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

1. (1) Advanced practice nurse--A registered nurse approved by the board to practice as an advanced practice nurse based on completing an advanced educational program acceptable to the board. The term includes a nurse practitioner, nurse-midwife, nurse anesthetist, and a clinical nurse specialist. The advanced practice nurse is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public and private clinics, and private practice. The advanced practice nurse acts independently and/or in collaboration with other health care professionals in the delivery of health care services.

2. (2) Alternate site--A practice site:

   1. (A) Where services similar to the services provided at the delegating physician's primary practice site are provided; and
   2. (B) Located within 60 miles of the delegating physician's primary practice site.
3. (3) Board--The Board of Nurse Examiners for the State of Texas.
4. (4) Carrying out or signing a prescription drug order--Completing a prescription drug order presigned by the delegating physician or signing (writing) a prescription by an advanced practice nurse after that person has been designated to the Board of Medical Examiners by the delegating physician as a person delegated to sign a prescription.
5. (5) Dangerous drug--A device or a drug that is unsafe for self medication and that is not included in schedules I-V or penalty groups I-IV of chapter 481 Texas Health and Safety Code (Texas Controlled Substances Act). The term includes a device or a drug that bears or is required to bear the legend: "Caution: federal law prohibits dispensing without prescription."
6. (6) Diagnosis and management course--A course offering both didactic and clinical content in clinical decision-making and aspects of medical diagnosis and medical management of diseases and conditions. Supervised clinical practice must include the opportunity to provide pharmacological and non-pharmacological management of diseases and problems considered within the scope of practice of the advanced practice nurse's specialty and role.
7. (7) Eligible sites--Sites serving medically underserved populations; a physician's primary practice site; or a facility-based practice site.
8. (8) Facility-based practice site--A licensed hospital or licensed long term care facility that serves as the practice location for the advanced practice nurse.
9. (9) Health Manpower Shortage Area--An urban or rural area, population group, or public or nonprofit private medical facility or other facility that the Secretary of the United States Department of Health and Human Services (USDHHS) designates as having a health manpower shortage, as described by 42 USC Section 254e(a)(1) or a successor federal statute or regulation.

10. (10) Medically Underserved Area (MUA)--

    1. (A) An urban or rural area or population group that the Secretary of the United States Department of Health and Human Services (USDHHS) designates as having a shortage of those services as described by 42 USC Section 300e-1(7) or a successor federal statute or regulation; or
    2. (B) an area defined as medically underserved by rules adopted by the Texas Board of Health (Texas Department of Health) based on demographics specific to this State, geographic factors that affect access to health care, and environmental health factors.
11. (11) Pharmacotherapeutics course--A course that offers content in pharmacokinetics and pharmacodynamics, pharmacology of current/commonly used medications, and the application of drug therapy to the treatment of disease and/or the promotion of health.

12. (12) Physician's primary practice site--

    1. (A) the practice location at which the physician spends the majority of the physician's time;
    2. (B) a licensed hospital, a licensed long-term care facility, or a licensed adult care center where both the physician and the APN are authorized to practice;
    3. (C) a clinic operated by or for the benefit of a public school district to provide care to the students of that district and the siblings of those students, if consent to treatment at that clinic is obtained in a manner that complies with Chapter 32, Family Code;
    4. (D) the residence of an established patient; or
    5. (E) another location at which the physician is physically present with the advanced practice nurse.
13. (13) Protocols or other written authorization--Written authorization to provide medical aspects of patient care which are agreed upon and signed by the APN and the physician, reviewed and signed at least annually, and maintained in the practice setting of the APN. Protocols or other written authorization shall be defined to promote the exercise of professional judgment by the APN commensurate with his/her education and experience. Such protocols or other written authorization need not describe the exact steps that the APN must take with respect to each specific condition, disease, or symptom and may state types or categories of drugs which may be prescribed rather than just list specific drugs.
14. (14) Shall and must--Mandatory requirements.
15. (15) Should--A recommendation.

16. (16) Site serving a medically underserved population--

    1. (A) a site located in a medically underserved area;
    2. (B) a site located in a health manpower shortage area;
    3. (C) a clinic designated as a rural health clinic under 42 USC 1395x(aa);
    4. (D) a public health clinic or a family planning clinic under contract with the Texas Department of Human Services or the Texas Department of Health;
    5. (E) a site located in an area in which the Texas department of Health determines there is an insufficient number of physicians providing services to eligible clients of federal, state, or locally funded health care programs; or
    6. (F) a site that the Texas Department of Health determines serves a disproportionate number of clients eligible to participate in federal, state, or locally funded health care programs.

Source Note:The provisions of this §222.1 adopted to be effective March 6, 2002, 27 TexReg 1489.