Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012 Page: 5,551
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(F) Obtain the patient's informed consent;
(G) Provide instructions for emergency and follow-up
care;
(H) Prepare and maintain an appropriate medical
record;
(I) Have signed and dated written protocols as de-
scribed in paragraph (7) of this subsection that are detailed to a level
of specificity that the person performing the Procedure may readily
follow; and
(J) Have signed and dated written standing orders.
(K) The performance of the items listed in subpara-
graphs (A) - (J) of this paragraph must be documented in the patient's
medical record.
(3) After a patient has been evaluated and diagnosed, as
described in paragraph (2) of this subsection, qualified unlicensed per-
sonnel may perform a procedure only if:
(A) a physician or midlevel practitioner is onsite during
the procedure; or
(B) a delegating physician is available for emergency
consultation in the event of an adverse outcome, and if the physician
considers it necessary, be able to conduct an emergency appointment
with the patient. The physician shall have a primary practice site lo-
cated within 75 miles of the site where the Procedure is performed.
(4) Regardless of who performs the Procedure, the physi-
cian is ultimately responsible for the safety of the patient and all aspects
of the Procedure.
(5) Regardless of who performs the Procedure, the physi-
cian is responsible for ensuring that each Procedure is documented in
the patient's medical record. A Procedure performed by unlicensed per-
sonnel must be timely co-signed by a supervising physician.
(6) The physician must ensure that the facility at which
Procedures are performed, there is a quality assurance program per-
taining to Procedures that includes the following:
(A) A mechanism to identify complications and unto-
ward effects of treatment and to determine their cause;
(B) A mechanism to review the adherence to written
protocols by all health care personnel;
(C) A mechanism to monitor the quality of treatments;
(D) A mechanism by which the findings of the quality
assurance program are reviewed and incorporated into future protocols;
and
(E) Ongoing training to maintain and improve the qual-
ity of treatment and performance of Procedures by health care person-
nel.
(7) A physician may delegate Procedures only at a facility
at which the physician has either:
(A) approved in writing the facility's written protocols
pertaining to the Procedures; or
(B) developed his own protocols for the Procedures as
described in paragraph (2)(H) of this subsection.
(8) The physician must ensure that a person performing a
Procedure has appropriate training in, at a minimum:
(A) Techniques for each Procedure;(B) Cosmetic or cutaneous medicine;
(C) Indications and contraindications for each Proce-
dure;
(D) Preprocedural and postprocedural care;
(E) Recognition and acute management of potential
complications that may result from the Procedure; and
(F) Infectious disease control involved with each treat-
ment.
(9) The physician has a written office protocol for the per-
son performing the Procedure to follow in performing Procedure dele-
gated. A written office protocol must include, at a minimum, the fol-
lowing:
(A) The identity of the physician responsible for the
delegation of the Procedure;
(B) Selection criteria to screen patients by the physician
or midlevel practitioner for the appropriateness of treatment;
(C) A description of appropriate care and follow-up for
common complications, serious injury, or emergencies;
(D) A statement of the activities, decision criteria, and
plan the physician, or midlevel practitioner, shall follow when perform-
ing or delegating the performance of a Procedure, including the method
for documenting decisions made and a plan for communication or feed-
back to the authorizing physician or midlevel practitioner concerning
specific decisions made; and
(E) A description of what information must be docu-
mented by the person performing the Procedure.
(10) The physician ensures that each person performs each
Procedure in accordance with the written office protocol.
(11) Each patient signs a consent form prior to treatment
that lists foreseeable side effects and complications, and the identity
and titles of the individual who will perform the Procedure.
(12) Each person performing a Procedure must be readily
identified by a name tag or similar means that clearly delineates the
identity and credentials of the person.
(13) Any time a Procedure is performed, at least one person
trained in basic life support must be onsite.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on July 16, 2012.
TRD-201203629
Mari Robinson, J.D.
Executive Director
Texas Medical Board
Earliest possible date of adoption: August 26, 2012
For further information, please call: (512) 305-7016
TITLE 28. INSURANCE
PART 2. TEXAS DEPARTMENT OF
INSURANCE, DIVISION OF WORKERS'
COMPENSATIONPROPOSED RULES July 27, 2012 37 TexReg 5551
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Texas. Secretary of State. Texas Register, Volume 37, Number 30, Pages 5519-5676, July 27, 2012, periodical, July 27, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth243959/m1/33/: accessed March 19, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.