TITLE 22. EXAMINING BOARDS

PART 1. TEXAS BOARD OF ARCHITECTURAL EXAMINERS

CHAPTER 1. ARCHITECTS

SUBCHAPTER A. SCOPE; DEFINITIONS

22 TAC §1.5

The Texas Board of Architectural Examiners (board) proposes an amendment to §1.5 of Chapter 1, Subchapter A, pertaining to defined terms. The amendment replaces the word "issued" with "prepared" in the definition of the term "Construction Documents." The amendment modifies the term to more accurately reflect a construction document as a document prepared by a design professional, though not necessarily one issued by an architect, to conform to board rules which apply to construction documents that have not been issued by an architect.

Cathy L. Hendricks, Executive Director, Texas Board of Architectural Examiners, has determined that for the first five-year period the amended rule is in effect, there will be no fiscal implications for state or local government.

Ms. Hendricks also has determined that for the first five-year period the amended rule is in effect the public benefits expected as a result of the amended rule are as follows: The amendment will make the definition more accurately reflect the actual practice of design professionals which will provide more meaningful guidance to the public when consulting the board's rules. The amended rule will have no impact on small or micro business.

There will be no change in the cost to persons required to comply with the section. The amendment does not impose any additional regulatory burden upon small or micro businesses or individuals. Therefore, no economic impact statement or flexibility analysis of these amendments is required.

Comments may be submitted to Cathy L. Hendricks, ASID/IIDA, Executive Director, Texas Board of Architectural Examiners, P.O. Box 12337, Austin, Texas 78711-2337.

The amendment to this rule is proposed pursuant to §1051.202, Texas Occupations Code Annotated which provides the Texas Board of Architectural Examiners with authority to promulgate rules necessary to enforce laws within the agency's jurisdiction.

The proposed amendment to this rule does not affect any other statutes.

§1.5.Terms Defined Herein.

The following words, terms, and acronyms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) - (20) (No change.)

(21) Construction Documents--Drawings; specifications; and addenda, change orders, construction change directives, and other Supplemental Documents prepared [issued by an Architect] for the purpose(s) of Regulatory Approval, permitting, or construction.

(22) - (74) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901458

Cathy L. Hendricks

Executive Director

Texas Board of Architectural Examiners

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-8544


CHAPTER 3. LANDSCAPE ARCHITECTS

SUBCHAPTER A. SCOPE; DEFINITIONS

22 TAC §3.5

The Texas Board of Architectural Examiners (board) proposes an amendment to §3.5 of Chapter 3, Subchapter A, pertaining to defined terms. The amendment replaces the word "issued" with "prepared" in the definition of the term "Construction Documents." The amendment modifies the term to more accurately reflect a construction document as a document prepared by a design professional, though not necessarily one issued by a landscape architect, to conform to board rules which apply to construction documents that have not been issued by a landscape architect.

Cathy L. Hendricks, Executive Director, Texas Board of Architectural Examiners, has determined that for the first five-year period the amended rule is in effect, there will be no fiscal implications to state or local government.

Ms. Hendricks also has determined that for the first five-year period the amended rule is in effect the public benefits expected as a result of the amended rule are as follows: The amendment will make the definition more accurately reflect the actual practice of design professionals which will provide more meaningful guidance to the public when consulting the board's rules. The amended rule will have no impact on small or micro business.

There will be no change in the cost to persons required to comply with the section. The amendment does not impose any additional regulatory burden upon small or micro businesses or individuals. Therefore, no economic impact statement or flexibility analysis of these amendments is required.

Comments may be submitted to Cathy L. Hendricks, ASID/IIDA, Executive Director, Texas Board of Architectural Examiners, P.O. Box 12337, Austin, Texas 78711-2337.

The amendment to this rule is proposed pursuant to §1051.202, Texas Occupations Code Annotated which provides the Texas Board of Architectural Examiners with authority to promulgate rules necessary to enforce laws within the agency's jurisdiction.

The proposed amendment to this rule does not affect any other statutes.

§3.5.Terms Defined Herein.

The following words, terms, and acronyms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) - (14) (No change.)

(15) Construction Documents--Drawings; specifications; and addenda, change orders, construction change directives, and other Supplemental Documents prepared [issued by a Landscape Architect] for the purpose(s) of Regulatory Approval, permitting, or construction.

