ADOPTED RULES
An agency may take final action on a section 30 days after a proposal has been 
published in the Texas Register. The section becomes effective 20 days after the 
agency files the correct document with the Texas Register, unless a later date 
is specified or unless a federal statute or regulation requires implementation 
of the action on shorter notice.
If an agency adopts the section without any changes to the proposed text, only 
the preamble of the notice and statement of legal authority will be published. 
If an agency adopts the section with changes to the proposed text, the proposal 
will be republished with the changes.

TITLE 4. AGRICULTURE
PART II. Texas Animal Health Commission
CHAPTER 39.Scabies
4 TAC sec.sec.39.2-39.4, 39.10
The Texas Animal Health Commission adopts amendments to sec.sec.39.2-39.4, and 
39.10, to allow Dectomax as a treatment for scabies in addition to Ivermectin 
without changes to the proposed text as published in December 17, 1996, issue of 
the Texas Register (21 TexReg 12042). 
The amendments are necessary to provide owners of livestock, which are infested 
with or exposed to scabies, requirements, procedures and guidelines for using 
Dectomax for treatment of scabies, in addition to using Ivermectin. These 
amendments advise the public that there is an additional method for the 
treatment of psoroptic scabies by dipping or using Dectomax. 
No comments were received regarding adoption of the amendments. 
The amendments are adopted under the Texas Agriculture Code, Texas Civil 
Statutes, Chapter 161, which provides the Commission authority to protect 
livestock from communicable disease, and Chapter 164 which authorizes the 
Commission to protect cattle and sheep from scabies. 
The amendments implement sec.sec.161.041, 164.025, and 164.0 of the Texas 
Agriculture Code which allows the Commission the authority to approve dipping 
methods for control and eradication of scabies. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704854
Terry Beals, DVM
Executive Director
Texas Animal Health Commission
Effective date: April 30, 1997
Proposal publication date: December 17, 1996
For further information, please call: (512) 719-0714

TITLE 22. EXAMINING BOARDS
PART IX. Texas State Board of Medical Examiners
CHAPTER 163.Licensure
22 TAC sec.163.6, sec.163.10
The Texas State Board of Medical Examiners adopts amendments to sec.163.6 and 
sec.163.10, without changes, to the proposed text as published in the January 7, 
1997, issue of the Texas Register (22 TexReg 99). 
The sections as adopted will require that all licensure applicants pass an 
examination or formal evaluation within ten years prior to licensure. The 
sections as adopted will function by correcting a typographical error and 
outlining examinations or formal evaluations required for relicensure of 
physicians. 
No comments were received regarding adoption of the amendments.
The amendments are adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704966
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 165.Medical Records
22 TAC sec.165.2
The Texas State Board of Medical Examiners adopts new sec.165.2, without 
changes, to the proposed text as published in the January 7, 1997, issue of the 
Texas Register (22 TexReg 100). The section as adopted will 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. 
The section as adopted will function by outlining the charges and procedures for 
providing copies of x-rays and other static diagnostic imaging studies.
No comments were received regarding adoption of the new section. 
The new section is adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704967
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 174.Telemedicine
22 TAC sec.174.3
The Texas State Board of Medical Examiners adopts an amendment to sec.174.3, 
with changes, to the proposed text as published in the January 31, 1997, issue 
of the Texas Register (22 TexReg 101). A nonsubstantive change is necessary to 
clarify sec.174.3(a)(6).
The section as adopted will require passage of the medical jurisprudence 
examination as a prerequisite for obtaining a special license to practice 
telemedicine. This will ensure that physicians practicing telemedicine will be 
knowledgeable regarding Texas laws governing the practice of medicine. The 
section as adopted will function by allowing the board to administer the Texas 
Medical Jurisprudence Examination for physicians applying for a special license 
to practice telemedicine. 
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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.

sec.174.3.Qualifications for Special Purpose License for Practice of Medicine 
Across State Lines. 
For a person to engage in the practice of medicine in Texas as defined under the 
Medical Practice Act, sec.3.06(i), and sec.174.2 of this title (relating to 
Definitions), the person must: 
(1)-(2) (No change.) 
(3) be certified in a medical specialty pursuant to the standards of and 
approved by the American Board of Medical Specialties or the Bureau of 
Osteopathic Specialists and Boards of Certification; 
(4) have passed the Texas Medical Jurisprudence Examination;
(5) be in possession of a special purpose license issued pursuant to the terms 
of this chapter after submission of a completed board-approved application for a 
special purpose license for the practice of medicine across state lines and any 
requisite initial fee and subsequent annual renewal fees; and, 
(6) not be ineligible for licensure under sec.174.5 of this title (relating to 
Denial of Application for Special Purpose License to Practice Medicine Across 
State Lines). 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on April 11, 1997.
TRD-9704968
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 31, 1997
For further information, please call: (512) 305-7016

CHAPTER 183.Acupuncture
22 TAC sec.183.4
The Texas State Board of Medical Examiners adopts the repeal of sec.183.4, 
without changes, to the proposed text as published in the January 7, 1997, issue 
of the Texas Register (22 TexReg 102). 
