually, and maintained in the practice setting
of the APRN. The term "protocols or other written authorization" is
separate and distinct from a prescriptive authority agreement. However,
a prescriptive authority agreement may reference or include the terms
of a protocol or other written authorization. Protocols or other written
authorization shall be defined to promote the exercise of professional
judgment by the APRN commensurate with his/her education and experience.
Such protocols or other written authorization need not describe the
exact steps that the APRN must take with respect to each specific
condition, disease, or symptom and may state types or categories of
drugs or devices that may be prescribed or ordered rather than just
list specific drugs or devices.
(22) Shall and must--Mandatory requirements.
(23) Should--A recommendation.
Source Note: The provisions of this §222.1 adopted to be effective November 20, 2013, 38 TexReg 8212