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 (APN) formerly known as Advanced Nurse Practitioner (ANP)--A registered professional nurse, currently licensed in the State of Texas, who is prepared for advanced nursing practice by virtue of knowledge and skills obtained through a post-basic or advanced educational program of study acceptable to the board. 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. APNs include Nurse Practitioners, Nurse Midwives, Nurse Anesthetists and Clinical Nurse Specialists.
2. (2) Board--The Board of Nurse Examiners for the State of Texas.
3. (3) Carrying out or signing a prescription drug order--Completion of a prescription drug order presigned by the delegating physician, or the signing of a prescription by an APN after the APN has been designated with the Board of Medical Examiners by the delegating physician(s) as a person delegated to sign prescriptions.
4. (4) 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."
5. (5) Eligible sites--Sites serving medically underserved populations; a physician's primary practice site; or facility based practices at a licensed long term care facility or hospital.
6. (6) Facility-based practice--An APN's practice which is based at a licensed hospital or licensed long term care facility.
7. (7) Health Professional Shortage Area (HPSA)--An area, population group, or facility designated by the United States Department of Health and Human Services (USDHHS) as having a shortage of primary care physicians.
8. (8) Medically Underserved Area (MUA)--An area or population group designated by the USDHHS as having a shortage of personal health services; or an area defined by rule adopted by TDH that is based on demographics specific to this State, geographic factors that affect access to health care, and environmental health factors.
9. (9) Pharmacotherapeutics--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.

10. (10) Physician's primary practice site--Any one of the following:

    1. (A) the practice location where the physician spends the majority of his/her 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, a clinic operated by or for the benefit of a public school district for the purpose of providing 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 the Family Code, Chapter 32, or an established patient's residence; or
    3. (C) where the physician is physically present with the APN.
11. (11) Protocols/or other orders--Written authorization to initiate 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 orders shall be defined to promote the exercise of professional judgement by the APN commensurate with his/her education and experience. Such protocols/or other orders 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 list specific drugs.
12. (12) Rural health clinic--A clinic designated as a rural health clinic under the Rural Health Clinic Services Act of 1977 (Public Law No. 95-210); the designation is made by the Health Care Financing Administration (HCFA) of the USDHHS.
13. (13) Shall and must--Mandatory requirements. morma
14. (14) Should--A recommendation.
15. (15) Sites serving medically underserved populations--A medically underserved area, a health professional shortage area, a rural health clinic, a public health clinic or family planning clinic under contract with the Texas Department of Health (TDH) or Texas Department of Human Services (TDHS) or other site approved by the TDH.

Source Note:The provisions of this §222.1 adopted to be effective December 20, 1995, 20 TexReg 10268; amended to be effective February 3, 1998, 23 TexReg 754; amended to be effective November 30, 1998, 23 TexReg 11954.