The section as adopted will clarify regulations related to the licensure of 
acupuncturists through extensive rewrite of the section. 
The section as adopted will function through new sec.183.4, which is adopted 
simultaneously. 
No comments were received regarding adoption of the repeal of the section.
The repeal is adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704969
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

22 TAC sec.sec.183.4, 183.20, 183.22
The Texas State Board of Medical Examiners adopts amendment to sec.183.20 and 
new sec.183.22, without changes, and adopts new sec.183.4, with changes, to the 
proposed text as published in the January 7, 1997, issue of the Texas Register 
(22 TexReg 102). The nonsubstantive change will clarify the procedures to follow 
regarding a licensure applicant who does not pass the National Commission for 
the Certification of Acupuncturists examination within three attempts and will 
reconcile a conflict with sec.183.4(a)(5) to establish licensure qualifications 
that will adequately protect the public by ensuring a minimum standard of 
competency for acupuncture licensees, and will establish licensure requirements 
relating to examination failures that are similar to those of the Texas State 
Board of Medical Examiners. 
New sec.183.4 as adopted is necessary to update the licensure process for 
applicants, by simplifying the existing licensure procedures, clarifying the 
licensure qualifications and documentation requirements, allowing for the 
issuance of temporary licenses and distinguished professor temporary licenses by 
the Executive Director. The rule establishes a procedure for the reissuance of 
an expired license, and will promote more efficiency in the licensure process. 
The amendment to sec.183.20 as adopted are necessary to clarify the authority of 
acupuncture schools in Texas that are National Accreditation Commission for 
Schools and Colleges of Acupuncture and Oriental Medicine (NACSCAOM) candidates, 
to issue masters of acupuncture and oriental medicine degrees. The amendment 
also defines the authority of the Acupuncture Board to recognize such degrees 
for licensure and regulatory purposes. 
New sec.183.22 as adopted is necessary to promote the health, safety, and 
welfare of the people of Texas, by establishing procedures and requirements for 
continuing acupuncture education by licensed acupuncturists. 
One written comment was received from a representative of a Texas acupuncture 
school, suggesting alternative wording in proposed sec.183.20 regarding the 
issuance of masters of acupuncture and of oriental medicine degrees. The Board 
disagrees with the commenter because the suggested changes are unnecessary to 
accomplish the intended result of the rule. The suggested changes merely reword 
the rule in a different manner and may confuse the intent of the rule. 
The amendment and new sections are adopted under the Medical Practice Act, Texas 
Civil Statutes, Article 4495b, sec.2.09(a), which provide 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.

sec.183.4.Licensure.
(a) Qualifications. An applicant must present satisfactory proof to the 
acupuncture board that the applicant: 
(1) is at least 21 years of age; 
(2) is of good professional character as defined in sec.183.2 of this title 
(relating to Definitions); 
(3) has successfully completed 60 semester hours of general academic college 
level courses, other than in acupuncture school, that are not remedial and would 
be acceptable at the time they were completed for credit on an academic degree 
at a two or four year institution of higher education within the United States 
accredited by an agency recognized by the Higher Education Coordinating Board or 
its equivalent in other states as a regional accrediting body. Coursework 
completed as a part of a degree program in acupuncture or Oriental medicine may 
be accepted by the acupuncture board if, in the opinion of the acupuncture 
board, such coursework is substantially equivalent to the required hours of 
general academic college level coursework; 
(4) is a graduate of an acceptable acupuncture school that was a candidate for 
accreditation or had accreditation through the National Accreditation Commission 
for Schools and Colleges of Acupuncture and Oriental Medicine (NACSCAOM) at the 
time of applicant's graduation, or received and completed training which, in the 
opinion of the acupuncture board, was substantially equivalent to training 
provided by such a school; 
(5) has taken and passed, within three attempts, the full NCCA examination; 
(6) has taken and passed the CCAOM (Council of Colleges of Acupuncture and 
Oriental Medicine) Clean Needle Technique (CNT) course and practical 
examination; and 
(7) is able to communicate in English as demonstrated by one of the following: 
(A) passage of the NCCA examination taken in English; or 
(B) passage of the TOEFL (Test of English as a Foreign Language) with a score of 
550 or higher; or 
(C) passage of the TSE (Test of Spoken English) with a score of 45 or higher; or 
(D) passage of the TOEIC (Test of English for International Communication) with 
a score of 500 or higher; or 
(E) at the discretion of the acupuncture board, passage of any other similar, 
validated exam testing English competency given by a testing service with 
results reported directly to the acupuncture board or with results otherwise 
subject to verification by direct contact between the testing service and the 
acupuncture board; or 
(F) an interview conducted in English with the acupuncture board, a committee of 
the acupuncture board, or the executive director of the acupuncture board. 
(b) Procedural rules for licensure applicants. The following provisions shall 
apply to all licensure applicants. 
