Part IX.
Texas State Board of Medical Examiners
Chapter 181.
Contact Lens Prescriptions
22 TAC §§181.1-181.7
The Texas State Board of Medical Examiners adopts on an emergency
basis new §§181.1-181.7, concerning contact lens prescriptions.
New chapter 181 is mandated by the 75th Legislature through the Texas Contact
Lens Prescription Act, Chapter 1345. The new chapter is adopted in order to
set forth the criteria under which a patient may request and receive a contact
lens prescription and under which a physician shall provide such prescription.
These sections are being adopted on an emergency basis due to
deadlines mandated by statute.
The new sections are adopted on an emergency basis under the Medical Practice
Act, Texas Civil Statutes, Article 4495b §2.09(a), which provides the
Texas State Board of Medical Examiners with the authority to make rules, regulations
and bylaws not inconsistent with this Act as may be necessary for the governing
of its own proceedings, the performance of its duties, the regulation of the
practice of medicine in this state, and the enforcement of this Act.
§181.1. Purpose.
These rules are promulgated under the authority of the Medical Practice
Act, Article 4495b, and the Texas Contact Lens Prescription Act, Chapter 1345,
75th Legislature Regular Session, to set forth the criteria under which a
patient may request and receive a contact lens prescription and under which
a physician shall provide such prescription.
§181.2. Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents clearly indicate otherwise.
(1)
Contact lens prescription - a written prescription that
contains the following information:
(A)
The patient's name;
(B)
The date the prescription was issued;
(C)
The contact lens manufacturer, if needed;
(D)
The expiration date of the prescription, which shall be
one year or more unless the health of the patient requires an earlier expiration
date;
(E)
The original signature of the physician;
(F)
The total number of disposal lenses authorized and recommended
replacement intervals if the prescription is for disposable contact lenses;
(G)
The brand name or model type of the lens prescribed;
(H)
The lens power;
(I)
The base curve measurements; and
(J)
The diameter.
(2)
Disposable contact lenses - soft contact lenses
that:
(A)
Are dispensed in sealed packages;
(B)
Are sterilized and sealed by the manufacturer; and
(C)
According to the wearing instructions suggest the lenses
be replaced at an interval of less than three months.
§181.3. Release of Contact Lens Prescription.
(a)
Except as provided in subsection (d) of this section,
each physician who performs an eye examination and fits a patient for contact
lenses shall, on request, prepare and give a contact lens prescription to
the patient. The physician may exclude categories of contact lenses if the
exclusion is clinically indicated. The physician may not charge the patient
a fee for providing the contact lens prescription but may charge a fee for
examination and a fee for fitting of contact lenses as a condition for giving
a contact lens prescription to the patient.
(b)
If a patient requests a contact lens prescription during
an initial or annual examination, the physician must prepare and give the
contact lens prescription to the patient at the time the physician determines
all of the parameters of the contact lens prescription, as that term is defined
in §181.2 of this title (relating to definitions). If the physician has
delegated the fitting of the contact lens as authorized by the Texas Contact
Lens Prescription Act, Texas Revised Civil Statutes, Article 4552-A, the physician
is not required to provide the prescription for the patient.
(c)
If the patient does not request or receive an original
contact lens prescription during the patient's initial or annual examination,
the patient may request the patient's contact lens prescription at any time
during which the prescription is valid. On receipt of a request, the physician
shall provide the patient with a contact lens prescription if the physician
has fit the patient. If the patient requests the physician to deliver the
prescription to the patient or to another person, the physician may charge
the cost of delivery to the patient.
(d)
A physician may refuse to give a contact lens prescription
to a patient if:
(1)
The patient's ocular health presents a contraindication
for contact lenses;
(2)
Refusal is warranted due to potential harm to the
patient's ocular health;
(3)
The patient has not paid for the examination and
for the fitting or has not paid for other financial obligations to the physician
if the patient would have been required to make an immediate or similar payment
if the examination revealed that ophthalmic goods were not required;
(4)
The patient has an existing medical condition that
indicates that the patient's ocular health would be damaged if the prescription
were released to the patient, or if further monitoring of the patient is
needed; or
(5)
The request is made after the first anniversary date
of the patient's last eye examination.