(16) - (64) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901459

Cathy L. Hendricks

Executive Director

Texas Board of Architectural Examiners

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-8544


CHAPTER 5. INTERIOR DESIGNERS

SUBCHAPTER A. SCOPE; DEFINITIONS

22 TAC §5.5

The Texas Board of Architectural Examiners proposes an amendment to §5.5 of Chapter 5, Subchapter A, pertaining to defined terms. The amendment replaces the word "issued" with "prepared" in the definition of the term "Construction Documents." The amendment modifies the term to more accurately reflect a construction document as a document prepared by a design professional, though not necessarily one issued by an interior designer, to conform to board rules which apply to construction documents that have not been issued by an interior designer.

Cathy L. Hendricks, Executive Director, Texas Board of Architectural Examiners, has determined that for the first five-year period the amended rule is in effect, there will be no fiscal implications for state or local government.

Ms. Hendricks also has determined that for the first five-year period the amended rule is in effect the public benefits expected as a result of the amended rule are as follows: The amendment will make the definition more accurately reflect the actual practice of design professionals which will provide more meaningful guidance to the public when consulting the board's rules. The amended rule will have no impact on small or micro business.

There will be no change in the cost to persons required to comply with the section. The amendment does not impose any additional regulatory burden upon small or micro businesses or individuals. Therefore, no economic impact statement or flexibility analysis of these amendments is required.

Comments may be submitted to Cathy L. Hendricks, ASID/IIDA, Executive Director, Texas Board of Architectural Examiners, P.O. Box 12337, Austin, Texas 78711-2337.

The amendment to this rule is proposed pursuant to Section 1051.202, Texas Occupations Code Annotated, which provide the Texas Board of Architectural Examiners with authority to promulgate rules necessary to enforce laws within the agency's jurisdiction.

The proposed amendment to this rule does not affect any other statutes.

§5.5.Terms Defined Herein.

The following words, terms, and acronyms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) - (13) (No change.)

(14) Construction Documents--Drawings; specifications; and addenda, change orders, construction change directives, and other Supplemental Documents prepared [issued by an Interior Designer] for the purpose(s) of Regulatory Approval, permitting, or construction.

(15) - (60) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901460

Cathy L. Hendricks

Executive Director

Texas Board of Architectural Examiners

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-8544


PART 9. TEXAS MEDICAL BOARD

CHAPTER 162. SUPERVISION OF MEDICAL SCHOOL STUDENTS

22 TAC §162.1

The Texas Medical Board (Board) proposes amendments to Chapter 162, §162.1, concerning Supervision of Medical School Students.

The amendment clarifies the intent of the amendment previously adopted, which became effective on March 9, 2009.

Robert D. Simpson, General Counsel for the Board, has determined that for each year of the first five years the section as proposed is in effect, the public benefit anticipated as a result of enforcing the proposal will be to clarify existing language.

Mr. Simpson has also determined that for the first five-year period the section is in effect, there will be no fiscal implications to state or local government as a result of enforcing the section as proposed. There will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small or micro businesses.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendment is proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

No other statutes, articles or codes are affected by this proposal.

§162.1.Supervision of Medical Students.

(a) In order to supervise a medical student who is enrolled at a Texas medical school as a full-time student or visiting student the[:]

[(1)] [a] physician must have an active and unrestricted Texas license.[, and the medical student must meet the following criteria:]

[(A) is enrolled at a Texas medical school; or]

[(B) is a student at a medical school located outside Texas and is enrolled as a visiting student at a Texas medical school; or]

[(2) a physician must:]

(b) In order to supervise a medical student who does not meet the criteria in subsection (a) of this section the physician must:

(1) [(A)] have an active and unrestricted Texas license; [and]

(2) [(B)] hold a faculty position in the graduate medical education program in the same specialty in which the student will receive undergraduate medical education; [ and]

(3) [(C)] supervise the student during the educational period; and

(4) [(D)] supervise the student's [ the medical student must receive supervised] medical education in either a Texas hospital or teaching institution, which sponsors or participates in a program of graduate medical education accredited by the Accrediting Council for Graduate Medical Education, the American Osteopathic Association, or the Texas Medical Board in the same subject as the medical or osteopathic medical education in which the hospital or teaching institution has an agreement with the applicant's school.

(c) [(b)] If the physician is not licensed in Texas as required in subsection (a) or (b) of this section, the physician must be employed by the federal government and maintain an active and unrestricted license.