(1) Applicants for licensure: 
(A) whose documentation indicates any name other than the name under which the 
applicant has applied must furnish proof of the name change; 
(B) whose application for licensure which has been filed with the board office 
and which is in excess of two years old from the date of receipt shall be 
considered inactive. Any fee previously submitted with that application shall be 
forfeited. Any further application procedure for licensure will require 
submission of a new application and inclusion of the current licensure fee. 
(C) will be allowed to sit for the NCCA examination only three times; 
(D) who in any way falsify the application may be required to appear before the 
acupuncture board. It will be at the discretion of the acupuncture board whether 
or not the applicant will be issued a Texas acupuncture license; 
(E) on whom adverse information is received by the acupuncture board may be 
required to appear before the acupuncture board. It will be at the discretion of 
the acupuncture board whether or not the applicant will be issued a Texas 
license; 
(F) shall be required to comply with the acupuncture board's rules and 
regulations which are in effect at the time the completed application form and 
fee are filed with the board; 
(G) may be required to sit for additional oral, written, or practical 
examinations or demonstrations that, in the opinion of the acupuncture board, 
are necessary to determine competency of the applicant; 
(H) must have the application for licensure completed and legible in every 
detail 60 days prior to the acupuncture board meeting in which they are to be 
considered for licensure unless otherwise determined by the acupuncture board 
based on good cause. 
(2) Applicants for licensure by examination who wish to request reasonable 
accommodation due to a disability must submit the request at the time of filing 
the application. 
(3) Applicants who have been licensed in any other state, province, or country 
shall complete a notarized oath or other verified sworn statement in regard to 
the following: 
(A) whether the license, certificate, or authority has been the subject of 
proceedings against the applicant for the restriction, cancellation, suspension, 
or revocation of the license, certificate, or authority to practice in the 
state, province, or country, and if so, the status of such proceedings and any 
resulting action; and, 
(B) whether an investigation in regard to the applicant is pending in any 
jurisdiction or a prosecution is pending against the applicant in any state, 
federal, national, local, or provincial court for any offense that under the 
laws of the state of Texas is a felony, and if so, the status of such 
prosecution or investigation. 
(c) Licensure documentation. 
(1) Original documents/interview. An applicant must appear for a personal 
interview at the board offices and present original documents to a 
representative of the board for inspection. Original documents may include, but 
are not limited to, those listed in paragraph (2) of this subsection.
(2) Required documentation. Documentation required of all applicants for 
licensure shall include the following: 
(A) Birth certificate/proof of age. Each applicant for licensure must provide a 
copy of either a birth certificate and translation, if necessary, to prove that 
the applicant is at least 21 years of age. In instances where a birth 
certificate is not available, the applicant must provide copies of a passport or 
other suitable alternate documentation. 
(B) Name change. Any applicant who submits documentation showing a name other 
than the name under which the applicant has applied must present copies of 
marriage licenses, divorce decrees, or court orders stating the name change. In 
cases where the applicant's name has been changed by naturalization the 
applicant must submit the original naturalization certificate by hand delivery 
or by certified mail to the board office for inspection. 
(C) Examination scores. Each applicant for licensure must have a certified 
transcript of grades submitted directly from the appropriate testing service to 
the acupuncture board for all examinations used in Texas for purposes of 
licensure in Texas. 
(D) Dean's certification. Each applicant for licensure must have a certificate 
of graduation submitted directly from the school of acupuncture on a form 
provided by the acupuncture board. The applicant shall attach to the form a 
recent photograph, meeting United States Government passport standards, before 
submitting it to the school of acupuncture. The school shall have the Dean or 
the designated appointee sign the form attesting to the information on the form 
and placing the school seal over the photograph. 
(E) Diploma or certificate. All applicants for licensure must submit a copy of 
their diploma or certificate of graduation. 
(F) Evaluations. All applicants must provide, on a form furnished by the 
acupuncture board, evaluations of their professional affiliations for the past 
ten years or since graduation from acupuncture school, whichever is the shorter 
period. 
(G) Preacupuncture school transcript. Each applicant must have the appropriate 
school or schools submit a copy of the record of their undergraduate education 
directly to the acupuncture board. Transcripts must show courses taken and 
grades obtained. If determined that the documentation submitted by the applicant 
is not sufficient to show proof of the completion of 60 semester hours of 
college courses other than in acupuncture school, which courses would be 
acceptable, at the time of completion, to The University of Texas at Austin for 
credit on a bachelor of arts degree or a bachelor of science degree, the 
applicant may be requested to contact the Office of Admissions at The University 
of Texas at Austin for course work verification or otherwise submit such 
documentation to the acupuncture board for a determination as to the adequacy of 
such education. 
(H) School of acupuncture transcript. Each applicant must have his or her 
acupuncture school submit a transcript of courses taken and grades obtained 
directly to the acupuncture board. 
(I) Fingerprint card. Each applicant must complete a fingerprint card for the 
Texas Department of Public Safety and return it to the acupuncture board as part 
of the application. 