(e)
Subsection (d) of this section does not prohibit a physician
from giving a patient the patient's contact lens prescription.
(f)
A physician may not condition the availability to a patient
of an eye examination, a fitting for contact lenses, the issuance of a contact
lens prescription, or any combination of these services on a requirement
that
the patient agree to purchase contact lenses or other ophthalmic goods from
the physician.
(g)
Unless a shorter prescription period is warranted by the
patient's ocular health or by a potential harm to the patient's ocular health,
a physician may not issue a contact lens prescription that expires before
the first anniversary of the date the person's prescription parameters are
determined. The physician may extend the expiration date of the prescription
without completing another eye examination or may require the patient to undergo
another eye examination.
(h)
If a physician refuses to give a patient the patient's
contact lens prescription for a reason permitted under subsection (d) of
this section or writes the prescription for a period of less than one year,
the physician must:
(1)
give the patient a verbal explanation of the reason for
the action at the time of the action; and
(2)
maintain in the patient's records a written explanation
of the reason.
§181.4. Delegation of Fitting of Contact Lenses.
If a physician notes on a spectacle prescription "fit for contacts"
or similar language and has specifically delegated to a specific optician
the authority to make the additional measurements and evaluations necessary
to derive the information required for a fully written contact lens prescription,
the optician may dispense contact lenses to the patient even though the prescription
is less than a fully written contact lens prescription.
§181.5. Contact Lens Dispensing Permit Not Required of Physician or Physician's Employees.
Neither a physician nor an employee of a physician is required to
obtain a permit under this act if the employee performs contact lens dispensing
services under the direct supervision and control of the physician.
§181.6. Physician's Prescriptions: Delegation.
(a)
These rules shall not be interpreted to prevent, limit,
or restrict a physician from treating or prescribing for the physician's patients
or from directing or instructing others under the physician's control, supervision
or instruction who assists those patients according to specific directions,
orders, instructions, or prescriptions.
(b)
If a physician's directions, instructions, orders, or
prescriptions are to be performed or filled by an optician who is independent
of the physician's office, the directions, instructions, orders or prescriptions
must be:
(1)
In writing;
(2)
Of a scope and content and communicated to the optician
in a form and manner that in the professional judgment of the physician best
serves the health, safety, and welfare of the physician's patients; and
(3)
In form in detail consistent with the particular
optician's skill and knowledge.
(c)
A person holding a contact lens dispensing permit under
this act may take measurements of the eye or cornea and may evaluate the
physical fit of the lenses for a particular patient of the physician and
may instruct the patient in the use and care of the contact lenses if the
physician has delegated in writing those responsibilities with regard to
that specific patient to the contact lens dispenser.
§181.7. Liability.
(a)
A contact lens prescription may not contain, and a physician
may not require a patient to sign a form or notice that waives or disclaims
the liability of the physician for the accuracy of:
(1)
The eye examination on which the contact lens prescription
furnished to the patient is based; or
(2)
The contact lens prescription provided to the patient.
(b)
A physician is not liable for any subsequent use of a
contact lens prescription by a patient if the physician does not reexamine
the patient and the patient's condition, age, general health, and susceptibility
to an adverse reaction caused by or related to the use of contact lenses
or other factors result in patient no longer being a proper candidate for
the contact lens or lenses prescribed.
Issued in Austin, Texas, on December 19, 1997.
TRD-9717073
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: December 22, 1997
Expiration date: April 21, 1998
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners adopts on an emergency
basis, the repeal of §183.17 and new §183.17 and §183.23, concerning
acupuncture. The repeal and new sections are as a result of Senate Bill 1765,
75th Legislature, which requires the Board of Medical Examiners to certify
acudetox specialists, annually renew certification, and monitor continuing
education for these registrants.
Chapter 183.
Acupuncture