(d) [(c)] Physician applicants who receive medical education in the United States in settings that do not comply with statutory requirements set forth in Texas Occupations Code §155.003(b) - (c) may be ineligible for licensure.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901449

Mari Robinson, J.D.

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-7016


CHAPTER 165. MEDICAL RECORDS

22 TAC §165.3

The Texas Medical Board (Board) proposes amendments to Chapter 165, §165.3, concerning Patient Access to Diagnostic Imaging Studies in Physician's Office.

The amendment expands the rule to include non-static diagnostic imaging studies and imaging studies that are maintained in electronic format.

Robert D. Simpson, General Counsel for the Board, has determined that for each year of the first five years the section as proposed is in effect, the public benefit anticipated as a result of enforcing the proposal will be to allow patients to obtain non-static as well as static imaging studies at a set fee from their physicians.

Mr. Simpson has also determined that for the first five-year period the section is in effect there will be no fiscal implications to state or local government as a result of enforcing the section as proposed. There will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small or micro businesses.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendment is proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

The amendment is also authorized by §159.008, Texas Occupations Code.

No other statutes, articles or codes are affected by this proposal.

§165.3.Patient Access to Diagnostic Imaging Studies in Physician's Office.

(a) Purpose. This section is promulgated to ensure that patients have reasonable access to [films and other static] diagnostic imaging studies maintained in the physician's office and that the practice of medicine by individual licensees and the delivery of health care to the public shall not be unduly hindered or interrupted by allowing for such access. As used in this section, "diagnostic imaging studies" or "imaging studies" includes static and non-static films and imaging studies in electronic format.

(b) Request and release.

(1) Upon receiving a written request and release of information that complies with [as provided for in the Medical Practice Act,] §159.005 of the Act, [ as required for the release of medical records,] a physician in possession or control of [films or other static] diagnostic imaging studies of a patient shall allow access to the [films or other diagnostic] imaging studies through one or more of the following means:

(A) providing copies of the [films or other static diagnostic ] imaging studies to the patient or recipient as designated in the request; or[,]

(B) releasing the original [films or other static diagnostic] imaging studies to the patient or recipient as designated in the request.

(2) Release and transfer of original [films or other static diagnostic] imaging studies may be evidenced by a signed and dated receipt from a patient or recipient of the original [films or other diagnostic] imaging studies, or from their authorized representative, acknowledging receipt of and responsibility for the original imaging studies.

(c) Exceptions. As provided for under [the Medical Practice Act,] §159.005 of the Act, a physician is not required to release [films or other static diagnostic] imaging studies directly to a patient if the physician determines that access to the [films or static diagnostic] imaging studies would be harmful to the physical, mental, or emotional health of the patient. If a physician makes a determination that access would be harmful to the physical, mental, or emotional health of the patient, the physician shall, within the time allowed after receipt of a proper request, provide access to the requested [films or static diagnostic ] imaging studies to an authorized representative of the patient as provided for in subsection (b) of this section.

(d) Time for release and denial. The requested copies or access to [films or other static diagnostic] imaging studies shall be provided by the physician within 15 business days after the date of receipt of the request. If the physician denies the request, in whole or in part, the physician shall furnish the patient or recipient a written statement, signed and dated, within 15 business days of receipt of the request stating the reason for the denial and how the patient or recipient can file a complaint with federal Department of Health and Human Services and the Texas Medical [State] Board [of Medical Examiners]. A copy of the statement denying the request shall be placed in the patient's medical records.

(e) Fees. The physician responding to a request by providing [ for] copies of [films or other static diagnostic ] imaging studies shall be entitled to a reasonable fee for providing the copies. A reasonable fee shall be no more than $8 per copy of an imaging study. In addition, a reasonable fee may include actual costs for mailing, shipping, or delivery.

(f) Emergency Request. The physician providing copies of requested [films or other static diagnostic] imaging studies shall be entitled to a reasonable fee prior to release of the copies unless the copies are requested by a licensed Texas health care provider or a physician licensed by any state, territory, or insular possession of the United States or any state or province of Canada if requested for purposes of emergency or acute medical care.

(g) Non-emergent Requests. In the event that the physician receives a proper request for access to [copies of films or other static diagnostic] imaging studies for purposes other than for emergency or acute medical care, the physician may retain copies of the requested information until payment is received. If payment is not routed with such a request, within ten calendar days from receiving the [a] request [for copies of films or other static diagnostic imaging studies], the physician shall notify the requesting party in writing of the need for payment and may withhold the copies until payment of a reasonable fee is received. A copy of the letter regarding the need for payment shall be made part of the patient's medical record.