(J) Other verification. For good cause shown, with the approval of the 
acupuncture board, verification of any information required by this subsection 
may be made by a means not otherwise provided for in this subsection.
(3) Additional documentation. Applicants may be required to submit other 
documentation, including but not limited to the following:
(A) Translations. An accurate certified translation of any document that is in a 
language other than the English language along with the original document or a 
certified copy of the original document which has been. 
(B) Arrest Records. If an applicant has ever been arrested, a copy of the arrest 
and arrest disposition from the arresting authority and submitted by that 
authority directly to the acupuncture board. 
(C) Malpractice. If an applicant has ever been named in a malpractice claim 
filed with any liability carrier or if an applicant has ever been named in a 
malpractice suit, the applicant shall submit the following:
(i) a completed liability carrier form furnished by the acupuncture board 
regarding each claim filed against the applicant's insurance; 
(ii) for each claim that becomes a malpractice suit, a letter from the attorney 
representing the applicant directly to this board explaining the allegation, 
dates of the allegation, and current status of the suit. If the suit has been 
closed, the attorney must state the disposition of the suit, and if any money 
was paid, the amount of the settlement, unless release of such information is 
prohibited by law or an order of a court with competent jurisdiction. If such 
letter is not available, the applicant will be required to furnish a notarized 
affidavit explaining why this letter cannot be provided; and 
(iii) a statement, composed by the applicant, explaining the circumstances 
pertaining to patient care in defense of the allegations. 
(D) Inpatient treatment for alcohol/substance abuse or mental illness. Each 
applicant that has been admitted to an inpatient facility within the last ten 
years for the treatment of alcohol/substance abuse or mental illness must submit 
the following: 
(i) an applicant's statement explaining the circumstances of the 
hospitalization; 
(ii) an admitting summary and discharge summary, submitted directly from the 
inpatient facility; 
(iii) a statement from the applicant's treating physician/psychotherapist as to 
diagnosis, prognosis, medications prescribed, and follow-up treatment 
recommended; and 
(iv) a copy of any contracts or agreements signed with any licensing authority. 
(E) Outpatient treatment for alcohol/substance abuse or mental illness. Each 
applicant that has been treated on an outpatient basis within the last ten years 
for alcohol/substance abuse or mental illness must submit the following: 
(i) an applicant's statement explaining the circumstances of the outpatient 
treatment; 
(ii) a statement from the applicant's treating physician/psychotherapist as to 
diagnosis, prognosis, medications prescribed, and follow-up treatment 
recommended; and 
(iii) a copy of any contracts or agreements signed with any licensing authority. 
(F) Additional documentation. Additional documentation as is deemed necessary to 
facilitate the investigation of any application for licensure. 
(G) DD214. A copy of the DD214 indicating separation from any branch of the 
United States military. 
(H) Other verification. For good cause shown, with the approval of the 
acupuncture board, verification of any information required by this subsection 
may be made by a means not otherwise provided for in this subsection.
(I) False documentation. Falsification of any affidavit or submission of false 
information to obtain a license by examination or endorsement shall subject an 
acupuncturist to denial of a license or to discipline pursuant to the Act, 
sec.6.11. 
(4) Substitute documents/proof. The acupuncture board may, at its discretion, 
allow substitute documents where proof of exhaustive efforts on the applicant's 
part to secure the required documents is presented. These exceptions are 
reviewed by the acupuncture board, a board committee, or the board's executive 
director on an individual case-by-case basis. 
(d) Temporary license. 
(1) Issuance. The Texas State Board of Acupuncture Examiners may, through the 
executive director of the Texas State Board of Medical Examiners, issue a 
temporary license to a licensure applicant who appears to meet all the 
qualifications for an acupuncture license under the Act, but is waiting for the 
next scheduled meeting of the Texas State Board of Acupuncture Examiners for the 
license to be issued. 
(2) Duration/renewal. A temporary license shall be valid for 100 days from the 
date issued and may be extended only for another 30 days after the date the 
initial temporary license expires. Issuance of a temporary license may be 
subject to restrictions at the discretion of the executive director and shall 
not be deemed dispositive in regard to the decision by the Texas State Board of 
Acupuncture Examiners to grant or deny an application for a permanent license. 
(e) Distinguished professor temporary license. 
(1) Issuance. The acupuncture board may issue a distinguished professor 
temporary license to an acupuncturist who: 
(A) holds a substantially equivalent license, certificate, or authority to 
practice acupuncture in another state, province, or country; and 
(B) agrees to and limits any acupuncture practice in this state to acupuncture 
practice for demonstration or teaching purposes for acupuncture students and/or 
instructors, and in direct affiliation with an acupuncture school that is a 
candidate for accreditation or has accreditation through the National 
Accreditation Commission for Schools and Colleges of Acupuncture and Oriental 
Medicine (NACSCAOM) at which the students are trained and/or the instructors 
teach; and 
(C) agrees to and limits practice to demonstrations or instruction under the 
direct supervision of a licensed Texas acupuncturist who holds an unrestricted 
license to practice acupuncture in this state; and 
(D) pays any required fees for issuance or renewal of the distinguished 
professor temporary license. 
