1. (a) The APN with a valid prescription authorization number may carry out or sign prescription drug orders under the following conditions:

   1. (1) The APN carries out or signs prescription drug orders in an eligible site.
   2. (2) The prescription drug order is carried out or signed in accordance with protocols, standing delegation orders, standing medical orders, practice guidelines or other physician orders for medical aspects of patient care including prescription drug orders.

   3. (3) The APN carries out or signs prescription drug orders under physician supervision which consists of the following and the additional supervision requirements set out in Board of Medical Examiners (BME) Rule §193.8 of this title (relating to Delegation of the Carrying Out or Signing of Prescription Drug Orders to Physician Assistants and Advanced Practice Nurses):

      1. (A) at a site serving medically underserved populations, the physician visits the site at least once every ten business days during which the APN is on site providing care; the physician receives daily reports from the APN regarding complications encountered; and the physician is available for consultation by direct telecommunications;
      2. (B) at a physician's primary practice site, the physician is limited to delegation to three full time equivalent APNs; the physician may delegate the carrying out or signing of a prescription drug order for patients with whom the physician has established or will establish a physician-patient relationship but no time period to establish this relationship is required;
      3. (C) at a facility-based practice, where the delegating physician is the medical director, chief of staff, credentialing committee chair, department chair or physician who consents to a request by the medical director or chief of staff; protocols or other orders must be developed in accordance with policies approved by the medical staff; the APN writing prescriptions for patients of physicians, other than the delegating physician, must have the approval of the patient's physician; delegation in long term care facilities is limited to three full time equivalent APNs; and the physician must have the approval of the BME to delegate at more than one licensed hospital or more than two long term care facilities.
   4. (4) The APN maintains appropriate documentation of physician supervision, patient records, and protocols which should comply with rules adopted by the BME.

2. (b) The APN with a valid prescription authorization number may carry out or sign prescription drug orders by providing the following information on the prescription:

   1. (1) the patient's name and address;
   2. (2) the drug to be dispensed;
   3. (3) directions to the patient in regard to the taking and the dosage;
   4. (4) the intended use of the drug, if appropriate;
   5. (5) the name, address, and telephone number of the physician;
   6. (6) the name, address, telephone, and identification number of the APN completing or signing the prescription drug order;
   7. (7) the date; and
   8. (8) the number of refills permitted.
3. (c) The format and essential elements of the prescription shall comply with the requirements of the rules of the Board of Pharmacy.
4. (d) The medications which can be carried out or signed by the APN through prescription drug orders shall be those drugs classified as dangerous drugs and shall be limited to those categories of drugs identified in protocol or other order.

5. (e) The APN with a valid prescription authorization number may request, receive, possess and distribute prescription drug samples provided:

   1. (1) protocols or other physician orders authorize the APN to sign the prescription drug orders;
   2. (2) all requirements for the APN to sign prescription drug orders are met;
   3. (3) the samples are dangerous drugs only; and
   4. (4) a record of the sample is maintained and samples are labeled as specified in the Dangerous Drug Act (Health and Safety Code, Chapter 483).

Source Note:The provisions of this §222.4 adopted to be effective December 20, 1995, 20 TexReg 10268; amended to be effective November 30, 1998, 23 TexReg 11954.