(h) Improper Withholding for Past Due Accounts. Access to or copies of [films or other static diagnostic] imaging studies requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agent, or the patient's designated recipient for such copies based on a past due account for medical care or treatment previously rendered to the patient.

(i) Subpoena. A subpoena shall not be required for access to or the release of originals or copies of [ static diagnostic] imaging studies requested pursuant to the provisions of this section.

(j) Maximum charges. The allowable charges set forth in this section shall be maximum amounts, and this section shall be construed and applied so as to be consistent with lower fees or the prohibition or absence of such fees as required by prevailing state or federal law.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901450

Mari Robinson, J.D.

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-7016


CHAPTER 173. PHYSICIAN PROFILES

22 TAC §173.1

The Texas Medical Board (Board) proposes amendments to Chapter 173, §173.1, concerning to Profile Contents.

The amendment requires that the profile of each licensed physician shall contain the physician's full name as the physician is licensed.

Robert D. Simpson, General Counsel for the Board, has determined that for each year of the first five years the section as proposed is in effect the public benefit anticipated as a result of enforcing the proposal will be to provide the public with accurate information on individuals licensed by the Board.

Mr. Simpson has also determined that for the first five-year period this section is in effect there will be no fiscal implications to state or local government as a result of enforcing the section as proposed. There will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small or micro businesses.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendment is proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

Section 154.006, Texas Occupations Code, is affected by this proposal.

§173.1.Profile Contents.

(a) The Texas Medical Board (the "board") shall develop and make available to the public a comprehensive profile of each licensed physician electronically via the Internet or in paper format upon request.

(b) The profile of each licensed physician shall contain the following information listed in paragraphs (1) - (27) of this subsection:

(1) full name as the physician is licensed [ requests that it be published];

(2) - (27) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901451

Mari Robinson, J.D.

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-7016


CHAPTER 174. TELEMEDICINE

22 TAC §§174.1, 174.2, 174.4, 174.6

The Texas Medical Board (Board) proposes amendments to Chapter 174, §§174.1, 174.2, 174.4, and 174.6, concerning Telemedicine.

The amendment to §174.1, relating to Purpose, adds a citation to the statute authorizing the Board to adopt rules regarding telemedicine and clarifies that these rules do not apply to a limited purpose telemedicine license. The amendment to §174.2, relating to Definitions, revises definitions to distant site physician, patient site location, and telemedicine medical service to conform to recent changes to definitions by the Texas Health and Human Services Commission (HHSC). The amendment to §174.4, relating to Use of the Internet in Medical Practice, provides that an out-of-state physician may provide only episodic consultations to patients in Texas without a Texas medical license, as provided in §172.12(f). The amendment to §174.6, relating to Delegation to and Supervision of Patient Site Presenters, provides that distant site physicians must adequately supervise patient site presenters and have the presenters with the patients when a telemedicine medical service is provided.

Elsewhere in this issue of the Texas Register, the Board contemporaneously proposes the rule review of Chapter 174.

Robert D. Simpson, General Counsel for the Board, has determined that for each year of the first five years the sections as proposed are in effect, the public benefit anticipated as a result of enforcing the proposal will be to improve access to and quality of health care services.

Mr. Simpson has also determined that for the first five-year period the sections are in effect, there will be no fiscal implications to state or local government as a result of enforcing the sections as proposed. However, these rules do conform to recent rule adoptions by the Texas Health and Human Services Commission (HHSC) to 1 TAC §354.1430, relating to Definitions, and §354.1432, relating to Benefits and Limitations, which did have a fiscal impact to state government. There will be no effect to individuals required to comply with the rules as proposed. There will be no effect on small or micro businesses.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

Section 151.056, Texas Occupations Code is affected by this proposal.

§174.1.Purpose.

Pursuant to §153.004 of the Medical Practice Act, the Board is authorized to adopt rules relating to Telemedicine Services. This chapter is promulgated to establish standards for the use of the Internet and the provision of telemedicine medical services to Medicaid and Medicare recipients by physicians who are licensed to practice medicine in this state [ State]. This chapter does not apply to special purpose telemedicine licenses issued by the Board pursuant to §151.056 of the Act and §172.12 of this title (relating to Telemedicine License).

§174.2.Definitions.

The following words and terms, when used in this chapter shall have the following meanings unless the context indicates otherwise.