(2) Duration/renewal. Any such distinguished professor temporary license shall 
have a duration of no longer than 60 days and may be renewed no more than three 
consecutive times for a total of an additional 180 days. 
(3) Termination. A distinguished professor temporary license shall automatically 
expire at the end of 60 days from issuance or 60 days from date of renewal 
unless otherwise renewed. A distinguished professor temporary license or renewal 
may be denied, terminated, cancelled, suspended, or revoked for any violation of 
acupuncture board rules or the Act, Subchapter F. 
(f) Relicensure. 
(1) If an acupuncturist's license has been expired for one year, it is 
considered to have been canceled, and the acupuncturist may not renew the 
license. The acupuncturist may obtain a new license by submitting to 
reexamination and complying with the requirements and procedures for obtaining 
an original license. The examination required by this section is the full NCCA 
examination. 
(2) A person may qualify for renewal of his or her original license without 
reexamination if that person: 
(A) held a license previously in this state; 
(B) moved to another state, province, or country; 
(C) legally practiced in the other state, province, or country for not more than 
two years since the expiration of his or her Texas license; and 
(D) files an application for relicensure under subsections (a)-(c) of this 
section. 
(g) Approved schools. A NACSCAOM approved acupuncture school may use the word 
college as a means of representation to the public as long as it maintains 
NACSCAOM accreditation. An approved school may not represent itself as a 
university. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704970
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 185.Physician Assistants
22 TAC sec.sec.185.4, 185.6, 185.9, 185.15, 185.25, 185.26
The Texas State Board of Medical Examiners adopts amendments to sec.185.4, 
185.6, 185.9, 185.15, 185.25, and 185.26, without changes, to the proposed text 
as published in the January 7, 1997, issue of the Texas Register (22 TexReg 
106). 
The sections as adopted will ensure that licensure applicants submit 
documentation of a name change, ensure that licensed physician assistants obtain 
a current annual registration permit, that they do not practice while their 
license is on an inactive status or without a current annual registration 
permit, will clarify the penalty for practicing without a current annual 
registration permit or while on an inactive status, and will allow for 
depositions during discovery, and will allow for the entry of default judgments 
by an administrative law judge if a properly noticed party fails to appear for a 
hearing in a contested case. 
The sections as adopted will function by outlining penalties for practicing 
without a current annual registration permit, clarifying procedures for an 
inactive status, and amending hearing procedures. 
No comments were received regarding adoption of the amendments.
The amendments are adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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, and the Physician 
Assistant Licensing Act, Texas Civil Statutes, Article 4495b-1, sec.23 which 
authorizes the Texas State Board of Physician Assistant Examiners to adopt 
reasonable and necessary rules for the performance of its duties. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704971
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 193.Standing Delegation Orders
22 TAC sec.193.9
The Texas State Board of Medical Examiners adopts new sec.193.9, with changes, 
to the proposed text as published in the January 7, 1997, issue of the Texas 
Register (22 TexReg 107). The nonsubstantive change will clarify 
sec.193.9(c)(5). 
The section as adopted will promote efficient administration and regulation of 
the delegation of drug therapy management pursuant to Texas Civil Statutes, 
Article 4495b, sec.3.061. 
The section as adopted will function by allowing properly qualified and trained 
pharmacists to perform specific acts of drug therapy management under the 
supervision and delegation of licensed physicians. 
The following comments were received in support of the proposal:
Pharmaceutical Research and Manufacturers of America, The American Academy of 
Family Physicians, The Texas Pharmacy Association, The Texas Medical 
Association, as well as a number of individual physicians. 
The following comments were received in opposition to adoption of the proposed 
rule:
The Texas State Board of Pharmacy submitted comments in opposition to the 
exception for Narrow Therapeutic Index Drugs, and suggested additional language 
to require that the physician ensure a pharmacist-patient relationship exists.
The General Pharmaceutical Industry Association commented in opposition to the 
exemption for Narrow Therapeutic Index Drugs. 
The National Pharmaceutical Alliance commented in opposition to the exemption 
for Narrow Therapeutic Index Drugs. 
Vinson and Elkins, Attorneys at Law, commented in opposition to the exemption 
for Narrow Therapeutic Index Drugs. 
Several individuals also presented testimony at the public hearing in opposition 
to the exception for Narrow Therapeutic Index Drugs. 
The Board agrees that it is good public policy to ensure that the citizens of 
the State of Texas receive competent medical care from its physicians. However, 
the Board disagrees with the comments in favor of the exception for Narrow 
Therapeutic Index Drugs. The exception goes beyond the authority granted to the 
Board by Texas Civil Statutes, Article 4495b, sec.3.061. The Board believes that 
the exception is prohibited by being in direct conflict with provisions of the 
Texas Pharmacy Act, Texas Civil Statutes, Article 4542a-1. In addition, the 
Board believes that an exception for Narrow Therapeutic Index Drugs is 
unnecessary when the provisions of the Texas Pharmacy Act are considered. 
The new section is adopted under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provide 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.

sec.193.9.Delegated Drug Therapy Management.
(a) Purpose. This section is promulgated to promote the efficient administration 
and regulation of the delegation by physicians to pharmacists of drug therapy 
management pursuant to the Medical Practice Act, sec.3.061 (related to 
Delegation of Certain Functions). 
(b) Delegation. A physician licensed to practice medicine in Texas may delegate 
to a properly qualified and trained pharmacist acting under adequate supervision 
the performance of specific acts of drug therapy management authorized by the 
physician through the physician's order, standing medical order, standing 
delegation order, or other order or protocol as provided for in this section. 
(c) Drug therapy management. Drug therapy management is the performance of 
specific acts by pharmacists as authorized by a physician through written 
protocol. Drug therapy management does not include the selection of drug 
products not prescribed by the physician unless the drug product is named in the 
physician initiated protocol or the physician initiated record of deviation from 
a standing protocol. Drug therapy management may include the following: 
(1) collecting and reviewing patient drug use histories; 
(2) ordering or performing routine drug therapy related patient assessment 
procedures including temperature, pulse, and respiration;
(3) ordering drug therapy related laboratory tests; 
(4) implementing or modifying drug therapy following diagnosis, initial patient 
assessment, and ordering of drug therapy by a physician, as detailed in the 
protocol; 
(5) generically equivalent drug selection if the physician's signature does not 
clearly indicate that the prescription must be dispensed as written; or 
(6) any other drug therapy related act delegated by a physician. 
(d) Supervision. Physician supervision shall be considered adequate for purposes 
of this section if the delegating physician is in compliance with this section 
and the physician: 
(1) is responsible for the formulation or approval of the written protocol and 
any patient-specific deviation from the protocol and review of the written 
protocol and any patient-specific deviations from the protocol at least annually 
and the services provided to a patient under the protocol on a schedule defined 
in the written protocol; 
(2) has established and maintains a physician-patient relationship with each 
patient provided drug therapy management by a delegated pharmacist and informed 
the patient that drug therapy will be managed by a pharmacist under written 
protocol; 
(3) is geographically located so as to be able to be physically present daily to 
provide medical care and supervision; 
(4) receives, on a schedule defined in the written protocol, a periodic status 
report on the patient, including any problem or complication encountered; 
(5) is available through direct telecommunication for consultation, assistance, 
and direction. 
(e) Written protocol. Written protocols for purposes of this section shall mean 
a physician's order, standing medical order, standing delegation order, or other 
written order. 
(1) A written protocol must contain at a minimum the following:
(A) a statement identifying the individual physician authorized to prescribe 
drugs and responsible for the delegation of drug therapy management;
(B) a statement identifying the individual pharmacist authorized to dispense 
drugs and to engage in drug therapy management as delegated by the physician; 
(C) a statement identifying the types of drug therapy management decisions that 
the pharmacist is authorized to make which shall include:
(i) a statement of the ailments or diseases, drugs, and type of drug therapy 
management authorized; and 
(ii) a specific statement of the procedures, decision criteria, or plan the 
pharmacist shall follow when exercising drug therapy management authority; 
(D) a statement of the activities the pharmacist shall follow in the course of 
exercising drug therapy management authority, including the method for 
documenting decisions made and a plan for communication or feedback to the 
authorizing physician concerning specific decisions made. Documentation shall be 
recorded within a reasonable time of each intervention and may be performed on 
the patient medication record, patient medical chart, or in a separate log book; 
and 
(E) a statement that describes appropriate mechanisms and time schedule for the 
pharmacist to report to the physician monitoring the pharmacist's exercise of 
delegated drug therapy management and the results of the drug therapy 
management. 
(2) A standard protocol may be used, or the attending physician may develop a 
drug therapy management protocol for the individual patient. If a standard 
protocol is used, the physician shall record, what deviations if any, from the 
standard protocol are ordered for that patient.
(f) Review and revision of protocols. 
(1) At least annually, written protocols shall be reviewed by the physician and, 
if necessary, revised. 
(2) Documentation of all services provided to the patient by the pharmacist 
shall be reviewed by the physician on the schedule established in the protocol. 
(g) Construction and interpretation. This section shall not be construed or 
interpreted to restrict the use of a pre-established health care program or 
restrict a physician from authorizing the provision of patient care by use of a 
pre-established health care program if the patient is institutionalized and the 
care is to be delivered in a licensed hospital with an organized medical staff 
that has authorized standing delegation orders, standing medical orders, or 
protocols. This section may not be construed to limit, expand, or change any 
provision of law concerning or relating to therapeutic drug substitution or 
administration of medication, including the Texas Pharmacy Act, Article 4542a-1, 
Texas Civil Statutes, sec.17(a)(5). 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 11, 1997.