(1) Distant site physician--A physician that uses telemedicine to provide health care services to a patient in Texas. The physician must be licensed to practice medicine in Texas.

(2) [(1)] Medical practice site--A patient-specific Internet site, access to which is limited to licensed physicians, associated medical personnel and patients. It is an interactive site and thus qualifies as a practice location. It requires a defined physician-patient relationship.

(3) [(2)] Medium--Any mechanism of information transfer including electronic means.

(4) Patient site location--The patient site location is where the client is physically located. It is limited to the following locations:

(A) State hospital;

(B) State school;

(C) One of the following locations in a rural or underserved area:

(i) physician office;

(ii) hospital;

(iii) rural health clinic (RHC);

(iv) federally qualified health center;

(v) intermediate care facility for persons with mental retardation (ICF/MR) that is not a state school;

(vi) community center as defined in Health and Safety Code §534.001 or outreach site associated with a community center; or

(vii) local health department established under Health and Safety Code §121.031, or public health district established under Health and Safety Code §121.041.

(5) Patient site presenter--The patient site presenter is the individual at the patient site location who introduces the patient to the distant site physician for examination and to whom the distant site physician may delegate tasks and activities. A patient site presenter must be:

(A) licensed or certified in this state to perform health care services and must present and/or be delegated tasks and activities only within the scope of the individual's licensure or certification; and/or

(B) a qualified mental health professional-community services (QMHP-CS) as defined in 25 TAC §412.303(31) (relating to Definitions)

(6) [(3)] Person--An individual unless otherwise expressly made applicable to a partnership, association, or corporation.

(7) [(4)] Physician-patient e-mail--A computer-based communication between physician (or their medical personnel) and patients within a professional relationship in which the physician has taken on an explicit measure of responsibility for the patient's care.

(8) [(5)] Telemedicine medical service-- The practice of health care delivery, by a distant site physician licensed by the Texas Medical Board who is physically located at a Texas site other than the site where the patient is located, for the purposes of evaluation, diagnosis, consultation, or treatment that requires the use of advanced telecommunications technology. Telephone conversations, chart reviews, electronic mail messages, and facsimile transmissions are not considered telemedicine. [A health care service initiated by a physician or provided by a health professional acting under physician delegation and supervision, for purposes of assessment by a health professional, diagnosis or consultation by a physician, treatment, or the transfer of medical data, that requires the use of advanced telecommunications other than by telephone or facsimile as described in §57.042 of the Utilities Code.]

[(6) Telepresenter--a remote site provider, as defined in 1 TAC §354.1430, who is not a physician, registered nurse, advanced practice nurse or physician assistant, unless such physician, registered nurse, advanced practice nurse or physician assistant is a qualified mental health professional as defined in §531.02175(a) of the Government Code.]

§174.4.Use of the Internet in Medical Practice.

(a) - (b) (No change.)

(c) State Licensure. Physicians who treat and prescribe through the Internet are practicing medicine and must possess appropriate licensure in all jurisdictions where patients reside. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in §172.12(f) of this title (relating to Telemedicine License - Exemptions).

(d) - (f) (No change.)

(g) Accountability. Medical practice sites must provide patients with a clear mechanism to:

(1) access, supplement, and amend patient-provided personal health information;

(2) provide feedback regarding the site and the quality of information and services; and

(3) register complaints, including information regarding filing a complaint with the Texas Medical Board, [State Board of Medical Examiners] as provided for in Chapter 178 of this title (relating to Complaints).

(h) (No change.)

§174.6.Delegation to and Supervision of Patient Site Presenters [Telepresenters].

(a) A distant site physician may delegate tasks and activities to a patient site presenter [telepresenter who is qualified by licensing, training or experience for the performance of the task or activity as long as the task or activity does not require the exercise of independent medical judgment for its performance];

(b) A distant site physician delegating tasks or activities to a patient site presenter [ telepresenter] shall ensure that the patient site presenter [telepresenter] to whom delegation is made is adequately supervised [ qualified by licensure, training, or experience to perform the task or activity delegated];

(c) A patient site presenter must be at the patient site location when the telemedicine medical service is provided [ physician delegating tasks or activities to a telepresenter shall ensure that the telepresenter to whom delegation is made is adequately supervised].

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on April 16, 2009.

TRD-200901452

Mari Robinson, J.D.

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: May 31, 2009

For further information, please call: (512) 305-7016