TRD-9704972
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Effective date: May 5, 1997
Proposal publication date: January 7, 1997
For further information, please call: (512) 305-7016

TITLE 37. PUBLIC SAFETY AND CORRECTIONS
PART VII. Texas Commission on Law Enforcement Officer Standards and Education
CHAPTER 211.Administration Division
37 TAC sec.211.77, sec.211.78
The Texas Commission on Law Enforcement Officer Standards and Education adopts 
the repeal of sec.211.77 and sec.211.78, concerning minimum training standards 
for peace officers and jailers, without changes to the proposed text as 
published in the January 3, 1997, issue of the Texas Register (22 TexReg 29). 
The sections will be repealed and replaced by new sections developed pursuant to 
an ongoing reorganization of the Commission's rules. The reorganization plan was 
developed by staff and considered by the Commission's Ad Hoc Rules Committee in 
response to concerns that the Commission's Administrative Code had become too 
complex and difficult to understand. Included in this ongoing reorganization is 
a schedule developed by staff for renumbering certain sections of the rules as a 
way to more clearly label specific topics and to more fully utilize the chapter 
numbers available in the Administrative Code for the Commission's rules. The 
repealed sec.211.77 and sec.211.78 will be replaced by new sec.219.77 and 
sec.219.78, which are contemporaneously adopted in this issue of the Texas 
Register. 
No comments were received regarding adoption of the repeals. 
The repeals are adopted under Texas Government Code Annotated, Chapter 415, 
sec.415.010, which authorizes the commission to promulgate rules for the 
administration of Chapter 415; under sec.415.031 which requires the commission 
to establish and maintain training programs for officers and county jailers; and 
under sec.415.032, which requires the commission to establish minimum curriculum 
requirements for preparatory courses and programs.
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704864
Edward T. Laine
Chief, Professional Standards and Administrative Operations
Texas Commission on Law Enforcement Officer Standards and Education
Effective date: June 1, 1997
Proposal publication date: January 3, 1997
For further information, please call: (512) 450-0188

37 TAC sec.211.96
The Texas Commission on Law Enforcement Officer Standards and Education adopts 
the repeal of sec.211.96, concerning reactivation of a peace officer license, 
without changes to the proposed text as published in the January 3, 1997, issue 
of the Texas Register (22 TexReg 30). 
The section will be replaced by new sec.217.96, which was developed pursuant to 
an ongoing reorganization of the Commission's rules. The reorganization plan was 
developed by staff and considered by the Commission's Ad Hoc Rules Committee in 
response to concerns that the Commission's Administrative Code had become too 
complex and difficult to understand. Included in this ongoing reorganization is 
a schedule developed by staff for renumbering certain sections of the rules as a 
way to more clearly label specific topics and to more fully utilize the chapter 
numbers available in the Administrative Code for the Commission's rules. 
No comments were received regarding adoption of the repeal. 
The repeal is adopted under Texas Government Code Annotated, Chapter 415, 
sec.415.010, which authorizes the commission to promulgate rules for the 
administration of Chapter 415; and under sec.415.052, which requires the 
commission to adopt rules relating to requirements for reactivation of a peace 
officers' license after a break in employment. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704861
Edward T. Laine
Chief, Professional Standards and Administrative Operations
Texas Commission on Law Enforcement Officer Standards and Education
Effective date: June 1, 1997
Proposal publication date: January 3, 1997
For further information, please call: (512) 450-0188

CHAPTER 217.Licensing Requirements
37 TAC sec.217.96
The Texas Commission on Law Enforcement Officer Standards and Education adopts 
new sec.217.96, concerning reactivation of a peace officer license, without 
changes to the proposed text as published in the January 3, 1997, issue of the 
Texas Register (22 TexReg 30). 
Section 217.96 was developed pursuant to an ongoing reorganization of the 
Commission's rules. The reorganization plan was developed by staff and 
considered by the Commission's Ad Hoc Rules Committee in response to concerns 
that the Commission's Administrative Code had become too complex and difficult 
to understand. Included in this ongoing reorganization is a schedule for 
renumbering certain sections of the rules as a way to more clearly label 
specific topics and to more fully utilize the chapter numbers available in the 
Administrative Code for the Commission's rules. New sec.217.96 will replace 
current sec.211.96, which is contemporaneously adopted in this issue of the 
Texas Register. 
The new section contains two important changes. First, it contains a new 
provision that allows the holder of an active license to maintain the active 
status of that license by completing the forty hours of continuing education 
training required of peace officer license holders every 24 months. Staff 
reasoned, and the Commissioners concurred, that it would benefit the citizens of 
Texas to encourage peace officers to maintain their continuing education in law 
enforcement during periods when they were not commissioned as peace officers, so 
that their knowledge would be up-to-date when they re-entered the profession. By 
maintaining their continuing education during periods of inactivity, peace 
officers would not be required to retake the licensing examination, and would be 
eligible to reenter service immediately upon being offered employment by a law 
enforcement agency. 
Second, the new section contains a change to the examination procedures for 
those officers whose licenses have become inactive. The current section allows a 
person who wishes to reactivate a peace officer license to take the exam once 
without obtaining additional training. If the licensee fails that attempt, the 
current rule requires that completion of a "supplementary" course before being 
granted another three opportunities to pass the exam. Only after failing those 
three attempts is the licensee required to complete the entire basic peace 
officer course again. The proposed new rule provides that a reactivator may 
challenge the examination three times. If the licensee fails those three times, 
he or she must complete the entire basic peace officer course before being 
allowed another three attempts . Staff reasoned, and the Commissioners 
concurred, that the practice of allowing a person seeking to reactivate a 
license four attempts to pass the examination before repeating the entire basic 
peace officer course was not fair to other license applicants, who are only 
allowed three attempts. The Commission has a responsibility to ensure that the 
peace officers it licenses are sufficiently trained and tested, and by allowing 
some officers to take the examination three times after having completed only 
limited, remedial training is not fair to the citizens of Texas. Finally, some 
out-of-date and burdensome provisions regarding temporary licenses were omitted 
from the new section. 
No comments were received regarding adoption of the new section. 
The new section is adopted under Texas Government Code Annotated, Chapter 415, 
sec.415.010, which authorizes the commission to promulgate rules for the 
administration of Chapter 415; and under sec.415.052, which requires the 
commission to adopt rules relating to requirements for reactivation of a peace 
officers' license after a break in employment. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704860
Edward T. Laine
Chief, Professional Standards and Administrative Operations
Texas Commission on Law Enforcement Officer Standards and Education
Effective date: June 1, 1997
Proposal publication date: January 3, 1997
For further information, please call: (512) 450-0188

CHAPTER 219.Prelicensing and Reactivation Courses, Tests and Endorsements of 
Eligibility
37 TAC sec.219.70
The Texas Commission on Law Enforcement Officer Standards and Education adopts 
an amendment to sec.219.70, regarding training standards for conditional reserve 
licenses, without changes to the proposed text as published in the January 24, 
1997, issue of the Texas Register (22 TexReg 949). 
Amendments to sec.219.70 were developed pursuant to an ongoing reorganization of 
the Commission's rules. The reorganization plan was developed by staff and 
considered by the Commission's Ad Hoc Rules Committee in response to concerns 
that the Commission's Administrative Code had become too complex and difficult 
to understand. Staff reasoned that a number of the provisions in this section 
were difficult to understand, out-of-date, overly restrictive or burdensome, and 
therefore those sections have either been amended to clarify them, or have been 
deleted. There will be no change in the procedures or requirements associated 
with the section. 
No comments were received regarding adoption of the amendment. 
The amendment is adopted under Texas Government Code Annotated, Chapter 415, 
sec.415.010, which authorizes the commission to promulgate rules for the 
administration of Chapter 415; under sec.415.031, which requires the commission 
to establish and maintain training programs for officers and county jailers; and 
under sec.415.032, which requires the commission to establish minimum curriculum 
requirements for preparatory courses and programs.
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704862
Edward T. Laine
Chief, Professional Standards and Administrative Operations
Texas Commission on Law Enforcement Officer Standards and Education
Effective date: June 1, 1997
Proposal publication date: January 24, 1997
For further information, please call: (512) 450-0188

37 TAC sec.219.77, sec.219.78
The Texas Commission on Law Enforcement Officer Standards and Education adopts 
new sec.219.77 and sec.219.78, regarding training standards for peace officer 
licenses and jailer licenses, without changes to the proposed text as published 
in the January 24, 1997, issue of the Texas Register (22 TexReg 949). 
New sec.219.77 and sec.219.78 were developed pursuant to an ongoing 
reorganization of the Commission's rules. The reorganization plan was developed 
by staff and considered by the Commission's Ad Hoc Rules Committee in response 
to concerns that the Commission's Administrative Code had become too complex and 
difficult to understand. Included in this ongoing reorganization is a schedule 
developed by staff for renumbering certain sections of the rules as a way to 
more clearly label specific topics and to more fully utilize the chapter numbers 
available in the Administrative Code for the Commission's rules. The new 
sections will replace sec.211.77 and sec.211.78 which are contemporaneously 
adopted in this issue of the Texas Register. 
Staff reasoned that a number of the provisions in the current sections were 
difficult to understand, out-of-date, overly restrictive or burdensome, and 
therefore those sections have either been amended to clarify them, or have not 
been incorporated in the new sections. There will be no change in the procedures 
or requirements associated with the sections. 
No comments were received regarding adoption of the new sections. 
The new sections are adopted under Texas Government Code Annotated, Chapter 415, 
sec.415.010, which authorizes the commission to promulgate rules for the 
administration of Chapter 415; under sec.415.031, which requires the commission 
to establish and maintain training programs for officers and county jailers; and 
under sec.415.032, which requires the commission to establish minimum curriculum 
requirements for preparatory courses and programs.
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on April 10, 1997.
TRD-9704863
Edward T. Laine
Chief, Professional Standards and Administrative Operations
Texas Commission on Law Enforcement Officer Standards and Education
Effective date: June 1, 1997
Proposal publication date: January 24, 1997
For further information, please call: (512) 450-0188